Head of Online Medical Content
Audiology Expert & Founder of Hearing Aid UK
Hearing Aids Versus Cochlear Implants
Hearing aids vs cochlear implants: Similarities and differences
Last Hearing Aid UK Update: 04
Overview
Hearing aids and cochlear implants both help people with hearing loss, but they work in very different ways. Hearing aids amplify sound and suit most people with hearing loss, from mild to severe, while cochlear implants are surgically implanted and are for people with severe to profound hearing loss who get little benefit from hearing aids.
Cochlear implants bypass damaged inner ear parts to stimulate the auditory nerve directly, giving access to speech for those who don’t benefit from hearing aids. The choice depends on hearing level, lifestyle, and medical advice.
At Hearing Aid UK, we provide and fit hearing aids. Cochlear implants are provided through specialist NHS cochlear implant centres, with referrals coming from your GP, an ENT specialist or an audiologist.
Not sure which option is right for you?
The distinction between hearing aids and cochlear implants isn't always clear-cut, and it's natural to have questions. If you're trying to work out whether hearing aids might be sufficient, or if a cochlear implant referral is needed, an audiologist can help.
Cochlear implants and hearing aids are both hearing loss treatments
Hearing aids and cochlear implants both help people hear, but in very different ways, and each has its own strengths and drawbacks. Which one suits you depends on your hearing and what matters to you.
Hearing aids are the go-to choice for most people with hearing loss. For people with severe hearing loss, or who are deaf, a cochlear implant can sometimes offer more.
Hearing aids are worn and can be removed day to day
Hearing aids are small devices that fit in or around your ear and help you hear more clearly. First, an audiologist tests your hearing. Then they’ll go through the options with you and fit your hearing aids so they’re set up just for you.
Most people who wear them have mild to moderate hearing loss and want to follow conversations more easily. But if your hearing loss is severe or profound, power hearing aids are available too.
Some people wear one hearing aid and others wear two. There’s also a choice of styles, from behind-the-ear to in-the-ear.
What to expect with hearing aids
Modern hearing aids are remarkably sophisticated devices that can handle a wide range of hearing losses. They're fitted and programmed specifically to your hearing profile, which means:
- You'll have a proper audiogram (hearing test) to determine exactly what frequencies and volumes you're struggling with
- The hearing aids are programmed to amplify precisely what you need, not just make everything louder
- Adjustments continue over several appointments as your brain adapts to the new sound input
- You can try different manufacturers and technology levels to find what works best for your lifestyle
The entire process is non-invasive and reversible. If you find hearing aids aren't providing sufficient benefit, which can happen with very severe hearing loss, your audiologist can advise whether a referral for a cochlear implant assessment is the right next step.
The benefits of hearing aids
One of the big advantages of hearing aids is that they’re simple. There’s no surgery involved, they’re easy to use, and your audiologist can adjust them whenever you need.
Hearing aids can also be programmed to reduce background noise and boost the frequencies you find hardest to hear, so busy places become easier to cope with.
The limitations of hearing aids
Hearing aids do have their limits. They can’t bring your hearing back to normal, and they rely on you having some natural hearing left. For people with severe to profound hearing loss, turning the sound up isn’t always enough to make speech clear, so a cochlear implant might suit them better.
When is a cochlear implant the better option?
Generally speaking, cochlear implants are considered when:
- Hearing aids, even the most powerful ones, provide minimal benefit in speech understanding
- Your hearing loss is severe to profound in both ears
- You score poorly on speech discrimination tests, even with optimally fitted hearing aids
- In some cases of auditory neuropathy spectrum disorder, where hearing test results don’t reflect how much someone is struggling, a cochlear implant assessment can still be considered
On the NHS, NICE guidance defines severe to profound deafness as only hearing sounds louder than 80 dB at two or more key frequencies in both ears, without hearing aids. For adults, it also looks at how well you can recognise words with your hearing aids, and you’ll usually need to have tried hearing aids for at least three months first.
The good news is that you don't have to figure this out on your own. A comprehensive hearing assessment will indicate whether hearing aids are appropriate or whether a referral for cochlear implant evaluation makes more sense.
It's worth noting that cochlear implant surgery and devices are available through the NHS, though there are waiting lists. Private options exist but are significantly more expensive. However, eligibility criteria apply too, since not everyone with severe loss will automatically qualify.
