Surgery for Hearing Loss

NYU Langone’s Cochlear Implant Center is one of the largest and most respected centers in the world. Our team of surgeons and audiologists has pioneered new technologies and techniques since the center opened in 1984. It offers specialized care for people who have been diagnosed with sensorineural hearing loss.

Our surgeons have successfully implanted cochlear devices in people from 4 months to 94 years of age. New research suggests that this surgery is safe for people of almost any age who are in good health.

A cochlear implant is a small electronic device that consists of an internal receiver that is surgically implanted just under the skin above the ear. The receiver connects to small devices that conduct electrical signals, called electrodes, that are implanted in the inner ear. An external device that contains a microphone, speech processor, and battery pack is worn above the skin behind the ear.

Cochlear implants work by completely bypassing the malfunctioning part of the ear. The external part of the device gathers and sorts sounds from the environment and converts them to electrical signals that are then transmitted to the internal receiver. The receiver sends these signals to electrodes in the inner ear. The electrodes then use these signals to stimulate the nerve pathway that connects the ear to the brain. The brain interprets information conveyed by the auditory nerve as speech or other sounds, allowing you to perceive sound.

Evaluation and Counseling

Before you decide to pursue surgery, doctors and counselors at the Cochlear Implant Center meet with you to ensure that you are a candidate for an implant. A good candidate is someone who has hearing loss caused by damage or dysfunction in the inner ear and whose hearing loss has not been improved by a hearing aid.

In addition, our doctors conduct imaging tests—for example, an MRI scan—to get a close look at the anatomy of your ear and confirm that a device can be implanted successfully. If doctors confirm that you are a candidate, the decision to proceed with surgery is a collaborative one.

NYU Langone’s expert team includes physicians, audiologists, counselors, and cochlear device experts who answer any questions you have about preoperative testing, the types of devices available, and surgery. In addition, an NYU Langone speech pathologist can perform a preoperative speech and language evaluation, and educators can provide comprehensive educational resources about what you can expect after surgery.

What to Expect During Surgery

The surgery to implant the cochlear device is frequently an outpatient procedure, which means no overnight stay at the hospital is required.

Doctors perform this procedure using general anesthesia. The surgeon makes an incision behind the ear, then creates a small opening in the bone behind the ear to access the inner ear and install a series of tiny electrodes. The electrodes connect to the internal component of the cochlear implant, called a receiver. The surgeon permanently installs the receiver under the skin above the ear. After the electrodes and receiver are in place, the incision is closed with stitches or staples.

What to Expect After Surgery

Recovery from surgery takes three or four weeks. During this time, skin and bone heal around the implanted device. Doctors schedule a follow-up visit 10 to 14 days after surgery to ensure everything is healing well.

Approximately four weeks after surgery, the external component of the cochlear implant—which contains a microphone, speech processor, and battery pack—is attached to the skull above the ear. Many people cover this component with their hair, making it less noticeable.

After all of the components of the device are in place, our cochlear implant care team activates the device and begin the process of adjusting the way it processes sound to optimize your ability to hear. During the following months, they meet with you regularly to ensure you are comfortable using the device and can adjust the settings as often as needed.

If the cause of your hearing loss is otosclerosis, a condition that affects a bone in the middle ear called the stapes, doctors may recommend a procedure to remove the stapes and replace it with a prosthetic part.

The stapes is a tiny wishbone-shaped structure that plays a vital role in the flow of sound from the middle ear to the inner ear. If otosclerosis occurs, abnormal bone growth develops on the stapes, preventing it from vibrating and transmitting sound signals. This limited movement interrupts the proper function of the middle ear and causes hearing loss.

To remove the stapes, a surgeon accesses the middle ear cavity through the ear canal. Using small surgical instruments and sometimes a precise laser, the surgeon temporarily lifts the eardrum membrane, extracts the stapes, and implants a replacement bone made of a durable material, such as Teflon^®.

The surgeon then repositions the eardrum membrane and packs the ear canal with soft gauze to hold it in place while the skin and bone heal. You schedule a follow-up exam in the days after the procedure so your doctor can remove the gauze and monitor healing.

Surgeons perform this procedure using regional or general anesthesia. Most people can return home the same day. Over the next few weeks, as the ear heals, hearing slowly begins to return. Many people experience a noticeable improvement in hearing after about four weeks.

Tympanoplasty is performed to repair or replace an injured eardrum, the thin membrane that separates the outer and middle ear. If this delicate membrane is punctured or torn—for example, if recurring ear infections lead to tiny perforations in the eardrum—our surgeons can reconstruct the eardrum and restore hearing.

Most of the time, tympanoplasty is performed through the ear canal using general or local anesthesia. This decision is made in consultation with your doctor. The surgeon places a graft, which is healthy tissue from your body, on the eardrum to repair the injury.

Your doctor may pack the ear canal with dissolvable packing or other materials to prevent the graft and eardrum from moving while it heals. After a period of healing, your doctor examines the ear to make sure the eardrum is healing well.

Over the following weeks, the graft merges with the eardrum membrane, restoring function and improving hearing.