Power hearing aids vs Cochlear Implant (no easy choice)

For someone like myself who has limited hearing, yet isn’t totally sold going the CI route - life choices can be hard. Being profoundly hard of hearing and a CI candidate for last ten years, life certainly has its ups and downs. I find with my Phonak P90 Nadia’s I do very well with general sounds yet very poorly with speech understanding. Face to face with voice projection works well but in normal speech conversation I’m probably missing 60%. In a group of five or more I might lose 70% word recognition.

With that said I’m fairly active with HA’s, do a lot of work outside and like the freedom of taking my aid off or leaving on when I’m doing something physically active. I’ve researched CI for years and feel I know benefits and drawbacks. When done right a CI will allow someone to hear (in a quiet environment) between one or several individuals And when I say hear - I believe the CI wearer is not straining to hear verbal communication nor lip reading. That is a huge benefit versus what I’m experiencing now. Yet I feel CI technology (for what ever reason) has not advanced as much as I’d like over over the years and decades. Hearing experts will tell you that a “CI connection” is not ideal as far as a processor capturing sound signals and sending to receiver implanted under the skin behind the ear. New technology seems to be lagging in the area where the receiver sends the signals to electrodes implanted in the snail-shaped inner ear. Case in point - it takes six months to a year plus to adapt to the way a CI allows you to hear and decipher sounds. Your brain has to be reprogrammed to learn how to accept new incoming CI sounds and foreign verbal communication.

Initially nothing happens quick with a new CI but sometimes good things have to waited for. Part of my hesitation in getting a CI is that they do not do well in noisy situations. In fact I’d say a CI user when compared to a power hear aid user both struggle to hear properly with background noise. Been that way since CI came out in the 1980’s. Generally I feel the operation part of the CI is fairly safe but no doctor or CI facility is going to guarantee everything will work properly or that you will have your hearing level restored to normal. Also if you look at the history of CI manufacturers there is on more than a few occasions a unfortunate track record of part defects and and moisture issues. But I’d say no more than what a typical HA user goes through wearing aids year in, year out. Of course a CI cost way, way more that a HA, so you would thing they would operate at a higher level quality wise.

Lastly I know there are lot of other people out there just like me that sit on the fence and wonder which way they should go regarding sticking with power aids or move towards a CI. Yes I know the standard line here is “well ask you Audi, or ear doctor, or specialists, etc”. Personally I think you can get all the info you need (some what unbiased) off the internet. And probably talking more directly with a CI user. This might hit a nerve with a few readers here but I’ve felt at times that a certain medical clinic or hospital or Audi pushing a CI is looking more at the ($30,000 to $50,000) collection fee more than the actual pros and cons of the CI itself.

In any case I’ll probably keep sitting on the fence before I make an future decisions. I do know (from my limited) research that replacement technology for a CI is probably ten years off. And though always hopeful restoration of damaged or dead ear nerve cells is probably fifteen years off. When you read things are being tested in mice, you know nothing is going to happen fast. And should any research facility get past the mice testing stage and still have money left to burn, you still have to through many levels of human trial testing and then long FDA review process which could take years. Just look how long OTC hearing action took to be approved by FDA - five long years.


CI user here, it is actually one of the best decision i made.I have been hearing the 15 year thing for years since 2010. it should be out by now… i gave up after hearing cricket from drug companies. Whenever you are ready, you will be glad you got the implant i can guarantee that…

it actually massively improved my understanding in noise as well like 50 fold increase when combined with my hearing aid


For those who are cochlear implant candidates the difference between understanding speech with ultra power hearing aids and cochlear implant is like comparing apples and oranges.

There is no comparison. CI bypasses all the damaged equipment.

When a person wants to be able to communicate with family and friends or hold a job and poor hearing is holding them back, CI could very well help them.
It sure helped me.


In a similar boat… Amen Brother !

Another CI (bimodal) user here. I also sat on the fence after being evaluated as a future recipient… I sat for 18 months, do I or don’t I.

My hearing pre op was 33% aided. I fell off the fence in July 2019, just over 3 years ago. I could understand speech upon activation, it took a hell of a lot of concentration though. By the end of the week speech comprehension was flowing easily. My hearing now is 96% aided. The difference is huge, you just can’t compare the difference. As Rick said the difference is like apples and oranges…

With the new N8 coming very soon, I think I’ve read that speech in noisy situations has been improved with the new processor. I will confirm this when I get it, hopefully in the not to distant future. I have absolutely no regrets about getting a CI, I have my life back now, it’s the best thing I ever did.


Why are you saying that? I don’t understand that part and who are the “hearing expert”? There is no problem with the interface used to communicate except for power loss sending through the skin, is that what you meant?.

