Hearing aids and cochlear implants Symptoms, Risk Factors, Diagnosis and Treatment | Narayana Health

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Hearing aids and cochlear implants

Understanding how they work



Conditions that cause hearing impairment

Aging is the most common cause of hearing impairment. Around 1 in 2 adults over 65 years experience some form of hearing loss. Some of the causes of age-related hearing impairment are as follows.

  • Changes that happen in the structure of the inner ear
  • Changes that happen in blood flow to the ear
  • Impairment of the nerves that are responsible for hearing
  • Changes might happen in the way the brain processes speech and sound
  • The tiny hairs in the ear might get damaged in older adults. They are responsible for transmitting sound to the brain and any damage can cause hearing loss.

Other cause of hearing impairment:

  • High decibel sounds and exposure to loud noises for a longer period
  • Smoking
  • Certain medications like antibiotics, aspirin, and drugs for malaria
  • Family history of hearing impairment
  • Illnesses such as heart disease, elevated levels of blood pressure, and diabetes
  • Trauma like a skull fracture or punctured eardrum
  • Blockage of the ear canal due to infections and ear wax
  • Certain bone disease of the ear



Symptoms of hearing impairment

Age-related hearing impairment begins with an inability to hear high-pitched sounds. It will be difficult to hear the voices of children, women and background noises. They may also find it difficult to hear voices clearly.

General symptoms of hearing impairment are as follows:

  • Some sounds seem too loud
  • It will be difficult to hear in noisy places
  • Ringing sensation in the ears
  • They may raise the volume of television or radio
  • They may ask others to repeat the sentences
  • They may not be able to understand telephonic conversations



What is a hearing aid?

Hearing loss can be treated with surgery or medical help but these treatments are not suitable for everyone. Technological advancement in hearing aids has significantly improved the quality of hearing and has been very helpful in managing hearing loss. Hearing aids are suitable for members with an open ear canal and a relatively normal external ear.

Hearing aid is a battery-powered electronic device, very small in size that can be worn in or behind the ear. Hearing aids are composed of a microphone, an amplifier and a receiver each with a specific function as follows:

  • Microphone picks up sounds in the area
  • The sounds are made louder by an amplifier connected to the device
  • The amplified sounds are sent to the receiver



How does a hearing aid help?

Hearing aids help to hear better in noisy and quiet environments. They are suitable for those with impairment to the inner ear or the auditory nerve. There are several other options like surgery and medical treatment to manage hearing loss but they are not suitable for everyone. These devices are ideal for those with an open ear canal and a normal external ear.



Types of hearing aids

Types of hearing aids

A healthcare professional has to be consulted before selecting a hearing aid. He will conduct tests to identify the type of hearing loss and the extent of damage. The type of hearing aid you will need depends on the following:

  • Life style
  • Age
  • Type of hearing impairment
  • Severity of hearing impairment
  • Ability to manage small devices
  • Cost of the device

The specialist might recommend any of the 2 kinds of hearing aids

  • Analog hearing aids: The regular sound waves are converted into electric signals which are further made louder with a device called amplifier. They are relatively less costly and are equipped with simple volume controls.
  • Digital hearing aids: The mechanism is similar to analog devices but the sound waves are converted into numerical codes which are further amplified. These are more sophisticated with the ability to adjust the sound based on what you need and your location. Many of them can adjust the sound automatically making it very user-friendly. They are expensive but more effective than analog devices.

Hearing aids are divided into various styles based on the size and placement of the device:

Types of hearing aids
  • Canal hearing aids: They are smaller in size and are placed inside the ear. In-the-canal (ITC) hearing aid, completely-in-canal (CIC) hearing aid and invisible-in-canal (IIC) hearing aid are the different types of this style.
  • In-the-ear (ITE) hearing aids: They come with a hard plastic case that holds the electronic components and is fixed inside the outer ear.
  • Behind-the-ear (BTE) hearing aids: They are fixed in a hard plastic case behind the ear.



Adjusting to a hearing aid

Hearing aids cannot replace the natural hearing or what it used to be earlier. With practice, users can tune to the hearing aid and can improve the comprehension of sounds. It will need time and patience to get used to the device. Some hearing aid providers allow you to use the device on a trial period to see if it works for you. You can return the device with a partial refund if that does not fit your needs.

You have to work closely with your doctor to avoid the following problems:

  • Discomfort with the device
  • Echo-like sounds from your voice
  • Feedback or a whistling sound
  • Background noise
  • Device causing a buzzing sound with the use of cell phone

Start using the hearing aid in quiet places initially and monitor the response.



