Ever wonder the different between hearing aid vs cochlear implant? There are two main interventions for individuals of all ages with hearing loss: hearing aids and cochlear implants. It can be confusing to understand the difference and what is most appropriate. Fortunately, it is more likely that someone is a good candidate for hearing aids than a cochlear implant due to the degree of hearing loss.
Additionally, almost everyone receiving a cochlear implant has worn hearing aids first. Let’s determine why this might be by exploring the differences in hearing aids vs. cochlear implants.
What Are Hearing Aids?
Hearing aids are devices worn on or in the ears which provide amplification, also known as making sounds louder. There are a few different types of hearing aids available these days: prescription devices which are specifically programmed by an audiologist or hearing aid dispenser according to a patient’s individual hearing loss using a proprietary manufacturer software, and over-the-counter (OTC) hearing aids which can be purchased directly by the patient and self-programmed.
Hearing aids provide different volume levels (more accurately known as “gain”) at different pitches or frequencies based on the patient’s specific hearing loss. When an audiologist fits prescription hearing aids, the programming is based on a diagnostic hearing test performed in a soundproofed booth. OTC hearing aids typically rely on a self-administered hearing test, which is less precise. Prescription hearing aids are designed for mild to profound hearing loss, while OTC hearing aids are only recommended for mild-moderate hearing loss.
Hearing loss due to aging, or presbycusis, typically presents as milder hearing loss in the lower frequencies, sloping to more severe hearing loss in the higher frequencies. Thus, hearing aids typically prescribe more amplification in the higher frequencies than the low frequencies. Prescription hearing aids also have sophisticated technology which seeks to amplify speech in the environment and minimize background noise.
This is done through algorithms that can identify patterns of speech versus noise, as well as through directional microphones, which can focus in front of the hearing aid user and minimize the noise coming from behind and to the sides.
When hearing aids are introduced, it is important to fit a symmetrical hearing loss with two hearing aids because there is strong evidence that a monaural fitting can result in hearing deterioration in the unaided ear. We were meant to hear with two ears, so a binaural fitting is essential for getting the best possible performance from hearing aids. Hearing aids can also alleviate tinnitus (ringing/buzzing in the ears), which is commonly experienced alongside hearing loss.
Who Is A Candidate For A Hearing Aid?
If you have started noticing difficulty hearing, particularly in noisy situations or when you cannot see the person you are speaking with, it might be a sign that you are experiencing hearing loss. As mentioned, hearing loss typically begins in higher pitches or frequencies. The consonant sounds of speech, such as “s,” “f,” and “th” are soft, high-frequency sounds. Clarity of speech is carried on consonant sounds, so you might find yourself having difficulty discerning “sin,” “fin,” and “thin,” particularly if you do not have context, if there is noise present, or if you can’t see the speaker’s mouth. We all learned during the mask-wearing days in the pandemic how much we rely on visual cues and lipreading to support our speech understanding.
Often this difficulty in understanding speech can lead to withdrawal from social situations, particularly those where it will be noisy or there will be multiple competing speakers. If you notice hearing difficulty and/or are avoiding these situations, it is time to have your hearing tested. The audiologist will measure your thresholds or the softest levels at which you can hear a range of frequencies, in each ear. They will also assess your ability to understand words presented at a comfortable level. If you do present with some degree of hearing loss, a recommendation will likely be made for hearing aids.
Okay, I’m A Candidate. What Hearing Aids Should I Get?
Your audiologist will probably have a recommendation for a specific hearing aid brand and style. There are several leading brands of hearing aids; all are good, but most audiologists prefer one or two. This simply means they have probably had a lot of good experience and training with that device and are comfortable adjusting the programming software. If you have a good relationship with your provider, you should trust their recommendation on which hearing aids to pursue.
