Hearing Implants
Whispering with cochlear implants
Hearing Implants for DHH
Hearing Implants are needed for a person who is deaf or is hard of hearing, if the hearing loss is severe or there are other complications. Hearing implants need medical intervention - often surgery. Hence, implants can be put only on the advice and under supervision of trained practitioners. This page covers the basic principle of working for the implants and their types, comparison between aids and implants, and information about major hearing implant brands.
Hearing Implants
A hearing implant is a hearing device that is typically implanted into the ear. They are electronic devices that can be surgically placed in the ear to prevent hearing loss and deafness. Hearing implants are implanted in the inner part of the ear of patients that suffer from mild to severe deafness. Hearing loss is generally of two types that are
conductive and
sensorineural
When hearing aids cannot fulfill the purpose of enabling a person to listen, hearing implants can be used. They are fitted in the person's ear for surgical purposes and comprise an electrode array, transmitter, speech processor, and microphone. The implanted hearing device tends to transform the sound vibrations into signals that can electrically stimulate the nerves. The signals are then sent to the auditory nerve, allowing the person to recognize the sounds and hear them clearly.
Although the implant is not capable of restoring the hearing capabilities, it allows the individual in order to interpret and understand the sounds. The hearing implant devices are effective, widely accepted, and are a long-term solution.
Types of Hearing Implants
There are different types of hearing implants. The one which is most relevant for a person with hearing loss depends on the cause and the type of hearing loss. But in all cases, hearing implants are relevant when a person with a hearing loss would not benefit properly from the sound amplification of hearing aids or for some reason is unable to wear hearing aids.
The common types of hearing implants are:
Cochlear Implants (CI Systems): It is a small electronic device that electrically stimulates the cochlear nerve (nerve for hearing). The implant has external and internal parts. The external part sits behind the ear. It picks up sounds with a microphone. It then processes the sound and transmits it to the internal part of the implant.
A CI is a surgically implanted neuroprosthesis that provides a person who has moderate-to-profound sensorineural hearing loss with sound perception. With the help of therapy, cochlear implants may allow for improved speech understanding in both quiet and noisy environments. A CI bypasses acoustic hearing by direct electrical stimulation of the auditory nerve. Through everyday listening and auditory training, cochlear implants allow both children and adults to learn to interpret those signals as speech and sound.
Electric Acoustic Stimulation (EAS Systems): It is the use of a hearing aid and a cochlear implant technology together in the same ear. EAS is intended for people with high-frequency hearing loss, who can hear low-pitched sounds but not high-pitched ones. The hearing aid acoustically amplifies low-frequency sounds, while the cochlear implant electrically stimulates the middle- and high-frequency sounds. The inner ear then processes the acoustic and electric stimuli simultaneously, to give the patient the perception of sound. SYNCHRONY 2 is such a device.
Bone Conduction Devices: Bone conduction is the conduction of sound to the inner ear primarily through the bones of the skull, allowing the hearer to perceive audio content without blocking the ear canal. Bone conduction transmission occurs constantly as sound waves vibrate bone, specifically the bones in the skull, although it is hard for the average individual to distinguish sound being conveyed through the bone as opposed to the sound being conveyed through the air via the ear canal. Intentional transmission of sound through bone can be used with individuals with normal hearing — as with bone-conduction headphones — or as a treatment option for certain types of hearing impairment. Bone generally conveys lower-frequency sounds better than higher frequency sounds.
There are many different types of bone conduction hearing aids. Most of them work on the same principle and are broadly categorized in two types:
Surgical bone conduction devices consist of an internal implant and an external audio processor used to transmit sound. They require surgery in order to implant the device, which is usually done as an outpatient procedure under general anesthetic, however this depends on the device being implanted and the health condition of the patient. Surgical implants are further classified as:
Active like BONEBRIDGE, Cochlear™ Osia® System bone conduction implants
Passive like Cochlear BAHA (Bone-Anchored Hearing Aid), Baha Attract, Baha Connect, Ponto Systems, Alpha 2, etc.
Non-surgical devices only consist of the external audio processor. The processor simply vibrates, making both the skin and the bone vibrate, conducting the vibrations through to the cochlea. Non-surgical devices are ideal for children, who may not be old enough for implantation surgery or who have temporary conductive hearing loss caused by glue ear or ear infections. ADHEAR, Baha Start are such a bone conduction system devices.
