Thursday, May 1, 2008

The Difference between Hearing Aids and Cochlear Implants

I’ve seen many references on various blogs/comments that say that hearing aids are non-invasive, so they are a better choice than the cochlear implant. The implication is that the cochlear implant works the same as hearing aids. That is like comparing camels and horses. You can ride both of them. But horses work better on solid ground, and camels work better on sandy ground. They each have different strengths and weaknesses.

Hearing aids work by amplifying sound. The idea is that the few working hair cells in the cochlea will then work harder, and send more sound signals to the auditory nerve. Hearing aids work best if the hair cells in the cochlea are evenly distributed. Newer digital hearing aids work better, because they can separate out different frequencies, and add more or less amplification at a given pitch range, depending on what the audiogram shows. The problem occurs when there are simply not enough hair cells in the cochlea in a given frequency for the amplified sound to work. If there are no hair cells, there is no sound sent to the auditory nerve, no matter how much amplification occurs.

This is where the cochlear implant comes in. Hearing aid trials are required before the implant can even be considered as an option. If you receive adequate amplification across the frequency range then you are not a candidate for the implant. You are only a candidate for implantation if hearing aids do not support reasonable hearing across the speech “banana” on an audiogram. The implant works by turning sound into digital signals, transferring them via radio type signals to the internal implant, which in turn transmits them directly to the auditory nerve via a transmitter electrode array implanted into the cochlea. This allows for the full spectrum of frequencies to reach the auditory nerve. As long as the entire electrode array is inserted into the cochlea, and the auditory nerve is healthy, sound IS getting to the brain. The key is how the brain handles the signals. If the brain is able to fully integrate the sound signals to understandable information, then the implant is considered a “success”. If the brain is unable to interpret the signals then the implant is considered a “failure”. But the truth is much more complicated than that. Partly it depends on what the implanted person expects to get from the implant. Part of it depends on how hard the person is willing to work to make their brain learn how to understand the implant. Part of it depends on how much sound the person was exposed to prior to implantation, and how well their brain understood that sound. And part of it depends on how old you are at the time of implantation.

The people who seem to do best at making sense of the implant signals are those who had the most hearing prior to becoming deaf, and those who have had the shortest period of deafness prior to getting implanted. Among that group are babies and toddlers. Even though they may not have had any hearing prior to implantation, their brains are so flexible (plastic) that they have no problem interpreting the signals. The older they get, the harder they have to work to make sense of sound.

If you have a mild to moderate loss, hearing aids are the answer. If you have a severe to profound loss, and hearing aids are not enough, then that is where implants can be considered.



Jodi Cutler Del Dottore said...

Really good post, K.L. I like the fact that hearing aids are a must before considering the cochlear implant. These posts are an important foundation for this site. Hugs, Jodi

Anonymous said...

I have severe hearing loss and hearing aid is very beneficial to me. It is not always true that for those who have severe to profound loss cannot benefit from hearing aids that they should resort to CI.

RLM said...

What's wrong with being Deaf?

Being a deaf person have many benefits than any hearing person in general.








Why many service organizations in the past hardly bother to provide TTY and VP to deaf individuals without CI or hearing aids?

More and more service organizations suddenly provide CIs value at $80,000+ and digital hearing aids at value about $5,000+ while denying many culturally deaf from possessing the TTYs and VPs.

I still do not get any VP device while the "audistic" society are much willing to spend very costly devices for deaf people to fit in their audistic outlook of people.

Robert L. Mason (RLM)

Aaron said...

RLM: wow, what a mouthful (no pun intended)

To answer what I believe to be your most important question: there is NOTHING wrong with being deaf, as long as you have the means to communicate with the world somehow. If someone who goes deaf does not have ASL, then being culturally Deaf isnt really an option (in the beginning). they can get a CI and learn ASL, assuming they arent shunned by other Deaf for having CI in the first place.

To address a couple other issues, I gotta say I dont know how you can generalize that people who have hearing aids and CI are a drain on society. I have had hearing aids for 10 years now and make more than enough money to pay for them. I wasn't aware there was any agency willing to shoulder the price of CI for adults unless they were already very poor.

Generalizations just dont work here. Deaf/HoH/Hearing are a continuum whether you like it or not. Example: I am severely HoH with hearing aids, but learning ASL. Where do I fit??

Deaf, CI, and HoH are all part of the same family, we all just have different needs. If we all cooperate, we will all reap more benefits.

Suey said...

Good information! Why can't I google these things?