As far as style, there are hearing aids that are worn on the ear, either behind-the-ear (BTE) or receiver-in-canal (RIC) styles, or hearing aids which are worn in-the-ear (ITE). Most audiologists recommend RIC styles because they fit a wide range of hearing losses, are very efficient in noisy situations, and are the most comfortable style. They are also surprisingly discrete if aesthetics is a concern for you. These are some great hearing aid options on the market now:
Phonak Audeo Lumity
This is suitable for mild through profound hearing loss, and the hearing aids are fully rechargeable. There are a few different models, one of which is fully waterproof and another which includes a telecoil for users who want to use that technology. This device is fully Bluetooth compatible with any Bluetooth device and is also compatible with their range of Roger devices. The Roger technology is digitally modulated (DM) and is particularly helpful when trying to hear over noise and/or over distance. The Lumity technology also builds upon previous directional microphone and noise reduction technologies to improve hearing in noise. They are available in eight different colors.
This device is available in receiver-in-the-ear (RITE) and behind-the-ear (BTE) models. They are suitable for mild through profound hearing losses, and the hearing aids are fully rechargeable if a model without a telecoil is selected. The telecoil models use a disposable 312 battery. This line of hearing aids builds on existing technology with a specific emphasis on managing wind noise and handling noise (i.e. adjusting your hair with hearing aids on). The hearing aids are available in nine different colors.
Image credit: ReSound
This hearing aid is available in all styles, from tiny completely-in-canal (CIC) to behind-the-ear (BTE). Because of the range of styles, all hearing loss configurations can be accommodated. There are rechargeable options for the receiver-in-ear (RIE), BTE, and in-the-ear (ITE) models, and the hearing aids will last a full day on a single charge. They have an IP 68 rating, meaning that they are waterproof and dustproof. The hearing aids are still Made for iPhone (and iPad, and iPod Touch), enabling direct audio streaming from Apple devices. The hearing aids can directly stream from some compatible Android devices, as well, and additional features can be enabled via the ReSound Smart 3D app installed on the iPhone or Android device.
These three prescription devices are going to vary in price point by both technology level and provider but are likely in the range of $2,500-$6,500 for a set. If you are interested in trying an OTC device first, we would still highly advise you to have a full diagnostic audiogram performed. If the professional determines that you have mild-moderate hearing loss, here are some options:
Jabra Enhance Plus ($799)
These are in-the-ear, earbud style hearing aids that are controlled through an app on your smartphone where you are able to stream music and media but also change the preferred listening settings between “Adaptive”, “Focus”, and “Surround Listen” modes.
Lexie B2 by Bose ($949)
Built by the well-known manufacturer of headphones and other electronics, these hearing aids offer manual controls for volume, treble and base, and microphone directionality via their proprietary app. If you get the settings to a good place in a particular environment, you are also able to save those settings for future use. There is more manual control than automaticity in the OTC hearing aids than prescription, but at a pretty affordable price point.
What Is A Cochlear Implant?
A cochlear implant is a medical device designed for people who have too much hearing loss to receive adequate benefit from traditional hearing aids. Cochlear implants are a treatment option for patients of all ages, from babies who receive a diagnosis of hearing loss at birth all the way up through elderly adults who are healthy enough for surgery. So, what is the difference in hearing aids vs. cochlear implants? Hearing aids are using the traditional sound pathway of normal hearing, but with amplification based on the degree of hearing loss.
Cochlear implants, on the other hand, are creating a new pathway for hearing. An electrode array is inserted directly into the cochlea to essentially take the place of those tiny hair cells, which are damaged or dysfunctional in a person with considerable hearing loss. The external portion of the cochlear implant, known as the sound processor or speech processor, picks up sound and transmits it to the electrode array, which stimulates the auditory nerve and the brain.
Who Is A Candidate For Cochlear Implants?
If you are currently using hearing aids and noticing that you are struggling, it might be time to have a cochlear implant evaluation. It is possible that you simply need adjustments to your existing hearing aids to account for a change in hearing loss, or your hearing loss may have progressed to the point of cochlear implant candidacy. There are two main parts of the evaluation to determine candidacy for a cochlear implant.
