Millions of people use hearing aids to treat hearing loss. However, traditional hearing aid technology may not work for all hearing problems. Bone-anchored hearing aids (BAHA) are surgically implanted hearing devices used to help people with atypical forms of hearing loss.
This guide will tell you about BAHA devices, what they are, how they work, and who can benefit from them.
What Is a Bone-Anchored Hearing Aid?
A bone-anchored hearing aid is a surgically implanted device placed into the bone behind the ear. Bone-anchored hearing systems bypass the outer and middle ear to carry sound waves to the inner ear via bone conduction.
How Do Bone-Anchored Hearing Aids Work?
A BAHA hearing device has three components:
- Titanium implant
- External abutment
- Sound processor
The titanium implant is placed inside the skull bone behind the ear, and the abutment connects it to a sound processor. The sound processor captures external sounds and transfers them to the inner ear through bone conduction.
When Are BAHA Devices Recommended?
Traditional hearing aids are the first choice for treating the most common types of hearing loss. They are less invasive or expensive than a BAHA system. However, they don’t work well for everyone.
Conductive Hearing Impairment
Conventional hearing aids compensate for damage in the inner ear by amplifying and enhancing sound carried through the air, but this won’t be effective for people with serious problems in the outer or middle ear, also known as conductive hearing loss.
People with conductive hearing loss caused by the following conditions may be candidates for a BAHA hearing device:
- Deformities of the ear canal (congenital aural atresia)
- Fluid build-up due to chronic ear infections (otitis media)
- Benign ear growths (acoustic neuroma and cholesteatoma)
- Mastoid cavities
- Meniere’s disease
- Middle ear disorders
Single-sided deafness refers to hearing loss in one ear that can’t be treated with regular hearing aids.
BAHA devices can help people with single-sided deafness by capturing sound waves from the side of the deaf ear and transmitting them directly through the skull bone to the normal-hearing ear.
Identifying Candidates for BAHA Implants
You’ll need to get your hearing loss diagnosed via a professional audiology exam to see if you’re a good candidate for a BAHA implant.
An audiologist will perform a battery of tests, including a bone conduction hearing test. They will transmit tones via direct bone conduction and the air to determine which you can hear better. People with normal hearing can hear sounds better through air conduction.
The difference between the two scores is called the “air-bone gap.” A significant air-bone gap signifies conductive hearing loss.
BAHA implants are appropriate for unilateral deafness and conductive or mixed hearing loss. Before recommending a BAHA device, the audiologist will consider the following criteria:
- Conductive hearing loss severity: People with an air-bone gap of more than 30-35 decibels benefit the most from a bone-conduction implant.
- Degree of sensorineural hearing loss: Those with mixed hearing loss may benefit from a BAHA device if their inner ear isn’t too damaged or degraded. A BAHA sound processor can compensate for a damaged but functioning cochlea so long as the hearing loss doesn’t exceed 65 decibels.
- Alternative treatment options: Some conductive hearing problems can be reversed medically through surgery or other treatments. The audiologist may refer you to an ENT physician for examination and testing before recommending BAHA implants.
- The extent of hearing loss in the good ear: Patients with single-sided deafness may be good candidates, provided there isn’t significant hearing loss in the other ear.
BAHA Implants vs. Other Hearing Devices
A casual observer might have a hard time distinguishing between a bone-anchored hearing device and other assistive technologies.
However, bone-anchored hearing systems are unique in form and function.
Traditional Hearing Aids
At first glance, the BAHA sound processor might be mistaken for a behind-the-ear hearing aid, but the mechanisms are quite different.
Unlike a conventional hearing aid, which transmits sound via air conduction, a BAHA implant channels sound signals from the sound processor directly into the mastoid bone via a small titanium implant.
Bone Conduction Hearing Aid
Before the bone-anchored systems were developed, conductive hearing loss was primarily treated with a bone conduction hearing aid. A bone conduction device uses a steel spring headband instead of an internal implant to transfer sound vibrations to the bone. While this is less invasive than a bone-anchored device, the headband is uncomfortable, and the sound quality is worse.
Cochlear implants are structurally similar to BAHA devices. They both utilize sound processors and implants, but a cochlear implant is connected to the auditory nerve instead of the bone.
