Dallas Ear Institute
7777 Forest Lane, Suite A-103, Dallas, TX 75230 | Phone: (972) 566-7600 | Fax: (972) 566-6560 | www.dallasear.com

Adult Otology Pediatric Otology Cochlear Implant Program Implanted Hearing Devices Hearing Aid Program Audiology Services

Cochlear Implant Program

The Dallas Ear Institute Cochlear Implant Team is a group of hearing specialists who provide the highest level of diagnostic, surgical, and rehabilitation services in all areas of cochlear implantation. The staff consists of neurotologic surgeons, audiologists, speech-language pathologists, auditory-verbal therapists, psychologists, and insurance reimbursement specialists.

Over 600 patients have had cochlear implants placed by our surgeons and have been cared for by our team of specialists. In the last year, we performed over 80 cochlear implants.

Our program participates in ongoing clinical trials and research projects allowing us to offer current and future technology. Our philosophy is that the decision to recommend a cochlear implant can only be made by a multi-disciplinary team of specialists and a well informed patient or parent.

Patient Testimonial Video

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As seen on the popular TV Show "Top Docs of DFW"

Dr. Bob Peters with The Dallas Ear Institute discusses the amazing procedure, Cochlear Implants, that he performs that enables individuals to hear. In this segment we hear the story of Kemper who was born deaf, and now thanks to The Dallas Ear Institute can hear. Truly amazing! (See video below)

As seen on the popular TV Show "Top Docs of DFW"

Dr. Bob Peters with Dallas Ear Institute discusses the amazing procedure, Cochlear Implants, that he performs that enables individuals to hear. In this segment we hear the story of Kemper who was born deaf, and now thanks to Dr. Peters can hear. Truly amazing! (See video below)


How Natural Hearing Works

Before going into details of how a cochlear implant works, it is important to understand the structure of the ear
and how it works.

Sound waves enter the ear canal and impact the ear drum (tympanic membrane). After the ear drum picks up the sound, it transmits sound wave vibrations through the hammer (malleus), anvil (incus), and stirrup (stapes). The hammer, anvil, and stirrup make up the chain of three (3) middle ear bones. The stirrup passes the vibrations to the inner ear fluids within the cochlea. Fluid waves travel through two and a half (2½) turns of the cochlea, bending the cochlea hair cells as it goes by. The hair cells correspond to the frequency of the original sound waves, initiating signals within their corresponding nerve endings prior to sending them to the brain.

1. Sounds enter the ear canal and travel to the eardrum.

2. These sound waves cause the eardrum to vibrate, setting the bones in the middle ear into motion.

3. This motion is converted into electric impulses by tiny hair cells inside the inner ear (cochlea).

4. These impulses are sent to the brain, where they are perceived by the listener as sound.


What is a Cochlear Implant?

The use of cochlear implants for the treatment of severe to profound hearing loss is one of the most revolutionary treatments of our time. The cochlear implant is a prosthetic replacement for the inner ear (cochlea) which was developed over 20 years ago, based on the idea that profoundly hearing impaired individuals have auditory nerve fibers remaining that can be electrically stimulated to produce a sense of hearing. A multichannel cochlear implant is an electronic device developed to restore auditory sensation through electrical stimulation of the auditory nerve for individuals age 6 months and older with severe to profound sensorineural hearing impairment. The stimulation provides a wide range of auditory information needed for recognizing environmental and speech sounds to expand communication ability.

The cochlear implant bypasses damaged parts of the inner ear and electronically stimulates the nerve of hearing. The cochlear implant system consists of two parts:

  • The internal part consists of wires that are surgically implanted into the cochlea through the skull behind the ear
  • The external part consists of a microphone, a speech processor (that converts sound into electrical impulses), and connecting cables

Individuals who receive little to no benefit from hearing aids are usually considered to be candidates for a cochlear implant.

How A Cochlear Implant Works:

1. The external sound processor captures sounds, then filters and processes the sounds.

2. The sound processor translates the filtered sounds into digital information, which is then transmitted to the internal implant.

3. The internal implant converts the digital information into electrical signals, and sends them to a tiny, delicate curl of electrodes that sits gently inside the cochlea.

4. The electrical signals from the electrodes stimulate the hearing nerve, bypassing the damaged cells that cause hearing loss, allowing the brain to perceive sound.

A cochlear implant is designed to bypass damaged or degenerating cochlear hair cells (within the inner ear that correspond to the sound wave frequencies). The hair cells are the "spark plugs" of the inner ear nerve endings. The vast majority of nerve deafness is usually the result of non-functioning hair cells, however, with the nerve endings still purposeful in the majority of those cases, it makes it possible for cochlear implants to work.

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Candidate Evaluation

Who is a Candidate?

