Hearing technology options
Last reviewed: 25 June 2024
Here’s an overview of the different types of hearing technology available, how they work and who they’re suitable for.
Many deaf children and young people use hearing technology such as hearing aids or cochlear implants. You may already be discussing some of these options with your child’s audiologist.
Deciding to use hearing technology is a personal choice, and there’s no right or wrong answer. Take your time to learn about the different options, and don’t be afraid to ask lots of questions.
Hearing aids
Hearing aids are electronic devices designed to make sounds louder and clearer. There are several different types of hearing aid available, and your child will be fitted with the most suitable hearing aid depending on the type and level of their hearing loss.
By using your child’s hearing test results, the hearing aid can be programmed to meet their hearing loss and needs.
They can give deaf children greater access to speech sounds, which can help with their spoken language development. However, hearing aids do not restore ‘normal’ hearing. A deaf child wearing hearing aids will not be able to hear in the same way as a hearing child. They may still struggle to hear if the speaker is not facing them, is too far away or if there’s lots of background noise.
Hearing aids may come in different sizes as well as a range of colours.
How hearing aids work
The most common type of hearing aid for children are behind-the-ear hearing aids. The hearing aid sits over the top of the ear and is attached to either an earmould which fits snugly in the ear or a soft plastic dome (open fit).
The hearing aid microphone picks up sound and processes it digitally to make it louder and clearer. The sound is then sent either through the tubing of the earmould into the ear canal or a through a thin wire attached to a soft plastic dome that fits into the ear canal. The open fit option is more suitable for older children due to the small parts and for those who have mild or moderate hearing loss.
Hearing aids amplify quieter sounds more than louder sounds so that they always stay within a child’s comfortable hearing range.
Who can wear hearing aids
Hearing aids can be useful for babies and children with any level of deafness. The type of hearing aid that will be suitable for your child will depend on the type and level of deafness they have.
Hearing aids can also be used on a temporary basis for children with glue ear.
Find out more about hearing aids.
Cochlear implants
Unlike hearing aids which make sounds louder, a cochlear implant gives a sensation of hearing by directly stimulating the auditory nerves using electrical signals.
The brain perceives sound through a cochlear implant differently than it would with normal hearing. Cochlear implant wearers who have previously heard naturally often describe the sound as being robotic or tinny. However, with time the brain adjusts to the new signals and what it hears becomes more natural sounding.
How cochlear implants work
A cochlear implant has three main parts:
- An external part which hooks over the ear, similar to a hearing aid. This includes the microphone and speech processor.
- An external transmitter coil that is attached to the speech processor by a cable. The transmitter coil is held in place behind the ear by magnetic attraction to the implanted receiver.
- An internal receiver which is surgically implanted under the skin behind the ear.
A cochlear implant sends sounds to the brain in these steps:
- The microphone picks up sounds.
- The speech processor converts the sounds into a digital code.
- The digital code is sent to the transmitting coil, which passes through the skin to the internal receiver.
- The internal receiver converts the digital code into an electrical signal.
- The electrical signal is sent along a wire to the electrodes in the cochlea.
- The electrodes stimulate the cochlear nerve fibres, and they send the signal to the brain.
- The brain interprets these sounds so the wearer can understand what was heard.
Who can wear cochlear implants
Cochlear implants are usually suitable for children with a severe to profound permanent deafness who gain limited or no benefit from their hearing aids.
It’s now common for children to be implanted before they are 12 months old. This is because evidence suggests that children are more likely to get the most benefit from a cochlear implant the younger they’re implanted. However, it takes time to find out the exact level of a child’s hearing loss and to assess their suitability for a cochlear implant, so some children are implanted later.
Older children can also benefit from cochlear implants, including those who have become deaf after learning to speak (for example, following meningitis). Cochlear implants may also be suitable for older children who have a progressive hearing loss and receive less benefit from their hearing aids.
Find out more about cochlear implants.
Bone conduction devices
Bone conduction hearing devices may be an option if your child has a conductive hearing loss, mixed hearing loss or single sided deafness and doesn’t benefit from wearing a conventional hearing aid.
Bone conduction uses the body’s natural ability to transmit sound vibrations through the bones in the skull to the inner ear.
How bone conduction devices work
A bone conduction hearing device transmits sound directly through the bone to the inner ear, bypassing the outer and middle ear. This is unlike hearing aids which use air conduction to amplify sounds and send them directly to the ear canal.