Cochlear implants are for profound hearing loss
Cochlear implants are designed for people with severe to profound hearing loss. Instead of making sounds louder like a hearing aid, they skip past the damaged hair cells in the inner ear and send signals straight to the hearing nerve. That means people can hear sounds that would otherwise be out of reach.
The benefits of cochlear implants
Cochlear implants are typically recommended for those who cannot benefit from hearing aids or who have limited or no residual hearing. They are surgically implanted by an ear, nose and throat (ENT) surgeon.
A cochlear implant has two parts that work closely together. The external processor sits behind the ear and picks up sound, processes it, and passes it along to the internal implant sitting just beneath the skin. From there, the implant converts that information into electrical signals sent directly to the auditory nerve, giving the brain what it needs to hear.
What makes cochlear implants stand out is that they can give access to speech for people who get little benefit from even the most powerful hearing aids. The sound is different from natural hearing, and many people describe it as electronic at first, but with time and rehabilitation, the brain learns to make sense of it.
For those living with severe to profound hearing loss, that difference can be profound in every sense of the word. Conversations that once felt exhausting or impossible can start to feel manageable again, and that kind of connection to the world around you is hard to put a price on.
The cochlear implant journey:
- You’re referred to an NHS cochlear implant centre.
- A team of specialists assesses your hearing to see if an implant could help.
- They explain what’s involved, including the risks and likely results.
- If it’s right for you, surgery is booked.
- Once you’ve healed, usually after a few weeks, the implant is switched on.
- Follow-up sessions help you adjust and get the most from it.
One thing that surprises many people is that a cochlear implant isn't like switching on a light. Where hearing aids often bring noticeable benefit quite quickly, a cochlear implant works very differently.
Your brain has never heard sound this way before, and it needs time to adapt. That rehabilitation process is a real commitment, often taking months and sometimes stretching to a few years. But it's a journey, not a setback, and one that many people find life-changing.
Cochlear implants' limitations and the risks
Because cochlear implants require surgery, there are risks, including infection and, in some cases, losing any natural hearing that remains in the implanted ear. You’ll also need to look after and charge the external processor, and you may need to take extra steps before certain medical scans, such as an MRI.
"We think a lot of people with severe hearing loss assume they’ve run out of options with hearing aids long before they actually have. A modern power hearing aid, properly fitted, can surprise people.
But we're also very honest when someone isn’t getting enough benefit, because for the right person, a cochlear implant can change everything. Our job is to make sure you’re getting the most from your hearing aids first, and to tell you plainly if it’s time to think about a referral.”
says Paul Harrison, Audiology Expert and Founder, Hearing Aid UK
Key takeaways
- Hearing aids amplify sound and suit most people with hearing loss, including many with severe loss.
- Cochlear implants are for severe to profound hearing loss when hearing aids give little benefit with speech.
- Cochlear implants are provided through NHS specialist centres, after a referral from your GP, ENT or an audiologist.
- Cochlear implant sound is different from natural hearing, and rehabilitation can take months.
Summary
Both hearing aids and cochlear implants can make a genuine difference to people living with sensorineural hearing loss, where the tiny hair cells in the inner ear, the nerve pathways to the brain, or both, aren't working as they should. It's actually the most common type of hearing loss there is.
Think of them as two different tools for the same job; they just suit different situations. Hearing aids sit in or around the ear and amplify sound, making them a great fit for people with mild to moderate hearing loss.
If your hearing loss is more significant, don't worry; more powerful hearing aids exist that can support even severe to profound hearing loss in many cases. Cochlear implants work differently.
Neither option is universally "better". The right choice is the one that works best for you. Your degree of hearing loss, your lifestyle, and your personal preferences all play a part. The best thing you can do is chat with an HCPC-registered audiologist who can look at the full picture and point you in the right direction.
Chat to us about hearing aids for severe hearing loss
If you’re not sure whether hearing aids are still right for you, our HCPC-registered audiologists can check your hearing, make sure you’re getting the most from your hearing aids, and tell you honestly if a cochlear implant referral is worth considering. We work across 93+ clinics and also offer free home visits.