Saying that a patient is a candidate for a cochlear implant means they should obtain significantly better hearing ability from a cochlear implant than they can from the most optimally fitted hearing aids. Current cochlear implant technology works so well that the candidacy criteria is expanding rapidly. The following are generally accepted candidate criteria.

  • Age: 6 months or older
  • Children: Profound hearing loss in both ears
  • Adults: Severe or profound hearing loss. When tested with optimally fitted hearing aids this means hearing thresholds are over 40db at all frequencies or word understanding scores are less than 50%.
  • No medical contraindications
  • High motivation and appropriate expectations
  • Involved in an educational or training program that emphasize auditory skills and oral communication.

The Cochlear Implant Process - Explanation of Evaluation Steps

Phase I

1. Initial Audiology Testing and Counseling- Your first visit will involve extensive testing of your or your child’s hearing with tests performed in a sound booth with and without hearing aids. This information combined with the history of hearing loss is used by the audiologist to determine if a cochlear implant is likely to be helpful to you or your child. If so the audiologist will spend time counseling and educating you about cochlear implants so that you understand all that is involved before you decide to proceed with the rest of the process. Time- 2 hours.

2. Otologic Medical Evaluation- The Dallas Ear Institute physician will take a full medical history, perform a physical exam, and review the hearing tests performed in step 1. If he agrees that a cochlear implant is the best option the next phase of evaluations will be scheduled. Time- 45 minutes.

Phase II

1. MRI or CT Scan- This is required on all patients to evaluate inner ear anatomy and to screen for any brain conditions prior to the placement of the implant. Children usually require sedation or anesthesia for the scan and therefore it is performed in Medical City’s radiology department. Adults and older children can have their scan performed in a nearby outpatient facility. Time- 45 minutes.

2. Genetics Evaluation (Children Only)- 80% of children born with hearing loss have a genetic cause. Determining the exact gene that has caused the hearing loss is helpful to the physician in understanding the condition. It helps the parents understand how future children can be affected. Dr. Scheuerle will take a detailed family history, perform a physical exam, and possibly obtain genetic blood testing. She will then counsel the parents with these results. Her office is at Medical City Dallas. Time- 1 hour.

3. Auditory/Verbal Evaluation- For adults, this assesses (a) the affects of hearing loss on the patient's listening and speaking skills at home, work, educational and in social settings, (b) the possible benefits of a cochlear implant, and (c) the need for hearing therapy or hearing and speech therapy after the cochlear implant is activated.

For infants, children and teens, this evaluation assesses the patient's potential for learning to (a) hear and comprehend spoken language with a cochlear implant and (b) develop speech to use as a primary means of communication. The roles of the parent and the child's educational setting are discussed as they impact benefit from implantation.

For all patients, the purpose of short term or long term therapy is discussed. Adult family members are encouraged to attend the evaluation to learn how to support the patient. Time- 1 to 2 hours.

4. Neuropsychology Evaluation-The purpose of pre-operative psychological/neuropsychological screening-

In children/adolescents:

(a) obtain information regarding overall cognitive, adaptive, emotional and behavioral functioning
(b) assist in developing a plan to address skills of compliance and independence relevant to cooperation in rehabilitation, as needed
(c) answer questions, address concerns, and offer emotional/behavioral support, as needed, to enhance pre-operative preparation or post-operative rehabilitation

In adults:

(a) obtain information regarding overall cognitive, adaptive, vocational, and emotional functioning relevant pre-operative concerns
(b) assist the individual and their family in identifying/addressing current stressors and other factors which could influence compliance following implantation.
This evaluation is usually not covered by insurance and requires the patient/parents to pay the evaluation fee of approximately $150 at the time of the visit. Insurance will not be billed for this evaluation. Time-1 hour.

5. Videonystagmography (VNG-Balance Testing- Adults Only)- This test is performed in the Audiology Laboratory of Dallas Ear Institute, Suite A107. It involves a series of balance tests to determine the amount of balance function in each ear. The results of these tests can affect the choice of ear for implantation and help detect certain patients who may be prone to balance difficulties after implant surgery. Time- 1 hour.

6. Second Phase Audiology Hearing Tests- There are other sentence and word recognition tests performed in quiet and in the presence of background noise that enable us to better compare your or your child’s hearing abilities after cochlear implantation with those prior. Time- 1hour.

7. Insurance Precertification- Obtaining approval from your insurance company for cochlear implantation can take several weeks. Debbie Spicer will be hard at work to obtain precertification for the surgery and will keep you up to date on the progress.

8. General Medical Preoperative Exam by your Primary MD- If you are age 40 or older or if you are any age but have other medical conditions (high blood pressure, heart conditions, diabetes, etc), you may need to see your primary physician for an exam that includes an EKG, Chest X-ray, and general blood tests before we can schedule your surgery. Your physician’s office must fax us these results with a note from the physician stating that you are in reasonable condition to undergo the implant surgery.

