BIHIMA interviews two of its members about the current picture and potential of bone anchored hearing technology.
In the hearing care sector, bone conduction technology is used to treat single-sided deafness, mixed hearing loss, and conductive hearing loss. These solutions replace the process of air conduction, which is how an unimpaired ear usually works (in a healthy ear, the ear drum vibrates, sending sound waves to the inner ear – the cochlear- and then on to the brain). In an ear where the ear drum cannot vibrate, bone conduction is able to replace this step of the process.
Bone Anchored Hearing Aids (BAHA), therefore, consist of two parts: an external processor, and a fixture surgically implanted into the bone near the inner ear. The processor captures sound and artificially transmits it to the internal fixture, which vibrates the inner ear, thereby allowing the person to hear. BIHIMA spoke to representatives from two of its member organisations, both leading experts in this area, to find out how the technology is currently benefitting people’s lives and how they expect it to develop in the future…
GN and Cochlear
From GN Hearing, Dr Laurel A. Christensen, Chief Audiology Officer, told us that “for more than 40 years, bone conduction implants have positively affected how people all over the world live their lives. They work by using the body’s natural ability to conduct sound and are designed to provide a complete and fulfilling listening experience to those living with single-sided deafness, mixed hearing loss or conductive hearing loss. As designs have developed, there continue to be more options across both implantable and wearable technology, with ergonomic and sound processing trends improving to enhance hearing and improve people’s quality of life.”
Its brand, ReSound, manufacturer of hearing technology, closely collaborates with Cochlear, which specialises in implantable hearing solutions, including cochlear implants and bone conduction implants. In a partnership they call their ‘Smart Hearing Alliance’, the two companies work together to create smart bimodal hearing solutions. “In a bimodal hearing solution, a hearing aid and an implant system can work together to provide people with a combined hearing experience with shared smart streaming capability across devices,” explains Dr Christensen.
Laura Bell, Area Director Baha Acoustics & Vistafix, Cochlear UK and Ireland, added that, “in recent years, one major development in implant technology has been the ability to connect and directly stream from smartphones. With a smart bimodal hearing solution from Cochlear and ReSound, people can connect to the people they love and the things they love to do while streaming phone calls, video, music and entertainment from a smartphone or accessory to both ears. Bone conduction continues to improve with advancements across sound processing algorithms, sound transduction efficiency and connectivity.
“In addition, we can help many more people who could benefit from bone conduction technology. For example, people living with chronic otitis media (COM). It’s estimated that COM contributes significantly to the global burden of hearing impairment. Medical conventions typically prioritise treating the infection to achieve a safe and dry ear, but not the resulting hearing loss. Research suggests that bone conduction implantation may be an effective alternative to treat COM-related hearing loss versus middle ear reconstructive surgeries for many patients.
Julie Neel Weile, Director of Product Management at Oticon Medical, explained that “there are two fundamental pillars required for good outcomes with bone anchored technology: firstly, the implant (and associated surgical procedure); secondly, the sound processor with its signal processing, wireless capabilities and reliability. Special attention is required in the development of both.
“In sound processing, Oticon Medical has strong ties with Oticon, which allow us to share the newest in sound processing technology, built on a foundation of thinking ‘brain processes and cognitive hearing’ first. This is also reflected in the strong outcomes we see in improved listening effort and speech understanding using a new, unique way of providing 360 degree open and balanced sound in both users of bone anchored devices and hearing aids.
“The mechanics and electronics of hearing aids and bone anchored sound processors are somewhat different. When delivering sound through the bone, we are fervent believers in providing as much maximum power output as possible. This means abutment-level superpower solutions, as well as the smallest devices on the market without compromise on power for conductive losses.
“As users of bone anchored hearing devices are just as keen to keep up with trends in technology, we are of course providing solutions that connect wirelessly to world of technology without decreasing output or overly draining the battery. The wireless connectivity also empowers our users to make changes to the settings of their device, and has enabled the development of an app-based solution for improving the trial period and monitoring the implant site, especially during these times where access to health care may be challenged.”
“The other, equally important part of bone anchored hearing is the implant and the surgical procedure to place it. Oticon Medical has developed a minimally invasive technique that allow the users to get the same great outcomes of surgery, but with better aesthetics, no suture removal, performed under local anaesthetics and at reduced surgical time. The percutaneous bone conduction surgery is safe (high implant survival rate 98%) and a low need for skin-related aftercare (95% of follow-up visit require no skin related aftercare).
“Most importantly, 98% of patients undergoing surgery to get a bone anchored solution (from Oticon Medical) report that it has improved their quality of life. Clinical results and patient reports are clear in demonstrating that the solution is a small procedure with life-changing outcomes. In the future, we expect that innovation in bone anchored hearing will keep the high pace that it is currently moving – to the advantage of new and current users. Discoveries in sound processing and cognitive hearing science will be key to secure long-term audiological outcomes for users.”
Maxine Oxford, National Sales Manager for Oticon Medical UK, added that “bone anchored (BA) hearing system users are often hearing aid users who can’t wear a hearing aid due to persistent infection. Over the last ten years, these former hearing aid users have influenced the BA market as they have demanded more reliable, more aesthetically pleasing and digitally programable BA processors with better feedback management, incorporating HA technology with BA processors has delivered this as the front end processing of all BA processors is a HA.
“We expect that BA surgical procedures will evolve to make implantation even more accessible. Hopefully, this will bring all the candidates closer to a bone anchored hearing system and the great benefits this entails.”
The British Irish Hearing Instrument Manufacturers Association (BIHIMA) represents in the UK and Ireland the world’s leading hearing instrument manufacturers. We work in partnership with other professional, trade, regulatory and consumer organisations within the health care and charitable sectors. Our goal is to raise awareness of the benefits of hearing well, making available the very latest in hearing technology aligned to consumer and hearing healthcare priorities to enhance the lives of those affected.
This article was published in the December 2020 issue of Audio Infos UK: https://online.fliphtml5.com/dacmw/jkjk/#p=1