Should I get a cochlear implant or a power hearing aid?
You should first try well-fitted power hearing aids; a cochlear implant is considered when hearing aids no longer give enough clear speech understanding. Power (and super-power) behind-the-ear hearing aids help most people with severe hearing loss and many with profound loss. When, even with the best hearing aids, a person still understands only a small part of speech, a cochlear implant usually gives better results [1][2]. The decision is made by an implant team after detailed tests.
What is the difference between a power hearing aid and a cochlear implant?
The difference is how sound reaches the brain: a hearing aid makes sound louder for the inner ear, while a cochlear implant bypasses the damaged inner ear and stimulates the hearing nerve directly with electrical signals [1].
| Power hearing aid | Cochlear implant | |
|---|---|---|
| How it works | Amplifies sound for the remaining hearing | Electrodes in the cochlea stimulate the hearing nerve directly [1] |
| Surgery | No | Yes, under general anaesthesia |
| Parts | One device behind the ear, with an earmould | An external sound processor and an implant under the skin [1] |
| When it starts working | The same day it is fitted | About 2–4 weeks after surgery, then several programming sessions [3] |
| Rehabilitation | Fine-tuning and practice | Regular programming (“mapping”) and listening/speech therapy |
| Best for | Mild to severe, and many profound, hearing losses | Severe to profound losses with poor benefit from hearing aids |
Who is a candidate for a cochlear implant?
A person is a candidate for a cochlear implant when they have severe to profound hearing loss in both ears (or in one ear — see below) and get limited benefit from properly fitted hearing aids. As an example of formal criteria, the US labelling for Cochlear Nucleus implants in adults includes profound high-frequency hearing loss and a score of 50% or less on a sentence test in the ear to be implanted, and 60% or less with the best hearing aids [2]. Each implant team uses its own detailed assessment, which usually includes hearing tests with and without hearing aids, CT or MRI scans, and counselling.
For children, the US Food and Drug Administration approved cochlear implantation from 9 months of age for profound hearing loss in both ears in 2020 [4]. Implants are also approved in some countries for single-sided deafness (from age 5 in the USA) [5] — see CROS hearing aids for one-sided hearing loss.
Why does age matter for children?
Age matters because the brain learns spoken language best in the first years of life. A systematic review found that children implanted before 12 months of age did better in speech production and hearing performance than children implanted later [6]. This is why babies should have newborn hearing screening and early testing — read hearing tests for children: OAE and BERA explained. Before an implant, children usually wear power hearing aids and receive therapy, so no time is lost.
How much does a cochlear implant cost in India?
A cochlear implant operation in India commonly costs about ₹5 lakh to ₹12 lakh in private hospitals, depending on the city, hospital and implant model, according to published hospital estimates [7]. Ongoing costs include processor batteries and accessories, programming visits, therapy and, after some years, a processor upgrade. Power hearing aids cost much less — see our hearing aid price list.
Is there government help for cochlear implants in India?
Yes, for children. Under the Government of India’s ADIP scheme (Department of Empowerment of Persons with Disabilities), a cochlear implant can be funded up to ₹7 lakh for children aged 1–5 years with hearing loss from before speech developed (pre-lingual), and up to ₹6 lakh for children aged 5–18 years with acquired hearing loss, for families with a monthly income of up to ₹30,000 [8]. Some state governments have their own schemes. Ask the implant centre or your district’s disability office how to apply.
What are the risks of a cochlear implant?
A cochlear implant involves surgery, so it carries the usual risks of an operation and anaesthesia. Some natural hearing left in the implanted ear may be lost, and results vary from person to person — most people need months of practice and therapy to get the full benefit. The implant team explains the specific risks and expected results for you or your child [1].
What should I do now?
If you or your child has severe or profound hearing loss, start with three steps:
- A full hearing test with your current hearing aids and without them, so your real benefit can be measured. Book a hearing test.
- A properly fitted power hearing aid, verified with Real Ear Measurement, if you are not already wearing one. See behind-the-ear (power) hearing aids and best hearing aids for severe hearing loss.
- Referral to an implant team if the hearing aids are not enough.
Fairfield Hearing Clinics fits and fine-tunes power hearing aids, provides speech therapy for children and adults, and guides families through the referral to an ENT and cochlear implant centre when an implant is the better choice.
References
- National Institute on Deafness and Other Communication Disorders (NIDCD). Cochlear implants. https://www.nidcd.nih.gov/health/cochlear-implants
- Cochlear Ltd. Cochlear Nucleus implant candidacy and indications. https://pronews.cochlear.com/cochlear-implant-candidacy/
- Advanced Bionics. Getting a cochlear implant. https://advancedbionics.com/gb/en/home/cochlear-implants-for-you/getting-a-cochlear-implant.html
- Cochlear Ltd. Cochlear receives FDA approval to lower the age of pediatric cochlear implantation to 9 months (18 March 2020). https://pronews.cochlear.com/fda-approval-lower-pediatric-cochlear-implantation-9-months/
- ASHA Leader. FDA approves cochlear implants for single-sided deafness, asymmetric hearing loss (2019). https://leader.pubs.asha.org/do/10.1044/fda-approves-cochlear-implants-for-single-sided-deafness-asymmetric-hearing-loss/full/
- Bruijnzeel H, Ziylan F, et al. A systematic review to define the speech and language benefit of early (<12 months) pediatric cochlear implantation. Audiol Neurootol 2016;21(2):113–126. Summary: ASHA Evidence Maps, https://apps.asha.org/EvidenceMaps/Articles/ArticleSummary/4094c11b-4bc4-4e79-83e7-fdad4d61ace5
- CARE Hospitals. Cochlear implant cost. https://www.carehospitals.com/surgery-cost/cochlear-implant-cost
- Department of Empowerment of Persons with Disabilities, Government of India. ADIP scheme — guidelines (RTI material). https://divyangjan.depwd.gov.in//upload/uploadfiles/files/RTI%20Material.pdf