How to care for your hearing aid

Hearing aids have some delicate electronic components and should be handled carefully. Normally they can last for 3 to 6 years but you may have to replace it if your hearing loss gets worse. Some recommendations from the experts to increase the durability of the hearing aid:

  • Clean the hearing aid regularly as per the instructions
  • The device can be switched off if it is not in use
  • Always use charged batteries. Replace them regularly
  • The hearing aid should be always kept away from children, heat, moisture, hair care products and pets.

Behind-the-ear devices have more flexibility as they are suitable for a wider range of hearing loss. Digital devices have an advantage as they can be upgraded based on the advances in computer technology.



What is a cochlear implant?

Cochlear Implant System

Hearing aids are not suitable for everyone. A cochlear implant is suitable for those with severe hearing impairment from inner-ear damage. The implant restores hearing to a certain extent by stimulating the auditory nerve to provide the sensation of the sound.

Cochlear implants include an external component and an internal component that is coupled with a strong magnet. The external components include a microphone, speech processor and a transmitter. The internal component has a receiver. Sound signals are captured by the speech processor and are sent to the receiver. The signals are sent to the brain which is interpreted as sound.

Member who had cochlear implants report:

  • Improved ability to hear speech
  • Ability to recognize regular environment sounds
  • Improved ability to listen in a noisy environment
  • Improved ability to find the direction of the sound
  • Ability to hear TV programs
  • Ability to hear telephonic conversations



Should you get a cochlear implant surgery?

Cochlear implantation surgery is performed by a specialist and is normally safe. Some of the risks with the surgery are as follows:

  • There may be loss of residual hearing or any remaining ability to hear in members who have a cochlear implant.
  • The surgery may cause a condition called meningitis (inflammation of the membranes surrounding the brain and spinal cord) in some children. Your doctor might recommend some preventive measures like vaccination before the surgery.
  • In some cases, surgery may be necessary to replace a malfunctioning device.
  • In some extreme cases, infections might happen at the surgery site. Surgery might also cause facial paralysis.

The surgery will be performed under anesthesia so you will need to follow certain measures before the procedure. Your doctor will explain to you about the medications and diet to be followed.

After the surgery, there may be slight pressure or discomfort over the implanted ear(s) along with nausea and dizziness. You can return home on the day of surgery or the next day. You will need to visit the clinic again to get the stitches removed. Your specialist will perform certain tasks to activate the implant.



Hearing aids versus cochlear implants: What is right for you?

Hearing aids are suitable for individuals with mild to moderate hearing loss. However, they may not be suitable for those who are deaf or with severe hearing impairment. Cochlear implants may be ideal for them.

Hearing aids are removable and can be taken in or out by the user. They are small devices that are ideal for children with mild to moderate hearing loss. Cochlear implants need to be inserted through a complex surgical procedure by a specialist. They provide the sensation of sound for deaf individuals or those with profound hearing loss.

Both hearing aids and cochlear implants are suitable for those with hearing loss caused by damage to the hair cells in the inner ear and/or the nerve pathways from the inner ear to the brain. This is also called sensorineural hearing loss.

A healthcare professional will evaluate your hearing loss and recommend a device based on the extent of damage and your preferences.



Hearing aid FAQs: All your concerns addressed.

Q.  Will there be an improvement in my hearing with a hearing aid?

  1. It depends on the reasons behind your hearing loss. Your doctor will evaluate the condition and will suggest options. If the hearing loss is caused by an obstruction due to wax or other reasons, it can be rectified by clearing the canal. If you still have hearing loss, your doctor may suggest a hearing aid. In some cases, the sensory hair cells in the inner ear may get damaged and cause hearing loss. You can benefit from a hearing aid if this is the reason behind the hearing loss. Hearing loss can also happen in older adults and can be managed with hearing aids.

Q.  How can I get a hearing aid?

  1. An ear, nose, and throat doctor (ENT) can evaluate your hearing impairment and suggest an appropriate device for you. He will examine your ear closely to understand the main cause behind the hearing loss and suggest an ideal hearing aid for you. Avoid purchasing hearing aids online or through other sources without consulting a specialist.

Q.  Can I get a hearing device that is not visible on the outside?

  1. Hearing aids used to be bigger and size and ugly. Currently, there are several devices that are smaller in size and can fit completely inside the ear. Invisible-in-canal hearing devices are the smallest version with better functionality. There will be some challenges with handling them as they are too small but your specialist can guide you on how to get used to them.

Q.  How long do hearing aids last?

  1. Hearing aids can last from 3 to 5 years and may have to be replaced if your hearing impairment gets worse. If you are using a digital aid, you can upgrade it regularly based on the updates in the software.

Q.  Will the sounds be too loud with a hearing aid?

  1. Current hearing aid devices are capable to adjust the sound automatically to make it audible to you and not necessarily just amplify it. Your specialist can explain all the options according to your budget and preferences.

