Bone anchored hearing aids why, when, pros and cons (2023)

Hearing solutions specializing in bone conduction

What are bone conduction hearing aids?

ABone conduction hearing aid (BAHA)It is a type of hearing aid that uses bone conduction of sound to provide better hearing. BAHAs are primarily used for people with unilateral conductive and deaf hearing losses (unilateral hearing loss). They are sometimes used for people who cannot wear traditional types of hearing aids due to chronic infection, malformed ear canals or ears, or missing ears. They are more expensive than traditional hearing aids and their placement involves invasive surgery. As with any surgery, there is a risk of complications, although generally the complications are minor.

How BAHA hearing aids work

BAHA hearing aids use a surgically implanted abutment to transmit sound by direct conduction through the bone in the skull (bone conduction) to the inner ear. By doing this, the sound bypasses the external auditory canal (ear canal) and the middle ear. Traditionally, a titanium prosthesis is surgically inserted into the skull with a small pillar exposed just outside the skin. Although this has changed in some cases in recent years with the introduction of subcutaneous (under the skin) magnetic plates. The magnetic plate is screwed into the skull and the surgical site is closed. There is no pillar visible with this type of configuration.

A BAHA sound processor is attached to the magnetic pillar or plate and transmits sound vibrations through it. The implant or magnetic plate, in turn, vibrates the skull and inner ear, which stimulates nerve fibers in the inner ear. By bypassing the underlying problem in the outer or middle ear, bone anchored hearing aids increase a person's ability to hear and localize sounds. Using a BAHA system also leaves the ear canal open, which can help reduce any problems caused by chronic ear infections, if that is the reason for implantation. In patients with single-sided sensorineural deafness, the BAHA device stimulates the healthy cochlea by sending the sound signal through the skull bone on the deaf side to the inner ear on the hearing side. This sound transfer offers 360° sound perception.

In a traditional BAHA device setup, the sound processor (a type of hearing aid) sits on top of the abutment and transmits sound vibrations to the titanium implant. The implant vibrates the skull and inner ear, which stimulates nerve fibers in the inner ear, allowing for better hearing. In the case of the magnetic plate, the sound processor is magnetically attached to the side of the head, but it works in the same way.

Who is the BAHA suitable for?

BAHA hearing aids are best suited for the following people:

  • Someone with chronic ear disease: Chronic ear disease is, in fact, relatively common and is associated with continuous or intermittent drainage of the ear canal. People with this problem often have an associated hearing loss and need amplification. A conventional hearing aid with an earmold is probably not the right solution here because of drainage. In fact, closing the ear canal with an earmold can cause ear infections that will increase rainfall. A bone conduction hearing aid will completely avoid the middle ear problem and leave the ear canal open.

  • Someone with single-sided deafness:a person withunilateral hearing lossYou may have trouble hearing even when your other ear is normal. Problems are particularly apparent in demanding situations, such as noisy environments or when several people are talking at once. A BAHA placed on the non-auditory side will allow for situational awareness and access to sounds on that side. However, most of the time, people with unilateral hearing loss can choose to use a CROS (Contra-Lateral Routing of Signal) hearing system.

  • Someone with external ear canal problems:Irritation in the external ear canal due to inflammation, psoriasis or eczema may mean that a traditional hearing aid is not suitable. A BAHA or other direct bone conduction hearing aid may be an option.

    (Video) Who is right for a Bone Anchored Hearing System? - SLUCare Audiology

  • Someone with malformations or missing auditory structures:People with malformations likeatresia (absence of the outer ear and/or ear canal) or microtia (malformation of the outer and/or middle ear)they are not always suitable for reconstructive surgery. For example, people withTreacher Collins syndrome (a genetic disorder characterized by deformities of the ears, eyes, cheekbones, and chin)may have significant malformations with ossicular defects and abnormal facial nerve routing. In essence, surgery can do more harm than good. Down syndrome patients can also have a narrow ear canal and a malformation of the middle ear that leads to hearing problems.

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Bone anchored hearing aids why, when, pros and cons (1)Bone anchored hearing aids why, when, pros and cons (2)Bone anchored hearing aids why, when, pros and cons (3)Bone anchored hearing aids why, when, pros and cons (4)Bone anchored hearing aids why, when, pros and cons (5)

How is BAHA surgery performed?

The surgery can be performed under local or general anesthesia and can be an outpatient procedure. A small incision is made in the scalp, the bone behind the ear is exposed through a straight or U-shaped incision. A hole 3 or 4 mm deep is made depending on the thickness of the bone. The hole is enlarged and the implant with the coupling mounted is inserted. The incision around the abutment is then closed. In the case of the magnetic plate, the same procedure is followed, but the incision is closed.

(Video) Bone Anchored Hearing Aid (BAHA) vs Hearing Aid

Some surgeons perform a subcutaneous soft tissue reduction. However, soft tissue reduction has been questioned and is performed minimally or not at all by some surgeons. Three to six weeks later, the audiologist will adjust the auditory processor according to the patient's hearing level.

fully reversible

Abutment placement is fully reversible, so if the BAHA is unsuccessful or rejected for any reason, the abutment can be easily removed.

