About this factsheet

This factsheet is part of RNID’s hearing aids range. You will find it useful if you are deaf and want to find out about bone conduction hearing aids. We use the term ‘deaf’ throughout to refer to all types of hearing loss.

You should read this factsheet to find out:

What is a bone conduction hearing aid?

A bone conduction hearing aid is like a conventional hearing aid – it helps you to hear – but it works in a different way. It is especially designed for people who cannot wear a conventional hearing aid.

How does a conventional hearing aid work?

A conventional hearing aid makes sounds louder and delivers them to the ear canal. The earmould or hearing aid generally fits the ear canal closely so that only sound from the hearing aid enters the ear. The amplified sounds are then heard normally through a process known as ‘air conduction’.

When you hear, sound passes along the ear canal to the eardrum making it vibrate. This is what is meant by ‘air conduction’. These vibrations are passed to three small linked bones in the middle ear. The small bones then carry the vibrations to the cochlea (inner ear) and the fluid within it. Movement in this fluid bends tiny hair cells along the length of the cochlea, generating signals in the auditory nerve. The signals travel along the nerve to the brain, which interprets them as sound.

For more information about how your ears work, read Ears and ear health.

How does a bone conduction hearing aid work?

A bone conduction hearing aid works differently. It also makes sounds louder but the sound is not passed into your ear canal. Instead, the aid conducts – or carries – sound through the bone in your skull. This process is known as ‘bone conduction’. You hear when the sound vibrations are transmitted directly from the vibrating part of the bone conduction hearing aid through your skull to the cochlea, missing out the outer and middle ears.

Hearing through bone conduction is not as efficient as hearing through air conduction. However, bone conduction hearing aids are an option for people who cannot use a conventional hearing aid.

Who is a bone conduction hearing aid suitable for?

A bone conduction hearing aid is suitable for anyone who cannot wear conventional hearing aids in their ear canal because:

Once a bone conduction aid is fitted, people usually find that they have fewer ear infections, less feedback and do not have as sore ear canals as when wearing conventional hearing aids.

Bone conduction hearing aids are also suitable for some people with a conductive hearing loss. Conductive hearing loss occurs when sound is prevented from reaching the inner ear, usually because of a blockage or abnormality of the outer or middle ear. Although bone conduction hearing aids can be suitable in these cases, a conventional hearing aid is often the best option for many people with middle ear problems and tends to be tried first.

Two main types of bone conduction hearing aid are available:

What is a traditional bone conduction hearing aid?

A traditional bone conduction hearing aid consists of an aid worn on the body and a bone conductor or vibrator fitted to a removable headband. The headband holds the vibrating part tightly to your head, so these aids can be uncomfortable to wear and can sometimes give you headaches and sore skin because of the pressure of the headband.

An alternative method is to fit the bone conductor to the arm of a pair of specially strengthened spectacles instead of a headband. There is also a type of aid that has a behind-the-ear hearing aid attached to the headband and bone vibrator.

Who is it suitable for?

A traditional bone conduction hearing aid is suitable for adults and children who cannot wear a conventional hearing aid, whether this is a temporary or permanent restriction.

How do you get one?

If you have an ear infection or if you have difficulty hearing, you should see your GP. If your GP thinks you have a physical problem that needs further investigation, they will refer you to the Ear, Nose and Throat (ENT) department at a local hospital to get your ears checked. They mad advise you to try a traditional bone conduction hearing aid. These are available from the NHS, except those that need to be fitted to spectacles.
If you prefer, you can buy a bone conduction hearing aid from a private hearing aid dispenser. For further information about buying hearing aids, see our factsheet Buying hearing aids?
An alternative to traditional bone conduction aids is a bone anchored hearing aid (BAHA).

What is a bone anchored hearing aid?

A bone anchored hearing aid or BAHA consists of a permanent titanium fixture or implant (instead of a removable headband), which is surgically inserted into the part of the skull bone that is behind your ear. This contains the vibrating part. A small detachable sound processor clips onto the fixture. BAHAs are now available with digital technology, although some models still use analogue technology.

Some BAHAs have additional features such as:

Who is a BAHA suitable for?