Over a month ago, I went from severe to profound hearing loss. Like a light switch, my hearing aid made me sick (lightheaded, nausea and feeling like passing out) and sounds more muffled. The doctor calls it a sudden hearing loss. I can't tell whether I lost a whole lot but I would think I can still use my hearing aid barely over 90dB. Now I get tinnitus and headaches these days. Ugh...

I always thought CI is better tool than hearing aid. Curious, do CI sound more robotic than hearing aids? How are the sound different?

Abbie said...

Kudos to you K.L, you did an excellent job of explaining the difference between a hearing aid and a cochlear implant.

Anonymous said...

Can these radio waves cause cancer? Cancer has been linked to power lines, cell phones and nuclear testing. If I had a radio in my head, I'd be very afraid.

RLM said...


With due respect, you are partly right about the real shames of generalization about deaf people with CI and hearing aids.

Didn't you know that the city of Washington, DC fully provides the digital hearing aids to anyone, who lives and works in DC at no cost?

How amazing of the DC government choose to bypass the large segement of deaf population like not emphasizing on the necessity of daily communication equipment, ex. VP or TTy or wireless pager!

The state of California did provide free wireless pagers to the low-income deaf population in limited numbers. This state have more sense than the DC government for providing free digtial hearing aids to anyone deaf, who resides and works in DC.

I personally will not benefit from the use of digital hearing aids at all.

The DC government is definitely engaged in "audistic" mentality, not really serve the community-wide interests of deaf community.

Wireless pager do benefit all the deaf community than just "very few" of the deaf. Huh!

Wireless pagers could lessen any deaf individual's communication frustration with the society at large and enchance them to the equal footings of the society than just $5,000 digital hearing aids for about 40 deaf people as compared to $100 wireless pagers for more than 4,000 deaf people.

Wireless pager is a necessary tool for emergency life-saving and time-efficency mode.

Why didn't the DC government improvise the costly digital hearing aids to wireless pager or other kind of accomodation for deaf people in general? They don't do that!

The deaf community in America must think deeply of our wounded and physically-jarred soliders and their psychological and psyiology needs than being selfish with the demands for Ci and digital hearing aids.

Our government do not spend enough on the funding of our American soliders' physical and psychological rehabilation.

Anyone deaf, who receive digital hearing aids and CI at the expense of taxpayers' money and health insurance payees would be seen as "unpatriotic".

Anyone deaf, who pay for the CI and hearing aids out of their own pockets would not concern me at all as they do not claim any deduction on the spending of special devices.


K.L. said...

First off, RLM, There is nothing wrong with being deaf. However, this site is specifically geared toward people who have already chosen, or are in the process of choosing to get implants, and want to use ASL along with spoken English. So your comments are just not appropriate for this blog. That is why you have your own blog. And I would love to see your proof that implants and hearing aids actually are an economic drain on society. I absolutely do not believe any of that.

For anon, I have never heard of anyone getting cancer from the low level transmissions from the implant.

Also, you may note that I said severe/to profound that do NOT get benefit from hearing aids would qualify for getting an implant. If your hearing aids work, you do not even qualify.

Barb DiGi said...

That's my point K.L., I am a severe-profound candidate but grew up with a hearing aid and do fine with it. I am very happy with it and felt it is so unnecessary if I were to have a CI.

What you are sharing is not that exactly correct since we need to look at their ability to listen to frequency level. Some may fall in the category between severe and profound but still have ability to listen to certain frequency sounds.

K.L. said...

Yes Barb,
There are a lot of very specific details that are unique to each individual that need to be answered if they are interested in getting an implant. My point of this post was just to generally give people a better idea of the differences between how a hearing aid worked, and how an implant worked.

Basically, it comes down to residual hearing, at the different frequency ranges. If you are happy with what you get with your hearing aids, you have no need to even consider the implant. But if your hearing levels ever drop off, and you become unhappy with your hearing levels, that is when you would want to consider the implant. Many people have no need or desire for the implant even with absolutely no hearing whatsoever. That is fine. I am the last person to say that someone else should get one if they don't want it.

But for those who WANT to hear better, and their hearing aids are not providing adequate hearing, that is when the implant should be considered.

Jean Boutcher said...

It has been said that there are
about 100,000 implantées in the USA. My question is: What is the
percentage of implantées who still
have to depend on the CART for a
lecture in a classroom and who cannot understand spoken conversations in a room? Can they
understand what an announcer makes
an announcement in an airport?

Albeit profoundly deaf (115 dB in the better ear), I am a wearer of biaural hearing aids. Why do I wear them? To hear sounds like door knocking, traffic, siren.

AL said...

