When Hearing Aids are Not Enough… Let’s Talk About Cochlear Implants

While hearing aids work with your existing hearing and are fitted accordingly, cochlear implants replace the function of your inner ear.

Hearing aids are a great solution if you have mild or moderate to severe hearing loss and can help you in many ways. But you need to know that they cannot help with every degree of hearing loss. When you have severe or profound hearing loss, hearing aids may not be able to make sounds loud enough for you to hear. People with severe or profound permanent hearing loss may need to seek other solutions like cochlear implants to make sound audible.  This technology has proven to be helpful for many people, we’re going to look at how it works and look at situations in which someone would need a cochlear implant instead of a hearing aid.

What is sensorineural or permanent hearing loss?

The most common type of hearing loss is sensorineural hearing loss. Sensorineural hearing loss means that some of the tiny hair cells in your inner ear or cochlea no longer work properly. Usually, it affects both ears and there are many conditions that cause hearing to worsen gradually over time, like aging or genetic conditions. In some cases, it can occur quite suddenly, like in the case of viral infections such as measles or meningitis, trauma due to accidents or noise, tumors, or even ototoxic medication. Many people call it nerve deafness and it is a permanent type of hearing loss. This type of hearing loss can be mild, moderate, severe, or profound. With injured hair cells in the inner ear or cochlea, sound cannot travel to the hearing nerve as it should. The more hair cells that are damaged – the more severe the hearing loss and the more you will struggle to hear clearly, especially if the hearing loss is severe to profound. Both hearing aids and cochlear implants are used to help people with sensorineural hearing loss, but there are big differences in how they work.

Hearing aids or cochlear implants?

Today’s hearing aids can do many things and technological developments ensure that they get better and better. For example, modern hearing aids can adapt to noise, distinguish between sounds, and connect you to other devices like your phone or music. Their most important function though is to amplify sound and make speech louder. This is very helpful if there is some degree of hearing ability in your ears to work with, but some people don’t have enough remaining hearing. A hearing aid can only make the sounds that you have access to louder and can’t replace the sounds that you can’t hear at all. People who have severe or profound permanent hearing loss cannot fully benefit from using a hearing aid. It can almost be like listening to a radio that is not tuned in properly. You can hear there is something but you can’t make out the words or music and only hear parts of the message, even at full volume.

While hearing aids work with your existing hearing and are fitted accordingly, a cochlear implant replaces the function of your inner ear. For those with severe or profound sensorineural hearing loss who do not benefit from hearing aids, cochlear implants may then be the best option. A cochlear implant bypasses the damaged parts of the inner ear by directly stimulating the hearing nerve so that you can hear. It is possible to have cochlear implants in both ears if you are a suitable candidate or to continue with a hearing aid in one ear and a cochlear implant in the other ear.

How do cochlear implants work?

A cochlear implant involves a surgical procedure and has an external and internal component. The external device on the ear picks up the sounds and transmits them to an internal part that will be implanted into your inner ear during surgery.  The external part is called a speech processor and the internal part is called an electrode array. The internal part replaces the function of the damaged inner hair cells in the cochlea. The hearing nerve is then stimulated and sends the sound to the brain where it is interpreted as sound. Listening training is important to help the brain to make out these sounds and to get better at hearing speech and conversations. Remember – if you had severe or profound hearing loss it may have had an impact on your life for a long time and it will take time to learn to listen and hear sounds again.

A quick guide to the difference between hearing aids and cochlear implants

How a hearing aid works: How a cochlear implant works:
1.A hearing aid has a microphone that picks up sound and makes it louder through an amplifier. 1. A microphone on the external speech processor picks up the sound. The sound is filtered and converted into a digital code.
2. There is a receiver that sends the amplified sound down the ear canal. 2. The signal is sent to a headpiece, called a coil. The sound is then transmitted across the skin to an internal receiver.
3. The eardrum and the middle ear bones will vibrate and send the sound to the cochlea. 3. The internal implant converts the digital information into electrical signals and sends them to a tiny curl of electrodes that sits gently inside your cochlea.
4. The cochlea is filled with fluids and the motion will then stir the tiny hair cells to convert the sound into bio-electrical impulses. 4. The electrical signals from the electrode stimulate the hearing nerve. In this way, it bypasses the damaged hair cells that result in hearing loss.
5. The impulses are sent to the brain via the hearing nerve and it is interpreted as sound. 5. The hearing nerve carries the electrical signal to the brain where they are interpreted as sound.

Are you a cochlear implant candidate?

If you would like to find out if you are a candidate for cochlear implantation, some skilled professionals specialize in this field. You can ask your hearing health care professional to refer you to such a team that will conduct thorough examinations, hearing tests, and medical assessments to make sure that you will benefit from a cochlear implant. You will only be considered for a cochlear implant if the results show promising hearing improvement. Many factors like the degree and type of your hearing loss, previous listening experience and hearing aid use, communication mode, willingness, and commitment to the process will also be considered to decide if you are a suitable candidate. To be eligible for a cochlear implant you must have hearing loss that is so severe that it interrupts spoken communication, and specialized tests need to confirm limited benefit from hearing aids. There should be no medical conditions or factors that increase any risks associated with cochlear implants. You should be highly motivated to participate in hearing rehabilitation with realistic expectations of what cochlear implants can and can’t do for you. Your change in your hearing ability will not only affect you but also the people you interact with daily. Ideally, make sure to encourage their involvement and ask for their support as they are important communication partners. Depending on your medical insurance or support via state health, funding for cochlear implants should also be considered.

For more information about specific cochlear implant manufacturers:

  • Advanced Bionics provides the world’s most advanced cochlear implant systems to help you hear again
  • Cochlear is a leader in implantable hearing devices that help to restore hearing and connect people to a world of sound.
  • MED-EL is a global technology company that researches in the field of hearing loss and develops and manufactures implantable hearing systems.

What are the benefits of cochlear implants?

Cochlear implants can significantly improve your quality of life by helping you to hear words and sentences better, even if you are severely or profoundly deaf. It is designed to make communication easier and interact with others more comfortably.

It helps to have appropriate expectations and understand that technology can’t give you back normal hearing. Patience with learning to listen is important throughout the process and your commitment to using your cochlear implants during ll waking hours will be important. Your brain needs time to make sense of all the sounds that you have not heard in a long time. Within a year of use, most people with cochlear implants make considerable gains in understanding speech.

Most people benefit from using cochlear implants together with lip-reading and communication strategies to make understanding easier.  It takes effort and commitment to learn to listen with any device. Many hearing health professionals can support you with the rehabilitation process after receiving hearing technology. Success does not happen alone!

Other benefits that you could experience include better social interaction with family, friends, or co-workers. Better hearing could also increase opportunities for education, work, and making progress in life.

So why struggle in silence when more could be done? A cochlear implant recipient summarised this life-changing procedure as follows: “I am now able to concentrate on my life, not my deafness!”

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