Cochlear Implant Evaluation: What Do the Hearing Tests, Speech Assessment and Imaging Decide?

The man in the audiology waiting room has already pieced together a strategy for living with his hearing loss. He sits with his back to the wall so the receptionist’s voice comes from one direction. He watches lips. He nods at the right moments in family dinners and reconstructs the conversation afterward from his wife’s summary in the car. His hearing aids are the third pair in ten years, and each pair has felt a little more like a radio tuned between stations.

What brings him in today is a single question that took months to say out loud: is it time to consider a cochlear implant? The cochlear implant evaluation process exists to answer that question with measurements instead of guesswork, and it is more nuanced than most people expect.

The three pillars of that evaluation, hearing tests, speech assessment and imaging, each decide something different. Understanding what each one is looking for takes much of the mystery, and much of the fear, out of the appointment.

What does the cochlear implant evaluation process actually involve?

A cochlear implant is a small electronic device with two parts: an external processor worn behind the ear that captures sound, and an internal receiver with a thin electrode array that a surgeon places inside the cochlea, the snail-shaped organ of the inner ear. Instead of amplifying sound the way a hearing aid does, it bypasses damaged sensory hair cells and stimulates the hearing nerve directly with tiny electrical pulses. The National Institute on Deafness and Other Communication Disorders (NIDCD) describes the sound produced this way as different from natural hearing, something the brain learns to interpret over time.

Because the device replaces part of the ear rather than boosting it, the decision to recommend one is deliberately layered. Most programs follow a broadly similar cochlear implant evaluation process. An audiologist, a hearing specialist trained to test and manage hearing, repeats and expands the standard hearing tests. The same audiologist then measures how well the person understands words and sentences while wearing properly fitted hearing aids, since the central question is not how loud sound needs to be but whether amplified sound still carries meaning.

An ear, nose and throat surgeon (otolaryngologist) reviews the medical history and examines the ears, and orders a CT scan, an MRI, or both, to look at the shape of the inner ear and the size of the hearing nerve. Many teams also include a speech-language pathologist, a social worker or psychologist, and for children a developmental specialist and educator.

Mayo Clinic frames the goal plainly: the team is looking for hearing loss severe enough to interrupt spoken communication, limited benefit from hearing aids on specialized testing, and no medical factors that would raise the risks of surgery unacceptably. Each test in the pathway maps to one of those three questions. The rest of this article follows them in that order.

How bad does your hearing have to be to qualify for a cochlear implant?

The honest answer is that the threshold is not a single number on an audiogram. Historically, implants were reserved for people with profound deafness in both ears. Over time, as devices and surgical technique improved, candidacy broadened to include many adults with moderate-to-profound sensorineural hearing loss, meaning damage in the inner ear or hearing nerve rather than a blockage in the ear canal or middle ear.

An audiogram plots the softest sound a person can detect at each pitch, measured in decibels of hearing level (dB HL). Roughly speaking, moderate loss begins around the level where normal conversation becomes hard to follow, and profound loss means even very loud sounds are barely heard. Where a person falls on that chart matters, but it is only the entry ticket to the evaluation.

What tips the balance is how the person performs on speech recognition testing with hearing aids optimally fitted. Someone with a severe audiogram who still understands most sentences with hearing aids may be advised that aids remain the better tool, at least for now. Someone with a less dramatic audiogram whose word understanding collapses in ordinary listening conditions may be a stronger candidate than the chart alone suggests. Mayo Clinic notes that specialized hearing tests, not the audiogram in isolation, are used to judge whether hearing aids offer limited benefit.

Hearing loss is common enough that these decisions happen constantly. The World Health Organization estimates that more than 5 percent of the world’s population, about 430 million people, need rehabilitation for disabling hearing loss. Only a fraction reach implant candidacy, but the pathway is designed so that those who do are identified by function, not just by a line on a graph.

What is the 60-60 rule for cochlear implant candidacy?

People searching for the 60-60 rule cochlear implant guideline are usually trying to work out whether they, or a relative, should ask for a referral. The rule is a screening tool proposed by audiology researchers in a study published in the journal Otology and Neurotology. It suggests that an adult should be referred for a full cochlear implant candidacy evaluation when the average of their hearing thresholds across the main speech frequencies is 60 dB HL or worse in the better-hearing ear, and when their unaided score on a standard single-word recognition test is 60 percent or lower in that ear.

