Both hearing aids and cochlear implants can help people with hearing loss hear and communicate better, but they work in very different ways. Hearing aids make sounds louder and adjust sound based on your type and degree of hearing loss. Cochlear implants bypass damaged areas of the inner ear and send sound information directly to the hearing nerve. They could help if your speech understanding doesn’t improve adequately using hearing aids alone.
According to Duke audiologist Erin Blackburn, a thorough evaluation will determine which option is best for you. Use this reference guide to compare hearing aids and cochlear implants.
| Hearing Aids | Cochlear Implants | |
| How do they work? | Acoustic amplification increases speech volume and adjusts sound based on your hearing loss. Your inner ear processes the amplified sound and sends the information to your brain. | Electrical stimulation converts sound into electric signals. Electrodes inside the cochlea stimulate the hearing nerve, which sends the information to your brain. |
| How do they affect speech understanding? | Because the volume is turned up, speech becomes easier to understand. | If speech remains unclear, even when using hearing aids, you may need more support. Cochlear implants allow you to hear and understand speech through a different mechanism. |
| Where are they located? | Depending on the type of hearing aid you choose, part or all of it sits just inside your ear canal, or part of it may rest on the top of and behind your ear. | Cochlear implants consist of two parts: an external sound processor that is attached to your skull behind your ear, and a surgically placed internal implant. |
| Is surgery required? | No. | Yes, surgery is required to place the internal implant -- this is usually done as an outpatient procedure. |
| Can they be used for one or both ears? | Hearing aids may be worn in one or both ears. | Cochlear implants may be used for one or both ears. They can also be used for one ear, with a hearing aid in the other. |
| How much professional support is required? | Initial fitting and fine-tuning, plus routine hearing care. | Initial activation, programming, and aural rehabilitation, plus routine follow up-care. |
| How long before they start working? | Soon after an appropriate fitting. | It takes time for your brain to adapt -- benefits usually increase over about a year. |
| Are they covered by insurance? | Insurance coverage varies by plan. | Most insurance plans provide coverage when candidacy criteria are met; benefits vary by plan. |
Should I Consider a Cochlear Implant Evaluation?
Even people without complete hearing loss can benefit from a cochlear implant. Consider an evaluation if you wear hearing aids but still experience the following:
- You have difficulty understanding conversations, especially in restaurants or other noisy places.
- You have difficulty talking on the phone.
- You rely heavily on watching someone’s face or lipreading to understand speech.
- Your hearing or speech understanding has continued to decline.
- You have significant hearing loss in one ear, or one ear hears much more poorly than the other.
A cochlear implant evaluation can help determine how much benefit you are receiving from your hearing aids and whether a cochlear implant could help.
