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What's the Difference Between a Cochlear Implant and a Hearing Aid?

Hearing aids are used by approximately 12 million Americans, but only 50,000 Americans use cochlear implants. What’s the difference?

Hearing aids are small electronic devices that amplify sounds for people experiencing hearing loss. They are worn in two ways: either completely within the ear canal (CIC hearing aid), or with a portion inside the ear canal and an external part that sits behind the ear (OTE hearing aids). They can help restore hearing to people that are experiencing mild to moderate hearing loss.

A cochlear implant is also a small electronic device that can simulate sound for people that are dear or experiencing severe hearing loss. Cochlear implants consist of two main parts: an external part that sits behind the air and an internal portion that is surgically implanted.

Both hearing aids and cochlear implants help people that have experience sensorineural hearing loss. This type of hearing loss involves damage to the hair cells in the cochlea of the inner ear or the nerve pathways that go from the inner to the brain. More Americans experience this type of hearing loss than conductive hearing loss, which involves damage to components in the outer ear. 

Cochlear Implants are Surgically Implanted, Hearing Aids are Worn externally

Among the many differences between cochlear implants and hearing aids, a big difference is that cochlear implants require surgery to implant the internal components in the inner ear and attach a component to the mastoid bone. Although hearing aids have a component that fits into the ear canal, they are considered external devices and are removable. However, the differences don’t stop there.

So what’s the difference between the two devices? Cochlear implants are surgically implanted by a surgical specialist. 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.

How Hearing Aids work and the Two Main Types

Hearing aids amplify sounds entering the ear canal, essentially boosting the sound signal to help the damaged inner ear hairs receive that signal. They work best in people that have mild to moderately severe hearing loss. All digital hearing aids contain a microphone, a computer chip that processes and amplifies the sound, a speaker, and a battery. Hearing aids come in two main types: in-the-ear (ITE), which fit completely within the ear canal, with no external component, and behind-the-ear (BTE), which have a component resting within the ear canal as well as a component that sits behind the ear. 

Hearing aids work by amplifying the sound that reaches the hair cells in the cochlea. As long the hair cells are only mildly to moderately damaged, sounds can be picked up in the cochlea, transmitted to the auditory nerve and to the brain, and understood. But the more the hair cells are damaged, then the more severe is the hearing loss. At a certain point of damage severity, no matter how powerful the hearing aid, the damaged hair cells can not pick up sounds and transmit them to the auditory nerve. At this point, hearing aids become of little to no use when it comes to understanding speech and hearing other sounds.

That’s where cochlear implants can help.

How Cochlear Implants Work and The Two Main Components

A cochlear implant works by bypassing the hair cells altogether, essentially replacing their job. The implant uses electrodes that are implanted onto the cochlea to transmit sound information from an external microphone to stimulate the auditory nerve directly in the form of electrical impulses which go on to the brain. The damaged hair cells are not used at all. For this to work, the implant has to transform sound information into electrical impulses which are received by the brain. In this way, cochlear implants do not restore hearing; rather, they simulate hearing or give the sensation of sound for people that are deaf or near deaf.

A cochlear implant has two main components: one external and one internal. The external component, which sits behind the ear, consists of a microphone and a speech processor. These are linked by a small wire to the transmitter, which sits slightly behind the ear against the skull at the implantation site. The microphone picks up speech and sounds, which are then transformed into electrical impulses by the processor. The impulses are sent to the transmitter, which transmits them to the receiver, which is implanted under the skin in a small hole in the skull. The transmitter and receiver are coupled together with a powerful magnet. The receiver then sends the electrical impulses to electrodes that are implanted on the cochlea. These electrical impulses stimulate the auditory nerve to produce a signal that is sent to and processed by the brain.

Hearing aids, although they require testing and prescription by a hearing care specialist, are easier to obtain compared to cochlear implants. Because of the commitment involved with cochlear implants, candidates must be evaluated by multiple health professionals including an audiologist, otolaryngologist, speech-language pathologist, and possibly a psychologist before purchase. The surgery only takes two to four hours, but a huge time commitment is required for the rehabilitation component, and will require years of speech therapy and practice so that your brain can properly interpret the new sounds that it is experiencing.

Cost & Other Differences Between Cochlear Implants

Hearing aids are expensive, ranging from around $1,000 and up to $5,000 per a single device. However, cochlear implants can cost up to $100,000. Insurance coverage for hearing aids is highly variable, whereas cochlear implants are usually covered by Medicare or Medicaid. Due to the high cost of cochlear implants, many surgeons have staff dedicated to helping patients navigate their coverage of such devices. Cochlear implants require care when engaging in athletic activities, particularly contact sports; if you go swimming, the external portion must be removed (waterproof versions are available).

Hearing aids require less care; waterproof versions are available as well as waterproof covers, or the entire device can easily be removed before engaging in the activity. Cochlear implants have potentially serious side effects including dizziness, facial paralysis, and meningitis. If hearing aids cause discomfort, they can easily be removed as they are not permanent like cochlear implants. Ultimately, the best way to determine whether hearing aids or cochlear implants are right for you or your child is to visit an audiologist for a hearing test.

The information in this guide has been written using the following reliable sources:

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