Two things about this rule are frequently misunderstood. First, it is a referral trigger, not a candidacy criterion. Meeting the 60-60 threshold does not mean a person qualifies for an implant; it means the numbers are in a range where a formal evaluation is worth doing. Plenty of people who meet it will, after speech testing with hearing aids, be told that aids still serve them well. Second, the rule was designed for adults with typical sensorineural loss in both ears. It was never meant for children, for people with single-sided deafness, or for those with unusual ear anatomy.

Why does such a rule exist at all? Because referral tends to happen late. Many adults spend years struggling with hearing aids before anyone raises the possibility of an implant, and audiologists needed a simple, memorable prompt built from tests they already perform at every visit. The 60-60 rule fills that gap. If your own audiogram and word scores sit near those figures, the reasonable next step is not to draw conclusions but to ask your audiologist whether a candidacy evaluation makes sense.

Which cochlear implant hearing tests are performed, and what does each one decide?

The first appointment usually starts with tests that feel familiar to anyone who has worn hearing aids, then adds several that most people have never had. Each answers a specific question about where and how the hearing system has failed.

Test	What it measures	What it helps decide
Pure-tone audiometry	Softest tone heard at each pitch, by air and by bone conduction	Degree of loss and whether it is sensorineural or conductive
Tympanometry	How the eardrum and middle ear move under gentle air pressure	Rules out fluid, perforation or stiff middle-ear bones
Otoacoustic emissions (OAE)	Faint echoes produced by healthy outer hair cells	Confirms inner-ear hair cell damage, especially in infants
Auditory brainstem response (ABR)	Electrical activity along the hearing nerve in response to clicks	Estimates hearing in babies; flags nerve or brainstem problems
Aided speech recognition	Words and sentences understood with hearing aids on	Whether amplification still delivers usable speech

Pure-tone testing with bone conduction is the crucial fork in the road. A bone-conduction vibrator on the skull sends sound straight to the inner ear; if hearing improves that way, the problem is in the outer or middle ear and a cochlear implant is the wrong tool. Only when bone and air results sit together, showing the inner ear itself is damaged, does the evaluation proceed.

The audiologist will also verify that current hearing aids are programmed correctly, often measuring the sound they deliver inside the ear canal with a tiny probe microphone. This matters because an implant decision rests on comparing implant potential with the best achievable hearing aid result, and an underperforming aid can make a person look like a candidate when they are not.

Why the speech assessment carries the most weight

If the audiogram is the map, the speech assessment is the road test. It answers the question people actually care about: can I follow what someone is saying?

The assessment is performed in a sound-treated booth with hearing aids worn and properly set. The audiologist plays recorded lists of single words, then full sentences, first in quiet and then with background babble added at a fixed loudness ratio. Recorded speech is used rather than live voice so that results can be compared fairly across visits and clinics. Each ear is usually tested alone and then both together, because an implant may be recommended for one ear even when the other still does reasonably well with an aid.

Two patterns are especially telling. The first is a large gap between detecting sound and understanding it. A person may hear that someone is speaking yet score poorly on words, a sign that the cochlea’s ability to encode fine detail has deteriorated beyond what amplification can restore. The second is a steep fall in performance once background noise appears. Hearing aids make everything louder, including the noise; an implant’s direct nerve stimulation can sometimes preserve speech contrast where a damaged cochlea cannot.

Programs set their own score ranges for candidacy, generally in line with regulatory labeling and published guidelines, and those ranges have shifted downward over the years to include people with more residual hearing. Because of that variation, this article deliberately avoids quoting a single cutoff. What is consistent is the principle: the speech test compares your best-aided performance against what implant recipients with similar hearing typically achieve, and the team weighs whether the likely gain justifies surgery. That is a judgment, informed by numbers, and it belongs to you and the team together.

What does the CT or MRI scan decide before cochlear implant surgery?

Imaging is the part of the evaluation that has nothing to do with how well you hear and everything to do with whether the surgery is physically possible and where the electrode should go.

A CT (computed tomography) scan uses X-rays to build detailed cross-sections of the bone around the inner ear. Surgeons study it for the size and patency of the cochlea, the term for whether its fluid-filled channels are open. After bacterial meningitis, for instance, new bone can grow inside the cochlea and partially block it, a finding that changes the choice of electrode and the surgical approach. The CT also shows the route through the mastoid bone behind the ear, the position of the facial nerve, and any congenital malformations of the inner ear.

