Cochlear implants vs. hearing aids: What’s the difference?

Hearing aids are the instrument of choice for the majority of people with hearing loss, but for those who are deaf or severely hard of hearing, cochlear implants may be a better option.

Both hearing aids and cochlear implants work best for people diagnosed with sensorineural hearing loss, meaning they have damage to the hair cells in the inner ear and/or the nerve pathways from the inner ear to the brain. Sensorineural hearing loss is the most common type of hearing loss in the United States.

Cochlear implants vs. hearing aids

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.

What is a hearing aid?

Both hearing aids and hearing aids for kids are small, electronic devices specifically designed to amplify sounds going into the ear. Ideally, these devices are prescribed by hearing healthcare professionals following a hearing evaluation. Hearing aids work best for children and people who have mild to moderate sensorineural hearing loss. 

Today, all digital hearing aids contain at least one microphone, a computer chip to amplify and process sound, a speaker and a battery. The amplified sound is sent directly to the inner ear for translation into electrical impulses which the auditory nerve transmits to the brain.

Hearing aids can be classified into two main types: in-the-ear (ITE) and behind-the-ear (BTE) models, each of which is available in a variety of styles, shapes, sizes and colors. Due to the sophisticated technology, hearing aid prices can range from $1,000 to as much as $4,000 per device, depending upon the technology, features, size and customizations. Insurance coverage is variable.

What is a cochlear implant?

Cochlear implants are complex medical devices which must be surgically implanted by a medical professional. These devices bypass the damaged portion of the inner ear to directly stimulate the auditory nerve. Cochlear implants do not restore hearing, rather, they provide the sensation of sound for those who are deaf or have profound hearing loss.  

There are two main parts to a cochlear implant: external and internal:

• The external component houses a microphone, speech processor and transmitter. A small wire links the microphone and speech processor to the transmitter, which is positioned outside the ear over the receiver.
• The internal component contains a receiver that is implanted under the skin just behind the ear, along with one or more electrode arrays which are implanted deep into the inner ear. 

A magnet connects the two main parts

The two components are coupled using a strong magnet. Sound gathered from the microphone and speech processor is transmitted to the receiver, which converts it to electrical pulses and dispatches it to the electrodes. When these electrodes stimulate the auditory nerve, the brain receives a signal to process the sound.

Before cochlear implant surgery, candidates must undergo audiological and psychological evaluation, a medical exam, and imaging studies. Due to the large commitment following surgery, patients (or their parents) may receive counseling about the devices’ performance and limitations  The implant is surgically placed in a two- to four-hour surgery under general anesthesia. Four to six weeks later—or once the surgical site has healed—the recipient returns to be fitted with the external component and to have their device activated and programmed.

Cochlear implants are usually covered by Medicare or Medicaid; many private and commercial insurers cover these devices, too. Depending upon the insurer, patients may be responsible for significant out-of-pocket expenses or be required to receive prior authorization for the surgical procedure. For this reason, many surgeons employ dedicated staff to help patients determine the scope of their coverage.

Bone-anchored hearing systems (BAHS)

Another option used to address a specific type of hearing loss is bone-anchored hearing systems. These systems work best for people who have at least one inner ear that functions normally, such as those with conductive hearing loss or those who have complete hearing loss in one ear only.

Bone-anchored hearing devices have two parts: a titanium bone implant and an external sound processor. Once implanted and functional, the external microphone and sound processor convert sound into vibrations for the embedded implant. In turn, the implant vibrates the surrounding bone which sends sound waves to the inner ear.

Placement of the BAHS is an out-patient procedure performed by a surgical specialist. Once the surgical site has healed, the patient returns to have the external device attached and programmed for their specific hearing loss. 

More: What surgeries can correct hearing loss?

Which one is right for you?

Only a hearing healthcare professional can evaluate your hearing and determine which hearing device, if any, is right for you. If you aren’t hearing your best, schedule an appointment to have your hearing evaluated. If you are diagnosed with hearing loss, work with your hearing healthcare professional to find the right hearing device for your hearing loss, lifestyle and budget. If you need a hearing care provider, visiting our directory of consumer-reviewed hearing clinics is a good next step.