A Parent's Guide to Cochlear Implants
Cochlear implants can be life-changing for some deaf children. This guide covers what they are, how they work, and what the journey looks like for families.
If your child has severe or profound hearing loss and hearing aids aren't providing enough benefit, you may be referred for a cochlear implant assessment. It's a big step, and it comes with plenty of questions. This guide is designed to answer the most common ones, based on what families tell us they wish they'd known earlier.
What Is a Cochlear Implant?
A cochlear implant is an electronic device that bypasses the damaged parts of the inner ear and stimulates the auditory nerve directly. Unlike hearing aids, which amplify sound, a cochlear implant converts sound into electrical signals that the brain learns to interpret as hearing.
The system has two parts: an internal component surgically placed under the skin behind the ear, and an external processor worn on the outside. The external part picks up sound, processes it, and transmits it to the internal device through a magnetic connection.
Who Is Eligible?
In the UK, the National Institute for Health and Care Excellence (NICE) recommends cochlear implants for children and adults with severe to profound sensorineural hearing loss who don't get adequate benefit from hearing aids. For children, the assessment usually takes place at a specialist cochlear implant centre — there are several across England, and your audiology team will refer you.
The assessment process can take several months and involves a series of hearing tests, speech and language assessments, scans, and consultations. The team wants to make sure that a cochlear implant is likely to benefit your child and that your family is ready for the commitment involved.
Age matters. Research consistently shows that children implanted before the age of two tend to develop spoken language more quickly and effectively. The NHS newborn hearing screening programme, which we discuss in our newborn hearing article, is designed in part to enable early identification and timely referral for implantation.
The Surgery
Cochlear implant surgery is performed under general anaesthetic and typically takes two to three hours. The surgeon makes a small incision behind the ear, creates a shallow bed in the skull bone for the internal receiver, and threads the electrode array into the cochlea.
Most children go home the following day. The wound heals over a few weeks, during which the implant sits silently under the skin — it isn't switched on until the surgical site has fully healed, usually four to six weeks later.
Like any surgery, there are risks: infection, damage to the facial nerve (very rare), and the possibility that the implant doesn't work as expected. Your surgical team will discuss these with you in detail before you consent.
Activation Day (Switch-On)
Activation, or "switch-on", is the day the external processor is fitted and the implant is turned on for the first time. Families often look forward to this with enormous anticipation, but it's worth managing expectations. Your child won't hear normally straight away. The sounds they perceive through the implant are initially quite different from natural hearing, and it takes the brain time to make sense of them.
Some children react with curiosity, some cry, and some seem barely to notice. All of these responses are completely normal. The audiologist will set the processor at a gentle level and gradually increase it over subsequent appointments.
Rehabilitation and Follow-Up
This is where the real work begins. A cochlear implant is a tool, not a cure. To develop spoken language, your child needs consistent, skilled support — and a lot of it. Rehabilitation typically involves:
- Regular speech and language therapy sessions, often weekly in the first year.
- Frequent mapping appointments at the implant centre to fine-tune the processor settings.
- Daily practice at home: talking, reading, singing, and drawing your child's attention to sounds.
- Ongoing monitoring of language development, hearing levels, and device function.
Families who do well with cochlear implants tend to be those who commit to the rehabilitation process. The device itself provides access to sound, but it's the language input and practice that turn that access into communication.
Bilateral Implants
Many children now receive two cochlear implants (bilateral implantation), either during the same surgery or in a second operation later. Two implants generally give better results for hearing in noisy environments, locating the direction of sound, and overall speech understanding. NICE guidance supports bilateral implantation for children.
Cochlear Implants and Sign Language
There's sometimes a perception that cochlear implants and sign language are opposing choices. They're not. Many families use BSL or other communication approaches alongside a cochlear implant, particularly in the early stages when the child is still learning to make sense of the auditory input. Having visual language access provides a safety net and ensures the child is never without a means of communication.
The Ear Foundation has excellent resources for families considering or using cochlear implants, and the NDCS publishes a comprehensive guide that covers the topic from multiple perspectives.
Everyday Life with an Implant
Once the initial rehabilitation phase settles, a cochlear implant becomes part of your child's daily routine. The external processor is worn during waking hours (not while sleeping or swimming, usually), and batteries or rechargeable units need regular attention. Children learn to manage their equipment surprisingly quickly, though younger ones will need your help.
School settings require some thought. A radio aid or FM system, which sends the teacher's voice directly to the implant processor, makes a significant difference in classroom listening. Our educational rights guide explains how to ensure your child's school provides the right support.
Questions to Ask Your Implant Team
Before making a decision, consider asking:
- What outcomes do you typically see for children with my child's hearing profile?
- What rehabilitation services will be available, and how often?
- What happens if the implant doesn't work as expected?
- Can you put us in touch with another family who's been through the process?
- What ongoing costs are there (insurance, replacement parts, batteries)?
If you'd like to talk to other parents in Croydon who've been through the cochlear implant journey, our parent support groups are a good starting point. You can also contact us and we'll try to connect you.