Advantages & Disadvantages: Hearing Aids vs. Cochlear Implants for Those with Severe Hearing Loss
Personal Thoughts of Ellen A. Rhoades, ©2000-2001
If hearing aid fitting has been assertive and well-managed, and if the child still cannot learn spoken language naturally, cannot use the telephone, and/or cannot converse with relative ease under the direction of an auditory-verbal therapist in partnership with parent, then the CI is likely the device of first choice. While thereare no guarantees when one opts for a cochlear implant, the chances are extraordinarily high that one with profound deafness will derive immeasurably greater benefit from implants than from hearing aids. Assuming that all amplification options have been exhausted, how well a child hears or does not hear normal conversation should be the primary reason for contacting a cochlear implant center and/or pursuing cochlear implantation.
This document does not purport to be a factor in the equation. This document is presented only as a piece of personal information and should not be construed as a factor in the decision-making process of whether or not to implant any child. The views contained in this document are strictly those of Ellen A. Rhoades and do not represent those of anyone else. Likewise, this document is not presented with the intention of influencing anyone in any manner whatsoever. No one should make a decision about implantation or amplification solely based on the data in this document.
For those with profound hearing loss, the CI is likely the prosthetic device of preferred choice...so as to learn natural auditory-verbal communication. For those with severe-profound hearing loss, most will do better with implants. For those with severe hearing loss, hearing aids are typically the preferred choice of prosthetic devices providing aided thresholds in the 30-35 dB range (or better) can be attained at least in the low-to-mid frequency range as a result of assertive amplification and ongoing effective audiological management.
These advantages and disadvantages are presented only in light of those experienced by Ellen A. Rhoades, formerly a sophisticated hearing aid user while having a congenital bilaterally severe (85 dB HL PTA) hearing loss and currently an implantee using body processors due to sudden loss of residual hearing. This comparison is presented largely as a response to the question frequently posed: Given that you were a lifetime hearing aid user with a severe hearing loss, how does your "hearing then" compare to what your "hearing now" with total deafness and a cochlear implant?
Advantages of Cochlear Implants
- Can enable one to hear conversation and thus learn spoken language with relative ease, particularly for those with severe-profound hearing loss
May enable one to use a regular telephone when otherwise not possible
- Avoids problems of acoustic feedback & earmold issues
Greater ease in high frequency consonant perception, e.gs., /sh/, /s/, /f/, /t/, /k/, /p/, /h/
Distance hearing is likely better than with hearing aids, although FM systems are still needed in classrooms due to noise factor.
- May be greater potential for incidental learning
- Greater opportunity for natural sounding voice
- Understanding women on the telephone may be easier as compared to understanding them with a cochlear implant for a severe-profound loss
- Provides impetus for enabling TC children to transition from signing to hearing’n’speaking
- Bypasses the cochlea which is likely the source of deafness
- Is "lifesaving" technology for those who otherwise might not hear or those who would have to struggle in order to hear, or for those who cannot do well with hearing aids even with a severe hearing loss, such as those with auditory neuropathy
Disadvantages of Cochlear Implants
- Environmental & practical living issues
- static: radar detector, playgrounds, trampolines, computers, carpeting
- pressure: some recommended restrictions such as scuba diving
- magnetic: suggested MRI restriction
- trauma: some restrictions from rough sports such as football
- Surgical issues
- staph infection (low risk)
- vertigo (low risk)
- tinnitus, may get worse or improve (low risk)
- partial facial nerve paralysis (low risk and if occurs, is typically temporary)
- competency of surgeon
- if complications, then travel time/cost enter the equation for follow-up care
- Insurance and cost issues:
- if inadequate insurance, medical costs and device are expensive
- processor and accessories are expensive
- securing approval from health policy may be time-consuming and aggravating
- Less control over prosthetic device, i.e., once a manufacturer’s device is implanted, the implantee has no option but to remain with that device for life, unless the device fails or the implantee elects to pay for another surgery/device.