Q.  How soon will I get adjusted to the hearing aid?

  1. It depends on the severity of your condition and how soon you have started using the aid. Your brain plays an active role in translating the signals into sounds and improves your ability to recognize them. The longer you delay in using the hearing aid, the more difficult it will be to rehabilitate. Your doctor will help you to get adjusted to the device sooner.

Q.  Can I return my hearing aid if I am not satisfied with it?

  1. Many of the hearing clinics offer a trial period where you can try the device for a limited period and see if it suits your needs. If you are not satisfied you can return the device. In some cases, the service provider might ask for a partial payment. Consult your doctor to understand the policies before you purchase the hearing aid.

Q.  What should I do before the cochlear implant surgery?

  1. Your doctor will perform a thorough evaluation including medical exams and imaging studies before the surgery. You will be provided counseling sessions to clarify the performance and limitations of the device. The surgery will be a 2-4 hours procedure and will be performed under general anesthesia. You have to share all the details of your medical history, especially if you are not comfortable with some specific medication. Your insurance provider might be covering some costs of the procedure. Your doctor can help you with details about the scope of coverage and out-of-pocket expenses. Be prepared to stay at least a day in the hospital.

Q.  Can I sleep with the hearing aid?

  1. Hearing aids are worn during the day time or while doing some active work. Once you are ready to sleep, you should remove the hearing aid and pull out the batteries to improve the battery life.

Q.  Can I have my hearing aid while swimming or bathing?

  1. Some hearing aids are water resistant but it is recommended to remove the device while having shower or swimming.

Q.  How often should I clean my hearing aid?

  1. Cleaning your hearing aid regularly will increase its durability. Accumulation of dust can damage the device. You are advised to clean the hearing aid once a month with a simple cloth.

Q.  What are the types of hearing impairment?

  1. Hearing impairment can be categorised into the following three types –
  • Sensorineural hearing loss: Sensorineural hearing loss is quite common and occurs when the inner ear nerves and hair cells suffer damage due to age, noise or other factors. This type of hearing loss affects the pathways from the inner ear to the brain and can’t be medically or surgically rectified. However, it can be managed by using hearing aids.
  • Conductive hearing loss: Generally, conductive hearing loss occurs when fluid, tumours, earwax or ear formation lead to obstructions in the outer or middle ear. Due to these obstructions, the sound doesn’t reach the inner ear. Conductive hearing loss can be treated with surgery and medicines.
  • Mixed hearing loss: Mixed hearing loss is a combination of the above-mentioned hearing loss types. It is important to know about the condition before going for a treatment procedure. Hence, it is recommended to consult with your doctor first to have a proper diagnosis of the type, cause and degree of hearing loss.

Q.  Can hearing aids lead to further hearing loss?

  1. In most circumstances, your hearing aids won’t lead to further hearing loss. However, if they are not programmed correctly, some damage to your hearing may occur.
  1. Prolonged exposure to loud noises, typically 80 decibels or more, can lead to hearing loss. Therefore, it is essential to program your hearing aids appropriately. Make sure that your hearing aids are programmed with precision, fit your ears well and filter sounds perfectly.

Q.  Can hearing aids slow or stop hearing loss?

  1. Yes, hearing aids are quite helpful in slowing down the progression of hearing loss. Your auditory nerve cells need stimulation to stay healthy. When you have hearing loss, these nerve cells are not used efficiently, and gradually, they weaken. As a result, the brain has to work harder to process the sounds and information coming in through those nerves leading to further loss of hearing abilities.

Q.  Can hearing loss be restored?

  1. Unfortunately, hearing loss cannot be restored, but it can be managed. Hearing aids are the most common way of treating hearing loss. Other methods involve using different types of implants and surgical procedures.
  1. Generally, hearing aids are used in cases of sensorineural hearing loss. For conductive hearing loss, the blockage of the ear has to be removed by operation. Hearing aids and implants might also be needed here.
  2. In cases of sudden hearing loss, treatment must be done immediately which may involve the use of steroids. Seeking immediate medical help is critical if you experience a sudden hearing loss.

Q.  Is it better to wear two hearing aids instead of one?

  1. If you have hearing loss in both ears, obviously you will have to go for two hearing aids. But if the level of hearing loss is different in each ear, it is still advisable to use two hearing aids. Your hearing care doctor or audiologist will take care to program the appropriate level of amplification for each ear so that both of your ears pick up sound and get the required stimulation to function properly.
  1. However, according to some research, people with dementia or cognitive delays may have trouble using two hearing aids as it could be over-stimulating for their auditory pathways and brains. So, they can use just one hearing aid.
  2. You can also use one hearing aid provided that one of your ears has no or mild hearing loss. You will still have to go for regular check-ups to see if your good ear is hearing well enough.