Bone-anchored hearing systems

Contributed by Joy Victory, managing editor, Healthy Hearing
This content was last reviewed on: March 11th, 2019 2019-03-11 00:00:00 Bone-anchored hearing systems are implantable devices that treat hearing loss. Learn how they work and whether this system may be right for you. 2019 1299 Bone-anchored hearing systems

Bone-anchored hearing systems are implantable devices that treat hearing loss. Learn how they work and whether they may be right for you.

Sometimes, hearing aids are not the best option for people with hearing loss, and bone-anchored hearing systems are suggested as a more suitable option. Yet, many people aren't aware of what they are and how they work. 

This woman is wearing the Ponto bone-anchored hearing aid from Oticon Medical.
The Ponto System from Oticon Medical,
seen here, is a bone-anchored hearing
system that fits behind the ear. 
(Photo courtesy Oticon Medical.)

The biggest difference from typical hearing aids is that bone-anchored hearing systems are surgically implanted devices. They treat hearing loss through bone conduction of sound vibrations to the inner ear—in contrast to regular hearing aids, which amplify acoustic sounds that enter the ear canal. For this reason, bone-anchored systems are considered specialty devices for certain hearing loss conditions, which are described below. 

Bone-anchored hearing systems are not to be confused with cochlear implants. While they are also a type of surgically implanted device for hearing loss, they are used for different hearing problems. To learn more, see our page on cochlear implants

Here's what to know:

Why bone-anchored hearing systems?

Bone-anchored hearing systems work best for people who have at least one inner ear that functions normally. They may have conductive hearing loss (their outer or middle ears do not transmit sound correctly) or complete hearing loss in one ear only.

These types of devices bypass particular problems by sending sound vibration directly to the inner ear through the skull bone. This can be helpful because middle ear and ear canal problems might prevent sound waves and signals from reaching the inner ear. In those cases, standard hearing aids are ineffective. 

The most likely candidates for bone-anchored hearing devices are children or adults who have severe outer or middle ear malformations, or those with single-sided deafness.

That's why people who typically get the greatest benefit from bone-anchored hearing systems include those who have severe outer or middle ear malformations and those with single-sided deafness. This type of hearing solution also may be recommended in extreme cases of chronic ear infections or allergies to traditional hearing aids. 

Malformations of the outer or middle ear

Malformations of the ear canal or middle ear, such as narrowing of the ear canal or a malformed or absent pinna (external ear) cause conductive hearing loss. These malformations are often congenital, or present at birth. A bone-anchored hearing solution delivers sound vibrations directly to the inner ear by being in direct contact with the skull bones. EarCommunity.org has a photo gallery of people with these conditions wearing bone-anchored hearing systems.

Single-sided deafness

Single-sided deafness (SSD) is a condition in which a person has lost all hearing in one ear, while having anywhere from normal hearing to profound hearing loss in the other ear. Single-sided deafness makes it difficult to determine which direction sound is coming from (localization) and diminishes the ability to understand speech in noisy environments. 

Common causes of SSD include acoustic neuroma (a tumor on the hearing nerve), Meniere's disease or sudden sensorineural hearing loss. If you have single-sided deafness, you can wear a special pair of hearing aids that route sounds from the poorer hearing side to the better hearing side (called a CROS device), but a bone-anchored hearing device may be preferable because it requires the use of only one discreet device. 

Other reasons to wear a bone-conducted hearing device

Because a bone-anchored hearing device does not block the ear canal, there are other, rarer conditions that might warrant this type of hearing treatment. For example, people with chronic ear infections may have difficulty wearing traditional hearing aids if they experience drainage of fluids from the middle ear into the ear canal. People who have extreme allergies to the materials used to fabricate custom hearing aids and earmolds may also prefer a bone-anchored system.

How does it work?

How bone-conduction devices transmit sound.
How sound is transmitted through a
bone-anchored hearing system.
(Photo courtesy Oticon Medical.)

Bone-anchored hearing devices have two parts: a titanium bone implant and an external sound processor. The external microphone and sound processor of the bone-anchored device picks up sounds and converts them into vibrations to the embedded implant. In turn, the implant vibrates the surrounding bone, which sets up sound waves in the inner ear that stimulate the hair cells and result in the firing of the auditory nerve.

What happens during surgery?

During an outpatient surgical procedure, an ear-nose-throat doctor or other surgical specialist places a small titanium implant (3-4 mm) into the mastoid bone behind the ear. The implant may have a small abutment that sticks out through the skin for attaching the external part of the device. Over time, the titanium implant integrates with the bone. The removable microphone and sound processor can then be attached via a built-in magnet or by clipping onto the abutment. 

The goal is that all parts fit snugly together, as a snug fit helps hearing implants convey vibrations through the bone more effectively

If you're considering a bone-anchored device, but first want to get a sense of if this type of device would work well for you, your doctor or audiologist may let you try out traditional bone conduction hearing aids (which don't require an implant or any surgery). Or, they may help you try out simulation devices.

Can you hear right away?

The skull and skin have to heal before the external device can be clipped on or magnetically connected. The time needed for healing is specified differently by each manufacturer, from 3 weeks to 3 months. Once the external device is attached, it can be programmed for the patient's specific hearing loss. Wearing a bone-anchored hearing system would be similar to wearing an acoustic hearing aid at this point—there may be some adjustments needed as the patient gets accustomed to hearing and listening to amplified sounds.

On the market

Currently, there are three manufacturers with FDA-approved bone-anchored hearing devices: Oticon MedicalCochlear Americas and Sophono (Medtronic). Each device brand fits a little differently but they're all placed behind the ear on the mastoid bone. Children may require a soft headband to ensure the device stays in place during active play. 

What is a BAHA?

People sometimes refer to any brand of bone-anchored hearing devices as a BAHA (short for "bone-anchored hearing aids"). However, BAHA™ also is the name of a specific brand of bone-anchored hearing aid, made by the Cochlear Americas company. People also may refer to any of the several brands as a "bone-anchored hearing device," or a "bone-anchored hearing system" (BAHS).

If you think you may be a candidate for a bone-anchored hearing system and you would like to find out more, contact a hearing care professional for a hearing test.

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