Everything You Need To Know About Bone Anchored Hearing Aids
February 01, 2022

Many people associate hearing loss as something that happens as a part of getting old. While this is certainly true, this only begins to take a look at the world of hearing loss and hearing impairment. 

Hearing is a complex function of the human body and relies on a number of things to work precisely and effectively within the ear. When one thing goes awry, it can result in a difficult time hearing specific sounds, including speech recognition and sound localization.

Conventional hearing aids are universally recognized as the main medical device to help with hearing loss, but what happens when someone cannot wear a hearing aid? The answer to this question is bone-anchored hearing aids.

While the name may sound intimidating, this device can provide those ineligible for standard hearing aids an opportunity to regain the ability to hear specific sounds. 

Below is a closer look at everything you need to know about bone-anchored hearing aids and how they compare to other hearing assistive devices. 

How Does Hearing Work?

Humans have a number of different senses, and hearing is one of the most important. While you can obviously live without it, having a sense of hearing can be immensely helpful in day-to-day communication and tasks. 

While many people live their lives without ever giving hearing a second thought, it can be an important bit of information to have to better understand your own body. In addition, this information is great to have a better understanding of the ways in which things can go wrong and contribute to hearing problems. 

The process of hearing can be broken down into two key processes, and below is a closer look at those two processes and how they contribute to your ability to hear. 


The first part of the hearing process is conduction. This refers to the transfer of air pressure waves into physical movement. While this sounds complex, it really is quite easy to understand by taking a deeper dive into the anatomy of the ear and how sound travels.

Sound is a type of energy that is emitted from vibrating objects.

The sound vibration causes small differentials in pressure in the surrounding air that then emanate from it in all directions. The conductive regions of the ear are responsible for turning these pressure differentials into the physical movement of the inner ear. 

The first structure that sound waves hit is the outer ear. The outer ear has a series of different ridges that help direct sound into the ear canal. Once the sound waves enter the ear canal, it hits a dead end known as the eardrum. The eardrum moves side to side as a result; this is where the sound wave is translated into physical movement.

From the eardrum, there are a series of tiny bones in the middle ear that move with the eardrum and transfer the energy to the inner ear. 


With sound optimally converted into physical movement, the energy is transferred to the inner ear, also known as the cochlea. The cochlea is the part of the ear that converts these physical movements into a neural impulse that is sent to the brain to be perceived as a sound. 

The cochlea’s structure resembles a nautilus shell: It is a hollow structure that has an inner lining of sensory nerve hairs. When the cochlea is struck by the middle ear bones a wave is sent through the cochlea at a specific frequency. Each sensory hair is specifically tuned to detect a certain frequency, and once that wave hits, it bends and allows for a nerve impulse to be sent. 

From there, the impulse follows out of the ear through the auditory nerve and to the brain. This entire process is known as the sensorineural aspect of hearing and plays a crucial role in your ability to hear. 

When Things Go Wrong

While the above explanation describes what happens when everything goes according to plan, there is the potential that it doesn't.

Below is a closer look at the two types of hearing loss and what it means for your ability to hear. 

Conductive Hearing Loss

Conductive hearing loss occurs when something impedes the ability of the outer and middle ear from effectively conducting sound to the cochlea. There are a number of different possible causes of conductive hearing loss, including earwax impaction, tympanic membrane rupture, and even malformations from birth or otherwise. 

Many instances of conductive hearing loss have some form of treatment. Some causes, such as earwax impaction, can allow you to completely reverse the hearing loss when treated appropriately. 

Sensorineural Hearing Loss

Sensorineural hearing loss is caused by a malfunction of the cochlea or auditory nerve. Unlike conductive hearing loss, sensorineural hearing loss is fairly permanent. There is little that can be done to revert hearing back to what it once one. 

A common cause of sensorineural hearing loss occurs when the sensory hairs within the cochlea become worn due to exposure to loud noises. Over time loud noises can reduce the sensitivity of hairs and require a higher volume to hear the specific tone.

For sensorineural hearing loss, the best solution is to utilize hearing aids as they increase the volume of sounds entering the ear. This amplification can allow you to hear sounds that would otherwise be outside of your hearing thresholds. 

Who Can Benefit From Bone Anchored Hearing Aids?

Bone anchored hearing aids are certainly less popular than traditional hearing aids, but they can be particularly useful in certain circumstances.

Below is a closer look at specific situations in which bone-anchored hearing aid may be preferred over a traditional hearing aid.


One instance that a bone-anchored hearing aid is beneficial is in the case of outer or middle ear malformations. These conditions can be hereditary or acquired through an injury, but an audiologist may recommend a bone conductive hearing aid in these situations. 

With these malformations, the sound is not effectively conducted through the normal structures of the ear, and having a separate device implanted into the bone behind the ear effectively circumvents this and allows the inner ear to function as it should. 

Frequent Ear Obstruction

Another potential reason a bone-anchored hearing aid may be utilized is for individuals that cannot wear traditional hearing aids due to issues pertaining to frequent ear infections or other issues pertaining to proper ear drainage. For these individuals, standard hearing aids will block the entrance to the ear and impede the proper drainage needed to maintain their optimal health. 

Positioning the hearing aid behind the ear and attaching it to the bone allows the ear to effectively drain and avoid issues associated with it being blocked. 

Are Air Conduction Hearing Aids Enough?

Standard hearing aids, also known as air conduction hearing aids, are devices that utilize the normal anatomy and functioning of the outer and middle ear. Rather than circumventing the conducting pathway, normal hearing aids simply increase the intensity of sound that is hitting the eardrum.

This is accomplished through a simple device with a microphone, amplifier, and speaker that detects the sounds around you. It amplifies their volume and emits the sound at a higher volume. 

Standard hearing aids for the vast majority of people is the best option because it is non-invasive (doesn't require surgery), less expensive, and requires a lot less maintenance. Bone conducting devices can be thousands of dollars, especially with the necessary outpatient procedure. Coupling the cost of the surgical procedure with post-surgical care and bone-anchored hearing aids can certainly rack up quite the bill. 

Another thing to note is that there are specific requirements to be a good candidate for bone-anchored hearing aids, and not everyone fits into them. Standard hearing aids are fairly universal. With so many options on the market, you can find exactly what you are looking for.

Audien Hearing Aids

When looking specifically at standard hearing aids, it can be a lot to take in all at once with thousands of options. Determining which hearing aids are too expensive and which ones are not good quality can be a large hassle, and that is where Audien comes in.

Audien has changed the industry by providing affordable rechargeable hearing aids that are not only a better value but also outperform the competition. 

Sound Quality and Signals

In summary, bone-anchored hearing aids are a useful medical device for those that may be unable to utilize standard hearing aids due to malformations, the need for proper ear drainage, or other medical issues.

By conveying the sounds through the skull bone behind the ear, the device can circumvent the ear's conductive pathway and stimulate the inner ear to detect sound. 

While this option is great for those individuals that cannot use air conductive hearing aids, the vast majority of people can utilize standard hearing aids, which are less invasive, cheaper, and all-around easier to utilize. 


How Do We Hear? | NIDCD

BAHA: Bone-Anchored Hearing Aid | NCBI

Sensorineural Hearing Loss | ASHA

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Drew Sutton M.D.

Drew Sutton, MD is a board-certified otolaryngologist. He has extensive experience and training in sinus and respiratory diseases, ear and skull base surgery, and pulmonary disorders. He has served as a Clinical Instructor at Grady Hospital Emory University for more than 12 years.

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