About comparing hearing aids and cochlear implants, it is difficult to do that unless one has experience with both. A person who wore hearing aids all her life then later got a CI said that it changed her life. She said that a CI is like a "supersonic hearing aid".

Of course it is fine if one prefers to stick with hearing aids. I don't think K.L. means that everyone who can benefit from CIs should get one. If you're satisfied with hearing aids, then so be it. It is better to have all the facts on hand before making a decision whether to get a CI or not, instead of depending on misinformation or half-truths or myths.

starrynight said...

My child never liked hearing aids as she kept taking them off because they didn't benefit her at all. Not worth to continue wearing aids. Now she has a CI and loves using it. She d leave it on all the time and that shows she could hear well with it. She also refuses to take it off at bedtime. That makes a big difference for her! Her average hearing level is 25 dB at all the frequencies with the CI and may continue to improve as she gets older. It s almost a flat line near the normal hearing level of 20 dB in the audiogram. I have heard other CI users have 10 dB or 20 dB average.

I also gave up hearing aids a long time ago although I could hear pretty well with the aids but had no access to the spoken language with the aids. CI offers access to the spoken language for those who are profoundly deaf with little or no benefit from hearing aids.

However, my child is still DEAF, signs ASL, and is part of the Deaf community. CI is just a tool to help her hear like a hearing aid for those who benefit from it.

Barb DiGi said...

I am just concerned that based on my observation, there are Deaf kids who are capable to benefit from hearing aids in the first place ended up getting a CI. I have worked with that kid and she is able to hear me when talking just like I am capable of with my hearing aid. However, her mother endlessly pursued to get a CI for her 2 year old daughter even after being denied since she was not the right candidate in her area so she seek elsewhere and got it. So what do you make of that? Unfortunately, this girl ended up in mainstreaming solitaire and no longer interact with her Deaf peers and adult role models.

K.L. said...

My daughter got no benefit from hearing aids either. The meningitis pretty much totally destroyed all her residual hearing. The only value the hearing aids had was as a chew toy when she was cutting teeth.

The implant gave her 20-25 db loss across the entire pitch range, and her New Freedom processor gives her 10-15 db loss across the pitch range. She too, wanted it on at all times.

RLM said...

With due respect,

What about the prospective "culturally deaf" employment seekers compete with the deaf individual(s) equipped with CI?

More likely for the "unqualified" deaf individual with CI to be hired than "real qualified" culturally deaf job applicant, because of the employer feel more comfortable with someone, who speaks their own language or accompany their own communication needs.

We have to think about the near-future forecasts for culturally deaf individuals being unfairly deprieved their employment possibilities.

Anyone deaf with CI or hearing aid, ought not to get any kind of affirmative action benefits (points) within the hiring process, period!

That will give deaf individuals with Ci and hearing aid users more advantage over culturally deaf job applicants.

We have to think about the possibilities of sleath discrimination against culturally deaf for employment hirings within private and public sectors.

We see WHY the Luddities back in the late 1800s revolted against the dehumanization of our society at large by installed the industrial machines to replace humans.

In the end, greedy employers used the industrial machines - more faster and effecient to enslave humans into horrible job conditions like 16-18 hours per day and unsafe work conditions.

The troubling trends of CI and digital hearing aids within the deaf population to divide and conquer our own given community.

Deaf individuals with CI and hearing aids ought to be banned from enclosed their devices or used them during the employment hiring interviews.

Something like that could be achieved for fair and uncompromising employment hiring process.

Robert L. Mason (RLM)

AL said...

Barb, in that situation, the real tragedy is not that the mother wanted a CI for her daughter, but that her daughter was denied the opportunity to interact with other deaf people like yourself.

This is the aim of this blogsite. We want ASL and deaf role models for all deaf children with CIs. It is difficult since both sides have their own myths and misinformation about CIs and ASL. Those on the CI side think that once a deaf child gets a CI, then there is no longer a need for the deaf community and sign language. Those on the deaf/ASL side often reject the deaf child because of the CI.

Talk about being between a rock and a hard place for the deaf child with a CI!

Barb DiGi said...

AL, I respectfully disagree.

You said that in that situation, the real tragedy is not that the mother wanted a CI for her daughter, but that her daughter was denied the opportunity to interact with other deaf people like yourself.

Well, I do agree with you the last part but still to me it is a tragedy because her residual hearing is wiped out since she actually benefit from wearing hearing aids at the first place based on my observation. It is a tragedy for this girl to bear at least 3 times to go through a surgery to have her implants replaced.

