July 14, 2009 Feature

New Bone-Anchored Amplification Options for Children

Ella uses Baha with a Softband.
The Baha® began as a treatment for children and adults with inoperable microtia/atresia, commonly seen in Treacher Collins syndrome, but recently has emerged with many more indications. The Baha system is now a viable amplification option to consider for children with bilateral conductive hearing loss, mixed hearing loss, unilateral conductive hearing loss, and unilateral severe-to-profound sensorineural hearing loss (Snik et al., 2005; Christensen & Dornhoffer, 2008).

The Baha system is an implanted device that works through direct bone conduction. Sound is conducted through the skull bone, bypassing the outer and middle ear and directly stimulating the cochlea. The device is composed of three parts: a titanium implant, an external abutment, and a detachable sound processor.

Trying It Out

The ability to try the Baha prior to surgery to determine the potential benefit makes this system unique in comparison to other implantable hearing devices. The Baha system can be trialed by using the Softband or Testband, a metal headband that holds the processor tightly to the skull, making it possible to estimate the benefit prior to surgical implantation. Children notice the difference immediately during the trial period, which often happens during a single office visit. However, the trial can occur over a period of time outside the clinic, depending on the availability of loaner processors and the family's preference for the trial.

As with earlier bone conduction devices, functional gain is the method of choice for verification of the Baha when used for bilateral conductive or mixed hearing losses. When the Baha system is implanted for bilateral conductive hearing loss, the amount of functional gain has been shown to close the air-bone gap. Seemann, Liu, and Toppa (2004) found that the pure-tone average (PTA) for 20 children prior to Baha implantation was 49 dB. After Baha implantation, their average aided PTA was 16 dB.

New Applications

Perhaps the latest and most unique application of Baha is implantation in children with severe-to-profound unilateral hearing loss, commonly referred to as single-sided deafness (SSD). Previously, many children with unilateral hearing loss performed poorly in school, displaying difficulties with learning and behavior (Bess & Tharpe, 1986). Outside of classroom interventions such as resource assistance and FM system amplification, treatment has been limited, leading to frustration for both the child and the parent. According to one study, three teenagers with SSD who received the Baha system showed increased speech understanding in noise using the Hearing in Noise Test by an average improvement of 43% at the 0 dB signal-to-noise ratio. Improved satisfaction in difficult listening situations was demonstrated by improved scores on the Children's Home Inventory for Listening Difficulties for both teenagers and parents (Christensen & Dornhoffer, 2008).

FM capability takes the technology further than traditional bone conduction aids. The Baha can be used with an FM system in difficult listening situations, giving those with Baha the same access to the auditory signal as those who have hearing aids or cochlear implants. The Baha FM receiver plugs directly into the signal processor without use of an extra adaptor.

Recent research shows that bone-anchored implants are a valid treatment for children with conductive or mixed hearing losses (Snik et al., 2005). Emerging evidence shows that Baha is also a viable option that benefits children with unilateral hearing losses and their families (Christensen & Dornhoffer, 2008).

Lisa Christensen, AuD, CCC-A, is a pediatric audiologist, director of the Bone-Anchored Implant Program at Arkansas Children's Hospital (Little Rock), and adjunct faculty member at The University of Central Arkansas. Contact her at christensenlv@archildrens.org.

cite as: Christensen, L. (2009, July 14). New Bone-Anchored Amplification Options for Children. The ASHA Leader.


Bess, F.H., & Tharpe, A.M. (1986). Case history data on unilaterally hearing impaired children. Ear and Hearing, 7(1), 14–19.

Christensen, L.V., & Dornhoffer, J.D. (2008). Bone-anchored hearing aids for unilateral hearing loss in teenagers. Otology & Neurotolgy, 29(8), 1120–1122.

Christensen, L., Nicholson, N., Luxen, V., & Martin, P. (2007). Aided verification of Baha softbands for children. Presented at the American Academy of Audiology Annual Convention, Denver, CO.

Seemann, R., Liu, R., & DiToppa, J. (2004). Results of pediatric bone-anchored hearing aid implantation. The Journal of Otolaryngology, 33, 71–74.

Snik, F.M, Mylanus, E. A., Proops, D.W., Wolfaardt, J.F., Hodgetts, W.E., Somers, T., et al. (2005). Consensus statements on the BAHA system: Where do we stand at present? Annals of Otology. Rhinology, & Laryngology, 114(12) Suppl 195, 1–12.

Spitzer, J.B., Ghossaini, S.N., & Wazen, J.J. (2002). Evolving applications in the use of bone-anchored hearing aids. American Journal of Audiology (Implantable Hearing Device Symposium Supplement), 11, 96–103.

Thompson, M. (2003, June 24). Bottom Line: Implantable hearing aids: The nuts and bolts on resimbursement. The ASHA Leader, 8(12), 3.


Read information about Medicare coverage of Baha.

Baha Criteria and Use

The U.S. Food and Drug Administration has approved the Baha system for children 5 years of age or older when the skull has become thicker and stronger to allow for osseointegration of the titanium implant to the bone of the skull. For infants and young children who are not yet surgical candidates, a Baha processor may be worn on a Softband, an elastic band with a Velcro fastener. The Baha sound processor snaps onto a plastic disk sewn into the Softband. For bilateral conductive losses, the BahaSoftband provides an average of 40.5 dB functional gain across the speech spectrum (Christensen, Nicholson, Luxen, & Martin, 2007).

The Softband is manufactured by Cochlear Americas and comes in a variety of colors. Alternatives to the Softband have been developed by KidlfyxKreations (www.kidlfyxkreations.com) and include baseball caps and headbands with a wider variety of colors and bows.


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