An MRI (magnetic resonance imaging) scan uses magnetic fields rather than radiation and shows soft tissue. Its main job in this setting is to confirm that the cochlear nerve, the bundle of fibers that carries signals from the cochlea to the brain, is present and of adequate size. A very small or absent nerve is one of the few findings that can rule out a conventional cochlear implant altogether, because the electrode would have nothing to stimulate. MRI also checks for tumors or inflammation along the hearing pathway.

Children are often imaged with both methods, sometimes under light sedation, because congenital malformations are more common in early-onset deafness and the findings shape counseling about expected benefit. Adults with straightforward age-related or noise-related loss may need only one scan; that choice sits with the surgeon.

Imaging also has a forward-looking role. Because the internal implant contains a magnet, the team documents baseline anatomy and discusses how future MRI scans for unrelated conditions would be handled. Modern implants are designed with MRI in mind, but the specifics depend on the device and are part of the informed-consent conversation.

Who is usually a candidate, and who is usually asked to wait?

Cochlear implant candidacy criteria have widened, but they still draw lines. The clearest candidates are adults with moderate-to-profound sensorineural loss in both ears who understand little speech even with well-fitted hearing aids, who are medically fit for general anesthesia, and who have realistic expectations along with the motivation for months of listening practice afterward. NIDCD reports that, at its most recent count, roughly 736,900 devices had been implanted worldwide, with about 118,100 adults and 65,000 children in the United States, a reminder that both age groups make up the candidate pool.

Several groups are commonly asked to wait or to try something else first:

• People whose hearing aids have never been properly fitted or updated. Most programs require a documented trial with appropriate amplification before concluding that aids have failed.
• Those whose loss is conductive or mixed and could improve with middle-ear surgery or a bone-conduction device.
• People with active middle-ear infection or uncontrolled medical conditions that raise surgical risk; these are usually treated first.
• Individuals whose hearing loss has been very recent and sudden, which may be treated medically and reassessed before any surgical discussion.

A few situations sit in a gray zone that the team will discuss openly. Single-sided deafness, where one ear hears normally, is now an accepted indication in many programs but involves a different balance of benefit and risk. Adults deaf since early childhood who have used sign language rather than spoken language may gain awareness of environmental sound but often less speech understanding, because the brain’s hearing pathways developed without sound; counseling here is careful and individualized.

None of these categories is a verdict. They are starting points for a conversation in which the treating team weighs the measurements against your goals and makes a recommendation you are free to accept, question or decline.

How is the cochlear implant evaluation process different for children?

A toddler cannot raise a hand when a tone is heard, so the pediatric pathway leans on objective tests and on time. Most children who reach an implant evaluation were first flagged by newborn hearing screening, then confirmed by auditory brainstem response testing, which records nerve activity while the baby sleeps. Otoacoustic emissions and tympanometry confirm the site of the problem. Behavioral testing, in which the child turns toward a sound and is rewarded with a lit-up toy, is added as soon as the child is developmentally able.

Hearing aids are fitted early, and the child’s response to them is tracked over months rather than a single session. Audiologists and speech-language pathologists watch for the milestones that hearing children reach: startling to loud sounds, babbling with varied consonants, responding to a name, and eventually producing first words. When aided hearing does not translate into progress, the team considers implantation, and the NHS notes that for children born deaf, implants are generally considered at a young age because the brain is most adaptable to sound in the early years.

Imaging is nearly always done in children, because inner-ear malformations and cochlear nerve deficiency are more common in congenital deafness and directly affect what an implant can do. Scans are usually performed under sedation or brief anesthesia, and preparation focuses on comfort: fasting instructions from the team, a familiar toy, and a parent present until the child is asleep.

The pediatric evaluation also includes people who never touch an otoscope. Developmental pediatricians look for additional conditions that could shape outcomes. Educators and therapists assess the family’s communication choices and readiness for the years of therapy that follow. Genetic counseling may be offered, since a substantial share of childhood deafness has a genetic cause. Decisions about a child’s implant rest with the parents and the team together, and good programs make space for families who choose a different path.

What are the steps involved in a cochlear implant procedure?