Middle Ear Implants (MEI): It is a hearing device that is surgically implanted into the middle ear. They help people with conductive, sensorineural or mixed hearing loss to hear. Middle ear implants work by improving the conduction of sound vibrations from the middle ear to the inner ear. There are two types of middle ear devices:
Active Middle Ear Implants (AMEI) consist of an external audio processor and an internal implant, which actively vibrates the structures of the middle ear.
Passive Middle Ear Implants (PMEI) replace damaged or missing parts of the middle ear, creating a bridge between the outer ear and the inner ear, so that sound vibrations can be conducted through the middle ear and on to the cochlea. Unlike AMEIs, PMEIs contain no electronics and are not powered by an external source.
VIBRANT SOUNDBRIDGE is an AMEI device.
Auditory Brainstem Implants (ABI): It is a surgically implanted electronic device that provides a sense of sound to a person who is profoundly deaf, due to retrocochlear hearing impairment (due to illness or injury damaging the cochlea or auditory nerve, and so precluding the use of a cochlear implant).
Hearing Aids vis-à-vis Hearing Implants
Criteria
Radio Analogy
Extent and Type of Hearing Loss
Speech Understanding
What the Devices Do and How They Do It
Timing
Surgery Required?
Risk
Age Limit
Cost & Insurance
Hearing Aids
All you need is to fine-tune your radio station and turn up the volume.
Hearing loss is mild to profound. Your type of hearing loss is either "conductive," meaning it stems from your outer or middle ear, or "sensorineural," meaning it stems from your inner ear or hearing nerve.
Excellent to fair/poor -- you are able to understand approximately 50% or more of spoken words during testing.
Hearing aids amplify acoustic sound generally and/or by specific frequencies.
Generally, it takes approximately two weeks or less for you to adapt to hearing aids.
No.
Little to none.
No upper age limit.
$3,400 - $6,000 for a pair. Some insurance plans cover the cost.
Cochlear Implants
Your radio receiver is damaged and sounds like static; turning up the volume will only make the static louder. You need a new radio.
Hearing loss is moderate to profound. Your type of hearing loss is called "sensorineural," meaning it stems from your inner ear or hearing nerve.
Fair to poor -- you are able to understand approximately 50% or less of spoken words during testing.
A cochlear implant device allows you to hear in a different way. This is called electrical stimulation. A surgically placed implant bypasses your inner ear. It translates acoustic sound into electrical signals. It sends the signals directly to the hearing nerve and then on to the brain.
Generally, it takes approximately 6 to 12+ months for you to adapt to a cochlear implant.
Yes -- outpatient surgery under general anesthesia.
Low to moderate risk, because of the surgical aspect.
No upper age limit.
$60,000 - $100,000+ per implant. Most insurance plans cover the majority or all of the cost.
Low-Pitched Sounds—Hearing Aid Technology
Sounds are detected by the microphones of the audio processor.
Low-pitched sounds are made louder & sent via the earmold to the ear
These sounds are processed by the cochlea and sent to the brain.
High-Pitched Sounds—Cochlear Implant Technology
Sounds are detected by the microphones of the audio processor.
High-pitched sounds are sent to the implant as electrical signals.
These sounds are processed by the cochlea and sent to the brain.
Audio Processors and Implant Devices
Audio Processors (MED-EL)
Implants (MED-EL)
Journey of Sound: NIH video to explain ow sounds make their way from the source to the brain
Cochlear Implants
The cochlea is a spiraled, hollow, conical chamber of bone, in which waves propagate from the base (near the middle ear and the oval window) to the apex (the top or center of the spiral). The spiral canal of the cochlea is a section of the bony labyrinth of the inner ear that is approximately 30 mm long and makes 2¾ turns about the modiolus.
The cochlea is filled with a watery liquid, the endolymph, which moves in response to the vibrations coming from the middle ear via the oval window. As the fluid moves, the cochlear partition (basilar membrane and organ of Corti) moves; thousands of hair cells sense the motion via their stereocilia, and convert that motion to electrical signals that are communicated via neurotransmitters to many thousands of nerve cells. These primary auditory neurons transform the signals into electro-chemical impulses known as action potentials, which travel along the auditory nerve to structures in the brainstem for further processing.
