Bone Anchored Hearing Aids (BAHA)
Specialist Bone Conduction Hearing Solutions
What Are Bone Anchored Hearing Aids
A bone-anchored hearing aid (BAHA) is a type of hearing aid which uses bone conduction of sound to deliver better hearing. BAHAs are primarily used for people who have conductive hearing losses and people with single-sided deafness. Sometimes, they are used for people who cannot wear traditional types of hearing aids. 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, any complications are usually minor.
How BAHA Works
Bone-anchored hearing aids use a surgically implanted abutment to transmit sound by direct conduction through the skull bone to the inner ear. In doing so, the sound bypasses the external auditory canal (ear canal) and middle ear. Traditionally, a titanium prosthesis is surgically embedded into the skull with a small abutment exposed 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 visible abutment with this type of setup.
In a traditional BAHA setup, a sound processor (hearing aid of sorts) sits on the abutment and transmits sound vibrations to the titanium implant. The implant vibrates the skull and inner ear, which stimulate the nerve fibres of the inner ear, allowing better hearing. In the case of the magnetic plate, the sound processor is attached to the side of the head magnetically but works in much the same manner.
Who is BAHA Suitable For
Someone With chronic ear disease
Chronic ear disease is in fact relatively common and is associated with continuous or intermittent drainage from the ear canal. People with this problem often have an associated hearing loss and need amplification. A conventional hearing aid with an ear mould is probably not the right solution here because of the drainage. In fact, closing off the ear canal with an ear mould may cause ear infections which will increase drainage.A bone conduction hearing device will completely bypass the middle ear problem and leave the ear canal open.
Someone with single-sided deafness
A person with unilateral hearing loss may have difficulty hearing even when the other ear is normal. The problems are particularly evident in demanding situations such as noisy environments or when several people are speaking the same time. A BAHA placed on the side with no hearing will allow situational awareness and access to sounds from that side. More often than not though, people with single-sided hearing loss may choose to use a CROS (Contra-Lateral Routing of Signal) hearing aid 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 appropriate. A BAHA or other direct bone conduction hearing aid could be an option.
Someone with malformations of, or absent ear structures
People with malformations such as atresia (Absence of the outer ear and, or, ear canal) or microtia (Malformation of the outer and, or, middle ear) are not always suitable for reconstructive surgery. For instance, people with Treacher Collins syndrome (A genetic disorder characterized by deformities of the ears, eyes, cheekbones, and chin) may have significant malformations with ossicular defects and an abnormal route of the facial nerve. In essence, the surgery could do more damage than good. Patients with Down syndrome may also have a narrow ear canal and middle ear malformation leading to impaired hearing.
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How is BAHA Surgery Performed?
The surgery can be performed under local or general anaesthesia and can be an outpatient procedure. A small incision in the scalp is made, the bone behind the ear is exposed through a U-shaped or straight incision. A hole, 3 or 4 mm deep depending on the thickness of the bone, is drilled. The hole is widened and the implant with the mounted coupling is inserted. The incision is then closed around the abutment. In the case of the magnetic plate, the same procedure is followed but the incision is closed up.
Some surgeons perform a reduction of the subcutaneous soft tissue. However, reduction of the soft tissue has been questioned and some surgeons do not perform any or the very minimum of it. Three to six weeks later, the audiologist will fit and adjust the hearing processor according to the patient's hearing level.
The placement of the abutment is completely reversible, so if for some reason the BAHA proves unsatisfactory or is rejected, the abutment can be removed simply.
Possible Side effects of BAHA Surgery
While there may be complications of BAHA systems, they are more often than not mild rather than severe. The complications can be classified as related to the bone (hard tissue) or the soft tissue. The following are possible if unlikely complications.
Failure of osseointegration (implant does not integrate with skull bone)
Irritation of the skin surrounding the implant
Skin flap necrosis (death of the skin flap)
Overgrowth of skin over the device
Wound dehiscence (splitting apart of the wound)
Bleeding or hematoma formation
Hard tissue or bone complications appear to be rare and soft-tissue complications are much more common. Most of them are managed with topical treatments. It appears that children are more likely to suffer both kinds of complications than adults. Complications are less likely with good wound hygiene.
Bone Anchored Hearing Aid Manufacturers
Currently, there are three manufacturers with FDA-approved bone-anchored hearing devices: Oticon Medical, Cochlear and Sophono (Medtronic). The devices fit differently for children and adults, with a soft band option available for children.
There are four suppliers of Bone Conducting Hearing Implants in the UK: Cochlear Europe, MED-EL (Tab "Hearing Solutions"), Sophono (Medtronic) and Oticon Medical
Oticon Medical is a member of one of the world’s largest groups of hearing healthcare companies, William Demant. They share a close link with Oticon (Demant's main hearing aid brand) and they have direct access to the latest advancements in hearing research and technologies from Oticon.
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 affixed to a traditional type of abutment.
Cochlear is a global manufacturer of BAHA devices, they are probably more famous for their Cochlear Implants and they dominate the world market for those products. They have over thirty years of experience and their current BAHA devices are the BAHA Connect system (First image below) which is fitted with a traditional abutment and the BAHA Attract system (second image below) which is fitted with a subcutaneous magnetic plate system.
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