Once the evaluation supports implantation and you have chosen to proceed, the procedure itself is surprisingly routine from the surgical team’s perspective, though not from yours. Knowing the sequence helps.

Surgery is performed under general anesthesia. The surgeon makes an incision behind the ear, opens a small window in the mastoid bone, and follows a carefully mapped path, guided by the CT scan, to the middle ear. A tiny opening is made into the cochlea, either through its natural round window or through the bone beside it, and the electrode array is threaded gently along the cochlea’s spiral. The internal receiver is seated in a shallow bed shaped in the skull bone under the skin, and the incision is closed.

Before the last stitch, the team usually tests the implant electrically while you are still asleep, confirming that the electrodes are responding and that the hearing nerve reacts to stimulation. This intraoperative check is one reason the evaluation imaging matters: the surgeon already knows what to expect inside.

Cleveland Clinic and Mayo Clinic both describe the procedure as typically an outpatient or single-night stay, with most people going home the same day or the next morning. A padded dressing covers the ear at first. Mild dizziness, a stiff neck and soreness around the incision are common for a few days, and taste changes on the side of the tongue can occur because a nerve serving taste runs through the middle ear.

What people find most surprising is that nothing is switched on. You leave the hospital hearing exactly as you did before, or slightly less in the operated ear. The external processor is fitted and activated weeks later, once the incision has healed, in a separate appointment described in the next section.

What do the following weeks look like, from healing to activation and mapping?

The waiting period after surgery is quiet in every sense. The scalp needs time to settle before a magnet and processor can sit against it. Mayo Clinic gives a typical range of 2–6 weeks between surgery and activation, though the exact timing is set by the surgeon based on how the incision is healing.

Activation day is often filmed by families expecting a cinematic moment. The reality is usually stranger and more modest. The audiologist connects the processor to a computer and, electrode by electrode, finds the softest level you can detect and the loudest that remains comfortable. This programming is called mapping, and the resulting settings are the map. First sounds through an implant are commonly described as beeps, buzzing, or cartoon-like voices; NIDCD is explicit that implant hearing is not the same as natural hearing and that learning to interpret it takes time.

Over the following weeks the map is adjusted repeatedly, because the nerve’s response changes as it adapts and because the brain begins to make sense of the new signal. Appointments are typically frequent at first and then spread out. Between visits, the work is yours: daily listening practice, reading aloud while following the text, listening to audiobooks with the transcript, and practicing conversation in gradually noisier settings. Speech-language therapy, called aural rehabilitation in this context, is standard for children and increasingly recommended for adults.

Progress is rarely linear. Many recipients describe a stretch where everything sounds mechanical, followed by a moment when a familiar voice suddenly sounds like itself. The timeline for that varies enormously between people and depends on how long the ear was without sound, the health of the nerve, and consistent daily use. Your audiologist will track your speech recognition scores at intervals, using the same recorded tests from the evaluation, so that gains are measured rather than guessed.

What are the risks, and what are the alternatives to a cochlear implant?

Any evaluation worth the name includes an unhurried conversation about what can go wrong and what else could be tried. Cochlear implant surgery is considered generally safe, but it is real surgery on a small and crowded piece of anatomy.

Risks described by Mayo Clinic and NIDCD include:

• Loss of any remaining natural hearing in the implanted ear, which may be permanent.
• Bacterial meningitis, an infection of the membranes around the brain, which is rare but serious; vaccination against the common bacterial causes is recommended for recipients, and the team will discuss timing.
• Injury to the facial nerve, which runs close to the surgical path and can cause weakness on that side of the face, usually temporary.
• Dizziness or balance disturbance, tinnitus (ringing) that is new or changed, and altered taste.
• Wound infection, skin breakdown over the implant, and device failure requiring revision surgery.

Alternatives depend on why hearing aids are not working. Newer hearing aid technology, properly fitted and verified, resolves the problem for some people who arrive assuming they need an implant. Bone-conduction implants transmit sound through the skull and suit conductive or mixed loss, or some cases of single-sided deafness. Middle-ear implants and, for a small group with a damaged or absent cochlear nerve, auditory brainstem implants are options a surgeon may raise. Assistive listening systems, captioning, and visual communication strategies remain valuable regardless of any device.

