Cochlear implant Surgery


If you have severe hearing loss, you may need a cochlear implant surgery. The device is surgically implanted inside your inner ear and replaces the cochlea’s function to restore hearing.

Today, implants are very sophisticated and provide a more realistic sensation of sounds. However, they aren’t suited for everyone. Also, they require extensive hearing therapy and training afterward. Hence, you must understand what surgery entails and what it can or can’t do for you.

How Is the Process of Hearing?

The ear has three parts: the outer ear, the middle ear, and the inner ear. Sound waves enter through the ear canal and make our eardrums vibrate. The vibrations are transmitted to the middle ear. This part includes a chain of three small bones, onto the inner ear filled with fluid.

The fluid movement inside the inner ear or cochlea stimulates hair cells that trigger nerve impulses. Then, these nerve impulses are carried to the brain to be interpreted as sounds.

What Is a Cochlear Implant?

The cochlear implant is an electronic device capable of turning sounds into electrical signals. It works by bypassing damaged portions of the ear and replacing the spiral-shaped bone of your inner ear, also known as the cochlea.

From there, the signals generated by the implant directly stimulate the auditory nerve (also known as the cochlear nerve) and travel to the brain, which recognizes the signals as sounds.

Although the brain will interpret the signals as sounds, they’re not the same as normal hearing.

Cochlear implant surgery

How Does a Cochlear Implant Work?

The cochlear implant is a device that is made up of two main components:

  • External hardware. It is placed behind the ear. It uses a microphone that picks up sounds, a speech processor that turns them into digital signals, and a transmitter that forwards them to the internal receiver.
  • Internal portion. It is implanted under the skin. It comprises the intracochlear electrodes and the receiver/stimulator. The latter gets the digital signals and turns them into electrical impulses.

External and internal parts are held together by a magnet. The entire system, including the power battery, is placed inside the bone. You can recharge the battery through magnetic induction. Usually, one hour at night is enough to complete the battery charge and lasts the whole day.

A Cochlear Implant Is the Same as A Hearing Aid?

hearing aid is also an electronic device designed for hearing loss. However, unlike a cochlear implant, it doesn’t use electrodes to transmit sound signals.

Instead, hearing aids make sounds louder with the help of a microphone, amplifier, and speaker. Also, hearing aids do not need surgery to be implanted. They go inside or behind the ear.

Hearing aids are ideal for mild or moderate hearing loss.

Cochlear implant

Which Patients Can Have Cochlear Implant Surgery?

cochlear implant can give a sense of sound to a person who is profoundly deaf or severely hard-of-hearing. They can help a deaf person to understand speech. Not to the level of normal hearing, though.

This device is used in patients in whom conventional hearing aids are not helpful. However, it will only work if the nerve that sends sounds to the brain (auditory nerve) is working correctly!

Other options are available, and the medical team will assess your case individually to offer you the best. After a series of hearing tests, they will inform you if you are the right candidate.

For example, a middle ear implant may be another option if you cannot use regular hearing aids because they do not fit correctly or you’re allergic to the materials they’re made from.

Also, an auditory brainstem implant (ABI) can be considered if you have severe, permanent hearing loss due to a problem with your cochlear nerve.  An ABI works like a cochlear implant, but the electrical sound signals are sent directly to the brain along wires instead of the cochlea.

When to Have Cochlear Implant Surgery?

Early surgery is key. This is especially true for children: The younger, the better. The surgery may provide more benefits the sooner it is performed on a child. This is to ensure proper development of listening and spoken language.

Additionally, rehabilitation therapy, commitment, and a language-rich home environment after the implantation are essential.

Cochlear implant surgery - Video


Surgery lasts approximately three hours. Your head will not be shaved completely—only a small area immediately behind the ear (1cm to 2 cm). Surgery is generally performed under general anesthesia. Once you’re asleep, your doctor makes an incision behind your ear and drills the underlying mastoid bone.  Then, your surgeon makes a tiny hole in the inner ear or cochlea to insert the electrodes. Next, he will insert the receiver behind your ear, just beneath the skin.