The first is the diagnostic hearing test. Candidates for cochlear implants typically present with severe to profound hearing loss in children, and moderately severe to profound hearing loss in adults / young adults. The second part of the evaluation is discrimination ability with appropriately fit hearing aids. The audiologist needs to be able to show that, even with hearing aids, the patient is missing a large percentage of meaningful speech. There are a couple of different tests, some of which use single monosyllabic words and others which use sentences, which are presented to the patient in the soundproofed booth with their hearing aids on. The performance on these tests needs to be below a certain percentage in addition to the results on the audiogram in order to be considered a candidate for a cochlear implant.
If a patient is deemed an audiological candidate, they would also need to be seen by a surgeon to determine medical suitability for surgery. The procedure takes place under general anesthesia, so the patient must be healthy enough to be put under. The surgeon will also make a referral for a CT scan in order to examine the anatomy of the inner ear within the temporal bone. For some patients, and especially for children, the surgeon may also recommend an MRI. A CT scan shows bone, while an MRI shows soft tissue. Depending on the etiology of hearing loss, the surgeon may or may not need both types of images.
Hearing Aid VS Cochlear Implant: Which One Should I Choose?
If you are a candidate for a cochlear implant, your providers will likely present you with a choice of manufacturers. There are three FDA-approved manufacturers of cochlear implants in the US: Advanced Bionics, Cochlear Americas, and Med-El. Here is a bit about each of the manufacturers and their devices:
AB is the only American cochlear implant company, based in Valencia, CA. They are under the umbrella of Sonova, a Swiss hearing healthcare organization, and they partner closely with Phonak for much of the directional microphone technology, accessories, and bimodal fitting (one hearing aid and one cochlear implant). The newest processor from Advanced Bionics is the Naida Marvel.
This processor incorporates much of the tried-and-true technology from Phonak hearing aids, including their AutoSense OS scene analyzer for automatic adjustments as the patient transitions into different listening environments. This processor also offers made-for-all Bluetooth connectivity, meaning you can directly stream from any Bluetooth device. As mentioned, AB and Phonak have partnered to offer a full bimodal system with the Naida Link M hearing aid, which communicates directly with the processor. AB also benefits from the Phonak partnership in the offering of Roger assistive listening devices, and there is a fully waterproof case as an accessory option, as well.
Cochlear is an Australian company with an American headquarters in Denver, CO. Cochlear was the first to market and they have the largest share of cochlear implant patients worldwide. The newest processor from Cochlear is the Nucleus 8.
The Nucleus 8 is the smallest cochlear implant processor on the market. It is a Made-for-iPhone device, with some streaming capabilities to non-Apple products. Cochlear does have a partnership with ReSound to offer bimodal streaming options with a compatible ReSound hearing aid and accessories. Cochlear also offers an all-in-one processor (Kanso) which does not have a portion that sits on the ear but rather the entire processor sits on the magnet site.
Med-El is an Austrian company with American headquarters in Durham, NC. Their latest processor is the Sonnet 2, and they also offer the Rondo 3 processor which is an all-in-one similar to Cochlear’s Kanso. Med-El offers some streaming via an audio accessory.
All three of the companies offer MRI compatible implants which provides some peace of mind for many patients. All three also offer some form of water accessory and different accessories for streaming and listening in more challenging environments. The best way to make a decision about a device is to get in touch with all three manufacturers. They all have local representatives who can meet with you either virtually or in-person to discuss your hearing needs and lifestyle, and let you know what their company can offer. They can also educate you about local events and support groups, as well as educational and rehabilitation tools available after you have received your implant.
More than likely, you will not have to make a decision between hearing aids vs. cochlear implants. The decision will be dictated based on your degree of hearing loss and performance with hearing aids. If you are just beginning to notice difficulty hearing, you should consult an audiologist for a diagnostic hearing evaluation and potentially a hearing aid trial. If you are an existing hearing aid user who is struggling, contact your audiologist and/or a local cochlear implant center to see if you qualify for a cochlear implant candidacy evaluation.
Erin Edwards received her Doctor of Audiology degree from Towson University in 2015 and her Ph.D. in Education and Leadership from Pacific University in 2022. She has worked with patients of all ages in a variety of settings and has a specific interest in cochlear implants, the relationship of hearing loss and dementia, and interdisciplinary healthcare.