Choosing not to proceed is also a legitimate alternative, and a good team will say so. Some adults decide the demands of rehabilitation outweigh the expected gain; some families in the Deaf community decline implantation for their children on cultural grounds. The evaluation’s job is to lay out the evidence clearly; the decision remains with you and the treating team.

What people often get wrong about cochlear implants

Cochlear implants attract more myth than almost any device in medicine, partly because activation videos travel fast online. Here is what the evidence actually supports.

“An implant restores normal hearing.” It does not. NIDCD describes implant hearing as a useful representation of sound that the brain must learn to interpret. Many recipients understand speech well in quiet; noisy restaurants and music remain hard for most.

“You have to be completely deaf to qualify.” Candidacy now includes many people with moderate-to-profound loss who still hear some sound but understand little speech with hearing aids. The speech assessment, not total deafness, drives the decision.

“Hearing improves the moment it is switched on.” Activation typically happens 2–6 weeks after surgery according to Mayo Clinic, and early sounds are often unrecognizable. Improvement builds over weeks and months of use.

“Older adults are too old.” Age alone is not a barrier. Fitness for anesthesia and general health matter, and older adults are routinely implanted.

“If the audiogram looks bad enough, I automatically qualify.” A poor audiogram earns a referral; it does not settle candidacy. Several people with dramatic audiograms score well on aided speech tests and keep their hearing aids.

“An implant means no more MRI scans.” Modern devices are designed to allow MRI under specified conditions. The details vary by device and are part of the surgical consent.

“The surgery drills into the brain.” The electrode sits inside the cochlea in the inner ear; the receiver rests under the scalp against the skull. The brain is not entered.

Correcting these ideas early makes the evaluation calmer and the decision better informed, whichever way it goes.

Questions to ask your care team during the cochlear implant evaluation process

The most useful thing you can bring to the evaluation is a short list of questions, written down, because the appointments are long and the information dense. These are the ones experienced audiologists say they wish more people asked.

• Based on my speech scores with hearing aids, how much room for improvement do you realistically see, and what range of outcomes do people with results like mine tend to have?
• Which ear are you recommending, and why that one rather than the other?
• What did my CT or MRI show about the shape of my cochlea and the size of my hearing nerve, and does anything there change your plan?
• Will I lose the natural hearing I still have in the implanted ear, and how would that affect me if the implant underperformed?
• How often will I need programming appointments in the first months, and what does the rehabilitation program look like day to day?
• What vaccinations do you recommend before surgery, and when?
• How would a future MRI for an unrelated problem be handled with this device?
• What are the signs that the implant is not working properly, and who do I contact if they appear?
• If I decide not to proceed now, what would prompt you to suggest we revisit the question?

Ask, too, about who will be your point of contact after surgery, and whether there are recipient support groups you can talk to before deciding. Hearing from someone who went through the same evaluation often clarifies expectations better than any leaflet. Write the answers down or ask a family member to take notes; most people remember far less of a medical consultation than they think.

When to call your doctor: red flags before and after a cochlear implant, and signs an implant may be failing

Some hearing symptoms should never wait for a scheduled evaluation. The NHS advises urgent assessment for hearing loss that develops suddenly, in one or both ears, over hours or a day or two, because some causes are time-sensitive and treatable. Seek same-day care for sudden hearing loss accompanied by severe dizziness, facial weakness, a severe headache, a stiff neck, fever, or discharge from the ear. Hearing loss after a head injury also needs prompt attention.

After surgery, contact the surgical team promptly if you notice:

• Fever, increasing redness, swelling, warmth or discharge at the incision.
• Severe or worsening pain not relieved by the measures your team suggested.
• New facial weakness or drooping on the operated side.
• Severe or persistent dizziness, vomiting, or difficulty walking.
• Headache with stiff neck, sensitivity to light or confusion, which can signal meningitis and warrants emergency care.
• Clear fluid draining from the ear or nose.

Once you are using the implant, a separate set of signs suggests the device itself may not be working properly. Report to your audiologist any sudden or steady drop in speech understanding that new programming does not fix, sound that cuts in and out or crackles, a sensation of electrical shocks, twitching or pain in the face or neck when the processor is on, persistent discomfort or swelling over the internal receiver, or a processor that repeatedly fails to connect. These signs do not always mean the implant has failed; external parts, cables and batteries account for many problems. They do mean the team should check, because internal device faults are confirmed with electrical testing and sometimes imaging, and revision surgery is a decision the treating team makes with you.

