Bone-Anchored Hearing Aid

What is a bone-anchored hearing aid (BAHA)?

Traditional hearing aids amplify sound through your middle ear. In contrast, a bone-anchored hearing aid (BAHA) is a surgically implantable device. It sends soundwaves through the bones of your skull directly into the cochlea (a spiral structure in your inner ear that plays a key role in hearing). Another name for this device is bone-anchored hearing implant (BAI). While BAI is the medically correct term, people use BAHA and BAI interchangeably.

A bone-anchored hearing aid may restore partial hearing in people with certain types of hearing loss or those who aren’t good candidates for traditional hearing aids.

A BAHA traditionally consists of three parts:

1. Titanium implant.
2. External connector.
3. Sound processor.

Types of bone conduction hearing systems

There are two main types of bone conduction hearing systems:

• Surgically implantable bone-anchored hearing aids (BAHA). This is the most common type. A surgeon places a small titanium implant in the bone behind your ear. Once the implant heals, you can attach the external sound processor to restore your hearing. You can remove the processor when you’re sleeping, showering or having hair treatments.
• Nonsurgical bone conduction hearing aids (BCHA). Providers typically recommend nonsurgical bone conduction hearing aids (BCHA) for children under age 5 and people who don’t want surgery. Some bone conduction hearing aids attach directly to your skin with adhesive. Others attach to a headband that you can wear as needed.

Your otolaryngologist (ENT) and audiologist can help determine which option is right for your situation. Bone-anchored hearing aid candidacy depends on several factors, including your age, medical history, type of hearing loss and personal preferences.

During an office visit with your healthcare provider, you can try out a nonsurgical BCHA. This helps you get an idea of how this type of hearing system works before you have surgery.

Conditions treated with BAHA hearing aid

BAHA hearing aids may work for people with:

• Conductive or mixed hearing loss (when sound doesn’t travel through your ear as it should).
• Single-sided deafness (one ear has hearing, the other has little to no hearing).

These types of hearing loss can result from conditions like:

• Chronic middle ear infections.
• Cholesteatoma.
• Acoustic neuroma.
• Ménière’s disease.
• Malformation of your outer ear or middle ear (aural atresia).

To find out if you’re eligible for a bone-anchored hearing aid, talk to your healthcare provider. They can refer you to an otolaryngologist for an evaluation.

What happens during bone-anchored hearing aid surgery?

This type of procedure usually takes between 30 to 60 minutes, depending on the type of bone-anchored hearing system you receive.

During bone-anchored hearing aid surgery, an otolaryngologist will:

1. Give you anesthesia to keep you comfortable. (This might be local or general anesthesia, depending on your situation.)
2. Make a small incision (cut) in the skin behind your ear.
3. Create a small hole directly behind your ear, in your mastoid bone (part of your skull).
4. Place a small titanium implant directly behind your ear, in your mastoid bone. The implant itself measures about three to four millimeters in diameter. That’s about half the size of a pea.
5. Place an abutment (connector) to the implant. (Your skin will heal around the connector, so it sticks out slightly.)
6. Close the incision with stitches and place surgical dressing.

Bone-anchored hearing aids rely on osseointegration. During this process, your bone fuses to the titanium implant, providing stability. This fusion must occur before you can attach the sound processor to the external connector. Healing times vary due to the type of BAHA you choose and your body’s healing capacity. But generally, this process takes about one to three months.

What are the pros of bone-anchored hearing aids (BAHA)?

Bone-anchored hearing aids offer several advantages, including:

• Better comfort. Unlike traditional hearing aids, you don’t have to put anything in your ear canal. This results in a more comfortable fit. It also reduces your risk for skin irritation.
• Optimal sound quality. Your skin won’t dampen the bone-conducting signal, resulting in better sound quality.
• Better prediction of results. Because you can try a nonsurgical BAHA during an office visit with your healthcare provider, you’ll have an idea of what to expect once you recover from surgery.

What are the cons of bone-anchored hearing aids (BAHA)?

The main disadvantage of bone-anchored hearing aids is that they require surgical placement. BAHA surgery is a minimally invasive procedure. But like all surgeries, it does carry some risk.

Possible complications may include:

• Inflammation.
• Infection.
• Implant failure (when your bone doesn’t properly fuse to the implant).

In addition, if people with bone-anchored hearing aids sustain head trauma (like a blow to the head), there could be more serious consequences. This could include infection, implant failure or repeat surgery. To reduce your risk for this type of trauma, wear a helmet while playing contact sports or while riding a bike or motorcycle.

How long will it take to recover after bone-anchored hearing aid surgery?

Initial recovery takes about three to seven days. During this time, you may have some soreness and redness around the implant site.

You won’t be able to use your BAHA hearing aid right away. You’ll need to wait until your bone fuses to the titanium implant. Once this happens, your provider will attach the external sound processor to your implant and customize the settings to restore your hearing. They’ll also show you how to remove and reattach your processor properly.

When should I call my healthcare provider?

If you’ve recently had bone-anchored hearing aid surgery, call your provider if you develop:

• Infection, swelling or drainage at the implant site.
• Ear pain that doesn’t get better with medication.
• Fever over 101 degrees Fahrenheit (38.3 degrees Celsius).

What is the success rate of bone-anchored hearing aids?

BAHA hearing aids offer impressive results. Research studies indicate success rates of 90% or higher.

What’s the difference between a cochlear implant and a bone-anchored hearing aid?

A BAHA hearing aid sends soundwaves to your inner ear, where the bones in your skull vibrate to help you hear. In contrast, a cochlear implant bypasses your inner ear and directly stimulates your auditory nerve. People who have inner ear damage may benefit from cochlear implants.

A note from Cleveland Clinic

Hearing loss can have a significant negative impact on your quality of life. It can feel disappointing and frustrating, especially if you’ve tried traditional hearing aids with limited success. Bone-anchored hearing aids use bone conduction rather than amplification to restore hearing in people with certain ear conditions and types of hearing loss. BAHA devices are minimally invasive and have high success rates. You can choose from several nonsurgical and surgical options, based on your specific needs and preferences. Talk to your otolaryngologist or audiologist to find out if a BAHA is an option for you.