Cochlear Implant Part 1, 2018
Cochlear Implant Part 2, 2018
Cochlear implants (CI) make it possible for people to hear and understand sounds even if they have damaged hair cells in the inner ear and have a severe or a profound hearing loss.
A cochlear implant is a small electronic device that can provide a sense of sound to people who are deaf or hard-of-hearing.
A cochlear implant is a hearing implant that bypasses the damaged hair cells in the inner ear and transmits signals directly to the brain via the auditory nerve.
How does Cochlear implants work?
Cochlear implants are designed for people with severe-to-profound sensorineural hearing loss. With this type of hearing loss, the hair cells in the inner ear are damaged, and can’t detect sounds properly. A cochlear implant bypasses these damaged hair cells and sends electric signals to the brain, where they are interpreted as sound.
A cochlear implant system has two main components. The externally worn audio processor detects sounds and sends them to the internal implant, which is placed just under the skin behind the ear.
Overall a cochlear implant works in the following way:
The sound processor / audio processor captures and digitalized sounds.
The antenna transmits the digitized signals from the sound processor / audio processor to the receiver.
The receiver transforms the digital signals into electronic signals.
The electronic signals are sent via the array into the inner ear.
On the array, there are electrodes that correspond to different signal frequencies.
The electrodes stimulate the auditory nerve that finally sends signals to the brain.
In this way, a cochlear implant bypasses the damaged hair cells in the inner ear and sends signals directly to the brain via the auditory nerve. It captures sounds and converts them to electronic signals that are sent to the brain.
The microphone captures sound waves.
The sound waves are converted into detailed digital signals by the sound processor.
The headpiece sends the digital signals to the cochlear implant and electrode array in the inner ear.
The electrode array stimulates the hearing nerve.
The hearing nerve sends impulses to the brain, which interprets them as sounds.
A cochlear implant uses a sound processor that you wear behind your ear. A transmitter sends sound signals to a receiver and stimulator implanted under the skin, which stimulate the auditory nerve with electrodes that have been placed in the cochlea. Some types of cochlear implants have one external unit that has a speech processor, microphone and transmitter combined (lower left), while others have these as separate external parts (upper left and on right).
Accessories
Water-safe Accessories
Osia® Sound Processor and Nucleus® Sound Processors are splash-proof and dust-proof as well as water resistant. And with the Aqua+ reusable silicone sleeve, your sound processor becomes waterproof as well.
Compatibility - Cochlear Nucleus 6 and Nucleus 5 Sound Processor
Help keeps your sound processor dry.
Warranty - 90 days
Safety Cords
Compatibility - Cochlear Nucleus Kanso 2 Sound Processor
Size - Long
Color - Black
The Cochlear Safety Line (long) reduces the risk of losing your sound processor. It connects to the socket of your Kanso 2 Sound Processor.
Warranty - 90 days
Compatibility - Cochlear Nucleus 7 Sound Processor
Size - Unilateral (for users with one sound processor)
The Cochlear Safety Cord provides extra security by clipping a sound processor to clothing
Bands
Cochlear Baha SoftBand Soft Pad
Compatibility - Cochlear Baha Sound Processor
Soft pad is suitable for use with softband with the new black and rounded connector shape.
The Baha SoftWear Pad’s memory foam adapts to the contours of your child's head, evenly distributing pressure and maximizing the contact surface to improve comfort and performance
Adjustable Length
Silicone Grip Sleeve
Non Slip Grip - Unilateral, Bilateral, Bimodal option
Processors & Accessories
Naída CI Q90
Bone Conduction Devices
Bone conducted hearing solutions are typically used by people who have a conductive hearing loss or a mixed hearing loss and whose outer ear or middle ear are not able to conduct sound properly into the inner ear. They may also be used in the event of an irritated, damaged or malformed ear canal.
Single-sided deafness
Bone conduction devices are also used to treat single-sided deafness (unilateral hearing loss) by sending sound from the non-hearing side to the hearing ear on the other side of the head
How does a Bone Conduction Device work?
Bone conduction devices normally consist of two parts – an external and an internal one. The external part picks up sound and processes it, then sends it to the internal part which makes the bones vibrate. There are active and passive bone conduction devices. With an active bone conduction device, the skin stays intact.
