BAHA (bone-anchored hearing aids) bypass the outer ear and the ear canal to provide hearing support. This option surgically implants the system to provide treatment by creating bone conduction of sound vibrations. It is an alternative to the traditional hearing aids which amplify the acoustics in the environment as they travel through the ear canal.
The first BAHA systems were developed in the 1960s by Dr. Per-Ingvar Branemark, using titanium screws that would meld and grow with bone in the skull to create an anchor without dense connective tissues getting in the way. After using his techniques on facial reconstruction procedures, he transitioned the work to hearing care, forming the first bone-anchored hearing aid industry in history.
Mona Anderson would become the first patient fitted with a BAHA hearing aid in 1977. Once it was implanted successfully, she said that she could hear birds singing for the first time since her childhood. These products have been available commercially since 1987.
If you’re struggling with hearing loss and are looking for options other than an amplification product, then here are the BAHA hearing aid pros and cons to review.
List of the Pros of the BAHA Hearing Aid
1. It provides hearing assistance for those with chronic ear disease.
Chronic ear disease creates intermittent or continuous drainage and damage for the ear canal. This issue creates a hearing loss, requiring amplification to push sounds through for full recognition. Any time ongoing drainage occurs because of this disease, a traditional hearing aid is not the best option as it would increase the risk of infections. The bone conduction feature of the BAHA hearing aid bypasses this issue, providing hearing support with the ear canal open to bypass the concerning health issues.
2. It helps individuals with single-sided deafness.
One option for people with a non-hearing ear is to use a CROS hearing aid. This technology takes the sounds on the ear that doesn’t hear, then transfers them over to the hearing one so that both sides are heard. The BAHA system offers a different option. When placed on the side without hearing, there is more access to sounds and better situational hearing available. This makes it easier to hear during noisy situations where sounds might be missed otherwise.
3. It avoids issues with external ear health that could interfere with hearing.
People who struggle with eczema, psoriasis, or inflammation in or around their ear canal are often not good candidates for a traditional hearing aid. The BAHA system provides added hearing support through the direct bone conduction while the ongoing skin conditions are treated in other ways. Even if the inflammation clears up, there is never a need to remove the hearing aid if a relapse occurs because it bypasses the middle ear altogether, allowing for consistent results.
4. It helps people hear when there are malformations or absent ear structures present.
People diagnosed with atresia, which is the absence of an ear canal and, or the outer ear; microtia, which is a malformation of ear structures; and Treacher Collins syndrome, which is a genetic disorder which creates malformations of the chin, cheekbones, eyes, and ears all have the option to be treated with BAHA hearing aids. Instead of pursuing reconstructive surgery, which may not be recommended in the first place, these individuals can still receive hearing support through this unique method.
5. It provides hearing support for individuals with Down’s Syndrome.
When individuals are born with Down’s Syndrome, there is often a narrowing of the ear canal which impacts their hearing. There could be middle ear malformations which impact how they hear too. The BAHA hearing aid works around these issues to create better long-term hearing through the vibrations created.
6. It is a reversible procedure.
The BAHA hearing aid is a reversible procedure, even though it is a surgically-implanted hearing aid. If you don’t like the results it offers, or if the device is rejected for some reason, then the abutment used to create sounds is removed.
The surgery to place the hearing aid can be an outpatient procedure. It is performed under local anesthesia, though general anesthesia is necessary for some patients. Then a small incision is made in the scalp to expose the bone behind the ear. Then a small hole, up to 4mm deep, is drilled, then widened, to allow placement. The incision is then closed around the abutment. Between 3-6 weeks later, the audiologist will then fit and adjust the hearing processor to the exact needs of the patient.
7. It is a procedure which continues to develop in technique.
Although the aesthetics of the BAHA hearing aid are something that younger patients may not appreciate, the technique to install the abutment has evolved over the years to reduce the risks of infection. Surgeons have learned various ways to support the thin skin which surrounds the implant, decreasing infection risks immediately after surgery and for the long-term.
8. It offers a higher level of user satisfaction.
Despite the need for surgical implantation, patients who choose the BAHA hearing aid over a CROS system are usually happier with the long-term results achieved for their hearing. The bone conduction transmits sound through a useful band of sound frequencies which encompass many of the phonetic sounds of human languages. That helps patients filter sounds from the side where they have an impairment while limiting noise inputs at the same time. This design creates less confusion when processing the audio heard by the patient.
9. It routes the sounds in the environment with greater efficiency.
The BAHA system delivers a sound which is stronger and clearer than a traditional hearing aid or a CROS system because it offers a better route for processing. Instead of dealing with amplification, which makes the noises louder, or a Bluetooth type of a system which transmits audio through an antenna for it to be heard, BAHA delivers audio in a way that feels natural to the user. There is less distortion because of this design, which means more sounds feel authentic to the individual.
