Treatment recommendations depend on the type of hearing loss at hand. Some common types of treatment are hearing aids, cochlear implants, assistive listening devices, and lip-reading/speech-reading. Below, we will describe in detail some of the more common treatments and devices for people with hearing loss.
Rehabilitation
Aural rehabilitation services are provided for people with hearing loss. These services are particularly helpful for people adjusting to their condition, making the best use of their devices, enhancing their communication performance, tips and strategies for conversations, etc. Rehabilitation programs can occur in an individualized manner, in small groups, online, or some combination thereof. The types of aural rehabilitation therapies include hearing aid orientation, listening strategies, speech-reading, auditory training, unisensory, cued speech, total communication, and manual communication.
Hearing Aids
Hearing aids help people hear through acoustic amplification, which means they make sounds louder. Most hearing aids are digital and function by collecting sounds from the environment, amplifying and adjusting them according to your hearing needs, and directing the new signal into your ears. Hearing aids are powered by a hearing aid battery. There are multiple styles of hearing aid available (UCSF Medical Center):
Behind-the-Ear (BTE) Hearing Aid (Washington University in St. Louis, http://hearing.wustl.edu/HearingAids/HearingAidStyles/Behindtheear.aspx)
- A Behind-the-Ear (BTE) hearing aid consists of the hearing aid itself along with a custom earmold. The hearing aid sits behind the ear; the earmold sits in the ear canal; and, the two are connected by a small tube that hooks over the top of the ear. BTE hearing aids are larger than other hearing aid styles but provide maximum acoustic benefit for almost any type of hearing loss. These are the most appropriate hearing aid devices for infants and young children.
- An Open-Fit Mini BTE hearing aid is the newest hearing aid style available. It consists of the hearing aid connected by a narrow tube to a small, non-occluding piece that sits in the ear canal. The earpiece directs high frequency sounds into the ear while its open fit simultaneously allows natural sound to enter the ear and stimulate functional low frequency hearing. This style is more discreet than standard BTE hearing aids and is beneficial for people with mild to moderate hearing loss who have functional low frequency hearing.
Open-Fit BTE Hearing Aid (Washington University in St. Louis, http://hearing.wustl.edu/HearingAids/HearingAidStyles/Behindtheear.aspx)
- In-the-Ear (ITE) hearing aids are made from shells custom-molded to fit the outer ear. This style is a good choice for people with mild to moderate hearing loss. ITE hearing aids are not an appropriate choice for infants or children.
- In-the-Canal (ITC) hearing aids are made from shells custom-molded to fit the ear canal. This style is a good choice for mild to moderate hearing loss, and is more discreet than some other styles. This style is not appropriate for infants or children.
- Completely-in-the-Canal (CIC) hearing aids are similar to the ITC hearing aids but sit further in the ear canal and are less visible (though not invisible). CIC hearing aids are appropriate for people with mild to moderate hearing loss. The small size and low visibility of these hearing aids make them cosmetically appealing. CIC hearing aids are not appropriate for infants or children.
- Invisible-in-the-Canal (IIC) hearing aids are the most discreet hearing aids available, making them cosmetically appealing. IIC hearing aids are appropriate for people with mild to moderate hearing loss but are not appropriate for infants or children.
If you think you might benefit from a hearing aid, you should make an appointment with your audiologist. If you do not know an audiologist, you should ask your doctor for a referral. Your audiologist will administer a hearing test, including an audiogram, and will use the results to help you choose the device that is best for you. Hearing aids generally cost anywhere from $1,500 to $4,000 dollars (UCSF Medical Center). Medicare does not cover the cost of hearing aids, but they may be covered by certain policies in private insurance companies (Medicare).