Candidates for bone conduction devices must have a working cochlea that can send sound signals to the brain. Bone conduction can be considered for patients with hearing loss in one and both ears.
A bone conduction device does not rely on sound amplification like in the case of conventional hearing aids. Hearing through the bones is a normal way of hearing sounds. You hear approximately half of your own voice through the bone – that is why you feel your voice sounds different when you record it – you miss the part conducted by the bone. The vibrations are so small that you cannot feel them, but you can indeed hear them.
Surgical vs. non-surgical devices
In some bone conduction devices, the external sound processor / audio processor is attached directly to the skull and involves a minor surgery to place a small titanium implant in the bones behind the ear. A direct contact through the skin between the vibrating external part and the bone via an abutment gives efficient transmission and gives a good sound quality.
Non-surgical solutions do not give the same hearing as implanted ones (you typically lose 10-20 dB as the sound must travel through hair and skin), it is critical to let young children hear sounds and they should be used as early as possible. Non-surgical solutions are also a way of testing how you will hear afte
The Cochlear™ Osia® System latest bone conduction solution, is an active osseointegrated steady-state implant that uses piezoelectric stimulation to send sound to your inner ear.
The Cochlear Baha® System uses advanced technologies to transmit sound to your inner ear. There are different sound processor models to choose from, each designed to treat a different level of hearing loss
Oticon's newest Ponto 5 sound processors are designed with powerful technology that gives you access to more sound than ever before. This approach supports the way your brain naturally makes sense of sound. It is called BrainHearing™ philosophy, which is all about making listening easier in any environment.
By connecting you with your full soundscape, Ponto 5 gives you the freedom and awareness to focus on what you want – from technology proven to improve speech understanding and reduce listening effort. You also get sounds and speech that are consistent and clear thanks to first-ever technology that stops audible feedback before it occurs.
Ponto 5 Mini
ADHEAR uses the latest generation of bone conduction technology to give you great hearing, with no surgery required. Simply stick the ADHEAR adapter behind your ear, click on the audio processor, and start hearing instantly.
What’s more, ADHEAR is the only non-implanted bone conduction device that doesn’t put pressure on your skin. ADHEAR is so comfortable to wear, you won’t want to take it off at the end of the day.
Effortless hearing: No surgery required
Reliable listening: Stays securely in place for optimal sound quality
All-day wearing comfort: No pressure on the skin
Sleek design: Easy to hide ADHEAR under hair
For all ages: Ideal solution for babies and toddlers
BONEBRIDGE is an implant designed around the user. Being fully under the skin, the ergonomic implant doesn’t leave any open wounds or skincare routines to worry about.
Most importantly, BONEBRIDGE offers great sound quality. MED-EL pioneered “under-the-skin” bone conduction implants over ten years ago.
Natural sound quality
Placed fully under the skin
Small and stylish audio processor
Middle Ear Implants - Vibrant Sound Bridge, FLANK, 2020: Lecture by Prof. Sri Ramachandra
Middle Ear Implants - Maxum, FLANK, 2020: Lecture by Prof. Sri Ramachandra
Middle Ear Implants - Cochlear Carina, FLANK, 2020: Lecture by Prof. Sri Ramachandra
Middle Ear Implant (MEI)
A middle ear implant (MEI) makes the structures in the middle ear vibrate in much the same way as normal sounds move the bones in the middle ear by converting sounds into vibrations.
Unlike a hearing aid, a middle ear implant converts sound into vibrations. This mechanical energy is used to directly stimulate the middle ear structures. With a middle ear implant, the ear canal remains completely open.
A middle ear implant consists of an internal and an external part.
External part: The external component of the middle ear implant is the sound processor / audio processor which contains the battery, the microphone and the digital signal processing
Internal part: The internal component of a middle ear implant is surgically placed under the skin towards the back of the head. One part of the internal component is the Floating Mass Transducer (also called FMT), which is attached to a vibratory structure in the middle ear
How does a Middle Ear Implant work?
A middle ear implant works like this:
Sounds are picked up by the sound processor / audio processor's microphone.
The sound processor / audio processor converts environmental sounds into a digital signal.
The digital signal is transmitted across the skin to the implant.
The implant sends the signal via the conductor link to the Floating Mass Transducer (FMT) in the middle ear.