A commercial cochlear implant today has a microphone, processor, and transmitter that are worn on the head, as well as a receiver and electrodes that are implanted. It typically has between 12 and 24 electrodes that are inserted into the cochlea to directly stimulate the nerve at different points. But the saline fluid within the cochlea is conductive, so the current from each electrode spreads out and causes broad activation of neurons across the frequency map of the cochlea. Because the frequency selectivity of electrical stimulation is limited, the quality of artificial hearing is limited, too. The natural process of hearing, in which hair cells trigger precise points on the cochlear nerve, can be thought of as playing the piano with your fingers; cochlear implants are more equivalent to playing with your fists. Even worse, this large stimulation overlap limits the way we can stimulate the auditory nerve, as it forces us to activate only one electrode at a time.

Just saying CI technology is in some way limited but its still the only game in town. I’d like to think something new will replace current CI in my lifetime but doubt that will happen. I’m in my late 60’s.


Another candidate here, but I have reached the conclusion not to be implanted because of lifestyle changes about to happen, I don’t honestly feel the need, I also have the Naida UP P90’s and they are without doubt wonderful aids, but combined with several Roger assistive listening devices, I hear really well, in actual fact I probably hear better than most non hearing aid users in certain situations? Roger On is a big step up…. The clarity is pristine. Cheers Kev :wink:

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I understand your dilemma, I think all of us who wear a CI went thru it. I have a profound hearing loss, required UP-type hearing aids, and an audie I really trust convinced me to get a CI. BEST decision I ever made. Hearing with a CI is magnitudes of order better than a hearing aid. I still wear an HA on one side, but it’s the CI side that carries the load.

With all due respect Steve, you are sharing with us some of what you perceive to be disadvantages of a CI, yet you don’t wear one. Let me assure you, once you get a CI, the only question will be “Why did I wait so long?”.

Good luck to you.


Totally true!


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I am aware of how the implant actually delivered sounds… Brain just sees neural impulses and sees pattern in those impulses, it doesn’t care what or how it gets into the brain

As an engineer myself, this was clever way to fool the brain into thinking there is sound when it is electrical impulse, They do everything they can to prevent cross talk interaction… that why i got the ci532/ci632 I asked specifically for that kind because it require way less power than the straight electrode and less of a fist more like 2 fingers because that thing wraps around the basilar membrane i instead of the wall of the cochlea .

see this excellent ted talk:
David Eagleman: Can we create new senses for humans? | TED Talk


A lot of people swear by cochlear implants. At 70 I never pulled the trigger on an implant. And from my understanding at my age I am no longer eligible for 2 implants only one. Like everything else in this world there’s no guarantees. You already know that you struggle with speech comprehension with your aids, and I don’t expect any great improvement in that area in the near future. On the other hand many people claim their speech comprehension improved immensely with the implant. But I know a lot of people who were disappointed in that area, especially in noisy environments. So like everything else regarding hearing loss one size isn’t the same for everyone. Basically on this forum you’re going to get I love my implants and I’m disappointed. I would seek advice from a specialist,more than one if possible. No one can guarantee that you will hear better with or without. And someone saying they hear great well I’m happy for them. But that doesn’t really mean all that much to anyone else. That unfortunately is how it works with hearing loss


You are 100% correct, I can tell you that it is a mixed bag for those that don’t have good speech understanding

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Interesting article, a couple years old but very informative.
In short, CI has a very high success rate with those that are CI candidates.

On this forum and CI Facebook groups, CI is very successful. There are very few but there are some that do not do well with CI. My reading about those that do not do well comes down to the rehabilitation. It takes an effort and mindset to be successful with CI.


Yeah, my take is that willingness to exert effort is very important. Is that stressed much during consultation with the surgeon?


At the CI evaluation this and much more is brought up.

I remember after the evaluation thinking the physical hearing loss was a small part of the evaluation. Most of the evaluation was talking about life, work, family, entertainment etc. and why I wanted CI.

The audiologist really wanted to know I would put the effort in to succeed!


The only CI “failure” that I’ve read about it here was from somebody who said they didn’t want to work at it. Seems like their evaluation wasn’t very thorough. It really seems that if one has a very severe to profound loss and one WANTS to hear better and is willing to work at it, CI is a no brainer. Makes a lot more sense than looking for the perfect hearing aid.


yeah, you have to put a lot of effort training yourself to hear… I was very disappointed the first time i got it. I heard nothing at all, my nerve was really sleeping at that time despite wearing hearing aid 18 hours a day… by 3rd month, i can hear the full spectrum but not perfectly as my brain was adjusting to changes and fully merge with my hearing aid. by a year later, i was able to take advantage of both side working together…


But what if “damaged equipment” is the brain? I was born deaf, and my brain doesn’t know what is a speech, and how to proceed words. I’m almost always cannot differentiate speech and noise. So CI will be the same unusual thing for me as HA. I think many of us are in same situation. So my choice is HA (Oticon Xceed 1 SP x 2). I can remove them for night and sleep without any metal things in my head.