Hearing aids vs. cochlear implants:

How to choose


This article first appeared in medical news today on 28th may 2021


Hearing loss can affect a person’s life, work, and relationships. Hearing aids and cochlear implants can amplify sounds and make them easier for people to hear.


This article explores the difference between cochlear implants and hearing aids.

What are hearing aids?

Hearing aidsTrusted Source are small, battery-operated devices that a person can wear in or behind the ear. They help people with mild-to-profound hearing loss hear better by amplifying sounds.

Hearing aids comprise three parts:

  • a microphone, which receives and converts sound waves into electrical signals
  • an amplifier, which magnifies the sound
  • a speaker, which sends the amplified sound into the person’s ear

Most hearing aids feature different sound profiles suitable for multiple sound environments, such as a quiet room and a busy stadium.

There are multiple styles of hearing aids, including behind-the-ear (BTE), completely-in-canal, and receiver-in-ear. Some of these styles may be more suitable for different degrees of hearing loss.

What are cochlear implants?

Cochlear implantsTrusted Source are small devices that sit behind the ear, with one part surgically inserted underneath the skin with strings or electrode arrays placed in the ear’s cochlea. Surgeons fit this by drilling the skull to anchor the implant.

These devices bypass the inner ear to stimulate the auditory nerve directly, giving a sensation of sound for those with profound hearing loss.

However, cochlear implants are only suitable for those with sensorineural hearing loss. This form of hearing loss results from damage to the hair cells in the inner ear, the brain’s central processing centers, or the vestibulocochlear nerve. Some common causesTrusted Source of sensorineural hearing loss include head injuries, diabetes, and noise-induced hearing loss.

Cochlear implants feature four main parts: a microphone that picks up sound and sends it to a speech processor, which a transmitter and receiver pick up and convert into electric impulses. An electrode array then collects this information and sends them to the auditory nerve

How are they different?

One of the largest differences between hearing aids and cochlear implants is that cochlear implants require surgery to implant the electrode into the cochlea. This is a two-hour ear surgery requiring an overnight stay in hospital.

Hearing aids are more suitable for those with mild-to-severe hearing loss, whereas cochlear implants are more suited for those with profound hearing loss. While hearing aids amplify sounds, cochlear implants provide a sense of sound. An audiologist can recommend which device is more suitable depending on an individual’s type of hearing loss.

Cochlear implants directly stimulate the auditory nerveTrusted Source, which the brain interprets as sound.

Individuals will need extra support after having a cochlear implant. Speech-language therapists and audiologists help people interpret the signals that cochlear implants send.

Cochlear implants are not available to purchase online. Individuals can be referred into the public cochlear implant programmes or they can be referred privately to a cochlear implant ENT surgeon to determine whether they are eligible for these devices.

How to choose?

Hearing aids and cochlear implants are medical devices — a doctor or audiologist can suggest which is more suitable for an individual’s requirements.

Modern hearing aids and cochlear implants come with a number of beneficial features to optimise an individual's hearing experience.

Hearing aids have numerous features and options:

  • different sound profiles and programs
  • Bluetooth or wireless compatibility
  • rechargeable or nonrechargeable batteries
  • compatible hearing aid apps
  • warranties, refunds, and guarantees
  • a suitable hearing aid style
  • digital noise reduction and feedback suppression
  • synchronization features if an individual has two hearing aids
  • directional microphone systems

If an audiologist recommends a cochlear implant, these have:

  • upgradable, programmable, and future-proof technology
  • water-resistance or waterproof capabilities
  • Smartphone compatibility
  • rechargeable or nonrechargeable batteries
  • a long expected life span
  • warranties and guarantees
  • features that are compatible with their lifestyle requirements, such as suitability during sports
  • easily available replacement parts
  • pre- and post-implantation support

Additionally, in Aotearoa New Zealand, cochlear implant users may wish to join local CI  support groups and online communities that can advise newer users on how to adapt to the device. Details of these can be found on our homepage.