How are cochlear implants different from hearing aids?

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. Sensorineural hearing loss is the most common type of hearing loss in the United States.

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 are taken in and out of the ear canal by the user.

What is a hearing aid?

Both hearing aids and hearing aids for kids 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 aids work best for children and people who have mild to moderate sensorineural hearing loss. 

Who is a candidate for a hearing aid?

Hearing aids are best suited for kids and adults with mild to moderate 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 two main types: in-the-ear (ITE) and behind-the-ear (BTE) models, each of which is available in a variety of styles, shapes, sizes and colors.

Due to the sophisticated technology, hearing aid prices can range from $1,000 to as much as $4,000 per device, depending upon the technology, features, size and customizations. Insurance coverage is variable.

What is a cochlear implant?

Cochlear implants are complex medical devices that must be surgically implanted by a medical professional. These devices bypass the damaged portion of the inner ear to directly stimulate the auditory nerve. Cochlear implants do not restore hearing, rather, they provide the sensation of sound for those who are deaf or have profound hearing loss.

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 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.

Cochlear implants are usually covered by Medicare or Medicaid; many private and commercial insurers cover these devices, too. Depending upon the insurer, patients may be responsible for significant out-of-pocket expenses or be required to receive prior authorization for the surgical procedure. For this reason, many surgeons employ dedicated staff to help patients determine the scope of their coverage. 

More:

• Cochlear implants for older adults
• 102-year-old WWII veteran receives cochlear implant

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.

Which device is best for unusual or low-frequency hearing loss?

In general, if you have an atypical hearing loss, such as low-frequency hearing loss, both hearing aids and cochlear implants are an option. However, if your hearing loss is due to auditory neuropathy, a cochlear implant may work better.

For either device, hearing care providers are far more accustomed to programming devices to adapt to high-frequency hearing loss (which is a lot more common). So it may require patience and more trial-and-error to get the amplification adjusted to comfortable settings and away from the "default" settings.

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 BAHS 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. 

More: What surgeries can correct hearing loss?

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.

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. If you need a hearing care provider, visiting our directory of consumer-reviewed hearing clinics is a good next step.