When it comes to hearing loss, everybody has a different experience, which is why the way it is treated varies from person to person. Both hearing aids and cochlear implants help those experiencing hearing loss to communicate more effectively, but they work very differently. Depending on the severity of your hearing loss, your audiologist will recommend one over the other.
Hearing aids do not require surgery and work well for those with moderate hearing loss. Cochlear implants are slightly more complex, require surgery, and are designed for people who have profound hearing loss. These are just the basic differences. Read on to learn more about how cochlear implants work, who they’re designed for, and dive into the main differences between implants and hearing aids.
What is a cochlear implant?
Like hearing aids, cochlear implants are a technological marvel. They are small electronic devices that help people who are profoundly deaf or severely hard-of-hearing achieve a sense of sound. The device is made of an external portion that sits behind the ear, and an inner portion that is surgically placed under the skin. Together, they work to give the wearer different representations of sound to help them understand speech.
The implant is made up of a few different parts:
- The microphone picks up sound from the surrounding environment
- The speech processor is responsible for selecting and arranging the sounds picked up by the microphone
- The transmitter works with the receiver/stimulator by receiving signals from the speech processor and then converting them into electric impulses
- The electrode array is a collection of electrodes that collects the electric impulses and sends them out to different regions of the auditory nerve
Though a cochlear implant doesn’t restore hearing, it does an excellent job of giving the wearer enough information from the sound collected to help people better understand speech. Many audiologists describe it as a different way of hearing, which is why it takes time and training to get used to it.
How does a cochlear implant work?
Hearing aids and cochlear implants work very differently. A hearing aid amplifies sounds so that even people with slightly damaged ears can hear. A cochlear implant works by bypassing the damaged portion of the ear entirely and working directly with the auditory nerve. The electronic signals created by the cochlear implant stimulate the auditory nerve, sending a message to the brain, which then recognizes the signal as sound.
When someone “hears” through a cochlear implant it is different from normal hearing, and it can take time to adapt to and learn. However, cochlear implants are a useful tool in helping those with severe hearing loss be able to recognize warning signals, and important sounds in their surroundings, as well as to understand speech in person and over the phone.
Who gets cochlear implants?
Both children and adults who are either deaf or severely hard-of-hearing can be fitted for cochlear implants. Data from the Food and Drug Administration (FDA) state that as of December 2019, roughly 118,100 devices have been implanted in adults and 65,000 in children. The best way to know if a cochlear implant is right for you is to see an audiologist. Performing an array of hearing tests will determine how severe your hearing loss is and highlight the best treatment option for you.
Cochlear implants require both a surgical procedure as well as therapy and training to learn or relearn how to use your sense of hearing. In fact, everybody will have a different experience with cochlear implants, which is why the decision to get one should not be taken lightly. If you are considering getting cochlear implants, it’s important to discuss the procedure with an audiologist and a cochlear-implant surgeon to ensure you have all the facts before making a decision.
While surgical implants are considered to be a relatively safe procedure, complications are still a possibility, just like with any other surgery. You want to be sure you are aware of all potential side effects so you’re not taken by surprise. Another important consideration is how long it will take to learn or relearn how to interpret the sounds created by an implant. It’s a long process that usually involves working closely with speech-to-language pathologists and audiologists, it’s not an instant fix.
And finally, the cost is a critical component of this decision. Health insurance varies greatly, and while some may cover the cost of a cochlear implant, others may not. Medicare, Medicaid, Tricare, and the Department of Veterans Affairs, for example, will sometimes pay for all or some of the cost, but they won’t if there are pre-existing conditions. And without health insurance, the cost of cochlear implants ranges from $30,000 to $50,000 – a prohibitive price for most. These are all important factors to take into consideration when deciding if cochlear implants are right for you.
Difference Between Hearing Aids and Cochlear Implants
We’ve already determined that hearing aids and cochlear implants work differently. We know that hearing aids amplify sounds, whereas cochlear implants work by sending electronic signals straight to the auditory nerve to stimulate the sense of hearing. Let’s hone in on the specific differences between them both to see which option is best for you.
If you were to compare your ears to a radio, the way you fix the radio would depend largely on what is affecting its function. If all you need to get your radio working is to fine-tune the station and raise the volume, then hearing aids are the best option. But if your radio receiver is damaged and emitting static, raising the volume will only make the static louder. In this case, you need a new radio—cochlear implants.
The extent and type of hearing loss you’re experiencing will also have an impact on what’s best. Hearing aids can work for those experiencing mild to profound hearing loss caused by either conductive (from the middle or outer ear) or sensorineural (from the inner ear or hearing nerve) hearing loss. Cochlear implants are used for those experiencing moderate to severe hearing loss that is only sensorineural.
If you are able to understand 50% or more of the spoken word during testing, then your comprehension of speech is good enough that hearing aids will be enough. But if you understand less than 50%, then cochlear implants are the better choice.
What other differences are there?
| Hearing Aids | Cochlear Implants | |
| Time | It usually takes two weeks to get used to wearing hearing aids. | It takes between six months to one year to get used to “hearing” with an implant. |
| Surgery | No surgery. | Surgery is generally outpatient and under anesthesia. |
| Risk | Little to none. | The surgical aspect means there is moderate risk. |
| Age | No age limit. | No age limit |
| Cost and Insurance | Some insurance plans cover the cost. Without insurance the cost runs between $1,000 to $4,0000. | Most insurance plans will cover the majority of the cost. Without insurance, the cost is between $30,000 and $50,000. |
What to expect with Cochlear Implants
For some, cochlear implants are the clear choice for improved hearing health. If that’s the case, then it’s important to go over some post-surgery expectations so you not only know what to expect but have best practices in place to get the most out of your investment.
1: First off, cochlear implants are not activated until after you’ve recovered from surgery, usually between two to four weeks. Once your audiologist has cleared you after a post-surgery check-up, you’ll receive the external component of the cochlear implant to activate the device.
2: It will take time to tune the device to work best for you, which means you will go in to see your audiologist three, six, and 12 months after device activation to ensure it’s working just right for your needs. Its settings will be tweaked as needed to address your specific hearing needs.
3: At the same time, you will also be meeting with speech-language pathologists to help you learn or re-learn how to “hear” using the cochlear implant. This training is critical to the success of your cochlear implant, and a necessary step that cannot be skipped.
One of the main benefits of cochlear implants is that they’ve been shown to have excellent long-term success. And as the technology continues to improve, the better they work. Better yet, implanted devices can be updated without additional surgery, which means it’s easier to keep up with the latest technology.
Clearly, hearing aids and cochlear implants are very different and are used for very different kinds of hearing loss. Their most important quality, the one they share, is that they help individuals regain a sense of hearing. If you’ve been experiencing hearing loss and you’re not sure what the best course of action to take is, don’t worry, there is help! Make an appointment with an audiologist to see what option works best for you. While articles like this one are helpful in giving you introductory information, the best way to know what you really need is to consult with a professional.
