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Hearing Aids vs. Cochlear Implants

Hi everyone, it’s Dr. Shopovick, and I hope you all had a wonderful holiday and a very happy New Year! Today we are going to review the differences between a hearing aid and a cochlear implant.

Now, the majority of you are probably more familiar with a hearing aid just because we talk all about
those on our channel, so I’m only going to briefly review that today, and we’ll spend the majority of the
time focusing on what an implant is. So, I’m just going to briefly go over the hearing aid portion. So,
most of you have probably seen this type of hearing aid before. It’s a receiver in the ear canal, and
sound comes in through the back of the hearing aid, goes through those microphones, and then the
sound gets transmitted down this wire straight into the ear canal. So, what a hearing aid is doing is
providing acoustic stimulation to our ear.

On the other hand, we have cochlear implants! There are two styles for implants. There are the on-the-
ear option, so it looks like a hearing aid, but nothing is going into the ear canal. It just kind of sits on the
back. Then you have the second piece, that is a magnet, that would go right, similar to this space on the
back of your head. The other style is off-the-ear so that nothing would be going behind the ear; this
would just stick directly on the back of the head.

Now, with the cochlear implant, what that is doing is providing electrical stimulation to our ears. So, a
hearing aid is acoustic, and a cochlear implant is electrical. Another main difference between a hearing
aid and a cochlear implant is that an implant does require surgery, so it is a surgical procedure that an
Otolaryngologist would perform. And for the procedure it is outpatient, and as long as you are healthy
to undergo anesthesia, you would be a good surgical candidate. So, some people are concerned about
age. “Oh, am I too old to get an implant?” Really, age is nothing but a number. As long as you are
healthy and you have cardiac clearance, you would be a good candidate. Another component, or an
important component of an implant, I want to touch on is the internal component. So, unlike a hearing
aid, there’s just one piece. This is just sitting behind your ear and sending sound into your ear canal.
With an implant, you have an internal and an external. So, for the internal, this is on the inside, so no
one, me, you, or the public, is going to see this part. This is all internal. So, the surgeon would just create
a little incision and slip the magnet underneath, and then at the bottom of this, there’s a little spiral at
the end that you see there. So, that spiral is going to go into our inner ear organ called the cochlea. It
looks like a snail. It just wraps around the cochlea, and this electrode array is what provides the
electrical stimulation. So, that is how you are hearing through those little electrode arrays. So, with the
cochlea, we are bypassing the inner ear; we are bypassing the middle ear; we are just providing direct
electrical stimulation to our inner ear and auditory nerve.

The other option, again, would be the off-the-ear. If someone did not want an in-the-ear or might have
some kind of ear abnormality, the off-the-ear may be a better option.

Another difference between the two is the candidacy criteria. Ao, for a hearing aid, a person needs to
have mild to profound hearing loss, and their word understanding is usually 50% or greater. For a
cochlear implant, it’s for someone that has more of a severe loss. So, that person needs to have
moderate to profound sensorineural hearing loss, and their word understanding needs to be 50% or
less. So, just as an example to put that percentage into perspective, if I’m testing someone in the booth
and they got 10% of word understanding in the right ear, that just tells me they are not going to perform well with a hearing aid. Because with a hearing aid, no matter how much I turn up that volume, it’s still
going to be distorted to that person. Words are going to be distorted, there’s not going to be good
clarity, and hearing aids are not the best option for them. With someone who has 10% word
understanding, we would want to switch gears and look into a cochlear implant for them because, again,
we are bypassing that 10%, we’re bypassing that inner ear, and really just providing direct stimulation.
So, that would probably be a better option for that individual because they are not going to get the
clarity they need with a hearing aid.

Another main difference, again, with a hearing aid and a cochlear implant is that the process for getting
a cochlear implant is more extensive, so it requires more visits. Just as an example, you would have to
get a cochlear implant evaluation, which is performed by the audiologist, and if you are a candidate, the
next step would be to meet with the ENT or Otolaryngologist, and you would have to get a CT scan to
make sure anatomically you are a good candidate for the surgery. Then, of course, you get your surgery,
and then you have to wait a month for the incision site to heal before the audiologist can activate the
implant for you. After the activation, it does require a lot of follow-ups with your audiologist. Unlike a
hearing aid, where it only takes a few weeks for your brain to adapt, a cochlear implant takes a little
longer. So, you may not reach your full potential with an implant until the one-year mark. So, you will be
seeing your audiologist quite frequently for the first year post-surgery because there are a lot of
programming adjustments that need to be done and a lot of fine-tuning. So, it does require more visits
and a little more work on your end. So, your audiologist would give you materials to take home. You
would have homework, essentially. You would be practicing aural rehabilitation and things like that to
really get your brain adapted to your implant because the sound is much different than a hearing aid.
Another question I get is: “Will my insurance cover it?” So, fortunately, with implants, most insurances
do cover implants, which is fantastic. So, unlike a hearing aid, where insurance does not cover it,
implants, on the other hand, most insurance companies do, which can be a relief for a lot of people.

That’s the main difference between an implant and a hearing aid. So, if you guys have any questions for
me you can feel free to comment below. Make sure to like and subscribe to our page if you like learning
all things about audiology, and hearing aids, and implants. I hope all of you have a great rest of your day!