We’re independent of any manufacturer, so we’ll recommend what genuinely suits you, at prices up to 40% less than the high street. Every hearing aid comes with aftercare for life and our 60-day money-back guarantee, and we’re Which? recommended, with over 31,000 customers. Call us free on 0800 567 7621 or book a free hearing test at a clinic near you or in the comfort of your own home.
FAQs on hearing aids and cochlear implants
What’s the difference between a hearing aid and a cochlear implant? A hearing aid is worn in or behind the ear and amplifies sound. A cochlear implant is surgically implanted and sends electrical signals straight to the auditory nerve, bypassing the damaged parts of the inner ear.
Who is eligible for a cochlear implant on the NHS? Generally, adults and children with severe to profound hearing loss in both ears who get little benefit from well-fitted hearing aids. A specialist NHS team will carry out a full assessment.
How do I get referred for a cochlear implant? Referrals can come from your GP, an ENT specialist or an audiologist, NHS or private. If you’re struggling with your hearing aids, speak to your audiologist or GP.
Does a cochlear implant sound like normal hearing? No. Many people describe the sound as electronic at first. With rehabilitation and time, the brain learns to make sense of it, and many people go on to follow speech much more easily.
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Hearing aids vs implants
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If you feel like your hearing has worsened, we advise that you check how well you're hearing with an audiologist as soon as you can.
For a free hearing assessment at home or in clinic, for any support, advice or hearing healthcare enquiries, please call us free on 0800 567 7621
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FAQs
In general, any audiologist will always recommend to you the hearing aid model that best suits your needs. Here is a useful checklist to make sure that is the case.
- Audiologist's level of knowledge: The audiologist you have seen will hopefully have a wide knowledge of all available hearing aids; however, some will only be familiar with a small number of brands and, therefore, may not really be in a position to know which model is the best for you. It is OK to challenge their recommendation and ask them to justify why this particular brand is the one for you.
- Do research: Read about the hearing aid that was recommended. Does it seem like it will suit your lifestyle? Does it have more or fewer features than you need?
- Be aware of sales targets: Many high street retailers have specific tie-ins to a particular manufacturer/brand. The hearing aid they have suggested may still be the correct one for you, but do your research so that you know why they might have recommended it. You can read our best hearing aids of this year here
If you have significant hearing loss in both ears, you should be wearing two hearing aids. Here are the audiological reasons why:
Localisation: The brain decodes information from both ears and compares and contrasts them. By analysing the minuscule time delays as well as the difference in the loudness of each sound reaching the ears, the person is able to accurately locate a sound source.
Simply put, if you have better hearing on one side than the other, you can't accurately tell what direction sounds are coming from.
Less amplification is required: A phenomenon known as “binaural summation” means that the hearing aids can be set at a lower and more natural volume setting than if you wore only one hearing aid.
Head shadow effect: High frequencies, the part of your hearing that gives clarity and meaning to speech sounds, cannot bend around your head. Only low frequencies can. Therefore, if someone is talking on your unaided side, you are likely to hear that they are speaking, but be unable to tell what they have said.
Noise reduction: The brain has its own built-in noise reduction, which is only really effective when it is receiving information from both ears. If only one ear is aided, even with the best hearing aid in the world, it will be difficult for you to hear in background noise as your brain is trying to retain all of the sounds (including background noise) rather than filtering them out.
Sound quality: We are designed to hear in stereo. Only hearing from one side sounds a lot less natural to us.
Fancy some further reading on this topic? You can read about why two hearing aids are better than one in our article, hearing aids for Both Ears, here
For most people, the main benefit of a rechargeable hearing aid is simple convenience. We are used to plugging in our phones and other devices overnight for them to charge up. Here are some other pros and cons:
For anybody with poor dexterity or issues with their fingers, having a rechargeable aid makes a huge difference, as normal hearing aid batteries are quite small and some people find them fiddly to change.
One downside is that if you forget to charge your hearing aid, then it is a problem that can't be instantly fixed. For most, a 30-minute charge will get you at least two or three hours of hearing, but if you are the type of person who is likely to forget to plug them in regularly, then you're probably better off with standard batteries.
Rechargeable aids are also a little bit bigger and are only available in Behind-the-Ear models.