The external sound processor of a cochlear implant converts the auditory signal into an electrical signal to directly stimulate the hearing nerve, whereas a BAHA implant carries the sound vibrations to the inner ear.
Pros and Cons of BAHA Implants
Before deciding if BAHA devices are right for you, carefully weigh their advantages and drawbacks. Here are some things to consider.
- Better speech recognition: One study showed an 89 percent improvement in speech recognition among participants who used BAHA systems compared to 67 percent in subjects who used a traditional hearing aid.
- Enhanced sound quality: Research shows that patients with BAHA devices report better sound quality—even with background noise.
- Doesn’t block the ear canal: Unlike hearing aids, bone-anchored auditory implants do not block the ear canal. People who wear hearing aids are more prone to infections, irritation, and ear wax blockage due to the increased humidity.
- More comfortable: BAHA sound processors are practically weightless and don’t irritate the skin like the headband of a bone conduction hearing aid
- BAHA surgery is relatively low risk and minimally invasive: The surgery takes about four hours, and the patient can begin using the device in roughly six weeks.
- General anesthesia risks: Since the procedure requires a general anesthetic, there are standard risks of adverse reactions.
- Surgery complications: While the procedure is relatively safe, complications like cerebrospinal fluid leakage or sigmoid sinus bleeding can occur, but these are rare.
- Implant can become dislodged: Severe head trauma can cause the implant to fall out, requiring a new surgery. Head protection is recommended for martial arts and other impact sports.
- Scarring around the implant site: Everyone will develop some scar tissue, but some people are prone to heavier scarring than others.
- Infections: The external abutment may develop infections if not cleaned thoroughly and regularly.
- Bone doesn’t fuse properly with the implant: A BAHA device uses an osseointegrated titanium implant, meaning the bone will fuse with the device. In rare cases, this may not occur as intended.
How Is a BAHA Device Implanted?
A BAHA implantation surgery can take up to four hours. This surgical procedure is performed under general anesthesia by an ENT physician.
Some surgeons may prefer local anesthesia. The surgeons make an incision in the skin and drill into the skull. The fixture is implanted. Doctors then screw the abutment onto the fixture.
A healing cap is sutured and removed on the tenth day after surgery. The sound processor is then installed six weeks after the surgery. This allows the fixture to integrate into the bone. The audiologist will activate the processor when you see them for a follow-up visit.
Frequently Asked Questions
Since you’re considering a bone-anchored hearing aid, here are a few frequently asked questions.
How Much Does a BAHA Implant Cost?
A BAHA costs around $10,000 on average, but the cost may vary depending on the hospital, surgeon, device, and insurance coverage.
Can I Try This Device First?
You can try the BAHA sound processor using a bone conduction band to see how it works in different sound environments. It doesn’t precisely recreate the full benefits of a BAHA implant, but it will give you some idea of what to expect.
Can I Wear It All the Time?
You can wear it during all your regular activities, but the sound processor isn’t waterproof, so you should remove it while swimming or showering. Most people also take it off while sleeping for comfort. If you are involved in contact sports or martial arts, you may need a covering to protect it.
How Long Does Recovery Take?
After the operation, you can head home the same day and return to work the next. Any pain is temporary and can be relieved with medications. In the rare event of complications, the surgeon may advise you to rest in bed for a few days.
Are BAHA Implants Suitable for Kids?
BAHA devices are approved by the FDA for children over 5.
Are BAHA Implants Compatible With Phones?
BAHA systems are compatible with hearing loop systems, and you can use them with any type of phone. However, phones may cause feedback if they are too close to the sound processor.
BAHA implants are an effective way to treat unilateral hearing loss and hearing disorders in the outer or middle ear that can’t be helped by traditional hearing aids. While they are considerably more expensive, BAHA implants offer better results than most hearing devices.
When deciding whether to get BAHA implants, consider the costs and surgical risk. While the procedure is fast and safe, complications are always a possibility. At the same time, a cheaper and less invasive option may be available. Consult an audiologist or ENT.
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2. Wazen JJ, Ghossaini SN, Spitzer JB, Kuller M. Localization by unilateral BAHA users. Otolaryngol Head Neck Surg. 2005;132(6):928-932. doi:10.1016/j.otohns.2005.03.014