The Floating Mass Transducer (FMT) converts the signal into vibrations that directly drive the middle ear structure
Who can benefit from middle ear implants?
A middle ear implant can be used as treatment for a sensorineural hearing loss as well as for a conductive hearing loss and a mixed hearing loss.
Among people who can benefit from middle ear implants are:
People with an obstruction of the outer or middle ear
People who cannot for some reason wear hearing aids or ear moulds
People who do not benefit from sound amplification
In other conditions or circumstances, middle ear implants may also be the right solution.
It is important to note that middle ear implants do not restore hearing to normal hearing like the hearing of a person without hearing loss.
VIBRANT SOUNDBRIDGE from Medel is a unique middle ear implant system that is ideal for individuals who don’t see any improvement with hearing aids, or cannot use them for medical reasons.
In contrast to a hearing aid, which amplifies sound from outside your ear, SOUNDBRIDGE brings the sound straight to the inside of your ear. This innovative way of hearing also ensures great natural sound quality, making it easier to hear the things you love most.
Natural sound quality: Clear, natural hearing without any noisy feedback
Preservation of delicate ear structures: The only middle ear implant with single-point attachment
Long-term reliability: Most successful middle ear implant for over 25 years
Comfortable to wear: With the small and stylish SAMBA 2 Audio Processor
The MAXUM System from Ototronix is a revolutionary middle ear implant consisting of a tiny rare-earth magnet implanted on the middle ear bones, and an advanced sound processor worn in the ear canal. The minimally invasive implant procedure can be performed in a procedure room or outpatient clinic under a local anesthetic.
Unlike hearing aids which use a speaker to amplify sounds, MAXUM uses an advanced sound processor which sends electric signals to a transceiver coil.
These signals are transferred by electromagnetic energy across the eardrum to the MAXUM implant which causes the ossicles to vibrate, thereby directly stimulating the cochlea (inner ear). Direct cochlear stimulation provides cleaner, crisper sound quality and more amplification without feedback.
"Preliminary data demonstrate that the MAXUM middle ear implant provides superior functional gain and word recognition scores in quiet for patients with severe high-frequency sensorineural hearing loss compared to optimally fitted hearing aids." - The ototronix MAXUM middle ear implant for severe high-frequency sensorineural hearing loss: Preliminary results by Jacob B Hunter et al., Laryngoscope 126(9):2124-7, 2016
The implant is placed under the skin behind; the electrode array is placed on the cochlear nucleus of the brainstem
Auditory Brainstem Implant (ABI)
An Auditory Brainstem Implant (ABI) is a hearing implant primarily made for people who have a non-functioning or non-existent auditory nerve.
It is a surgically implanted electronic device that provides a sense of sound to a person who is unable to hear because of a non-functioning or non-existent auditory nerve.
Is the auditory brainstem implant a type of cochlear implant?
Although the design and function of the implants are similar, these devices are different.
The cochlear implant is used in individuals with cochlear damage but who still have a functioning auditory nerve. A cochlear implant works by bypassing the damaged areas of the inner ear. It uses an array of electrodes to stimulate the auditory nerve directly. The auditory nerve sends signals generated by the implant to the brain, which recognizes the signals as sound.
The auditory brainstem implant bypasses the inner ear and the auditory nerve. It uses an array of electrodes to stimulate the hearing pathways on the brainstem directly.
Cochlear implant surgery is an inner ear surgery. Auditory brainstem implant surgery is brain surgery and is much more complex.
How does an Auditory Brainstem Implant (ABI) work?
The implant consists of two separate parts.
One part, worn on top of the ear, is called the processor. This part contains a microphone that picks up the surrounding sounds. The processor converts sounds to an electrical signal and sends it to the internal implant.
The internal implant consists of a receiver, which is implanted just under the skin on the side of the head, and ends in an electronic “paddle.” The paddle is positioned on the surface of the brainstem in an area called the cochlear nucleus complex. The electrodes on the paddle activate different neuron types in the brainstem, creating sound and pitch sensations.
The auditory brainstem implant uses technology similar to that used in a cochlear implant. The main difference is where and what the electrodes stimulate. With the cochlear implant, the array of electrodes stimulates the auditory nerve in the cochlea. The ABI’s array of electrodes are placed directly on the brainstem. They bypasses the cochlea and the auditory nerve entirely.