Finally, just like with a mobile phone, the amount of charge you get on day one is not going to be the same as you get a few years down the line. Be sure to ask what the policy is with the manufacturer's warranty when it comes to replacing the battery.
For most people, the answer is yes. But it's never that simple.
The majority of hearing problems affect the high frequencies a lot more than the low ones. Therefore, open fitting hearing aids sound a lot more natural and ones that block your ears up can make your own voice sound like you are talking with your head in a bucket. Therefore, in-ear aids tend to be less natural.
However, the true answer is we can't tell until we have had a look in your ears to assess the size of your ear canal, and until we have tested your hearing to see which frequencies are being affected.
People with wider ear canals tend to have more flexibility, also there are open fitting modular CIC hearing aids now that do not block your ears.
There is also the age-old rule to consider, that a hearing aid will not help you if it's sat in the drawer gathering dust. If the only hearing aid you would be happy wearing is one that people can't see, then that's what you should get.
Most people can adapt to any type of hearing aid, as long as they know what to expect. Have an honest conversation with your audiologist as to what your needs are.
Generally speaking, six or more. Unless it's none at all. The number of channels a hearing aid has is often a simplistic way an audiologist will use to explain why one hearing aid is better than another, but channels are complex, and it is really not that straightforward. Here are some reasons why:
Hearing aids amplify sounds of different frequencies by different amounts. Most people have lost more high frequencies than low, and therefore need more amplification in the high frequencies. The range of sounds you hear is split into frequency bands or channels, and the hearing aids are set to provide the right amount of hearing at each frequency level.
Less than six channels, and this cannot be done with much accuracy, so six is the magic number. However, a six-channel aid is typically very basic with few other features and is suitable only for hearing a single speaker in a quiet room. The number of channels is not what you should be looking at; it's more the rest of the technology that comes with them.
As a final note, different manufacturers have different approaches. One method is not necessarily better than any other. For example, some manufacturers have as many as 64 channels in their top aids. Most tend to have between 17 and 20. One manufacturer has no channels at all.
Manufacturer's warranties typically last between 2-5 years, depending on the brand and model, and cover defects in materials and workmanship. This includes repairs for component failures, electronic malfunctions, and manufacturing defects, but excludes damage from misuse, accidents, or normal wear. Most manufacturers also include loss and damage insurance for the first year.
We handle all warranty claims on your behalf, liaising with manufacturers and ensuring you get replacement devices quickly when needed. This comprehensive warranty coverage, combined with our lifetime aftercare, gives you complete peace of mind. Find out more about our warranty cover here
Our hearing tests are completely free, whether at our clinics or in your home. Unlike other providers who charge £30-£100 for home visits, we believe hearing healthcare should be accessible without financial barriers. Our comprehensive assessments include examination by an HCPC-registered audiologist, audiogram results, and personalised recommendations.
All testing, future adjustments, and ongoing support are included at no extra cost. While NHS tests are also free, typical 6-week waiting periods often lead people to seek immediate private testing. We provide prompt, professional assessments that fit your schedule and budget.
Yes, we offer completely free home visits throughout the UK, and this service is included in our prices with no additional charges. Home visits are particularly valuable for people with mobility issues, busy schedules, or those who simply prefer the comfort and convenience of their own environment.
Our audiologists can conduct full hearing tests, fit hearing aids, and provide ongoing support in your home. This service sets us apart from many providers who either don't offer home visits or charge extra for them.
We can offer prices up to 40% lower than high street retailers because of our business model. As a network of 200+ independent audiologists, we don't have the massive overheads of large retail chains - no expensive high street premises, no sales targets pushing audiologists to sell the most expensive options, and no costly marketing campaigns.
However, we maintain the same buying power as the big chains because we purchase on behalf of our entire nationwide network. This means you get access to the same premium hearing aids with professional service, but at genuinely competitive prices.
We offer a comprehensive 60-day money-back guarantee, which gives you twice the industry standard time to properly assess whether your hearing aids are right for you. This extended period recognises that adjusting to hearing aids takes time, and your brain needs several weeks to adapt to the amplified sounds.
Unlike many providers who offer just 30 days, we believe 60 days gives you the confidence to test your hearing aids in all the situations that matter to you - from quiet conversations at home to busy restaurants and outdoor activities.
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