Bone Conduction Implants

Bone conduction technology allows sound vibrations (sound energy) to bypass the outer and middle parts of the ear to reach the inner ear (cochlea), where the process of carrying sound signals to the brain proceeds. Bone conduction technology does not require you to have a functioning outer ear, ear canal, ear drum or ear bones to hear well.

How a Bone Conduction Implant Works

All bone conduction implants work by sending sound energy (vibrations) through the bone of the skull to stimulate the cochlea directly. For all systems, there is an internal implant that is placed into the bone behind your ear and a sound processor that is worn externally. The sound processor picks up the sound and sends it to the implant. A vibration is created which stimulates the hearing organ, the cochlea. The sound then travels through the hearing nerve to the brain. There are two main types of bone conduction implants:

• Percutaneous: With these implants, there is a small titanium abutment (post) that passes through the skin. The processor snaps onto this abutment. The Cochlear Americas BAHA Connect and Oticon Medical Ponto systems are percutaneous.
• Transcutaneous: With these systems, the implant is fully covered by the skin and tissue. The external processor attaches to the implant magnetically and transmits the signal through the skin. The Osia, Sentio and Bonebridge are transcutaneous.

Our team will help you determine which type of bone conduction implant is the best option for you based on your anatomy, hearing loss and lifestyle.

Types of Bone Conduction Implants

There are several different manufacturers and types of bone conduction systems available. Currently available systems include:

• Cochlear Americas (not a cochlear implant)
  • BAHA Connect
  • Osia
• Oticon Medical
  • Ponto
  • Sentio
• Med-El
  • Bonebridge

Who Should Consider a Bone Conduction Implant

A bone conduction implant may be the best treatment option if you have:

• Chronic middle ear disease such as cholesteatoma, infections and/or middle ear fluid
• Narrowing of your ear canal (ear canal stenosis)
• Atresia and/or microtia (born without an ear canal or outer ear)
• No longer have an outer ear because of trauma or cancer
• Conductive or mixed hearing loss
• Your middle ear bones are not functioning appropriately, either due to trauma or disease
• Unilateral (one-side) profound sensorineural hearing loss, particularly if the hearing loss is caused by a tumor or other injury to the hearing nerve

Bone Conduction Implant Process

We perform a comprehensive evaluation to ensure that a bone conduction implant is the right choice for you. Your evaluation typically includes the following steps:

• Audiology evaluation and discussion (about 90 minutes): You will undergo a full hearing test. The audiologist will then review which bone conduction options are best for you given your history, lifestyle and hearing loss. You will also have the opportunity to listen to a bone conduction processor on a headband. This will give you an idea of how you will hear after surgery.
• CT scan (about 30 minutes): Depending on your past medical and/or surgical history, you may be asked to complete a CT scan. This may be important in evaluating the quality of the bone that your bone conduction implant will go into.
• Medical evaluation (about  30 minutes): You will meet with your bone conduction implant surgeon. They will review your audiology results and, if applicable, your CT scan, discuss the surgery and recovery and explain potential surgical risks.
• Scheduling surgery: Once all evaluation steps are complete and you decide to proceed, our team will contact you — typically within 1 to 2 weeks after your surgical consultation — to schedule your surgery.
• Preoperative medical clearance appointment (about 30 minutes): This visit occurs within 30 days of surgery to ensure you are medically ready for the surgery.

Bone Conduction Implant Surgery

Here is what happens during bone conduction hearing implant surgery.

• An incision is made in the scalp behind the ear, usually about 3 to 6 cm in length depending on the device type.
• The surgeon gently exposes the skull bone (temporal bone) and prepares a small, precise opening in the outer layer of the bone. This allows secure attachment of the implant that will transmit sound vibrations directly to the inner ear through bone conduction.
• For some devices (such as percutaneous systems), a small connector passes through the skin, so the sound processor can attach externally. For other devices (magnetic or fully under-the-skin systems), the implant sits completely beneath the skin and communicates with the external processor across the skin using magnets.
• The internal implant is secured to the skull bone with a small titanium fixture or plate designed to bond with the bone over time (a process called osseointegration).
• The implant is tested to confirm stability and proper function.
• The incision is closed using dissolvable stitches. A protective dressing or head wrap may be placed over the area to protect the surgical site during early healing.
• The external sound processor is fitted later by your audiologist, after the area has healed, and the implant has fully integrated with the bone.

