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Oticon Medical - BAHS - January 2024

Setting Patient Expectations for Bone Anchored Hearing Device Users

Randi Tepper, AuD, CCC-A

July 14, 2021

In this interview conducted by Oticon Medical, audiologist Randi Tepper provides guidance and tips to hearing care professionals on how to set new bone anchored hearing device wearer expectations.


AudiologyOnline: How do you conduct a typical first meeting with a candidate for a bone anchored hearing device?

Randi Tepper, AuD: A typical first meeting for a bone anchored hearing device (BAHD) candidate and/or parent would entail review and discussion of the patient’s audiogram/hearing loss.  Depending on the type and degree of hearing loss, as well as structural limitations of the ear canal, different options would be discussed.  I would also assess the benefits of a bone anchored hearing device over a conventional air conduction hearing aid or CROS for that particular patient (should the patient not have outer ear malformations), and review the different features available in the bone anchored hearing devices.   Once we have reviewed the information above, I would program a demo softband BAHD with the use of our Skull Simulator, and the patient would undergo testing in various listening environments in our soundproof booth to determine benefit.

AudiologyOnline: Do you offer a trial period during which you loan patients a bone anchored hearing device for them to wear on a band to test out? If so, how long does this period usually run?

Randi Tepper, AuD: Yes, typically we offer our patients 2-3 weeks with a loaner device.  It is recommended that, during this period, the patient utilize the device in a variety of active listening environments to determine benefit and improvement.  Should they require additional time, we would extend the trial on a case-by-case basis.

AudiologyOnline: What do you make sure to tell patients to expect who have never worn hearing aids and are starting with a bone conduction device?

Randi Tepper, AuD: The new bone anchored hearing devices on the market today are smaller, more comfortable, and more visually appealing than those previously available.  While this type of device is different from hearing aids you probably have seen in the past, it is often the best option and consistently provides the best outcomes given your (or your child’s) type/degree of hearing loss. 

AudiologyOnline: What do you make sure to tell patients to expect who are switching from air conduction to bone conduction hearing aids?

Randi Tepper, AuD: When switching from an air conduction hearing aid or CROS to a BAHD, it is important to inform patients that they will no longer need to wear anything in their ears.  Often patients switch from an air conduction to a bone conduction device due to drainage of the ears, which could lead to infection.  Other patients may also reject the idea of the CROS when they learn that they would also be required to wear something in their normal hearing ear, which might partially occlude that ear canal, making it more difficult to hear naturally. The use of BAHD eliminates these concerns, and the patient will likely become more aware of a greater variety of sounds in their environment and hopefully will appreciate more natural, clearer speech.

AudiologyOnline: When switching from an air conduction to bone conduction hearing aid it is important for the patient to understand that…

Randi Tepper, AuD: The BAHD bypasses the ear canal completely by directly stimulating the cochlea via bone conduction. The sound is then transmitted by vibrations through the bone and will require less gain, as it no longer needs to account for the air-bone gap or to overcome the conductive component.  When less gain is required, it is less likely that feedback or a distortion of sounds will occur.

AudiologyOnline: What kind of guidance do you provide to patients pre-surgery with regards to putting their minds at ease about the procedure?

Randi Tepper, AuD: We have a wonderful, comprehensively experienced team of surgeons at our facility that performs this procedure routinelyMost patients are able to return to their normal activities within a few days to a week.  Should you have further questions, your surgeon would be happy to meet with you to discuss any additional concerns.

AudiologyOnline: Can you provide examples of the kinds of questions you frequently receive from patients (including those treated previously with hearing aids and those not)?

Randi Tepper, AuD: 

  • Do I need to limit sports activity?
  • How tight does the magnet/softband need to be?
  • Do I need to wear anything in my ears?
  • How will I hear the sound if there is nothing in my ears?
  • Can I connect the BAHD to my phone?
  • Where is the correct placement for the BAHD?
  • Is it ok if I take it off sporadically throughout the day?
  • Can I wear it in the rain, pool, or shower?
  • How can I let my spouse/children listen to how it sounds?

AudiologyOnline: Are there any online or written guides or app you offer new bone anchored users to help them acclimate to hearing with a bone anchored device?

Randi Tepper, AuD: I generally defer to the manufacturers’ websites, as they tend to provide extensive resources for patients and families to access and read.  There are also a great number of Facebook groups in which users, candidates, and families share stories, ask questions, and provide insights into what has proven successful in their experience.

AudiologyOnline: What do you say to patients in order to set reasonable expectations about getting used to hearing with a bone anchored device-- how long it will take to acclimate, etc.

Randi Tepper, AuD: It is essential for patients, and in the case of pediatric populations, parents, to set realistic expectations when acclimating to a bone anchored hearing system.  They must acknowledge that it can take time to adjust and to retrain the brain as to how to process sounds they may have been missing in the past.  Often it takes patience, practice, and a commitment to active listening.  Be kind to yourself!

AudiologyOnline: Are there any other tips or suggestions you’d like to offer other audiology professionals with regards to working with bone anchored hearing device candidates?

Randi Tepper, AuD: I would highly recommend dispensing audiologists invest in the Skull Simulator, which converts vibrations from the attached BAHD into electrical signals displayed on the Verift, thereby allowing the hearing professional to observe outcomes in the Hearing Instrument Test Box and to understand the output provided by the BAHD.

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randi tepper

Randi Tepper, AuD, CCC-A

Randi Tepper is the Supervisor of the Pediatric and Cochlear Implant Audiology Programs at New York Eye and Ear Infirmary of Mount Sinai.  Her clinical expertise resides in pediatric audiology, including confirmation of congenital and perinatal hearing loss, electrophysiologic testing, and diagnosis/treatment of hearing loss in medically complex pediatric populations.  Dr. Tepper collaborates on research addressing and identifying early indications of hearing loss in the infant/pediatric population, assisted in establishing NYEE’s atresia/microtia clinic, and was awarded an earmold grant from the Children's Hearing Institute, allowing audiologists to fit earmolds and loaner hearing aids at no cost to patients while awaiting state Early Intervention Program approval or Cochlear Implantation.  Dr. Tepper takes profound professional joy in observing pediatric patients enjoy the process of building earmold designs that match their individual personalities. 

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