BAHAs are not suitable for everyone. You will only be advised to have one if you:

Some bone diseases, for example osteogenesis imperfecta, may mean that your skull bone is too thin and so a BAHA would not suit you.

As part of your assessment, you may be asked to bite on to a test rod attached to a BAHA sound processor. If you hear the sound properly, a BAHA is likely to work for you because sound is conducted more efficiently through the skull than through teeth.

How do you get one?

You can get a BAHA free from the NHS though it is not available in every hospital. This means you may have to travel some distance to get one. Your GP will refer you to your nearest hospital where you will be assessed to see if a BAHA would be suitable for you.

How is it fitted?

BAHAs are surgically implanted. Before surgery, the surgeon will discuss which side would be best for the implant depending on which ear you hear better with. If your hearing is similar in both ears and you drive a lot, it may be better to choose your left or passenger-side ear. Or, it may be better for you to choose the ear you usually use for the telephone.

Surgery is usually carried out in one or two stages under a local or a general anaesthetic. The standard procedure is to carry out both stages at once in adults and older children. However, this varies from hospital to hospital and depends on the surgeon. Each stage involves a minor operation that takes about an hour.

What happens during the first stage?

In stage one, a 3-4mm titanium implant is inserted into the mastoid bone, which is the part of the skull directly behind your ear.

What happens during the second stage?

If carried out separately, the second stage will be done three or four months after stage one. By this time the titanium implant should have bonded strongly to the skull bone. This is known as ‘osseointegration’. During this stage, the implant will be connected through your skin to a small screw called a ‘percutaneous abutment’. This is the vibrating part, which conducts sound through your skull bone to your inner ear.

About a month after the second stage – or longer if both stages of the operation were done at once – you will be ready to use the sound processor. You will be given an appointment at the hospital. You will be shown how to attach and remove the processor, which can be snapped on and off, how to use the controls on it and how to clean the area around the screw. You must keep this area clean as daily cleaning reduces the risk of infection.

The external parts of the BAHA will need to be replaced every five years – but you won’t need to have any more surgery once the BAHA has been implanted successfully.

What are the benefits of a BAHA?

Remember that a BAHA – like any other hearing aid - will not restore your hearing, but it will improve your hearing in everyday life.

If you feel you need more help with your BAHA directly from other people who also use a BAHA, you could contact a local BAHA support group. Go to www.baha-users-support.com (external link, opens new browser window) to find your nearest support group.

Can children have BAHAs?

in the UK, children as young as three can be fitted with a BAHA. Children are more likely to dislodge the titanium implant as they have thinner bone and a more active life than adults do, so some surgeons routinely fit two implants in children so that there is a spare in case one fails. A new screw can then be inserted into the spare implant.

For more information about BAHAs for children, contact the National Deaf Children’s Society (NDCS). See below for contact details.

Where can I get further information?

National Deaf Children Society (NDCS)

NDCS supports all children and young people who are deaf and their families in overcoming the challenges of childhood deafness.
NDCS, 15 Dufferin Street, London EC1Y 8UR
Information Line 0808 800 8880   Textphone 0808 800 8880
Fax 0207 251 5020
helpline@ndcs.org.uk   www.ndcs.org.uk (external link)

Support groups for patients with a BAHA

This website has a range of information about BAHAs including equipment such as loops to use with your BAHA, news, support groups and a discussion forum.
www.baha-users-support.com (external link)

Further information from RNID

Our Information Line offers a wide range of information on many aspects of deafness and hearing loss. Contact us for further copies of this factsheet and our full range of information factsheets and leaflets. You can also contact us if you would like information in Braille, on audiotape or large print.

RNID Information Line

19-23 Featherstone Street, London EC1Y 8SL
Telephone 0808 808 0123   Textphone 0808 808 9000   Fax 020 7296 8199
informationline@rnid.org.uk   www.rnid.org.uk (external link)

RNID Tinnitus Helpline

19-23 Featherstone Street, London EC1Y 8SL
Telephone 0808 808 6666   Textphone 0808 808 0007   Fax 020 7296 8199
tinnitushelpline@rnid.org.uk  

Buying equipment from RNID

Visit www.rnid.org.uk/shop (external link) or contact the RNID Information Line for a copy of our Solutions catalogue, full of products for people who are deaf or hard of hearing.