The other thing you said: "Those on the deaf/ASL side often reject the deaf child because of the CI." Often? Can you show me the statistics? I didn't even see that happening here in my community at all! I believe they reject the concept of CI not those who wear CIs so I want to clarify that myth.

starrynight said...


I am sorry to hear that this girl had to go through surgery 3 times! Did she fall and hit her head hard or did the CI itself fail? That seems uncommon as the statistics show that CI failure is rare today.

Was the girl able to understand all the spoken language with hearing aids? I could hear a lot of sounds with hearing aids but could never understand the spoken language and had to work hard in learning speech skills. I'd risk losing my residual hearing for more access to spoken language and it’d help me learn to hear and speak much more easily. Not everyone lost their residual hearing with today's CI but only some of them did. The CI keeps improving to reduce the risk of destroying residual hearing.

Based on my experiences, some deaf parents with deaf children don't seem too comfortable with my child's CI. Most deaf parents with HOH and hearing children that I know seem to be more accepting and supportive of my child's CI. Also, deaf schools aren't strong advocates of CI and don't provide adequate spoken language for students with CIs as they use only ASL as the main language. I ve asked one of deaf schools to seriously consider increasing spoken language for students with CIs but they neglected my request. So those ASL deaf folks aren't exactly supportive of deaf children with CIs.

Li-Li's Mom said...

Hello, and thank you KL for such a great comparison. I'm always surprised by the common comment from people suggesting that CI recipients use hearing aids instead. I thought hearing aid trials and assessment were standard practice for anyone considering CIs. We tried hearing aids for at least 4 months (and still have one for Li-Li's left ear) with very little benefit. Her audiogram showed that it did take her down from the profound hearing loss range into severe, and even dipped into moderate at one frequency for one ear, but couldn't bring any voice or conversational sounds into range.

And just like the cat that curiosity killed, I made the very painful mistake of trying one of her hearing aids, and found myself without hearing in one ear for quite some time after (I know, I know stupid move, thought it would just be loud, not ear-splitting): I found that they were set to a jet engine-like roar, blasting sound into her little head, without any reaction from her!

She hated having these floppy things on her little ears, and it was a continuous struggle to keep them on, which we thought we'd encounter with the CI, but surprisingly, she races in and places her coil on her own head in the mornings, and requests help whenever her processor falls off.

Hearing aids gave her no valuable benefits, just a wall of incomprehensible noise blasting into her head. The CIs bypass that usual pathway and provide her with the ability to hear and respond to voices and understand spoken language as well as she understands ASL. And even though the processor arrangement is a ridiculous piece of technology that someone better improve soon :), she loves having it on!

Anonymous said...

I have posted two spots and do not get a response from you. You quote at the very top of each blog

"Connecting people to a place where they can share stories, ask questions, and learn more about different issues related with the Cochlear Implant, Sign Language, and the Deaf community."

This is no help...

K.L. said...

I did respond to your question about your concern about getting cancer. It was the 9th response. Your first comment didn't have a question that needed answering. I had already said in my post that if hearing aids work, there is no need to get the implant. So you were basically agreeing with what I had already said.

I apologize for being out of touch these last couple of days. I was at a church conference.

Anonymous said...

I do believe the purpose of the passage was to settle some of the differences of the cochlear implant vs hearing aids since the deaf community makes it such a huge issue. First off cochlear implant means the person is completely profoundly deaf and have no benefit from hearing aids. Why is it that it's "okay" for a supposed deaf person to use hearing aids (meaning they are HOH, not deaf because they have functioning hair cellsin their cochlea, which cochlear implant users do not have), but it's such a horrible thing when someone chooses to get the implant?

Hearing aids are used to "aid hearing" or what's left of it. If the hearing aid does not work for someone they have just as much right as the hearing aid users to take it to another level. Hearing aid users get "Digital hearing aids to improve the sound. Other's who do not benefit have the option of a cochlear implant which does the serves the exact same purpose.

As for TTY and VP, if anyone did not receive a FREE tty or vp, it has nothing, absolutely nothing to do with the cochlear implants. This is the United States. Feel free to take that up with President Bush or whomever the next President will be and be sure he/she hears your complaint. The cochlear implants official office and creator is in Australia, which is an entirely different country! They have absolutely no association to tty or vp or any other deaf products.

We, the deaf community needs to stop readily pointing our finger at the world and analyze ourselves.

Anonymous said...

Thanks for the share KL! I'm very sure there are people like the hearing aids and cochlear Implants. But generally it depends for the people where they satisfied. I found a great site of information hearing aid issues.

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