If you are ever unsure whether a symptom is urgent, call. A short phone consultation is always preferable to waiting out a warning sign.

Frequently asked questions

What is the 60-60 rule cochlear implant guideline, and does meeting it mean I qualify?

The 60-60 rule is a referral screen, not a qualification. It proposes that adults whose average hearing thresholds are 60 dB HL or worse in the better ear, and whose unaided word recognition is 60 percent or lower in that ear, should be sent for a full candidacy evaluation. Whether you actually qualify depends on aided speech testing, imaging and medical review by the implant team.

How bad does hearing have to be for a cochlear implant?

There is no single number. Most adult candidates have moderate-to-profound sensorineural loss in both ears and understand little speech even with properly fitted hearing aids. Mayo Clinic describes candidacy as hearing loss severe enough to interrupt spoken communication plus limited benefit from hearing aids on specialized tests. Someone with a severe audiogram who still does well on aided speech tests may be advised to keep their aids.

What are the signs a cochlear implant is failing?

Warning signs include a sudden or steady fall in speech understanding that reprogramming does not correct, sound that cuts out or crackles, electrical or shock-like sensations, facial or neck twitching when the processor is on, and persistent pain or swelling over the internal device. Many such problems trace to cables, batteries or the external processor, so the first step is always to contact your audiologist for testing.

What are the steps involved in a cochlear implant procedure?

After the evaluation confirms candidacy, surgery is performed under general anesthesia through an incision behind the ear. The surgeon opens a path through the mastoid bone, threads the electrode array into the cochlea, seats the receiver under the scalp and tests the device before closing. Most people go home the same day or after one night, and the processor is activated in a later appointment once the incision has healed.

Why do I need a CT and an MRI if my hearing tests already show I am deaf?

Hearing tests show how much you hear; imaging shows whether an implant can physically be placed and work. CT reveals whether the cochlea is open and maps the surgical route around the facial nerve. MRI confirms that the cochlear nerve is present and large enough to carry the implant’s signal to the brain. Both findings can change the surgical plan or, rarely, rule out a conventional implant.

Do I have to try hearing aids first before a cochlear implant evaluation?

In most programs, yes. Candidacy is defined by limited benefit from appropriately fitted hearing aids, so the team needs to see how you perform with well-programmed amplification before concluding it has failed. If your current aids are old or poorly fitted, the audiologist may adjust or replace them and retest before recommending surgery. This step protects you from surgery you may not need.

How long after cochlear implant surgery is the device turned on?

Mayo Clinic describes a typical wait of 2–6 weeks between surgery and activation, allowing the incision and the skin over the receiver to heal before a magnet and processor are worn against them. Your surgeon sets the exact date based on your healing. The first programming session, called mapping, is followed by several adjustment visits as your nerve and brain adapt.

Can an older adult have a cochlear implant?

Age by itself is not a barrier to candidacy. The team looks at general health and fitness for general anesthesia, at aided speech understanding, and at the person’s motivation for rehabilitation, not at a birth date. Older adults are routinely evaluated and implanted, and the decision is made individually by the treating team based on the same hearing tests, speech assessment and imaging used for younger candidates.

What are the cochlear implant candidacy criteria for children?

Children are usually considered when objective tests such as auditory brainstem response confirm severe-to-profound sensorineural loss in both ears and months of consistent hearing aid use have not produced expected listening and language progress. Imaging confirms the cochlea and hearing nerve are suitable. The NHS notes implants are generally considered at a young age for children born deaf, because the brain adapts to sound most readily early in life.

Will a cochlear implant give me normal hearing?

No. NIDCD describes implant hearing as a useful representation of sound that the brain learns to interpret, not a return to natural hearing. Many recipients understand conversation well in quiet, while noisy settings and music remain challenging for most. Outcomes vary widely with the health of the hearing nerve, how long the ear went without sound, and daily practice, so your team will discuss a realistic range rather than a promise.

References

• Cochlear Implants, National Institute on Deafness and Other Communication Disorders (NIH)
• Hearing loss: Treatment, NHS
• Cochlear implant, MedlinePlus Medical Encyclopedia
• Deafness and hearing loss fact sheet, World Health Organization

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.