Bone-Anchored Hearing Devices (BAHDs)

Bone-anchored hearing devices (BAHDs) are specialized hearing systems that transmit sound through bone vibrations instead of the normal air conduction pathway of the ear. By bypassing the outer and middle ear, BAHDs deliver sound directly to the inner ear (cochlea) via bone conduction—making them especially useful for certain hearing losses where traditional hearing aids are ineffective.

What Are Bone-Anchored Hearing Devices?

A bone-anchored hearing device is an implantable hearing system that uses bone conduction to stimulate the inner ear, rather than sending sound through the ear canal and eardrum. A small titanium implant is placed in the skull (usually in the mastoid bone behind the ear) and integrates with the bone through a process called osseointegration. An external sound processor snaps onto either an abutment or magnet attached to this implant.

When sound is picked up by the processor's microphone, it is converted into vibrations that travel through the skull bone to the cochlea, stimulating the hearing nerve endings. In this way, BAHDs bypass the outer ear and middle ear entirely, delivering sound directly to the inner ear.

Bone Conduction vs. Air Conduction

In normal hearing (and with traditional hearing aids), sound travels as airborne vibrations through the ear canal, vibrates the eardrum and tiny middle-ear bones, and then reaches the cochlea. BAHDs skip this route—they vibrate the skull so that sound reaches the cochlea through the bone. This means a BAHD can effectively send sound to a functioning inner ear even if the ear canal is blocked or the middle-ear bones are damaged.

Device Components

A typical BAHD system has three main parts:

• Titanium Implant: A small screw-like fixture surgically embedded in the skull bone behind the ear. This is the anchor that conducts sound vibrations into the bone.
• Abutment or Magnetic Attachment: A connector piece. In some systems an abutment sticks out through the skin (a small post), whereas in others a magnet is implanted under the skin.
• External Sound Processor: The visible part that sits on the head, containing the microphone, amplifier, and vibrating transducer. It picks up sound and generates the vibrations that travel through the implant.

Because a BAHD requires minor surgery to place the implant, it is classified as a prosthetic hearing device rather than a hearing aid—an important distinction for insurance coverage.

Types of Bone-Anchored Systems

Bone-anchored hearing systems come in different designs. They all use bone conduction, but the way they attach and transmit sound varies:

Percutaneous BAHD (Abutment Systems)

These have a small abutment that protrudes through the skin. The external processor clips onto the abutment directly, creating a direct bone connection. Examples include the Cochlear Baha® Connect system and the Oticon Medical Ponto® system.

Advantages: Maximizes sound quality and power output (better for larger hearing losses). The implant is typically MRI-safe without special precautions.

Considerations: The abutment requires daily cleaning and care of the surrounding skin. There is a small permanent post visible on the head. Skin complications can occur in some patients over time, though proper hygiene minimizes this.

Transcutaneous BAHD (Magnetic Systems)

These implants keep the skin intact. A magnet is implanted under the skin, and the external processor attaches through the skin via magnetic attraction. Examples include passive systems (Cochlear Baha® Attract, Medtronic Sophono®) and active systems (Cochlear Osia®, MED-EL Bonebridge®).

Advantages: No through-skin abutment—greatly reduced skin complications and no daily wound care. Cosmetically more discreet.

Considerations: Some energy is lost passing through the skin in passive systems. Having an implanted magnet means MRI limitations—most are MRI-conditional, allowing MRI up to a certain strength with precautions.

Non-Surgical Bone Conduction Options

For individuals who cannot undergo implant surgery, are too young for it, or want to test the benefit before surgery, there are non-implanted options: headband-held processors, softbands (often used in infants and toddlers), and adhesive devices like the MED-EL Adhear®.

Advantages: No surgery required—invaluable for pediatric use (most centers won't implant children under age 5) and for trial periods before committing to surgery.

Considerations: Headbands require pressure against the scalp, which can cause soreness. Sound quality may be slightly reduced. Important: Insurance typically does not cover non-surgical bone conductors if classified as "hearing aids."

