What’s The Difference Of Bone Anchored vs Bone Conduction Hearing Aids?

There are specially designed hearing assistive devices made for people with unilateral hearing loss (hearing loss in one ear) or with severe outer or middle ear malformations. These devices are known as bone-anchored hearing aids or bone-conduction hearing devices. They both work in much the same way, except one is surgically implanted and the other isn’t. They work by transferring sound directly to the cochlea through bone vibrations, whereas hearing aids amplify sounds that enter the ear canal.

Both are excellent alternatives for those who have problems in their outer or middle ears, or for those who experience frequent ear infections. If you’ve been using traditional hearing aids and haven’t had much success, bone-anchored or bone-conduction hearing aids may be worth exploring! Read on for details on how both work, their many benefits, and what getting fitted for one of these devices entails.

What is a bone-anchored hearing aid?

Bone-anchored hearing aids (also known as osseo-integrated devices or “BAHA” devices) are surgically implanted devices. Unlike traditional hearing aids, they bypass the middle ear, sending vibrations through the bone straight to the cochlea transmitting sound. This means hearing loss is treated through the bone conduction of sound, rather than the amplification of sound entering the ear canal. Bone-anchored hearing aids only work with a fully functioning cochlea.

People with single-sided deafness (unilateral hearing loss), with severe outer or middle ear malformations, as well as those with collapsed ear canals, stand to benefit the most from these hearing assistive devices. This is because the middle ear is bypassed entirely, and bone vibrations are transmitted directly to the cochlea, allowing the wearer to hear. This is also an excellent solution for those who suffer from chronic ear infections or for those who struggle with traditional hearing aids.

Bone-anchored devices come in two parts, one internal and the other external. The internal part is a titanium bone implant that is surgically implanted. And the external is a microphone and sound processor that picks up the sound and converts it into vibrations. Once the vibrations have been transmitted to the internal part, the implant vibrates the surrounding bone, which sends sound waves into the inner ear, stimulating the hair cells, which communicate with the auditory nerve, allowing the wearer to hear.

The best way to know if a bone-anchored hearing aid is right for you is to consult with an audiologist. With answers to the right questions and the proper testing, the audiologist will be able to determine if your experience will be better with a bone-anchored device.

What is a bone-conduction hearing aid? 

Bone-conduction hearing aids work by amplifying sound via bone conduction, also known as vibrations through the bone. Similar to bone-anchored hearing aids, bone-conduction hearing aids are an excellent choice for people with collapsed ear canals, frequent ear infections, or some kind of malformation of the outer or middle ear. This is because the device bypasses the inner ear entirely and sends sound directly to the functioning cochlea via bone vibrations. These non-surgical devices are worn on a headband or can be attached to the skin with a powerful adhesive.

Bone-conduction hearing aids are an effective alternative for those who cannot use traditional hearing aids, or for when a hearing aid doesn’t provide the required clarity or effect. Without the need for an ear mold, bone-conduction hearing aids are more comfortable, especially if the wearer is prone to frequent ear infections. While these devices do not restore hearing to normal, people do report they have a more natural sound when compared to traditional hearing aids.

One feature of the bone-conduction hearing aid is its compatibility with the hearing loop (telecoil) system. The device offers the wearer the option to pick up sound through its microphone, the loop, or both the microphone and loop, which makes listening in public spaces a little easier! Some devices already come with a telecoil feature, but if not, there are telecoil accessories that can be plugged into the processor whenever it’s needed.

Bone-conduction hearing aids work just like bone-anchored hearing aids, except there is no surgical implant. Instead, the device is secured either through a headband or adhesive. However, the way the sound is transmitted is the same; vibrations through the bone directly stimulate the cochlea.

What is it like to have a BAHA or a bone-anchored device? 

