Bone-anchored hearing aids (BAHAs) and cochlear implants are devices that can improve the quality of a person’s hearing. They work in different ways, and each has specific advantages and disadvantages.

People whose hearing loss does not respond to the use of hearing aids and who wish to amplify their hearing ability may be eligible for a BAHA or cochlear implant.

The devices do not restore hearing completely. Rather, they help people perceive and discern speech and other sounds more effectively. This may help some individuals manage and cope with their hearing loss.

This article looks at BAHAs and cochlear implants in detail and compares the two.

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BAHAs and cochlear implants are both devices doctors can implant to provide a sense of sound to someone with hearing loss.

People with severe to profound hearing loss who wish to improve their hearing ability may opt for an implantable device if wearable hearing aids are inadequate.

One of the main differences between the two implants is the type of hearing loss they can treat. BAHAs generally help manage conductive or mixed hearing loss, which affects the middle ear, whereas the cochlear implant helps with sensorineural hearing loss, which affects the inner ear.

BAHAs and cochlear implants do not cure hearing loss or restore perfect hearing. The devices provide a sense of sound and can help someone differentiate and understand certain sounds within various environments and contexts. A person may have to learn to interpret the sounds they perceive through the devices over time.

Despite their name, BAHAs are not hearing aids. They are prosthetic devices that a doctor attaches to an area of the skull behind the ear using a minor surgical procedure.

A BAHA has three components:

  • A sound processor: This is a small device that attaches to an abutment, or connector, that protrudes from the skin. The sound processor transmits vibrations through the abutment.
  • An external abutment: This transfers the sound vibrations from the sound processor to a small titanium device that a doctor implants in the bone behind the ear.
  • The titanium implant: When sounds travel from the sound processor, through the abutment, and to the implant, they vibrate the bones near the ear and stimulate the nerve fibers involved in hearing.

The surgery to implant a BAHA is typically a minor outpatient procedure that requires local anesthesia.

A cochlear implant is a complex device that stimulates auditory nerves to represent sound. The implant sends signals to the brain via the auditory nerve, which the brain interprets as sounds.

The way a person hears through a cochlear implant differs from typical hearing. It generally takes time for someone to familiarize themselves with hearing through the implant.

A cochlear implant has an external portion that rests behind the ear and a portion that a doctor surgically implants beneath the skin.

A cochlear implant consists of:

  • A microphone: This captures sounds and transmits them to a speech processor.
  • A speech processor: The speech processor arranges specific sounds and sends them as signals to a stimulator.
  • A transmitter and receiver stimulator: This converts the signals into electric pulses and transmits them to an electrode array.
  • An electrode array: These grouped electrodes gather the electric impulses from the stimulator and transfer them to different areas of the auditory nerve to represent sounds.

The surgical procedure for cochlear implantation typically requires general anesthesia. However, the procedure can have greater risks than BAHA implantation, as surgeons must gain access to the cochlea in the inner ear to place the implant.

Learn about how hearing works.

BAHAs and cochlear implants work in different ways, and each has various advantages and potential disadvantages. A healthcare professional can help a person decide which device is the most appropriate for their needs.

BAHACochlear implant
Advantagesimproves a person’s ability to perceive speech
– provides better comfort than a hearing aid
– is typically a minor procedure that does not require general anesthesia
– a person can remove the device for comfort or to prevent it from getting wet
– less expensive than cochlear implants
– provides a clearer perception of speech than a BAHA
can help a person differentiate sounds, such as footsteps, music, and voices
– can benefit people with profound hearing loss and those unable to use hearing aids or BAHAs
Disadvantages– includes an abutment that protrudes from the skin, which requires daily care
– may not be effective for people with profound hearing loss
– has a minor risk of complications due to the procedure
– requires surgical implantation under general anesthesia
may lead to various complications due to surgery
– more expensive than BAHA implants
– may prevent a person from undergoing certain medical procedures, such as MRI scans
– relies on batteries, which will require replacement
– may not function correctly if they get wet
– may require expensive replacements over time
may require therapy to help a person adapt to hearing with the implant
Most suitable for people who– have conductive hearing loss due to something preventing sound from reaching the inner ear
– have unilateral hearing loss, which is hearing loss in one ear
– experience chronic ear infections or have congenital ear abnormalities that prevent the use of hearing aids
– have mild to moderate hearing loss
– have profound hearing loss or permanent deafness
– cannot use hearing aids
– have found hearing aids or BAHA implants inadequate
– have sensorineural hearing loss
Cost$10,000–$17,000, with additional costs for the sound processor, which may cost $5,000–$8,000
Medicare classifies BAHAs as prosthetic devices and will typically cover the cost
– Medicare may pay $23,566–$31,276 of the total cost
Risksskin infections
skin reactions
– doctors cannot achieve fusion between the bone and the implant
raised, thickened scar tissue
– skin overgrowth
– risks of general anesthesia
– injury to the facial nerve
– numbness near the ear
– collection of blood or fluid at the wound site
cerebrospinal fluid leakage
– changes in taste
vertigo and dizziness
– loss of residual hearing
– changes in sound perception
– implant failure

A person can discuss all the risks and benefits of implants with their healthcare professional.

Bone-anchored hearing aids (BAHAs) and cochlear implants are implantable devices that can help improve or provide a sense of sound. The devices do not cure hearing loss or restore hearing ability completely. Rather, they can improve a person’s quality of hearing.

BAHAs are devices that a doctor can implant in the bone behind the ear as part of a minor procedure. The device vibrates bones near the ear to cause the sensation of sound. The device is typically suitable for those with mild to moderate conductive hearing loss.

Cochlear implants require more comprehensive surgery that involves access to the inner ear. The device can help improve hearing quality in people with profound sensorineural hearing loss. It converts sound vibration to electrical impulses, which the brain interprets as sound. A person may require therapy to learn how to hear with the implant.