Comparison of BAHD Types

Who Is a Candidate for a BAHD?

BAHDs are indicated for specific types of hearing loss, particularly when the outer or middle ear is the main issue or when one ear is profoundly deaf. You may be a candidate if you have:

Conductive Hearing Loss

A problem conducting sound through the outer ear or middle ear (blocked ear canal, damaged eardrum, or ossicle problem), but the inner ear (cochlea) functions relatively well. BAHDs are often the preferred solution for permanent conductive losses because they bypass the conduction problem.

Common situations include: atresia (born without an ear canal), chronic middle ear infections or cholesteatoma, otosclerosis (when surgery isn't possible), or canal stenosis/exostoses that make wearing normal hearing aids difficult.

Mixed Hearing Loss

A combination of conductive and sensorineural loss. BAHDs can help if your bone conduction hearing thresholds (indicating cochlear function) are in the mild to moderate range. Most devices have recommended bone threshold limits around ≤45 dB HL for standard devices, up to ~55–65 dB HL for high-power versions.

Single-Sided Deafness (SSD)

Having one ear that is profoundly deaf and the other ear with normal or near-normal hearing. A BAHD can be used as a CROS solution via bone—the device is implanted on the deaf side, picks up sound from that side, and vibrates the skull to send the signal to the hearing ear's cochlea.

This can dramatically improve awareness of sounds on the poorer side and helps overcome the "head shadow" effect that makes it hard to hear people on your deaf side. BAHDs are FDA-approved for SSD.

Age Considerations

Both children and adults can benefit from BAHDs. However, implants are typically not placed until around age 5 because an infant's skull is thinner and still forming. Young children with atresia or other conductive losses will use a softband or adhesive BAHD system until they're old enough for the implant surgery.

For adults, there isn't an upper age limit as long as one can undergo the minor surgery. However, skin healing and bone quality should be considered when choosing between abutment and transcutaneous systems.

The Evaluation & Candidacy Process

If you think a bone-anchored hearing device might help you, getting a thorough evaluation is crucial. A team consisting of an otolaryngologist (ENT physician)—often specifically an otologist or neurotologist—and an audiologist will guide this process.

Initial Consultation

You would first see an ENT physician to discuss your history and examine your ears. The doctor will identify why your hearing is impaired and whether that underlying issue is treatable medically or surgically. BAHDs are considered only after treating any fixable problems.

The ENT may order imaging—CT scans can reveal the status of the middle and inner ear, ensuring there's a functional cochlea and no contraindications for implant placement.

Audiological Evaluation

An audiologist will perform a complete hearing test battery, including air conduction and bone conduction audiometry and speech discrimination testing. This confirms the type and degree of hearing loss in each ear and determines whether you meet candidacy criteria.

Trial with a Test Device

One of the most important parts of the evaluation is getting to experience bone conduction hearing. In the clinic, the audiologist can fit you with a tester BAHD on a headband or softband. This allows you to hear voices and sounds via bone conduction.

Patients are often astonished and pleased by how much clearer and louder things sound during this trial—for instance, if you have SSD, you'll suddenly hear the audiologist's voice from your deaf side. Some clinics let you take a demo device home for a few days or weeks to try in real-world settings.

The Surgical Procedure (Implantation)

Getting a bone-anchored hearing device implant is typically a minor surgery, often done as an outpatient procedure—you go home the same day.

Setting and Anesthesia

BAHD surgeries are usually performed under either local anesthesia with sedation or general anesthesia, depending on patient and surgeon preference. Many adults tolerate the procedure with just local numbing and a light sedative. Children almost always have general anesthesia. Surgery time is relatively short—about 30 minutes to 1 hour in most cases.

