| Hearing aids are the instrument of choice for the majority of people with hearing loss, but for those who are deaf or severely hard of hearing, cochlear implants may be a better option.
Both hearing aids and cochlear implants work best for people diagnosed with sensorineural hearing loss, meaning they have damage to the hair cells in the inner ear and/or the nerve pathways from the inner ear to the brain. |
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Cochlear implants vs. hearing aids
So what’s the difference between the two devices? Cochlear implants are surgically implanted by a surgeon, often an ENT also known as a otolaryngologist. They stimulate the auditory nerve to provide the sensation of sound for those who are deaf or severely hard of hearing. Hearing aids are removable and are used to amplify sound for people with residual hearing. They can be taken in and out of the ear canal by the user.
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What is a hearing aid?
Hearing aids are removable.
Hearing aids are small, electronic devices specifically designed to amplify sounds going into the ear. Ideally, these devices are prescribed by hearing healthcare professionals following a hearing evaluation. Hearing aidsare small, battery-operated devices that a person can wear in or behind the ear. They help people with mild-to-profound hearing loss hear better by amplifying sounds.
Hearing aids comprise three parts:
- a microphone, which receives and converts sound waves into electrical signals
- an amplifier, which magnifies the sound
- a speaker, which sends the amplified sound into the person’s ear
Who is a candidate for a hearing aid?
Hearing aids are best suited for kids and adults with mild to moderately severe hearing loss, although power hearing aids are available for people with more severe hearing loss. For some people, though the amplification is not adequate, and they may be a better candidate for a cochlear implant. Increasingly, some doctors think it’s a good idea to transition to a cochlear implant sooner rather than later, especially if a person has progressive hearing loss, to maintain the highest levels of speech comprehension.
Hearing aids can be classified into three main types: in-the-ear (ITE), receiver-in-the-canal (RIC) and behind-the-ear (BTE) models, each of which is available in a variety of styles, shapes, sizes and colors. Some of these styles may be more suitable for different degrees of hearing loss. |
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What is a cochlear implant?
Cochlear implants look similar to hearing aids but require surgical implantation.
Cochlear implants are complex medical devices that must be surgically implanted by a medical professional. These devices bypass the inner ear to stimulate the auditory nerve directly, giving a sensation of sound for those with profound hearing loss. Cochlear implants do not restore hearing, rather, they provide the sensation of sound for those who are deaf or have profound hearing loss. Some cochlear implants, such as hybrid models, are suitable for people with residual hearing.
They consist of two parts: an external component that houses a microphone, speech processor and transmitter; and an internal component that contains a receiver and an electrode array that is implanted deep in the inner ear.
The two components are coupled using a strong magnet. Sound gathered from the microphone and speech processor is transmitted to the receiver, which converts it to electrical pulses and dispatches it to the electrodes. When these electrodes stimulate the auditory nerve, the brain receives a signal to process the sound.
Who is a candidate for a cochlear implant?
Cochlear implants are best suited for people with moderate to profound hearing loss in both ears with intact auditory nerve who are not helped enough by hearing aids. This is usually determined by a hearing test while wearing hearing aids, especially sentence recognition. In kids, the candidacy criteria is largely the same, except additional speech-recognition tests may be given, such as the multisyllabic lexical neighborhood test.
Before cochlear implant surgery, candidates must undergo audiological and psychological evaluation, a medical exam, and imaging studies. Due to the large commitment following surgery, patients (or their parents) may receive counseling about the devices’ performance and limitations. The implant is surgically placed in a two- to four-hour surgery under general anesthesia. Four to six weeks later—or once the surgical site has healed—the recipient returns to be fitted with the external component and to have their device activated and programmed. |
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Can I wear a hearing aid and have a cochlear implant?
Yes, this is known as bimodal hearing. A person may have a cochlear implant in one ear, and a hearing aid in the other. Your ENT doctor and audiologist can help you decide if this is a good option for you.
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Another option: Bone-anchored hearing aids
Another option used to address a specific type of hearing loss is bone-anchored hearing aids. These systems work best for people who have at least one inner ear that functions normally, such as those with conductive hearing loss or those who have complete hearing loss in one ear only.
