The Cochlear Implant Journey: From Evaluation to Activation

The journey to cochlear implantation can quite often be a rollercoaster of emotions. When you start thinking about implants or your Audiologist starts discussing the option, it means you are at a point where your hearing aids are no longer helping you, and you are struggling to communicate daily. Simple things like talking over the phone, watching television, communicating even in quiet one-on-one situations, or even listening to environmental sounds around you, become difficult or cease to exist. You are possibly relying on a family member or friend and most likely lip reading.

You start training your brain to cope with these additional skills, communication starts becoming effortful. Overtime your coping skills start deteriorating and you start withdrawing from social situations. It’s not easy to connect at times, so text messages, online chats and emails indicate you have a community. At this point, after much time, thought, and deliberation, you start realising, “I have much to gain by getting the implant and very little to lose”. You are very motivated to make the implant work. You are inspired by stories of other implantees. Family, friends, and colleagues are sharing in your excitement of deciding to go down the cochlear implant pathway. You have a support network, and you are bound to thrive with all these pillars of support!

The cochlear implant journey involves a multidisciplinary approach. The Audiologist you have had over the years may or may not be trained as an Implant Audiologist. Both your hearing aid specialist and Implant Audiologist work together to provide you support. The journey also involves a medical team, primarily your Ear, Nose and Throat (ENT) specialist, who is a cochlear implant surgeon. You may have additional specialists such as Vestibular Audiologists, Speech Pathologists and Psychologists involved in your care. This specialised team come together to identify if you would be a successful cochlear implant candidate.

Initial Discussion and Candidacy Evaluation

The first step to determining if you can get a cochlear implant is to identify if you are in fact audiologically an implant candidate. This is carried out by an Implant Audiologist. It is a 2 hour long comprehensive assessment of your hearing and speech, with your current hearing aids. It involves 3-4 critical listening tests for speech. Each test is performed with your hearing aids, but only one ear at a time, and both in some instances. The tests are lengthy; some tests have no context or clues, and the others involve high levels of background noise. It can be a very exhausting assessment; you may also experience some auditory fatigue. So, give yourself a break! Your ears and brain are working extra hard at this point. Be kind to yourself.

The results are collated to identify if you fall within the Cochlear Implant criteria. We look to see if you are going to perform better with the implants in comparison to your hearing aids. If you are deemed a candidate, then we continue to the next step of meeting your Implant Surgeon. If you are not a candidate at this stage, then we monitor your hearing, and you continue to wear your hearing aids. These tests can give you some reassurance that, in fact, you may not be performing as bad as you think you are.

We also discuss the realities of getting the Cochlear Implant. The realistic expectations and the work that needs to go into your rehabilitation. Much like an infant learning speech, your brain must re-learn and attach meaning to sounds all over again. It is a long road to rehabilitation but in the end, a very rewarding one. Your support system that also includes your Audiologist will be with you throughout this process.

Medical Clearance

The consult with the surgeon involves looking into your medical health. Magnetic Resonance Imaging (MRI) and Computerized Tomography (CT) scans will be done to review your ear anatomy. In some cases, at the request of the implant surgeon, Balance Testing can be carried out. These appointments are conducted at The Royal Victorian Eye & Ear Hospital.

Pre-Op Counselling

Once the surgeon identifies you to be medically fit for the surgery, the next step involves some counselling. Discussion on surgical risks, which are quite rare, and answering any questions or concerns you might have.
Once confirmed, the devices are ordered. We can investigate colour options, styles and accessories that can be quite exciting!


With your surgical date around the corner, the reality of surgery can be a bit scary. However, there’s a magical quality to hope. With a cochlear implant comes a renewed sense of hope. The possibility of improvement and change for the better. The cochlear implant surgery is relatively simple and takes 1-2 hours under general anaesthesia. It involves an overnight stay at the hospital.

The internal part of the device is implanted at this stage. The surgery only involves a small incision behind the ear to place the implant. The cochlear implant is not turned on at the time of surgery, therefore no sound will be heard from that ear until the next appointment, which is your ‘Switch On’.

Switch On!

The cochlear system is activated by your Audiologist typically 2-3weeks after surgery using the external part of the device. Initial sounds may be beeps, hums, mechanical and of strange quality as the brain re-learns and adapts to the new type of sound. You will be hearing a completely new way. It’s not good or bad, it’s just different. It will get better as you continue using the implant and going through aural rehabilitation. The brain is pretty amazing in its power to adapt, and you will surprise yourself many times along this journey.

Follow up Programming and Mapping appointments

Post Activation, you will have a few follow up appointments with your Implant Audiologist to adjust the sound with slow increases to volume. For most clients, sound quality will continually improve over the first 6 to 12 months as your brain adapts. The length and time of support will vary for each patient. Appointments and activities may include continual tuning of our program (mapping), helping you practice listening and communication, activities designed to increase your ability to interpret sounds, support and strategies to enhance listening in different environments. Listening practice outside appointments is the key to success.

Ongoing Care

After the initial mapping appointments, you will have follow up appointments at 6 months and then again at 12months from surgery. After which, you will continue having annual reviews as you normally would with your hearing aids.

Every journey is different – The cochlear implant journey is a rewarding one. To not be sidelined in conversations and be involved in conversations is all we hope for in this community. We at Victorian Hearing are proud to offer Cochlear Implant Services and are able to take care of your audiological needs, from your hearing aid journey to your potential cochlear implant journey.

To learn more, reach out to the team at Victorian Hearing, your local, independent, and Australian owned and operated hearing clinic. With ten clinics across Melbourne, you can expect a friendly smile and support from the Victorian Hearing team. Call (03) 9558 8842 or book online.