What Happens During Surgery

The surgeon makes a small incision behind the ear and drills a tiny hole into the outer layer of skull bone (the mastoid). The titanium implant screw (only a few millimeters in diameter) is inserted and designed to osseointegrate with bone. For percutaneous systems, an abutment piece is attached, sticking out through the skin. For transcutaneous systems, the magnet or device is anchored under intact skin.

Recovery and Healing

Initial healing of the skin incision takes about 1 to 2 weeks. Stitches are usually removed at 7–14 days post-op. It's normal to have some soreness and slight swelling or redness for a few days. Pain is generally mild; many patients manage with just acetaminophen or ibuprofen.

The critical part is osseointegration—the bone needs to integrate tightly around the implant. Surgeons typically require a healing period of 6–12 weeks before the device is activated. During this time, you'll follow care instructions and avoid trauma to the area.

Device Fitting (Activation Day)

Once cleared, you'll get your external sound processor. The audiologist will attach it to your abutment or magnet for the first time, program the device to your hearing prescription, and test and fine-tune the settings. They will teach you how to attach, remove, and care for the device. This is an exciting day for most patients—finally hearing the benefits after the waiting period!

The long-term success rate of BAHD implantation is very high—over 90% in many studies—and most patients report high satisfaction with the outcomes.

Insurance, Coverage & Costs

One of the most common questions is "Will my insurance cover a bone-anchored hearing device?" The good news: BAHDs are often covered by insurance, especially if you meet certain medical criteria.

Medicare (U.S.)

Medicare classifies bone-anchored hearing devices as prosthetic devices, not hearing aids. This is crucial because Medicare by law does not cover traditional hearing aids, but it does cover prosthetics. In 2005, Medicare updated its policy to explicitly include BAHDs as covered prosthetics that "replace the function of the middle ear."

If you are a Medicare beneficiary and medically need a BAHD, Medicare Part B can cover the cost of the device and surgery. Documentation must show that conventional hearing aids are medically inappropriate or ineffective for you. Medicare also covers replacement processors after the device's reasonable lifetime (typically 5 years) and repairs.

Medicaid (U.S.)

Medicaid is state-run, so coverage for BAHDs varies by state. Many state Medicaid programs do cover bone-anchored hearing devices, at least for children. Under EPSDT mandates, state Medicaids must cover necessary hearing devices for children. For adults, some states cover BAHDs and others may require strict prior authorization. Check your state's specific Medicaid policy.

Private Insurance

Many private plans cover BAHDs, especially if the plan covers prosthetic devices. Since BAHDs are FDA-approved and have well-established medical indications, insurers often follow Medicare's lead. However, some plans have blanket exclusions for "hearing aids" which can cause confusion.

The key is that a BAHD is classified as a surgical implant or prosthetic. Prior authorization is typically required. If a claim is denied as a "hearing aid," it can often be appealed on the basis that it's an osseointegrated prosthetic device.

Costs

The cost of a BAHD system (surgery plus device) can run in the tens of thousands of dollars—the device alone can be $5,000–$10,000+ and surgery costs vary. With insurance, patients typically pay their usual deductibles or co-insurance. Both major BAHD manufacturers offer insurance support teams that help with authorizations and appeals. Financial assistance programs may be available for those without coverage.

Veterans Administration (VA)

Veterans who qualify for VA health benefits can usually get BAHDs through the VA system at no cost. The VA covers cochlear implants and bone-anchored devices as needed for service-connected hearing issues or substantial hearing loss affecting quality of life.

Living with a Bone-Anchored Device

Daily Care and Hygiene

For abutment systems: Clean the abutment site regularly—think of it like having a pierced ear. In practice, this means washing around the abutment area daily with mild soap and water (in the shower). Use a soft brush or cotton swab to gently clear any skin debris from around the abutment base. Manufacturers often provide a small cleaning brush.

For transcutaneous (magnet) systems: Your skin is intact, so there's less daily fuss—just keep the skin clean as you normally would.