There are two different ways that bone conduction hearing devices can be worn. They can either be worn as hearing aids on a softband (non-surgical) or on a surgically implanted abutment/magnet (surgical).
Who can wear bone conduction devices
Bone conduction devices may be an option if your child has temporary or permanent conductive deafness and doesn’t benefit from wearing a conventional hearing aid. Conductive deafness is when sound cannot pass effectively through the outer and middle ear to the cochlea and auditory nerve.
Bone conduction hearing aids (non-surgical) may be suitable for children with:
- perforated eardrums
- atresia/microtia (underdeveloped ear canal and outer ear)
- glue ear or persistent ear infections
- cholesteatoma
- mixed hearing loss (conductive with sensorineural hearing loss)
- single-sided (unilateral) deafness
- certain syndromes including Down’s syndrome and Treacher Collins syndrome.
They may also be an option for children who are too young for bone conduction hearing implant surgery.
Bone conduction hearing implants (BCHI) (surgical) may be suitable for children with permanent or long-standing conductive deafness. Children are generally considered for a BCHI around the age of five years when there is sufficient bone thickness to allow for the implant to be inserted. This can vary from child to child.
Find out more about bone conduction devices.
Middle ear implants
Middle ear implants are surgically implanted hearing aids and are a suitable treatment option for mild to severe sensorineural, conductive and mixed hearing loss. They are used when conventional hearing aids are not an option due to medical reasons.
How middle ear implants work
A middle ear implant has an internal receiver that is implanted just beneath the skin behind the ear. An external processor and microphone are connected to the internal receiver by a magnet. The implant itself is attached to one of the middle-ear bones (stapes or incus) or to the round window between the middle ear and the cochlea (inner ear).
The microphone of the external audio processor picks up sounds and converts them into electrical signals. These signals are then transmitted across the skin to the implant.
The implant sends the signal to the Floating Mass Transducer (FMT) in the middle ear, which converts electrical signals into vibrations. The vibrations are transferred to the cochlea of the inner ear where they are converted into electrical signals that the brain interprets as sound.
Who can wear middle ear implants
Middle ear implants are a suitable treatment option for mild to severe sensorineural, conductive and mixed hearing loss. They’re typically used for children who:
- have previously had surgery on their ears which makes using a conventional hearing aid difficult (for example mastoid cavity problems following surgery for cholesteatoma)
- were born with underdeveloped outer ears (microtia, atresia)
- are not able to wear bone conduction hearing implants due to medical problems of the soft tissues or loss of fixture
- are not able to wear conventional earmoulds due to allergies, eczema or recurrent outer ear infections (otitis externa).
Find out more about middle ear implants.
Auditory brainstem implants
Auditory brainstem implants (ABIs) stimulate the auditory brainstem directly, bypassing the ear and auditory nerve, to provide a sensation of hearing.
ABIs are still a fairly new development. They are mainly used by adults, but a small number of congenitally (born) deaf children who have an absent cochlea or cochlea nerve, and who are unable to benefit from a cochlear implant, may be referred for an ABI.
Because of the small numbers implanted so far and the variability of results, it’s difficult to predict how well children may be able to use the information they receive from an ABI and whether it could help them develop spoken language. Most are able to recognise and discriminate different environmental sounds such as a doorbell or phone ringing. ABIs can also aid with lipreading.
How ABIs work
An ABI is similar to a cochlear implant in the way it looks and works. The external part consists of the microphone, speech processor (which either sits behind the ear or is body-worn), lead and transmitter coil.
Unlike a cochlear implant where the electrode is inserted into the cochlea, the internal part of the ABI is surgically implanted directly onto the cochlear nucleus of the brainstem, therefore bypassing the cochlea and auditory nerve. It includes the receiver and a number of electrodes that directly stimulate the brainstem to provide a sensation of hearing.
Who can wear an ABI
ABIs may be suitable for children who are profoundly deaf (as hearing aids will not be an option for this type of deafness) and who are also not suitable candidates for cochlear implants.
For example, if a child has an underdeveloped or absent auditory nerve or cochlea, sound cannot pass effectively between the inner ear and the brain. In this case, cochlear implants may be of very limited or no benefit, and the child may be considered for an ABI instead.
Find out more about auditory brainstem implants.
No technology
Due to their medical circumstances, some children are not able to use any hearing technology, or it provides little benefit for them.
Some children and their families choose not to use technology for a wide range of reasons.
While hearing technology can give deaf children greater access to speech sounds, which may be needed for speech development, there are communication approaches that do not rely on speech, such as sign language.