- Loud buzzing sound when implant user is within close proximity to neon lights; interferes with speech signal
- Programming issues: dependent on mapper/audiologist
- travel and time costs if mapper is not in child’s area
- mapping session is time-consuming, boring, and can be expensive
- should be re-programmed annually (more often for young children)
- programming is not always easy, especially for establishing the comfort levels
- changing from one program to another oftentimes involves a temporary setback in one’s discrimination
- adapting to a change in strategies is difficult for many people
- Wearing a body processor is more problematic than a BTE processor/hearing aid
- interferes in the romance department
- may be difficult for women when using the bathroom
- gets in the way of clothing for many women and may require a different wardrobe
- cable wire (cord) sometimes falls off
- bodily leaning against something may cause one of the setting controls to move (However, by the end of the year 2001, it is expected that all implant manufacturers will have BTE processors available.)
- Processor battery gives no warning that it will "go dead" and may place the implantee in the uncomfortable position of suddenly not being able to hear while engaged in conversation (although the option of having a warning that is audible to everyone within earshot is available, this is not a viable choice for most teens and adults)
- Batteries have a dramatically shorter life span than do hearing aid batteries; this can be very inconvenient and more expensive.
- If and when the device fails, the implantee may go through a prolonged period of emotional anguish due to not hearing/understanding, at least until the insurance company approves another surgery. Then, after surgical re-implantation, the implantee must go through another month of silence between time of surgery and initial stimulation.
- Because residual hearing is typically destroyed upon implantation, the difference between hearing and not hearing (due to device not being used) becomes dramatic; this is "a black‘n’white issue" unless implantee has either another implant or hearing aid in the other ear.
- If and when the stimulator (the internal part of device) fails or is damaged, then another surgery may be mandated; each successive surgery carries the additional risk of the electrodes not working as well as before.
- Low frequency consonant discrimination for placement cues may be more difficult
- We still don’t know the long-term effects of implants, i.e., 30-50 years, and implants may cause bone growth and scarring inside the cochlea.
Advantages of Hearing Aids
- Greater control over the prosthetic device:
- can try different hearing aids to see which is qualitatively preferred, so that user can conceivably purchase a new device every couple of years
- can take advantage of new technology as it becomes available (improved earmolds, tubing, telecoils, digital/analog programming strategies)
- Greater affordability:
- can have a back-up hearing aid (older model) for times when device malfunctions
- can afford to buy new device every few years
- cost of accessories are minimal
Greater flexibility & accessibility for repairs:
- can use hearing aid dispenser or audiologist in just about any neighborhood
- can adjust controls on some personal device
- Easier maintenance (once the earmold issues are minimized)
- visit audiologist/hearing aid dispenser only when the aid malfunctions, which may be rarely or until a new hearing aid is needed/wanted
- can easily change the tubing at home
- Battery gives a few hours warning that it is "dying" with sufficient time to change batteries at a more convenient time/place.
- Retain residual hearing for later optimal hearing aid technology
- For those with severe hearing loss, may be greater ease in discriminating of low frequency sounds, e.gs., /m/, /ee/ and may better enjoy bass sounds of music
- With an aided severe hearing loss, understanding men on the telephone may be easier as compared to understanding them with a cochlear implant
- Hearing aids don’t "mess" with the body’s biology to quite the degree that cochlear implants do; e.g., hearing aids won’t cause scarring or bony growth inside the cochlea.
Disadvantages of Hearing Aids
- Limited hearing assistance in high frequency range
- Earmolds and their acoustic feedback issues may be repetitive, time-consuming, aggravating
- Loud noises are bothersome for those using linear amplification
- Hearing aids for those with severe loss need to be fitted carefully, assertively, and well-monitored; securing the appropriate audiologist to accomplish aided thresholds that provide ease in "access to conversational sound" may be difficult in some locations
There are some problems that will be similar for both hearing aid and implant users, such as having the CI coil or the BTE aid frequently getting knocked off while the child is in a car seat. Another similarity is that understanding speech within background noise remains problematic for people with hearing loss, regardless of prosthetic device employed. Still another similarity is that understanding speech over distance remains severely limited with either device, so that FM systems are typically needed for the classroom or other large-room settings.
As with any auditory-verbal therapy situation, for both hearing aid and cochlear implant users, wide individual differences remain in terms of device effectiveness.
- Ellen A. Rhoades, Ed.S., Cert. AVT, CED ©2000-2001 www.AuditoryVerbalTraining.com