Possible side effects of BAHA surgery

While there can be complications from BAHA systems, most of the time they are mild and not serious. Complications can be classified as bony (hard tissue) or soft tissue related. The following complications are possible but unlikely.

bone complications

  • Osseointegration failure (the implant fails to integrate with the skull bone)

  • chronic infection

  • Trauma

soft tissue complications

  • Irritation of the skin around the implant.

  • Cutaneous Flanecrosis (death of the skin flap)

  • Excessive skin growth on the device

  • Wound dehiscence (wound separation)

  • Bleeding or hematoma formation

  • persistent pain

Hard tissue or bone complications appear to be rare and soft tissue complications are much more common. Most of them are controlled with topical treatments. It appears that children are more likely to suffer from both types of complications than adults. Complications are less likely with good wound hygiene.

Bone anchored hearing aids why, when, pros and cons (6)

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Bone anchored hearing aids why, when, pros and cons (7)

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Manufacturers of Bone Anchored Hearing Aids

There are currently three manufacturers with FDA-approved bone anchored hearing aids: Oticon Medical, Cochlear, and Sophono (Medtronic). The devices fit children and adults differently, with a softband option available for children.

(Video) How Bone Conduction Hearing Aids Work | Cochlear BAHA, Oticon Medical Ponto, Medel ADHEAR

There are four providers of bone anchored hearing implants in the UK: Cochlear Europe, MED-EL ('Hearing Solutions' tab), Sophono (Medtronic) and Oticon Medical.

oticon doctor

Bone anchored hearing aids why, when, pros and cons (8)Oticon Medical is a member of one of the world's largest groups of hearing care companies, William Demant. They share a close relationship with Oticon (Demant's flagship hearing aid brand) and have direct access to Oticon's latest hearing technology and research.

The Oticon Medical BAHA systems are called Ponto and the processors are wireless enabled, allowing connection to the Oticon Connect Line portfolio of accessories. The Ponto system is fixed to a traditional type of abutment.

Bone anchored hearing aids why, when, pros and cons (9)

Point 4

Oticon introduces a new bone conduction hearing system they call the Ponto 4. The new Ponto 4 uses the Velox S chipset that powers their Opn S hearing aids. This means that the Ponto 4 must be Bluetooth enabled with direct connection to iPhones and connected to the Internet with the Oticon On app. The Ponto 4 will also use Oticon's OpenSound Navigator, made famous by the Opn and Opn S. It offers a completely new type of directionality that allows users to experience a more natural and nuanced sound experience.

Bone anchored hearing aids why, when, pros and cons (10)


Bone anchored hearing aids why, when, pros and cons (11)

Cochlear is a global manufacturer of BAHA devices, probably most famous for their cochlear implants and they dominate the world market for these products. They have over thirty years of experience and their current BAHA devices are the BAHA Connect system (first image below) which is equipped with a traditional abutment and the BAHA Attract system (second image below) which is equipped with a magnetic plate system.

Bone anchored hearing aids why, when, pros and cons (12)Bone anchored hearing aids why, when, pros and cons (13)

A bone-anchored click-on hearing aid

Cochlear announced the January 2018 introduction of a new device that is a non-surgical bone conduction option for children with conductive or mixed hearing loss or single-sided deafness (SSD) who are not yet eligible or ready for an implant. The new device offers real help for children who are simply not ready to face the surgery needed for a more permanent solution.

Bone anchored hearing aids why, when, pros and cons (14)

The device opens up the possibility of understanding the benefits that a bone conduction hearing aid will provide without the need for surgery.

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What are the disadvantages of bone-anchored hearing aids? ›

As with many procedures, there is a risk of infection and inflammation at the implant site after surgery. There is a small risk that the growth of new bone around the implant (osseointegration) will fail. If this happens the implant may fall out and you should seek advice from your audiologist on what to do next.

When would you use a bone-anchored hearing aid? ›

In general, bone-anchored auditory implants are appropriate for adults and children with conductive or mixed hearing loss in one or both ears, or certain cases of single-sided deafness (SSD).

What is negative about bone conduction? ›

Bone conduction headphones usually rest on your temples. Because of this, wearing bone conduction headphones can get uncomfortable or cause headaches. Some users have even reported vertigo or dizziness when using them. These effects are mostly due to the vibrations used to transmit the sound through the cheekbones.

What are the advantages of bone-anchored hearing aids? ›

A key advantage of the BAHA is that the ear canal is not occluded by ear-moulds, preventing humidity build up and skin irritation. Certainly, there are obvious advantages of the BAHA over air conduction hearing aids when there is no external ear canal, such as in cases of congenital or acquired external canal absence.

How long do bone anchored hearing aids last? ›

Because the device bypasses the middle ear and directly stimulates the cochlea, it has been recommended for individuals with conduction hearing loss or discharging middle ear infection. The titanium implant is expected to last a lifetime while the external sound processor is expected to last 5 years.

Can a bone anchored hearing aid be removed? ›

A BAHA can be placed on only one side of the ear, instead of having to have a device for each ear. The surgery is an outpatient procedure. If you decide in the future that the BAHA is not desirable, the internal piece can be surgically removed.


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