Bone-anchored hearing devices have two parts: a titanium bone implant and an external sound processor. Once implanted and functional, the external microphone and sound processor convert sound into vibrations for the embedded implant. In turn, the implant vibrates the surrounding bone which sends sound waves to the inner ear.
Placement of the BAHA is an out-patient procedure performed by a surgical specialist. Once the surgical site has healed, the patient returns to have the external device attached and programmed for their specific hearing loss.
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Which one is right for you?
Only a hearing healthcare professional can evaluate your hearing and determine which hearing device, if any, is right for you. If you aren’t hearing your best, schedule an appointment to have your hearing evaluated. Hearing aids and cochlear implants are medical devices — a doctor or audiologist can suggest which product is more suitable for an individual’s requirements.
If you are diagnosed with hearing loss, work with your hearing healthcare professional to find the right hearing device for your hearing loss, lifestyle and budget.
Once an audiologist has made their recommendation, there are several factors to consider when choosing a hearing aid or cochlear implant.
People purchasing a hearing aid may wish to consider whether the device has:
- different sound profiles and programs
- Bluetooth or wireless compatibility
- rechargeable or non-rechargeable batteries
- compatible hearing aid apps
- warranties, refunds, and guarantees.
- a suitable hearing aid style
- digital noise reduction and feedback suppression
- synchronization features if an individual has two hearing aids
- directional microphone systems
If an audiologist recommends a cochlear implant, individuals may wish to consider whether the cochlear implant has:
- upgradable, programmable, and future-proof technology
- water-resistance or waterproof capabilities
- rechargeable or non-rechargeable batteries
- a long expected life span
- warranties and guarantees
- features that are compatible with their lifestyle requirements, such as suitability during sports
- easily available replacement parts
- pre- and post-implantation support
Additionally, cochlear implant users may wish to consider the availability of rehabilitation or support groups and online communities that can advise newer users on how to adapt to the device. |
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Summary
Both hearing aids and cochlear implants are helpful for people with hearing loss. While hearing aids may be more suitable for those with mild-to-moderate hearing loss, cochlear implants are appropriate for those with profound hearing loss or who are severely hard of hearing.
People should consider their level of hearing loss and lifestyle requirements when purchasing a hearing device. Hearing aids are available through an audiologist/ Hearing care professional. Individuals cannot purchase cochlear implants online and need an appointment with an audiologist or otolaryngologist to determine if these devices are suitable for them. |
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References
- What-is-the-difference-between-hearing-aids-and-cochlear-implants, Healthy Hearing
- Cochlear Implant Candidacy Criteria, Cochlear Ltd
- Kral, A., et al. (2019). Neuronal development of hearing and language: Cochlear implants and critical periods
- Woodson, E. A., et al. (2014). The hybrid cochlear implant: A review.
- hearing-aids-vs-cochlear-implants, medical news today
- Cochlear implants. National Institute on Deafness and Other Communication Disorders.
- Before, during, and after implant surgery. U.S. Food & Drug Administration.
- Cochlear implant health. American Academy of Otolaryngology–Head and Neck Surgery.
- Weber PC. Hearing amplification in adults.
- Smith RJH, et al. Hearing loss in children: Treatment.
- Flint PW, et al. Pediatric cochlear implantation. In: Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Elsevier; 2021.
- Carlson ML. Cochlear implantation in adults. New England Journal of Medicine. 2020; doi:10.1056/NEJMra1904407.
- Position statement: Cochlear implants. American Academy of Otolaryngology-Head and Neck Surgery.
- Ching, T.Y.C., van Wanrooy, E., Dillon, H. (2007). Binaural-bimodal fitting or bilateral implantation for managing severe to profound deafness: A review. Trends in Amplification, 11, 161-192.
- Dunn, C.C., Tyler, R.S., Witt, S.A. (2005). Benefit of wearing a hearing aid on the un-implanted ear in adult users of a cochlear implant. Journal of Speech, Language, and Hearing Research, 48(3), 668-680.
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