Phase III

1. Preoperative Appointment, Dallas Ear Institute Physician- When (and only when) all of the above steps are complete, a surgery date will be scheduled. You will be asked which cochlear implant brand you have selected—this is something that you will decide during the above process. The practice administrator will call and inform you of your estimated out of pocket expenses related to the surgery. The day prior to surgery you will meet with your physician to review all of the information, confirm which ear is to be implanted, and which device has been selected. You will also be given a Pneumococcal vaccine as recommended by the FDA and CDC, unless you know for sure that you have received it in the past. Time 1 hour.
Notify the Auditory-Verbal Therapist of your surgery date and schedule your first therapy session that will follow activation of the implant.

2. Cochlear Implant surgery- The surgery takes approximately 1 ½ hours to perform. The majority of patients go home the same day of surgery. Further surgical details will be discussed with your physician and can also be found within this section of the web site.

3. One Week Postoperative Check and Initial CI Training- You will return to see your physician one week after surgery to check the incision for proper healing. You will then see the audiologist who will perform electrical checks on the implant. She will counsel and educate you concerning all of the external components of the cochlear implant system. You will be sent home that day with all of your implant accessories and instructions to learn at home. You or your child will not have your cochlear implant turned on at this visit. Time 1 hour.

4. Activation and Programming, Start AV Therapy- Cochlear implant activation usually takes place 3 weeks after surgery. That day you or your child will have the processor programmed and leave the office with the implant functioning. This is the beginning of learning to hear with the implant. You will schedule your Auditory-Verbal Therapy to begin sometime after this visit. You will be returning to the audiologist for programming of the implant processor at regular intervals to slowly increase the strength of the implant stimulation. Auditory-Verbal Therapy will take place on a weekly basis with a frequency and duration to be determined by your therapist.

Download Cochlear Implant Process to take with you
Download Cochlear Implant Process Map

Cochlear Implant Surgery

The surgical placement of cochlear implants has been performed for over 20 years. Newer implant designs and surgical techniques allow us to place these devices with very few complications and excellent cosmetic results.

The procedure is performed in a day surgery unit with most patients going home the same day. General anesthesia is administered in the operating room, and a small amount of hair behind the ear is shaved. An incision is made in the crease behind the ear, which makes the scar very inconspicuous once it has healed. A pocket is created under the skin to accommodate the receiver-stimulator portion of the implant. This part of the implant has a very flat design so that it will not produce a noticeable deformity. An opening is then made into the air-filled bone called the mastoid. This mastoidectomy allows us to access the inner ear cochlea without disturbing the ear canal or eardrum. A very small opening is made into the cochlea, and the implant electrode is threaded in as far as possible. Most cochleas can accommodate the complete electrode unless meningitis is the cause of deafness, in which case a partial insertion may be necessary. The incision is closed with hidden absorbable stitches that do not require removal. A Velcro cup dressing is placed on the ear and remains in place for 2 days. Patients usually leave the hospital 3 to 4 hours after surgery is completed. Pain is mild-to-moderate for 1 to 2 days and can be controlled with oral pain medicines. Some patients experience imbalance for a few days after surgery, but this resolves spontaneously within the first week. Patients are seen in the office 1 week after surgery to check the incision. Most patients are able to return to work or school at that point. The initial activation of the device and placement of the external equipment is performed 3 weeks after surgery. Once healed there is practically no visible evidence of the implant’s presence. The incision can tolerate water 3 days after surgery. Sports, exercises and air travel should be suspended for 3 weeks. After that, there are no activity restrictions.

Cochlear implants are extremely reliable. It is expected that a patient will never need to have their implant replaced. Less than 1% of implants have malfunction that requires replacement. Thankfully, if necessary, implants can be surgically replaced without losing any hearing performance. This also means that in the future patients can be upgraded to newer technology if warranted by the expectation of improved performance.

Preoperative Instructions

Below are instructions to follow prior to surgery:

  • Once the surgery date is scheduled, the patient will have a pre-operative appointment for an examination by a Dallas Ear Institute physician the day before surgery followed by pre-admission at the surgery center, which includes a brief tour of the surgery center, lab work, paperwork, and further instructions for surgery arrival time the following day.
  • It is advised that no aspirin, aspirin products, Motrin, or Ibuprofen be taken two weeks prior to the surgery.
  • Any signs of illness or temperature that may occur prior to surgery must be reported to our office immediately.
  • If given prescriptions, have them filled prior to surgery.
  • Take NOTHING by mouth after midnight the night before surgery unless given specific instructions otherwise. This includes foods, liquids, or medications.
  • Note: The anesthesiologist will call you at home the night before surgery, therefore please be sure you give us the phone number where you can be reached the night before surgery.

