Adults with Hearing Loss: Hearing aid and implant? (2017)

The full report is available to download here Adults with Hearing Loss: Hearing aid and implant?This study has kindly been supported by Advanced Bionics (AB). 


“Having both of these ears, even though they weren’t very good, individually they weren’t nearly as good as the sum of the two, I mean like two hands are much more useful than one hand...what you actually get even though it’s very small, together is much greater”

"I’m getting a lot of benefit from my implant and didn’t feel I needed my hearing aid, but being curious, I like to try things, that’s why I did it [...] I find use of both enables me to do more and more than just with my implant"

This report highlights the personal and societal challenges of adult hearing loss, the impact of hearing aids, cochlear implants and other implantable devices but focuses on the experiences of users and hearing aid audiologists. There is much evidence to show that “two ears are better than one”, for listening in background noise, being able to tell where sounds come from and to follow group conversation. With most adults receiving only one implant and interest in changes in criteria for cochlear implantation, there is increased interest in the benefits and challenges of bimodal hearing.  However, while there is some evidence on the benefit of bimodal hearing, it seems most adults with one implant do not continue to wear a hearing aid in the other ear. This report explores some of the reasons for this and includes for the first time the views of the audiologists who manage hearing aid provision.

The report clearly shows that there is little coordination between hearing aid and cochlear implant clinics in England for joint management. There are huge gains in benefit to be made through co-ordination of services with better information and support for adults receiving implants about the possible benefits of also wearing a hearing aid. However, this rarely seems to happen, and most adults appear to give up wearing a hearing aid in the other ear. Providing the management of an adult's hearing aid and cochlear implant in two different clinics, as is common in England at the moment, does not make sense in terms of patient benefits or cost-effective use of NHS services.

This report's recommendations are in line with the NHS Five Year Forward plan and the Action Plan on Hearing Loss (APoHL, 2015) which recognise that services should be coordinated around patients' needs to ensure health and well-being are improved. Joint management of hearing aid and implant for adults with hearing loss is one way to do so.   

This report recommends:

  • Greater information available about the possibility of wearing a hearing aid and implant
  • Clarification of the roles and responsibilities of cochlear implant centres and audiology clinics with regard to advice about the use of bimodal hearing and its ongoing management.
  • Development of agreed protocols for ongoing bimodal management by hearing aid and cochlear implant clinics
  • CI and HA programming and management to be planned in the same appointment wherever possible, so bimodal technology management is seen as one rather than separate entities for holistic intervention
  • Training for audiologists on the joint management of cochlear implant and hearing aid
  • Clear information for hearing aid audiologists and users about the issues concerning bimodal usage
  • Further in-depth research into the characteristics of good bimodal users