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Treatments

Hearing rehabilitation

Devices are not the consolation prize when surgery is unsuitable. For many ears they are the best treatment available, and for others they are the necessary complement to an operation.

Conventional hearing aids

A modern hearing aid is a small computer that amplifies sound selectively, compresses loud sounds, reduces noise and, in many models, uses two microphones to favour speech in front of the listener. For a conductive loss with a healthy inner ear — otosclerosis, a dry perforation, a fixed chain — amplification works exceptionally well because the cochlea can use everything it is given. For a sensorineural loss the benefit is real but limited by the damaged inner ear: sounds become audible, but clarity in noise is only partly restored.

Costs are practical rather than medical: daily use, batteries or charging, maintenance, cosmetics for some people, and the reality that an aid amplifies rather than restores. A wet or discharging ear makes conventional aids difficult; a repaired, dry ear makes them easy.

Bone-conduction devices

These bypass the outer and middle ear entirely, vibrating the skull so that sound reaches the cochlea directly. They suit ears that cannot be aided conventionally — chronic discharge, canal atresia, a mastoid cavity — and single-sided deafness, where a device on the deaf side routes sound to the hearing ear. Options range from headbands and adhesive devices to percutaneous and transcutaneous implants placed under local or general anaesthesia. They rely on an inner ear that still works: bone-conduction thresholds must be good enough.

Middle-ear implants

Active implants drive the ossicles or the round window directly. Their place is narrow: people who cannot wear a conventional aid for medical reasons and are not candidates for a bone-conduction device. Results are good in selected cases; the surgery is more involved than for other devices.

Cochlear implants

When the inner ear can no longer make use of amplification — severe to profound sensorineural loss with poor speech understanding even with aids — a cochlear implant stimulates the auditory nerve electrically. Candidacy criteria have widened to include single-sided deafness and asymmetric losses, and electrode designs now aim to preserve residual low-frequency hearing (electric-acoustic stimulation). Advanced otosclerosis that has reached the cochlea is one of the situations where the choice between a further stapes operation and a cochlear implant has to be weighed carefully.

Selecting the device

Match the device to the audiometric type and the ear. Conductive or mild-to-moderate mixed loss with a dry ear: conventional amplification, with the option of surgery in otosclerosis. Conductive loss with a wet ear, cavity or atresia: bone conduction, provided BC thresholds are ≤ about 45–55 dB HL depending on the device. Moderate-to-severe SNHL: conventional aids; consider CI when aided word recognition falls below roughly 50–60% in the best-aided condition, with local criteria varying. Single-sided deafness: CROS/BiCROS, bone conduction, or CI — in the CINGLE randomised comparison the implant was the only option that restored objective localisation and gave the largest tinnitus reduction (research). In otosclerosis with mixed loss, stapedotomy plus a hearing aid generally outperforms either alone when BC thresholds permit; far-advanced otosclerosis with poor discrimination is a CI indication.

Devices and surgery together

The choice is rarely either/or. Stapedotomy followed by a hearing aid in a mixed loss; tympanoplasty to allow an aid to be worn; a cochlear implant when stapes surgery can no longer help. What matters is the sequence and what each step protects — which is why hearing preservation applies to devices as much as to operations.

Beyond the audiogram

A device can make thresholds normal and still leave the person exhausted at dinner. Fitting is only the beginning: verification with real-ear measurements, counselling, communication strategies and, where two ears are usable, binaural fitting all determine whether a device changes daily life.

Beyond the audiogram

  1. Thresholds
  2. Speech
  3. Noise
  4. Space
  5. Binaural function
  6. Listening effort
  7. Patient experience

An audiogram is part of the story — not the whole story.

This page provides general educational information. It cannot replace an individual assessment, which depends on a full history, examination, audiometry and, where relevant, imaging. If you have sudden hearing loss, severe pain, facial weakness, severe dizziness or discharge with fever, seek medical care promptly.