After Surgery/Recovery

Patients usually leave the hospital 3 to 4 hours after surgery is completed. Listed below are some factors to consider for the recovery process:

  • Pain will be expected and may be mild to moderate for 1 to 2 days and can be controlled with oral pain medicines.
    Some patients experience imbalance for a few days after surgery, however, this usually resolves spontaneously within the first week.
  • Patients are to return to the office one (1) week after the surgery for a follow-up visit.
  • After the follow-up visit, most patients are able to return to work or school.
  • During the healing process, sports, exercise, and flying should be suspended for approximately 4 weeks
  • After the healing period, patients can expect minimal visible evidence of the implant's presence and there will be no activity restrictions.

Activation of the Device

The initial activation of the device and placement of the external equipment is performed 3 to 4 weeks after surgery. At that time, the patient will be fitted with the external parts of the device, which requires "programming" of the external speech processor by the audiologist. During this process, the patient will begin to hear their first sounds generated by the implant.

The programming of the external speech processor is a procedure that must be repeated one week later and then periodically thereafter. The reason for this is because the implant system must be programmed to suit each individual's needs. Each patient's tolerance of sound improves with time. Therefore, the implant stimulation level can
be adjusted to suit each patient’s needs. The implant team is committed to work with the implant recipient as long as it is necessary to ensure optimal benefit from the device.

Reliability and the Future

Cochlear implants are extremely reliable. In fact, less than 1% of implants have required replacement due to a malfunction. Therefore, patients can be assured they should not expect they would need to have their implant replaced. If it becomes necessary for the implant to be replaced, it can be done without any impact on the hearing performance. This is encouraging since it means patients can have their implants upgraded to newer technology in the future if it will prompt an improvement in the hearing performance.


Recipients vary greatly in the amount of benefit they derive from the cochlear implant devices. The outcomes can be broken down into three (3) groups.

Group 1
Congenital or infancy onset hearing loss.If a child born deaf is detected soon after birth, fitted with hearing aids in the first year of life, and subsequently obtains a cochlear implant by age 2 to 3 years (the earlier the better) there are great expectations for this child to obtain excellent auditory and oral communication skills with a cochlear implant. This requires intensive speech therapy for several years after the implant is placed to achieve these results. It is reasonable to expect such a child to enter mainstream classrooms upon starting the 1st grade and to not have the hearing impairment be a significant limiting factor in the child's ultimate educational and occupational goals. Children in this group are considered excellent candidates for a cochlear implant.

Group 2
Adult Onset Hearing Loss: Adults who grew up with normal hearing or at least hearing adequate enough to learn to speak proficiently, and subsequently have their hearing deteriorate to a severe level are considered excellent candidates for cochlear implants. These patients adjust to the implant very rapidly (usually within a few months) and require only short term therapy. With practice and patience these individuals experience great improvement in face to face communication. Many can learn to talk on the telephone. There is great improvement in environmental sound awareness. Background noise still creates a challenging communication environment.

Group 3
Older Children and Adults Born Deaf: Any child greater than 5 years old up through adulthood who was born deaf and spent many years with very poor hearing is a challenging cochlear implant candidate. The success of cochlear implantation in these cases is affected by many factors: oral speech training and skills, dependency on manual communication (sign language), and motivation of the individual and parents to obtain improved auditory and spoken communication skills. The advisability of cochlear implantation in these individuals must be determined on an individual basis.

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Bilateral Cochlear Implantation

Placing a cochlear implant in both ears has now become a standard of care for children and adults who meet certain candidacy criteria. The rationale for and benefits of bilateral cochlear implantation are complex. The Dallas Ear Institute is world renowned for its research in this field. Our surgeons and audiologists will discuss this possibility as part of your or your child’s comprehensive plan for restoring the best hearing possible in both ears.

Download Rationale for Bilateral Cochlear Implantation in Children and Adults
Download Importance of Age and Post-Implantation Experience on Speech Perception Measures in Children with Sequential Bilateral Cochlear Implants
Download Worldwide Trends in Bilateral Cochlear Implantation
Download Presentation at AAA 2010

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Patient Testimonials

How Natural Hearing Works
What is a Cochlear Implant
How a Cochlear Implant Works
Candidate Evaluation
Cochlear Implant Surgery
Who Benefits
Bilateral Cochlear Implants

The Sound of Success
A story about a girl and her family who
embarked on a 5,296 mile journey when she
was 2 years old to give her the gift of hearing

Click Here to Download Story

Cochlear Implants Patient Forms

Download Appointment Agreement
Cochlear Implant Expectations Pediatric
Cochlear Implant Expectations Adult
Cochlear Implant Surgery
Cochlear Implant Risk & Complications
Cochlear Implant Hook-Up Form
Cochlear Implant Post-Op Instructions



Dallas Ear Institute
7777 Forest Lane, Suite A-103, Dallas, TX 75230 | Phone: (972) 566-7600 | Fax: (972) 566-6560 | www.dallasear.com