10. It doesn’t require an ear mold.
According to the Triological Society, some youth and teens don’t like the BAHA hearing aid because it makes them look like “Frankenstein.” If that aesthetics issue doesn’t get in the way, there is the advantage that an ear mold isn’t required with this hearing aid system. Because it is worn off the ear, it tends to be more comfortable for patients once the healing process from the surgery is complete. That means it is easier to disguise this system if it is bothersome than it is with others.
11. It will not place pressure against the skin or skull.
After the abutment heals into the bone when surgically placed, patients will not experience the same feelings of pressure or pain against their skin and skull with the BAHA device. It uses similar advanced technologies to transmit audio to the individual as other systems without the need to wear multiple devices at once to generate results. Nothing goes into your ear canal. You’re not required to have something fit over your ear either, which could interfere with your glasses.
12. It stays in place.
Multiple studies and trials of BAHA devices have found the success rate for abutment implantation to be 100% dating as far back as 2006. Although inflammation occurs underneath the device for some patients, the vast majority of people find that this stable implant offers them access to sounds which were not possible in the past.
List of the Cons of the BAHA Hearing Aid
1. Although it is a procedure which is usually successful, it may not be for some patients.
Complications with the BAHA hearing aid procedure are unlikely, but it may cause issues with the bone or the soft tissues around the area of abutment placement. The implant might fail to integrate with the skull bone in some situations. Chronic infections have happened, along with trauma at the incision site.
Soft tissue concerns include irritation of the skin at the implant site, the death of the skin flap, and overgrowth of skin around the device are possible too. Some patients report that the wound splits apart as it heals, while others have chronic pain or consistent bleeding with their BAHA hearing aid.
2. It may cause a nerve injury during placement.
The placement of the abutment for the BAHA hearing aid may sometimes cause nerve damage because of its location. Although the issue with the injury is typically minor, it could change your sense of taste immediately or over time. Some people may experience feelings of weakness in their face after the procedure, prickly sensations, or paralysis in facial muscles because of the damage to the nerve too.
3. There is a chance that the device will not work.
Although the BAHA hearing aid works for most people, there is a chance that it might not work for some patients. This issue could happen due to an issue with the device itself, physical concerns that don’t transmit vibrations as well, or some other form of unanticipated issue. Infections may cause the device to stop working too. When this occurs, you’ll likely need to have the implant removed, then replaced, which means additional surgery and recovery time for another six weeks.
4. Meningitis is possible during placement of the BAHA hearing aid.
Meningitis is an infection which occurs in the membranes which surround the brain. It is a rare condition and complication of the BAHA hearing aid surgical process. If it occurs, the infection is treated as a medical emergency. Vaccines are recommended by the U.S. government for anyone who receives this implant type before surgery to reduce the risks of infection occurring. Those who have an inner ear which formed abnormally while receiving the abutment seem to be at the highest risk of this potential disadvantage.
5. It requires good hearing to be a useful treatment option.
It is not unusual for people to schedule an appointment to discuss the option of a BAHA hearing aid, thinking that they’re a good candidate for the procedure, only to discover that they are not. Many people consider the hearing in their “good” ear to be better than it happens to be, which means it may not qualify for this procedure. A cochlear implant is the better alternative in this situation.
There are additional health factors which come into consideration for some patients too. If you are a smoker or have a history of smoking, use steroids, or have T1D or Type 2 diabetes, then the healing process may not work as well after surgery and graft loss might occur.
6. Cost is a severe barrier which some patients might not overcome.
The price of a BAHA hearing system varies by center. Expect the system on its own to cost about $10,000 without any of the operative costs involved. Patients should budget at least another $10,000 for the medical and recovery costs associated with abutment placement. If there are complications after the surgery, including infection treatment or the need for another surgical placement, another $10,000 to $30,000 adds itself to the final price.
Some patients may qualify for healthcare coverage for this device, including insurance, Medicare, Medicaid, and other forms of help. Coverage for children under the age of 5 does not usually exist because their bone material isn’t thick enough to support the abutment.
7. There are athletic activity risks to consider with BAHA.
One of the benefits of using the BAHA hearing aid is that it allows users to participate in athletic activities which might not be possible when using an alternative hearing assistance device. There are still plenty of sports-related risks to using this system to review, however, as you must be careful when playing any contact sport. Water-related activities are not usually recommended after abutment placement either. Running sports and similar individual ventures do offer athletic outlets, which may not be of interest to some patients.
8. Natural audio sources may interfere with sound pickups.
People who have the BAHA system report that days with heavy wind can make it difficult to distinguish speech if they are outside. Using a phone is difficult for some patients too, as the audio pickup through the receiver (landline and cell) isn’t as strong for them. Continuous growth of the bone after the implant may create even more interference with these issues for some patients. Some people even report immediate dizziness and nausea when they use a mobile phone with this device.
These BAHA hearing aid pros and cons take a look at the benefits of being able to hear again against the potential complications of the surgery and equipment. Many patients decide that the risks are worth the reward of hearing better once again. There were only 10,000 people with a BAHA device in 2006, but in 2016, that number grew to over 150,000 patients. Only you and your doctor can decide if pursuing this technology over other forms of support is the correct course of action to take.