The cochlear implant is secured to the skull, and the incision is closed using stitches. Usually, you’ll be discharged a few hours after the surgery or the next day.

Before you leave the hospital, the doctor will instruct you to change dressings and care for your incisions.  Also, he will schedule a follow-up appointment a week later to check the healing process and remove the stitches. Bear in mind that the incision needs to heal before the implant is activated!

Around a month after surgery, your doctor will add the external part behind your ear and activate the internal components.

The cochlear implant is programmed and personalized according to each patient’s hearing needs. You may need several visits over a few days or weeks for adjustments. After all, learning to use it is a gradual process and a lifelong commitment.

Following the initial appointments, you should expect check-ups every three to six months for the first two years and then every year from that moment on.

Surgery does not entail greater risks than any other otological microsurgery procedure. Infection, vertigo, or tinnitus are very rare and may happen in less than 1%.

What Is the Rehabilitation Process Like After Cochlear Implant Surgery?

Hearing through a cochlear implant is different from normal hearing and takes time to learn or relearn. Audiologic rehabilitation is recommended for both children and adults before and after implantation.

When it comes to children, it is important to do hearing training before implantation. This training will help the child gain an auditory experience. It is recommended for approximately six months. Once the cochlear implant is programmed, rehabilitation exercises will continue.

Right after surgery, the child should attend five weekly sessions. The sessions will decrease as the child acquires more vocabulary and listening experiences.

Child parent’s role is critical since they will help the child acquire language outside the school environment. The speech therapist will guide them through such training.

Rehabilitation time usually lasts between 6 months and a year. Although, it is recommended to maintain language therapy throughout the entire compulsory school stage.

In the case of adults, rehabilitation is faster since they generally already have hearing experience prior to hearing loss. Speech therapists will assess each case and decide how many sessions are necessary. The adult patient should keep in mind that although he/she will regain hearing, it will not be as before the hearing loss. Hence, lip reading is also an essential aspect in the rehabilitation of the implanted patient, especially in noisy environments.

What to Expect After Surgery?

Over time, the quality of the sounds will improve as the brain relearns the stimulation patterns sent by the cochlear implant.

Thanks to this type of implant, the patient recovers hearing and has a better life quality. They can carry a conversation, and some can even manage to communicate with the phone.

Are Cochlear Implants Permanent?

Each year, the commercially available external parts of the cochlear implants may undergo transformations to improve their quality and precision. Such transformations may be related to the computer software and increasing miniaturized size.

For this reason, a re-implantation may have to be considered over time if the external parts of the implant (in case they are updated) are no longer compatible with the internal components.

As for the internal parts may have to be replaced in case of ruptures due to knocks or malfunction.

What Maintenance Does a Cochlear Implant Require?

The maintenance of a cochlear implant is simple. However, great care must be exercised with external parts to avoid damage or accidental knocks.

You must also be careful with the cable that connects the processor to the microphone since rubbing can break it.

It is also convenient to clean the connection poles of the cells or batteries for proper functioning.

How Much Does Cochlear Implant Cost?

The cochlear implant cost can vary. The medical team will carefully analyze your request. If you want to receive a free quote without any commitment, please fill in the contact form.

You can attach medical reports carried out in other health care facilities. This information is necessary to give you a suitable solution adapted to your needs. It will always be kept in the strictest confidence.

For several decades, the García-Ibáñez ENT Institute (Barcelona, ​​Spain) has stood out as the reference otology center in cochlear implants.

In 1985 Dr. Emilio García-Ibáñez performed the first House 3M cochlear implant surgery in Spain.

Doctor Emilio García-Ibáñez is considered one of the best ENT specialists in the world. He has received the Certificate of Honor from the North American ENT Academy and excellence awards from the American Neurotology Society and the Politzer Society.

