Direct Bone Conduction

Direct bone conduction systems can be more effective than hearing aids1,2

We hear sound in two different ways―air conduction and bone conduction. Air conduction hearing is when sound waves travel from the outer ear, through the middle ear to the inner ear. In contrast, bone conduction hearing is when sound vibrations travel directly to the inner ear through the skull bone.  In cases where there is damage to the outer or middle ear, or when one of these parts does not function, an air conduction hearing pathway cannot reach the inner ear. Instead of trying to push sound through the damaged area, as is done with hearing aids, direct bone conduction systems send it directly through the bone, naturally stimulating the inner ear.

Most hearing healthcare professionals agree that direct bone conduction systems are a more effective solution than air conduction devices (like hearing aids) for patients with mixed hearing loss, conductive hearing loss or single sided deafness.2, 3

Direct bone conduction systems are widely covered by insurance policies

Unlike hearing aids, direct bone conduction systems are covered by many private insurance policies, as well as by Medicare and, in some states, Medicaid, as long as you meet certain guidelines or requirements.

Direct bone conduction systems naturally stimulate the inner ear

A direct bone conduction system is a medical device that uses your body’s natural ability to conduct sound through bone. Unlike hearing aids, which simply amplify sound, direct bone conduction systems bypass the damaged part of the outer and middle ear to send sound directly to the inner ear.

If you are deaf in one ear, direct bone conduction systems send sound via the skull bone from the deaf side to the inner ear of the hearing side. This transfer of sound gives you 360-degree sound awareness.

Components of a direct bone conduction system

A direct bone conduction system has three parts: an external sound processor, an abutment and an internal titanium implant.

External sound processor

• The external sound processor (or outer part) is snapped onto the abutment.


• The abutment (or connector) links the sound processor and a titanium implant.

Internal titanium implant

• The internal titanium implant (or inner part) is inserted into the bone, behind the ear by the implanting surgeon. The titanium implant naturally fuses with the bone and becomes affixed to the bone.

Direct bone conduction systems create a natural pathway to better hearing

  1. The microphone(s) on the external sound processor picks up sound from the surrounding environment and changes it into vibrations.
  2. The vibrations are passed through the abutment to the titanium implant in the bone. The bone helps the sound vibrations reach the inner ear.
  3. Once sound reaches the inner ear, the sound vibrations are turned into electrical impulses by tiny hair cells inside the inner ear.
  4. These impulses travel to the brain, allowing the user to recognize sound naturally.

Direct bone conduction systems are a proven treatment for both adults and children2

Direct bone conduction systems are approved for people who have conductive hearing loss, mixed hearing loss, or single sided deafness with normal hearing in the other ear and who meet the criteria.

Direct bone conduction systems are especially effective for people with single sided deafness.3,4 When worn on the deaf side, a direct bone conduction system sends sound directly to the healthy cochlea on the other side. This enables users to hear sound from all directions, which may lead to improved speech understanding in noisy environments.5

Find a hearing specialist in your area to discuss whether a direct bone conduction system is right for you.

Do I need a direct bone conduction system on each side?

If you have hearing loss in both ears, you should talk to your audiologist or hearing healthcare professional about getting a direct bone conduction system for both sides. It could improve your hearing in challenging listening environments and could help you locate where a sound is coming from, an obvious benefit in your everyday life.

You can try out a direct bone conduction system before you decide

A unique feature of a direct bone conduction system is the ability to try it out before you decide to get one. Your hearing healthcare professional can fit you with a sound processor (using a headband or test rod) for you to hear how it might sound. Most people who try it say they are amazed at how much better they hear. Even with skin acting as a sound barrier, you will hear how bone conduction can improve the clarity and quality of sound. You may hear even better after the direct bone conduction system is implanted and you receive a direct connection.

The information contained on this website is for informational purposes and is not intended to replace medical advice. Please consult a hearing healthcare professional.

References: 1. Hol MK, Snik AF, Mylanus EA, Cremers CW. Long-term results of bone-anchored hearing aid recipients who had previously used air-conduction hearing aids. Arch Otolaryngol Head Neck Surg 2005 Apr;131(4):321-5. 2. Snik AF, Mylanus EA, Proops DW, Wolfaardt J, Hodgetts WA, Somers T, Niparko JK, Wazen JJ, Sterkers O, Cremers CW, Tjellström A. Consensus statements on the Baha system: Where do we stand at present? The Annals of Otology, Rhinology & Laryngology 2005 Dec;114(12) Suppl 195:1-12. 3. MK, Bosman AJ, Snik AF, Mylanus EA, Cremers CW. Bone-anchored hearing aids in unilateral inner ear deafness: an evaluation of audiometric and client outcome measurements. Otology and Neurology 2005 Sep;26(5):999-100.  4. Lin LM, Bowditch S, Anderson MJ, May B, Cox KM, Niparko K. Amplification in the rehabilitation of unilateral deafness: speech in noise and directional hearing effects with bone-anchored hearing and contralateral routing of signal amplification. Otology and Neurology 2006;27(2):172-82. 5. Zeitooni M, Sadeghi A, Flynn MC. Benefits of localization and speech perception in patients fitted with bilateral Baha or air conduction hearing aid. Proceedings of the 11th International Conference on Cochlear Implants and Other Implantable Auditory Technologies; 2010; Stockholm, Sweden.