Bone-Anchored Hearing Aids: How They Work and What They Cost

Bone anchored hearing aids (BAHAs) are innovative devices designed to help people with certain types of hearing loss who receive limited benefit from traditional hearing aids.

How BAHAs Work

Unlike traditional hearing aids that amplify sound through the ear canal, BAHAs bypass the outer and middle ear entirely, making them a better option for those with conductive or mixed hearing loss. Traditional hearing aids might struggle with occlusion and feedback, issues that BAHAs largely avoid. However, BAHAs require surgery and long-term maintenance, which is not necessary with traditional hearing aids.

BAHAs consist of two main components:

• Implant: A titanium implant surgically inserted into the skull behind the ear
• Sound Processor: An external sound processor that attaches to the implant

Types of BAHAs

There are two primary types of BAHAs:

• Abutment BAHA: The implant protrudes through the skin, and the sound processor attaches to it via a connecting abutment.
• Magnet BAHA: The implant is completely under the skin, and the sound processor attaches magnetically.

Abutment BAHAs

Abutment BAHAs generally provide better sound quality and more powerful amplification due to their direct contact with the bone, making them suitable for individuals with more severe hearing loss. However, the visible protrusion of the abutment can be cosmetically unappealing, and it increases the risk of infection and potential trauma from accidental bumps. Regular cleaning is required to maintain the area where the abutment exits the skin.

Baha® 6 Max Sound Processor

Released in 2021 by Cochlear™, the Baha 6 Max Sound Processor is a popular abutment BAHA.

The Baha 6 Max features:

• Six color choices, including a new mint color
• Improved IP68 rating for better resistance to dust and moisture
• Direct streaming capabilities with both Apple® and Android™ devices
• An extended frequency bandwidth for improved sound quality
• Enhanced feedback reduction and impulse noise reduction systems

The Baha 6 Max is ideal for individuals with single-sided deafness (SSD), conductive, or mixed hearing loss, fitting up to a 55 dB HL sensorineural hearing loss. It offers significant improvements in power output, battery life, and overall design, making it a preferred choice for many existing BAHA users.

Magnet Bahas

On the other hand, magnet BAHAs are cosmetically more appealing and have a lower infection risk since the implant is completely under the skin, eliminating the need for an external abutment. Maintenance is easier with no daily cleaning required, but the magnetic attraction can cause skin irritation or thinning, and the sound quality may be slightly reduced compared to abutment BAHAs due to the skin barrier. For those with thicker skin or more severe hearing loss, stronger magnets might be necessary, which could lead to discomfort.

The choice between abutment and magnet BAHAs should be made based on individual hearing needs, lifestyle, and personal preferences, with guidance from an audiologist and ENT surgeon.

Cochlear™ Osia® 2 System

The Osia 2 System, introduced in 2019, is a popular magnet Baha. It is the first active osseointegrated steady-state implant, featuring a piezoelectric transducer fully implanted under the skin.

Key features include:

• A lightweight, off-the-ear sound processor design
• SmartSound® iQ signal processing for automatic sound adjustment
• Direct wireless streaming for compatible Apple® devices
• A more stable and cosmetically appealing system compared to traditional BAHAs

The Osia 2 System is approved for individuals aged 12 and older with SSD or conductive/mixed hearing loss, offering enhanced high-frequency gain and improved speech understanding in noisy environments. It is particularly suitable for those seeking a fully implantable solution with superior sound quality and minimal cosmetic impact.

Candidacy for BAHAs

BAHAs are typically recommended for individuals who:

• Have conductive or mixed hearing loss
• Have single-sided deafness
• Cannot use traditional hearing aids due to ear canal or outer ear malformations
• Experience chronic ear infections or allergies to traditional hearing aids

The BAHA Procedure

The surgical procedure to implant a BAHA is typically performed as an outpatient procedure under general anesthesia. It usually takes between 30 to 60 minutes, depending on the type of system being implanted.

After surgery, there is a healing period of about 1-3 months to allow for osseointegration, where the bone fuses with the titanium implant. Once healing is complete, the external sound processor can be fitted and programmed by an audiologist.

Long-Term Maintenance and Follow-Up

BAHAs require regular follow-up visits with your audiologist to ensure the device is functioning properly. The implant site needs to be monitored for any signs of infection or irritation. The external sound processor may also need occasional updates or replacements, typically every 5-7 years. It's essential to follow the recommended care routine to maximize the lifespan of the BAHA system.

Insurance and Cost Considerations

The cost of a BAHA system can be substantial, often ranging from $5,000 to $15,000, including the surgery, device, and post-operative care. Unlike traditional hearing aids, which are often not covered by insurance, BAHAs are generally considered prosthetic devices and may be covered by many insurance plans. However, coverage can vary significantly depending on the type of insurance and specific plan details.

Medicare Coverage: Medicare considers BAHAs to be prosthetic devices and typically covers them. Beneficiaries should work with their surgeon's office to determine eligibility for coverage and benefits.

Medicaid Coverage: Coverage for BAHAs under Medicaid varies by state. Prior authorization is generally required, and coverage for adult recipients may differ based on state-specific guidelines.

Commercial Health Plans: Coverage under private insurance plans can vary widely. It's recommended that patients:

1. Work with their surgeon's office to determine eligibility and benefits
2. Request a voluntary predetermination of benefits review from their health plan
3. Have their doctor's office submit a predetermination packet to the health plan

Factors Affecting Coverage: Insurance coverage for BAHAs may depend on:

• The terms of the coverage document
• Applicable state laws and regulations
• Medical coverage policies
• The plan's classification of the BAHA system (as a prosthetic device or hearing aid)

It's important to note that some insurance companies may initially deny coverage by classifying BAHAs as hearing aids. In such cases, patients may need to appeal the decision, emphasizing that BAHAs are prosthetic devices that function differently from traditional hearing aids.

If coverage is denied, there are resources available to help patients appeal the decision. Some BAHA manufacturers also offer assistance programs to help navigate the insurance process or provide financial support.

Given the complexity of insurance coverage for BAHAs, it's advisable for patients to thoroughly review their plan documents and work closely with their healthcare providers and insurance company to understand their coverage options.

Innovations and Future Developments

The field of bone-anchored hearing aids is rapidly evolving, with ongoing research focused on improving sound quality, device comfort, and cosmetic appeal. Future developments may include rechargeable batteries, even smaller processors, and enhanced wireless capabilities.