Comparison:Advantages & Disadvantages of Cochlear Implant & Hearing Aids

Cochlear implant surgery

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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
  • 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
  • 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:
  • 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
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