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Do You Need an Implanted Hearing Device?

Traditional hearing aids don't work? New generation of implants are better than ever

spinner image Do You Need an Implanted Hearing Device?
If traditional hearing aids don't work for you, you may want to try an implanted hearing device.
STR New / Reuters

So you have tried different hearing aids, and nothing works. You are frustrated; your family, friends and coworkers are frustrated. But "there are options out there if traditional hearing aids cannot help," says ear, nose and throat surgeon Kourosh Parham at the UConn Health Center in Farmington, Conn.

Advances in hearing device technology over the past few years have improved the three leading implants a cochlear implant, bone-anchored device and middle-ear implant a and resulted in a brand-new hybrid cochlear implant. But just do not call them hearing aids, Parham says.

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Hearing aids only amplify sounds. These devices bypass the outer ear and either translate sounds into vibrations delivered to the middle ear or electrical impulses delivered directly to the inner ear. Which device you choose depends on your specific type of hearing loss.

Ellen DeVoss, 59, for example, kept misunderstanding phone conversations and missing out on dinner-table discussions. Life was "very stressful," DeVoss says. "Straining to hear really wears you out." She spent "thousands and thousands" of dollars on traditional hearing aids, but nothing helped.

Bruce Gantz, chair of the Department of Otolaryngology-Head and Neck Surgery at the University of Iowa Carver College of Medicine in Iowa City, correctly identified the problem: DeVoss hearing loss was in the higher frequencies, which prevented her from understanding speech. Her low-frequency hearing was still good. "You are a perfect candidate for the hybrid cochlear implant," he told DeVoss. "It puts back the high frequencies and allows you to keep the hearing you have." DeVoss implant is the newest type of implanted device on the market - one that was approved by the Food and Drug Adminstration in 2014.

The result: almost normal hearing. DeVoss says her word understanding has improved from 33 percent to 94 percent.

While each of the implants described below is appropriate for a specific hearing loss, most consist of an external component and an internal or implanted portion. And they all require surgery-usually on an outpatient basis.

Otolaryngologists are reluctant to quote costs for these devices and surgical procedures, citing differences in how much Medicare or a private insurance company will cover. But expect a total cost of between $30,000 and $100,000.

Hybrid cochlear implant

Who benefits: Helps those who can hear low-pitched sounds but have lost the ability to hear most high-pitched sounds.

How it works: The hybrid cochlear implant combines the functions of a hearing aid to improve the perception of low-frequency sounds with an implant-placed under the skin and above the ear-that directly stimulates the high-frequency hearing nerve cells.

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Pros: Can restore high-frequency hearing while boosting low-frequency hearing. Device may be covered by Medicare and private insurance companies.

Cons: Invasive procedure; requires surgery and recovery time. Device must be activated weeks after surgery. Getting an MRI could be complicated.

Cochlear implant

Who benefits: Individuals with severe to profound hearing loss who cannot benefit from traditional hearing aids.

How it works: A standard cochlear implant consists of an external portion that looks like a behind-the-ear hearing aid. It is connected by a magnetic disk to a second component surgically implanted under the skin and behind the ear. The implant receives sound from the external components and translates it into electrical energy that stimulates both high- and low-frequency hearing nerve cells.

Pros: Especially effective for adults who lost hearing after attaining speech and language abilities. Device is covered by Medicare and most private insurance companies.

Cons: Invasive procedure; requires surgery and recovery time. Device must be activated weeks after surgery. Total estimated cost including pre-op testing, surgery and the implant: $100,000. Getting an MRI could be complicated.

Bone-anchored device

Who benefits: People with single-sided deafness. Most common cause of single-sided deafness is sudden deafness — waking up one morning with no hearing in one ear. A slow-growing benign tumor on the auditory nerve called an acoustic neuroma can also cause single-sided deafness.

How it works: An osseointegrated, or bone-anchored, device that also consists of external and internal components. A small titanium implant is inserted into the bone of the skull behind the ear. A sound processor attached to the implant via an abutment or internal and external magnets sends sound vibrations to the inner ear via direct bone conduction.

Pros: Covered by Medicare and most private insurers. About the only option for those with single-sided deafness. MRI OK for abutment option (device is not magnetic).

Cons: Invasive procedure; requires surgery and recovery time. Processor is placed three months after surgery. Costs about $20,000 per ear. Getting an MRI could be complicated.

Middle-ear implant

Who benefits: Those with moderate to severe hearing loss who have tried and rejected hearing aids because of the occlusion effect — that plugged up feeling — or the annoyance of feedback, the irritating screeching sound that sometimes comes from your hearing aid. "A candidate for the middle-ear implant will have had to try other hearing aids before being eligible," Parham says.

How it works: Typically the implanted component consists of a receiver just below the skin and another part attached to one of the bones of the middle ear. The external processor transmits sound to the receiver. It is then relayed to the internal unit, causing the bone to vibrate and send signals to the inner ear. New fully implanted devices integrate all the elements into a system under the skin; the battery must be replaced approximately every five years.

Pros: Provides a choice for those not getting optimal benefit from hearing aid. No feedback.

Cons: Invasive procedure; requires surgery and recovery time. Costs about $15,000-$30,000 per ear. Not covered by Medicare; some private insurers may pay. Cannot have an MRI.

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