Routine Device Care

• Putting on/off: Becomes a quick part of your routine—in the morning, click the device on; at night, take it off and store in a case.
• Batteries: Most processors use small disposable batteries (often size 675) lasting a week or more. Some newer models have rechargeable options.
• Moisture protection: Use a drying jar overnight if you live in a humid area.

Lifestyle Considerations

Showering and Swimming: Remove the processor before any water exposure. The devices are splash-proof but not meant for submersion. The implant itself is fine in water—just take off the external processor.

Sports and Activities: Non-contact activities pose no issue. For contact sports, it's often recommended to remove the processor to avoid damage. Consider using a safety line (many processors come with one) during vigorous activities.

Sleeping: You'll remove the processor at night. For abutment users, a small abutment cover can keep it clean and prevent it from catching on bedding.

Technology and Connectivity

Modern BAHD processors are quite advanced—many have wireless connectivity similar to hearing aids. You can stream audio from phones and TVs, use remote mics, pair via Bluetooth, and adjust settings through smartphone apps. These features can significantly enhance daily life.

Realistic Expectations

Hearing Quality: For conductive losses, a BAHD can often bring hearing levels into the normal or near-normal range for quiet environments. Many patients report very natural sound quality.

For SSD patients: The benefit is hearing sounds on the deaf side and improved hearing in noise—but you won't have true stereo separation or perfect localization since one cochlea is still receiving all the sound.

In Noise: BAHDs can improve speech understanding in noise but aren't magic noise-filters. You may still need strategies like positioning yourself favorably in challenging environments.

Comparing Options: BAHD vs. Other Solutions

BAHD vs. Traditional Hearing Aid: If your outer/middle ear problem causes a large hearing gap, a hearing aid might struggle. BAHDs excel by bypassing the issue entirely. However, if you can hear well with a regular hearing aid, that's usually the simpler, non-surgical route.

BAHD vs. Cochlear Implant: BAHDs require decent inner ear function to work. Cochlear implants are for severe-to-profound sensorineural hearing loss where even BAHDs can't provide sufficient benefit. For single-sided deafness, both are options—BAHDs are less invasive while CIs can restore a form of binaural hearing.

Frequently Asked Questions

How long does the BAHD surgery take?

The surgery typically takes 30 minutes to 1 hour and is usually done as an outpatient procedure, meaning you go home the same day. Many adults have the surgery under local anesthesia with sedation.

When can I start hearing with my BAHD after surgery?

You'll need to wait for the implant to osseointegrate (bond with the bone), typically 6–12 weeks. After that healing period, you'll have your external processor fitted and programmed—that's when you'll start hearing through the device.

Will insurance cover my BAHD?

Many insurance plans cover BAHDs because they're classified as prosthetic devices, not hearing aids. Medicare covers BAHDs for qualifying patients. Private insurance and Medicaid coverage varies—your clinic's insurance coordinator can help with prior authorization and appeals if needed.

Can I get an MRI with a bone-anchored implant?

It depends on the type. Titanium abutment systems are MRI-safe. Magnet-based systems are MRI-conditional—they can undergo MRI with precautions (special head bandage or magnet strength limits). Always inform the radiology team about your implant before any scan.

Can children get bone-anchored hearing devices?

Yes. Many children with conditions like aural atresia or chronic ear disease benefit from bone conduction devices. Implants are usually placed around age 5 or older, when skull bone is thick enough. Younger children often start with a softband or adhesive device until they're ready for surgery.

Will a BAHD give me "normal" hearing?

A BAHD can significantly improve access to sound, especially for conductive hearing loss and single-sided deafness, but it does not restore hearing to a perfectly “normal” state. Most people notice clearer speech, better awareness of their environment, and easier listening in many situations—while still using communication strategies in noisy or complex settings.

Next Steps: Is a BAHD Right for You?

Bone-anchored hearing devices are highly effective for the right candidates, but they’re not the best match for everyone. The most important step is a personalized evaluation with an otologist and audiologist who know your medical and hearing history.

Learn How to Get Evaluated Explore Other Hearing Devices