Implantable Devices

When a conventional hearing aid is not enough or not suitable: bone- conduction and middle-ear implants, and the cochlear implant.

Bone-conduction devices

Bone-conduction devices bypass the outer and middle ear, delivering sound as vibration through the skull directly to the cochlea. They are the answer when air-conduction aiding is impossible or unhelpful — a chronically draining or absent ear canal, congenital atresia, or a conductive/mixed loss that an air-conduction aid cannot serve — and for single-sided deafness, routing sound to the better cochlea. Coupling may be a percutaneous abutment, a transcutaneous magnet, or a non-surgical softband in young children [12].

Middle-ear implants

Middle-ear implants drive the ossicular chain (or round window) directly with a small transducer rather than delivering acoustic energy down the canal. They are an option for selected sensorineural or mixed losses, particularly where conventional aids are poorly tolerated — for example chronic canal problems or unmanageable feedback and occlusion[1].

Cochlear implants

When a severe-to-profound sensorineural loss yields too little benefit from well-fitted hearing aids, the cochlear implant bypasses the damaged hair cells and stimulates the auditory nerve directly with an electrode array. Candidacy combines the audiogram with demonstrably limited aided benefit, supported by imaging and a multidisciplinary assessment [13]. Outcomes depend on device programming and structured rehabilitation, and bilateral implantation is standard for suitable candidates [16].

Paediatric cochlear-implant candidacy, the imaging and aetiology work-up, and outcome predictors are covered in depth in the Paediatric Hearing Assessment set; the same audiological logic — limited aided benefit drives the move from hearing aid to implant — applies across the lifespan.