What This Guide Covers
You’ll learn why hearing aids can make sound louder without improving clarity for some types of hearing loss, how cochlear implants work differently, who may be eligible (including single-sided deafness), and what a typical evaluation includes.
Try this first: a quick “is it time to ask?” check
- Notice the pattern. Are you doing “okay” in quiet but struggling badly in restaurants, groups, or the car?
- Does louder help… or just get harsher? Distortion can be a clue that amplification alone isn’t solving clarity.
- How’s speech understanding? If you rely heavily on captions or avoid phone calls even with hearing aids, write that down.
- Check the basics. A cleaning/repair, updated programming, or a different hearing-aid style can make a big difference.
- If clarity is still poor, ask about a cochlear implant evaluation. An evaluation is information — not a commitment.
Hearing aids are excellent at making sound louder. But for some types of hearing loss, the main problem isn’t volume — it’s how clearly the inner ear and hearing pathways can code speech. In those cases, “turning it up” can make sound louder without making words easier to understand.
How cochlear implants are different
A cochlear implant (CI) is a medical device that can provide access to sound by stimulating the hearing (auditory) nerve when the inner ear’s sensory cells are too damaged to transmit clear information. Hearing aids amplify sound; cochlear implants convert sound into electrical signals delivered to the inner ear through an implanted electrode array.
The “broken speaker” analogy
Imagine a speaker with a torn cone. Turning up the volume doesn’t restore clarity — it increases distortion. For some ears, a CI can be more like replacing the speaker than turning the knob.
Signs hearing aids may not be enough
- Speech is unclear even with well-fit, powerful hearing aids
- Phone calls are very difficult (without captions or speakerphone), even in quiet
- Noise is overwhelming — restaurants, groups, meetings, or the car feel impossible
- “I can hear you, but I can’t understand you.” This phrase shows up a lot in CI candidacy discussions
- Increasing volume makes sound sharper or distorted rather than clearer
Many clinics use speech-understanding testing with your hearing aids on to guide next steps. A common screening rule of thumb is sometimes called “60/60” — but thresholds vary, and candidacy decisions are individualized.
Cochlear implants aren’t just for total deafness
Single-sided deafness and asymmetric hearing loss
Some people have one ear that hears much worse than the other. In selected cases, cochlear implantation in the poorer ear can improve access to sound on that side, which may support localization and listening in noise.
Preserving natural low-frequency hearing
If low-pitched hearing is relatively preserved but high-pitch hearing is poor, some people may be candidates for approaches that combine acoustic hearing (hearing aid) with electric stimulation (implant) in the same ear. Your team can explain whether this applies to you.
What an evaluation usually includes
- Hearing tests (including aided testing with your current hearing aids)
- Medical evaluation to confirm you’re a safe candidate for surgery
- Imaging (often CT and/or MRI) as part of the workup
- Device counseling to discuss expectations, options, and rehabilitation
- Planning for follow-up: programming visits and listening therapy/practice
When to get checked
Seek prompt evaluation if you have sudden hearing loss, sudden one-sided hearing change, severe dizziness/vertigo, ear drainage, or new neurologic symptoms. These situations need medical attention regardless of whether you’re considering a CI.
Go to the Emergency: Hearing, Tinnitus, and Balance Safety Guide
Common questions
The Bottom Line
Hearing aids make sound louder. For some types of hearing loss, the bigger problem is clarity — especially on the phone and in noise.
If speech still feels unclear with well-fit hearing aids, a cochlear implant evaluation may be worth discussing. An evaluation is information — not a commitment.
Next Steps
If clarity is still poor, consider asking about a cochlear implant evaluation. You can also use these UCSF EARS resources to plan next steps and get care safely.