Hearing aids and implantable devices

Hearing aids and implantable devices help people with hearing loss to hear sounds and communicate better. However, they work differently and are for different types of hearing loss.

A hearing aid is an externally worn device that makes sounds louder. Implantable devices, such as cochlear implants, are surgically placed in your ear. They don’t amplify sounds but change how your ear processes sound.

Hearing aids and implantable devices come in different shapes, sizes, and styles. They also have different features, such as the ability to connect to cell phones and televisions.

At Penn Medicine, our audiology, hearing, and balance experts provide comprehensive hearing device evaluations to help you select the best device for your age, lifestyle, and hearing needs. We work with industry-leading hearing aid and implantable device manufacturers to give you access to the latest, most effective treatments. We aim to improve your ability to hear, communicate, and live life to the fullest.

All hearing aids contain a microphone to pick up sound, an amplifier to make sound louder, and a speaker to send the sound to your ear. Louder sounds are easier for damaged sensory cells in your inner ear to process.

Hearing aids don’t require surgery. You wear them behind or inside your ear. Hearing aid styles include:

• Behind-the-ear (BTE): The device wraps around the back of your ear. A thin tube connects to a molded earpiece that sits just inside your ear.
• In-the-ear (ITE): All parts are contained in one piece that sits inside your ear. ITEs tend to be larger than BTEs but more discreet.
• In-the-canal (ITC): This is the smallest device and fits deeper in your ear canal. It’s for people with more severe hearing loss.

Hearing implants work by bypassing damaged parts of your ear. They each have a different way of getting electrical impulses to your brain. Types of implantable devices include:

• Cochlear implant: A cochlear implant turns sound waves into electrical impulses and sends them directly to your auditory nerve, bypassing the damaged cochlea. Cochlear implant surgery is for people with profound sensorineural hearing loss (damage to sensory cells in your inner ear).
• Bone-anchored hearing aid (BAHA): A BAHA, or bone conduction hearing aid, sends sound waves through your skull directly to your inner ear, bypassing the middle ear. It’s for people with conductive hearing loss (damage in the external or middle ear).
• Auditory brain stem implant (ABI): An ABI is for people with a severely damaged or missing cochlea or auditory nerve, usually the result of tumors or congenital (present at birth) conditions. The implant bypasses your inner ear and auditory nerve to stimulate your brain stem.

Anyone with hearing loss may be a candidate for a hearing aid or implant. We recommend trying a hearing aid before considering a surgically implanted device.

Hearing aids are typically for people with mild to severe hearing loss in one or both ears. Implantable devices are for people with profound hearing loss or deafness in one or both ears. The type of device that’s right for you will depend on whether you have sensorineural hearing loss (hearing loss in the inner ear), conductive hearing loss (when sounds cannot be received by the outer and middle ear), or a mix of the two.

Before you receive a hearing aid or implant, you’ll have a comprehensive physical and auditory evaluation. If your audiologist determines that a hearing aid is your best option, they’ll guide you through the process of selecting the right style and manufacturer. We can also help you choose features and accessories that fit your lifestyle, such as custom swim molds, noise reduction molds, and connectivity for cell phones, tablets, and computers.

Any hearing aid you purchase through Penn Medicine comes with:

• Hearing aid fitting
• Device training and education
• Comprehensive warranty
• Options for maintenance and repair services

If you’re a candidate for an implantable device such as a cochlear implant, BAHA, or ABI, an audiologist and a surgeon will walk you through everything you can expect during and after the surgery. The procedure for each type of implant varies, but in general, you can expect these steps to happen:

1. You receive general or local anesthesia.
2. Your surgeon makes an incision behind your ear.
3. They create an opening in the bone behind your ear.
4. They implant an internal device in bone, inside your ear, or under your skin.
5. You’ll wear an external device around your ear or on your scalp.

Hearing aids don’t require a recovery period, but they can take some getting used to. Your audiologist will work with you to program the device to meet your needs. Start using your hearing aid gradually in quiet environments and take frequent breaks. Practice putting the device in and taking it out, adjusting the volume, and using the various features.

If you have a surgically implanted device, recovery can take several weeks. You may have swelling, discomfort, headaches, or other side effects for the first few days. Follow your care team’s instructions about showering, working, driving, and returning to your daily routine.

You won’t be able to hear right away. Your doctor will wait about a month until you heal from your implant surgery before turning on and programming your external device. Working with an audiologist or speech-language pathologist can help you adapt to your implant.

Since hearing aids are worn externally, they don’t carry any significant risks. However, surgery to implant a device can cause:

• Bleeding
• Cerebrospinal fluid leak
• Implant failure
• Infection
• Nerve damage

For more than 30 years, Penn Medicine has been helping people hear the world better. Our audiologists work with specialists from otology and neurotology, speech and language pathology, and other experts to help you achieve your communication goals. We are a high-volume program, providing more cochlear implants and bone conduction systems than any other center in the Philadelphia region. Here, you’ll find an experienced, compassionate team that puts your needs first.