Bone-Anchored Hearing Systems
Bone-Anchored Hearing Systems (BAHSs) are surgically implanted small metal abutments that transmit sound through bone conduction to stimulate a functional inner ear, bypassing the outer and middle ear areas. These devices are appropriate for people with conductive hearing loss, mixed hearing loss, and/or single-sided deafness. Implantation of a BAHS involves a minor outpatient surgical procedure lasting 40-60 minutes and involving a choice of general anesthetic (in which the patient goes “under”) or local anesthetic (in which the patient is awake but the surgical area is numbed). During the surgery, the small metal implant is integrated into the bone just behind the ear. The implant either protrudes through the skin via a small metal fixture called an abutment or is topped with a magnet and completely covered with skin. An external processor sits behind the ear over top of the implant and collects sounds from the environment, converts them into vibrations, and communicates them to the implanted device via either an external magnet or direct attachment to the abutment (University of Maryland Medical Center). BAHS implantation is a minor procedure, but like any procedure, can lead to complications. Risks associated with the surgery include skin reactions, loss of implant, or implant failure. Sometimes, a revision surgery is needed (American Academy of Audiology, 2013). For more information about benefits and risks of BAHS implantation, please contact your physician.
Bone-Anchored Hearing Aid System (Image courtesy of Cochlear Americas, ©2017)
Cochlear Americas, Oticon Medical, MED-EL, and Sophono are four companies offering BAHSs. BAHSs range in price and are usually more expensive than hearing aids, but they are covered by Medicare/Medicaid and/or certain policies in private insurance companies. Your audiologist and doctor will be able to work with you to determine if a BAHS is right for you. Find out more about BAHSs at the company websites:
Cochlear Implants
Cochlear implants (CIs) are surgically implanted hearing devices that bypass the inner ear function and transmit sound through direct electrical stimulation of the auditory nerves. These devices consist of an internal device, which is implanted behind the ear and into the cochlea, and a set of external devices including an external processor, transmitter, and microphone (UCSF Medical Center).
Cochlear Implant - How It Works
(Image courtesy of Cochlear Americas, ©2017)
CIs can provide immense benefit to both adults and children who have severe to profound sensorineural hearing loss. In fact, children as young as 12 months are FDA-approved to receive CIs, and research indicates that early implantation is beneficial to the language development of children with severe sensorineural hearing loss (Niparko et al., 2010). CI implantation often results in increased speech intelligibility and continued improvement in the months and years following implantation, though outcomes are variable; many have near-normal hearing ability, while others may experience little or no benefit (American Speech-Language-Hearing Association).
In order to receive a CI, patients must undergo an evaluation process lasting about two days. Evaluation includes a medical evaluation, CI scan, audiological evaluation, and psychological screening. After these are complete, candidates attend a CI counseling meeting in which the results of their evaluation are presented to them and device options are discussed. If the CI candidate is a child, a school visit may also be required in order to establish a relationship between the family, healthcare team, teachers and administration. Professional training is provided if needed (UCSF Benioff Children’s Hospital).
Device implantation is often an outpatient procedure, but it is not without risk of complication. Risks associated with CI implantation include general anesthesia risks, injury to the facial nerve, meningitis, cerebrospinal fluid leakage, perilymph fluid (which is contained in the cochlea) leakage, infection, fluid/blood collection, dizziness or vertigo, tinnitus, taste disturbances, numbness around the ear, inflammation, and device failure/need for surgical revision (U.S. Food & Drug Administration, 2014). During surgery, the patient is first placed under anesthesia (meaning the patient “goes under”). The surgeon then creates an incision in the area behind the ear. S/he places an internal processor under the skin over the temporal bone and inserts a very thin electrode array into the cochlea. The incision is then closed. CI implantation surgery usually takes around three hours. After receiving an implant, patients return to the audiology clinic after approximately four weeks for a follow-up visit and for activation and programming of their device. Additional follow-up visits are made at one month, three months, six months, and twelve months post-activation, and further visits may be needed (UCSF Medical Center).
The total cost of a CI, including evaluation, device, surgical procedure and rehabilitation, is estimated around $100,000 (American Academy of Otolaryngology-Head and Neck Surgery, 2015). Fortunately, this is covered totally or partially by Medicare/Medicaid and some private insurance company policies. There are currently four manufacturing companies that produce CIs: Cochlear Corporation, MED-EL, and Advanced Bionics, and Oticon Medical. Each company offers a variety of internal devices, external processors, and CI programs (called processing strategies), allowing CI recipients to customize according to their hearing needs and preferences. Find out more about the CI device options at the company websites:
- advancedbionics.com
- cochlear.com
- medel.com
- oticonmedical.com (US FDA approval pending)