Recovering From Surgery

Patients typically have a smooth recovery following bone conduction implant surgery. Here’s what to expect.

• Go home the same day: Bone conduction implant surgery is usually outpatient. You will need a responsible adult to drive you home and stay with you for 24 hours.
• Expect some swelling, bruising and numbness around the ear and incision. This is normal and improves with time. Numbness may linger for several months.
• Pain is usually mild to moderate and most often managed with Tylenol or Ibuprofen (if allowed). Narcotic medication, if prescribed, is usually needed only for a few days.
• Keep the incision clean and dry: You may gently wash your hair after 48 hours but avoid scrubbing or soaking the incision.
• Do not use antibiotic ointments like Neosporin or Bacitracin on the incision unless instructed. This can cause a rash. Instead, use unmedicated white petroleum jelly (e.g., Vaseline).
• Avoid heavy lifting, strenuous activity and contact sports for about 4 weeks. Light walking is strongly encouraged as soon as you feel able.

As with all surgeries, there are some risks that come with bone conduction implant surgery. These are rare but can include:

• Infection at the incision site
• Bleeding
• Pain and/or numbness
• Cerebrospinal fluid (CSF) leakage

Bone Conduction Implant Activation: Turning on the Bone Conduction Implant

You will see your audiologist after surgery to turn your bone conduction implant on. This appointment is about 4 to 12 weeks after surgery depending of the type of implant you have chosen.

At this appointment, your audiologist will:

• Fit the sound processor.
• Complete initial programming. The audiologist will play sounds (like beeps) through your bone conduction implant and ask you to raise your hand when you hear them. This is like a hearing test.
• Make adjustments for volume and sound quality so you can wear your implant all waking hours. 
• Go over how to use and take care of your sound processor.

Bone Conduction Implant Follow-Up 

Following up with your bone conduction implant is important to ensure you are continuing to heal well and to make adjustments to the programming (settings) of your bone conduction implant. This ensures you have good access to sound and helps improve sound quality and speech understanding. Our current follow-up schedule is:

• 2-week post-activation (90 minutes)
• 1-year post-activation (90 minutes)
• Regular follow-up every 1 to 3 years (90 minutes)

At these appointments, you may have some testing in the sound booth to see how you are detecting sounds with your bone conduction implant and how well you are understanding speech. Programming adjustments may be made based on testing results as well as your report about the loudness and quality of the sound.

Benefits of Bone Conduction Implants

Bone conduction implants improve hearing and quality of life for many patients. Benefits may include:

• Decreased issues with ear canal drainage and ear infections associated with the use of a conventional hearing aid use, if applicable
• Improved speech understanding
• Enhanced quality of life
• Reduced listening fatigue
• Improved social engagement
• Better awareness of sounds in the environment, which may have positive safety implications
• Improved ability to locate the source of sounds
• Decreased tinnitus while wearing the sound processor

It is important to remember that even with a bone conduction implant, you may still struggle to understand speech in certain environments.Background noise makes understanding more difficult for everyone and will still be challenging, even with an implant.

Insurance and Costs

Bone conduction implants are covered by most insurance companies if you meet their criteria, including Medicare and WI Medicaid.

At your evaluation, your audiologist will be able to tell you if you meet candidacy guidelines. Once you have a surgery day scheduled, we will be able to submit to your insurance company for authorization.

We recommend you reach out to your insurance company to make sure you understand your insurance coverage including your deductible, co-insurance and out-of-pocket maximum. This will help you estimate how much you may have to pay.

In addition to surgery, most insurance companies help cover the costs of repairing and/or replacing your external equipment including the batteries.