Today’s blog is the second installment in our series exploring the 3 types of implantable hearing devices – cochlear implants, bone anchored implants (BAI) and brainstem implants. Today we’re covering bone anchored implants, or BAI, which were formerly known as bone anchored hearing aids.
Most people hear two ways, via air conduction and bone conduction. Air conduction is sound waves traveling through the ear canal, to the ear drum and then the rest of the pathway to the brain. Bone conduction is when sounds pass through the mastoid bone and ossicles in the middle ear space and then to the rest of the pathway to the brain.
What is a Bone Anchored Implant?
A bone anchored implant, formerly known as bone anchored hearing aid, is a hearing device that can be used for those who have conductive or mixed hearing loss. There are surgical and non-surgical options available. It works by directly stimulating the cochlea through vibrations in the skull.
Parts of a Bone Anchored Implant
Components of a BAI include an external sound processor and titanium abutment or an external soft sound processor with soft band/sound arc. Non-surgical options are more common for children 5 years and younger (Cochlear, 2025).
Who is a candidate for a bone anchored implant?
- Those who have a mixed or conductive hearing loss with 30dB or greater air bone gaps.
- Those who have a bone conduction pure tone average of ≤ 55 dB
- Those who have been diagnosed with single-sided deafness, i.e. profound sensorineural hearing loss in one ear and normal hearing in the other ear
- Patients who do not like or want BiCROS systems
- Patients who have contraindications to cochlear implantation
- (Cochlear, 2025) (Cleveland Clinic, 2023)
Common Causes of Hearing Loss that may benefit from BAI
Disease or malformations of the outer or middle ear such as
- Microtia/atresia
- Chronic otitis media
- Disease of the ossicles, etc.
(Cochlear, 2025)
How does bone anchored implant surgery work
The surgery is generally outpatient and lasts anywhere from 30-60 minutes. First, an incision is made into the skin behind the ear. Next, a surgeon will drill a space into the mastoid bone and insert the titanium abutment.
The healing process varies from person to person and can take up to 3 months. The device cannot be activated until the surgical site is completely healed, and Osseointegration has occurred. Once the surgical site has healed, the Audiologist will activate and verify the device for use! (Cleveland Clinic, 2023)
Citations
Bone conduction candidacy, treatment determination, and care pathway. (2025). Cochlear.com.https://www.cochlear.com/us/en/professionals/products-and-candidacy/candidacy/bone-conduction-system
Cochlear™ Baha® System. (2025). Cochlear.com. https://www.cochlear.com/me/en/home/ongoing-care-and-support/device-support/mri-considerations/mri-bahaBone - Anchored Hearing Aid. (2023, November). my.clevelandclinic.org.https://my.clevelandclinic.org/health/treatments/14794-bone-anchored-auditory-implant
