Cochlear Implantation for Bilateral Profound Hearing Loss

Indications and Benefits

The American Academy of Otolaryngology-Head and Neck Surgery recommends cochlear implantation for patients with severe to profound sensorineural hearing loss who receive limited benefit from conventional hearing aids 1, 2, 3, 4.
Cochlear implantation can improve tinnitus symptoms, with 96% of patients reporting improvement following implantation 1, 2, 3, 4.
The American Academy of Otolaryngology-Head and Neck Surgery identifies cochlear implantation as an option for rehabilitation of patients with severe to profound hearing loss, especially in those with associated tinnitus 1, 2, 3, 4.

BAHA is contraindicated in bilateral profound hearing loss, as it requires a better-hearing ear to receive the signal 1, 2, 3, 4.
CROS aids are designed for single-sided deafness, not bilateral profound hearing loss, and are ineffective in this patient population 5, 6.

The left ear should be implanted because it has the severe tinnitus and the stable dry perforation does not contraindicate cochlear implantation 1, 2, 3, 4.
The presence of a dry perforation is manageable surgically and does not preclude successful cochlear implantation 1, 2, 3, 4.

Patients with bilateral profound hearing loss who undergo cochlear implantation can expect a 96% likelihood of tinnitus improvement 1, 2, 3, 4.

Do not delay cochlear implantation in favor of continued hearing aid trials when conventional amplification has clearly failed, as patients with bilateral profound hearing loss and no benefit from hearing aids are definitive candidates for cochlear implantation 1, 2, 3, 4.
Do not select BAHA or CROS devices based on the presence of a "normal" right ear on examination without confirming audiometric function, as bilateral profound hearing loss requires direct cochlear stimulation 1, 2, 5, 6.
Do not avoid the left ear due to the dry perforation, as the perforation can be managed during cochlear implant surgery and does not represent a contraindication to implantation 1, 2.

The American Academy of Otolaryngology-Head and Neck Surgery recommends the "60/60" guideline (60 dB presentation with ≤60% word recognition) which has 96% sensitivity for identifying cochlear implant candidates 7
For asymmetric hearing loss indication, unaided pure-tone average ≥70 dB HL in the affected ear is required 8
For bilateral sensorineural hearing loss, documentation must show >40 dB loss with limited speech perception benefit (best aided word/sentence cognition ≤60% at 60 dB) 7
The American Academy of Otolaryngology-Head and Neck Surgery recommends confirmation of intact cochlear nerves by CT or MRI for cochlear implant placement 7

Aided word recognition score ≤60% at 60 dB presentation in the ear to be implanted 7
MRI or CT confirming intact cochlear nerve 7
Documentation of appropriate hearing aid fitting with real-ear measurements 7
Best aided word or sentence cognition ≤60% at 60 dB presentation 7

Cochlear implants restore substantial hearing levels and improve sound localization and speech reception in noise, which are critical for safety and social participation 9, 10
Cochlear implants provide superior auditory function compared to alternative amplification methods when sensorineural hearing loss is severe 9, 10