The surgery for a bone-anchored device is usually an outpatient procedure under general anesthesia that takes about an hour. Only the internal component is placed during surgery. After the surgery you will feel the incision, but once it is fully healed most wearers confirm they don’t feel the implant. It is only after a full recovery that the external sound processor is placed and the system can be turned on. You will see your audiologist one month after initial activation, to make sure everything is working well, and then periodically for any upgrades or adjustments.

Similar to a hearing aid, the external sound processor is only worn during the day. Most users say it’s easy to attach the external processor to the abutment, and better yet, that they don’t feel it when attached, so it’s very comfortable. Everybody will have a different experience with their device, but most patients have real success!

For many, the implant means it’s more comfortable for them, as they don’t have the constant pressure of wearing a headband all day long. Many patients report that their hearing feels more natural and detailed, not only when compared to no hearing assistive devices but in comparison to traditional hearing aids too.

For those with active lifestyles, be they athletes or theater performers, the implant allows them to move with ease, without the fear of the sound processor falling off because of a loose strap. This empowers them to keep doing those activities they love, that fulfill them, and that allows them to connect to their communities.

What kinds of accessories work with bone-anchored hearing aids? 

Another benefit of bone-anchored hearing aids is their compatibility with a variety of different accessories, improving hearing even more! These accessories include:

  • Audio streamers – These are relay devices traditionally worn around the neck or as clips. They allow the wearer to stream sound from televisions, cellphones, or music players directly into their sound processor.
  • FM/DM receiver – Students typically use these to tap into their school’s FM system, which allows them to stream a teacher or lecturer’s voice directly into their processor. This also comes in handy in crowded, noisy, or large, echoing venues like auditoriums or stadiums.
  • TV streamers – Most televisions and computers can be connected to bone-anchored hearing aids, allowing the wearer to stream the audio wirelessly, straight into their hearing device for improved clarity.
  • Smartphone apps – Some bone-anchored hearing systems are advanced enough to be able to integrate with a variety of smartphone apps. These apps can provide simple functionality like volume control. Better yet, most of these apps are provided free of charge by Oticon Medical or Cochlear Americas.

The most exciting part is that technology is always advancing, so even if a particular accessory isn’t compatible with a bone-anchored hearing aid today, it very well could be in the next few years. Be sure to keep up on the latest, and ask your audiologist if they know of any advancements coming down the pike!


Whether you have trouble with normal hearing aids, frequent ear infections, or malformations in the ear that make wearing a normal hearing aid impossible, there are options for you! Bone-conduction and bone-anchored hearing aids function in exactly the same way. The only difference?

  • Bone-conduction hearing aids need no surgery.
  • Bone-anchored hearing aids require surgery.

As of this writing, there are two FDA-approved bone-anchored hearing devices on the market, Oticon Medical, and Cochlear Americas. While each is slightly different from one another, they are both placed behind the ear on the mastoid bone. The exact cost of a bone-anchored device will vary, but they fall in the range of $10,000 and $17,000. And then the sound processor is an additional cost of between $5,000 and $8,000, depending on the manufacturer. The good news is that most of these devices are covered by insurance, at least in part.

If you think a bone-anchored or bone-conduction hearing aid is right for you, talk to an audiologist today! They will be able to guide you through the process and educate you on whether it’s the best option for your needs.

Dr. D’Anne Rudden

Dr. D’Anne Rudden has been helping Longmont and the surrounding communities hear better and find tinnitus relief for over 20 years. She is an expert in the fitting, dispensing, programming, and verification of advanced hearing technology and implantable devices, as well as in the diagnosis of hearing problems. She uses best practices to assure that your hearing solutions are personalized and customized for your specific needs.
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Dr. D’Anne Rudden

Dr. D’Anne Rudden has been helping Longmont and the surrounding communities hear better and find tinnitus relief for over 20 years. She is an expert in the fitting, dispensing, programming, and verification of advanced hearing technology and implantable devices, as well as in the diagnosis of hearing problems. She uses best practices to assure that your hearing solutions are personalized and customized for your specific needs.
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