Cochlear Implant Surgery in Children

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For many children with severe to profound hearing impairment, a cochlear implant can improve hearing and access to communication. Whether your child’s hearing loss is congenital (meaning it was present at birth) or acquired, early implantation is key to minimizing delays in language and speech development. Our team makes every effort to create a plan that matches your family’s goals and preferences.

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How Do Cochlear Implants Work?

Hearing loss is often caused by problems in the cochlea, snail-shaped tubes inside the inner ears. Unlike a traditional hearing aid, which amplifies sound, a cochlear implant bypasses the portion of the inner ear that is damaged and stimulates the auditory nerve directly with electric pulses. The pulses travel on to the brain, which interprets them as sound.

A cochlear implant has two parts. The internal part is placed during a short, outpatient surgery. The external part is activated a few weeks later and fine-tuned over the following months.

After contracting meningitis as an infant, Anthony (“AJ”) was left with profound hearing loss in both ears. AJ’s family found hope in the team at Duke Hearing Center for Children and Families, where they learned that cochlear implants could improve his hearing.

Is My Child a Candidate?

We work hard to ensure that children who will benefit from cochlear implantation, in one or both ears, have that opportunity as soon as possible. Children must meet the following FDA eligibility criteria to receive a cochlear implant:

  • Be 9 months of age or older (earlier implantation is possible under certain conditions) and have severe to profound hearing impairment in both ears 


  • Be 5 years of age or older and have single-sided deafness (meaning profound hearing loss in one ear and normal to mildly impaired hearing in the other) or asymmetrical hearing impairment (meaning profound hearing loss in one ear and mild to moderately severe hearing loss in the other)


  • Hearing loss is categorized as sensorineural (meaning the cause stems from the inner ear or cochlea)
  • Have one or both auditory nerves present
  • Receive little or no benefit from hearing aids
  • Be healthy enough to have surgery
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What to Expect

Comprehensive Evaluation and Testing

To determine whether your child is a candidate for a cochlear implant in one or both ears, team members from multiple specialties perform a thorough evaluation. Audiologists measure your child’s ability to hear and understand speech; they also facilitate and/or review hearing aid trial results. Speech-language pathologists determine whether your child is meeting communication milestones. A pediatric otolaryngologist or neurotologist (a specialist who treats neurological ear disorders) will determine whether surgery is feasible and safe. Our patient navigator will work alongside you to coordinate appointments, gather updates, and communicate next steps.

Imaging Scans

A neurotologist may order imaging tests -- like CT or MRI scans -- to ensure your child’s ear anatomy is compatible with cochlear implantation. These scans may also indicate whether one or both ears should be implanted.

Choosing Your Implant

Once your child has been cleared to move forward with surgery, you will learn about the three implant manufacturers: Advanced Bionics, Cochlear Americas, and MED-EL. Then, you and your provider team will choose an implant based on what's important to you and your child, including how they fit (behind or off the ear), what accessories are available, and wireless compatibility options. 

Preparing for Surgery

The Centers for Disease Control and Prevention (CDC) recommends that all cochlear implant recipients receive anti-pneumococcal vaccinations before surgery to protect against potential infection (for example, meningitis). Our doctors will explain the timing and types of vaccines that are advised, and your child will need to get these from their pediatrician.

Cochlear Implant Surgery

For most children, cochlear implant surgery is an outpatient procedure, meaning they can usually go home the same day. It’s performed using general anesthesia and takes two to three hours per ear. There is a three-to-four-week healing period before the external part of the device (the speech processor) can be turned on.

Our Locations

Duke Health offers locations throughout the Triangle. Find one near you.

After Surgery

Implant Activation

Following a successful post-operative check-up, your child will see an audiologist to receive the external component and have the implant activated. It’s important to remember that hearing with a cochlear implant takes time and effort, so you shouldn’t expect your child to be able to hear and understand perfectly right away. With the dedicated assistance of your care team, you should begin to see rapid progress, especially in the first six months to a year.

Fine-Tuning the Device

You can expect six to eight follow-up appointments with your child’s audiologist in the first year. During this time, we adjust the implant to help your child gradually become accustomed to sound without being overstimulated. It is critical for your child to wear their device during all waking hours.

Aural Rehabilitation

To maximize their communication potential, your child will require consistent and long-term therapy with pediatric speech-language pathologists, who have completed specialized training in teaching children with hearing loss to listen and talk. This helps your child interpret new sounds, understand language, and build speaking skills. Therapy plans are tailored to match your family’s goals and preferences, and even consider your child’s school performance. We teach you how to develop your child's language, speech, and listening skills throughout your daily family routines. We also work with the other helpers in your child's life to further support your family's goals.

Long-Term Support

Our specialists will continue to provide your child with personalized care to manage and optimize the implant’s performance. Although the internal part of the implant is generally considered permanent, manufacturers continue to design new external speech processors with improved technology and accessories. We will work with you to determine your child's eligibility for upgrades as they become available.

Best Children's Hospital in NC

Duke Children's Hospital & Health Center is proud to be nationally ranked in 10 pediatric specialties.

Why Choose Duke

Expert Team Approach
Our comprehensive hearing team brings together pediatric specialists who work together to meet your child’s unique needs. All team members -- including specialists in neurotology, ENT surgery, audiology, speech-language pathology, psychology, and social work -- have extensive experience in helping children to hear and communicate better.

Family Support
Our clinical social workers provide information on financial and other support services available to your child and family. Our child life specialists help children understand, at a developmentally appropriate level, what will happen on the day of surgery. Finally, our patient navigator will personally guide you through evaluation, surgery, follow-up care, and therapy. These support services remove some of the administrative tasks from your list so you can focus on your child’s care.

Coordination with Local Specialists
No matter where you live, our team will work closely with speech-language pathologists and audiologists in your own community to make follow-up care as convenient as possible. 

Experts and Pioneers in Cochlear Implant Surgery
Our surgeons are neurotologists -- meaning they are board-certified in neurotology, the study and treatment of neurological ear disorders. Duke neurotologists performed some of the first cochlear implant surgeries in the United States; our research has advanced -- and continues to advance -- care and outcomes.

This page was medically reviewed on 04/16/2024 by