In 2006Dr. Luis García-Ibáñez implanted the first device completely hidden inside the ear of a 45-year-old patient who, due to a cholesteatoma, had lost a lot of hearing.


Are There Any Risks from Bathing or Swimming with The Internal Parts of the Cochlear Implant?

There are risks only during the first few months after the surgery when the healing process has not been completed. Hence, during these first months, you should avoid bathing or swimming! After that time, the internal parts are essentially waterproof since they are placed under the skin.

However, you must remove the external part if you are going to have contact with water (similar to a hearing aid). Currently, some models of external processors are waterproof, but you should discuss these options with your doctor.

Can I Play Sports If I Have a Cochlear Implant?

Sports are not restricted when having a cochlear implant. However, to avoid complications, you should remove the external parts before practicing sports.

Also, it is better not to perform any contact sports since a blow to the internal part would damage the implant.

Once Implanted, Can You Differentiate Between Different Voices?

During rehabilitation and programming of the cochlear implant, you will have better discrimination of voices.

Indeed, you will identify different pitch levels and voice intonations, being able to differentiate people just by hearing them.

Does A Cochlear Implant Help Tinnitus?

Unfortunately, a cochlear implant won’t help with your tinnitus.

However, since the patient receives more auditory information, the tinnitus can be masked to the point of becoming negligible.

I Am a Foreign Patient. Will I Have Communication Difficulties?

We have qualified staff who will accompany you throughout the hospital process.

If the doctor does not speak your language, we will offer you the possibility of having an interpreter.

Doctor Luis García-Ibáñez Cisneros

Doctor Luis García-Ibáñez Cisneros

ENT Specialist. Specialist in otosclerosis, vertigo, acoustic neuroma, middle ear implants (IOM), cochlear implants, Oto-Neuro-Surgery

ENT Specialist with more than 20 years of experience. Responsible for the implantation of the first hearing system completely hidden inside the ear of a practically deaf man.
Degree in Medicine and Surgery at the University of Barcelona (1991, Spain).
Otolaryngology specialist (ENT) at the Universita di Verona (1996, Italy).
Master in Otoneurology at the House Ear Institute in Los Angeles (1996, United States).
Director of the Integral ENT Center of the Teknon Medical Center (Barcelona, ​​Spain).
Director of the García-Ibáñez Otology Institute in Barcelona (the first private center in Spain to treat ear diseases).
Secretary of the non-profit García-Ibáñez Otology Foundation.
Director of more than 150 training courses at the García-Ibáñez Otology Institute.
Member of the Catalan Academy of Otolaryngology (ENT).
Member of the American Academy of Otolaryngology (ENT).
Member of the Spanish Society of Otolaryngology (SEORL).
Languages: Spanish, Catalan, English
License number: 28781

Bibliography – More recent publications:

Cochlear implants as a treatment option for unilateral hearing loss, severe tinnitus and hyperacusis. Ramos Macías A, Falcón González JC, Manrique M, Morera C, García-Ibáñez L, Cenjor C, Coudert-Koall C, Killian M. Audiol Neurootol. 2015

One-Year Results for Patients with Unilateral Hearing Loss and Accompanying Severe Tinnitus and Hyperacusis Treated with a Cochlear Implant. Ramos Macías A, Falcón-González JC, Manrique Rodríguez M, Morera Pérez C, García-Ibáñez L, Cenjor Español C, Coudert-Koall C, Killian M. Audiol Neurootol. 2018;

Do you want more information about cochlear implants?

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    García-Ibáñez Otorhinolaryngology ENT Clinic

    C/ Doctor Roux, 91 Barcelona 08017 (Barcelona, Spain)
    Closest metro stations: Sarrià / Les Tres Torres

    García-Ibáñez Otorhinolaryngology ENT Clinic

    García-Ibáñez Otorhinolaryngology ENT Institute Barcelona Spain - otolaryngology clinic - Ear, Nose, Larynx and throat diseases