Bone Conduction
by Cochlear Guest Author

Choosing the right bone conduction solution for your patients

April 4, 2018
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By Ginger Grant, AuD, Professional Education Manager

A Cochlear bone conduction solution may be the best option for patients with conductive hearing loss (CHL), mixed hearing loss (MHL) or single-sided deafness (SSD).  In fact, did you know that patients with an air-bone gap > 30 dB typically perform better with bone conduction than with hearing aids?1 Cochlear has a portfolio of options with a proven history of reliabilitythat can help along the hearing treatment journey.2,3

Evaluating the needs of each individual patient will help you to determine if a surgical or non-surgical option is preferred, the amount of desired gain and output needed, patient expectations and the right accessory choices. Considerations include:

  • Response to a bone conduction demonstration
  • Hearing health history
  • Hearing loss (including presence/absence of air-bone gap)
  • Age of the patient
  • Goals for treatment
  • Other health concerns

Baha® Start

Baha Start is the first step in bone conduction.  Using the Baha 6 Max Sound Processor with either a Baha Softband or SoundArc™ supports up to a 55dB SNHL fitting range for patients with CHL, MHL or SSD.  This non-surgical option is ideal for young children, those with fluctuating hearing loss or those who either don’t qualify for or don’t want a procedure. 

Osia® System

The Osia System uses a powerful, active osseointegrated steady-state implant with a transcutaneous connection to provide maximum power, especially in the high frequencies without the tissue and hygiene challenges of a traditional percutaneous solution.  While providing up to 12dB of additional high frequency gain compared to traditional electromagnetic bone conduction systems, the Osia 2 Sound Processor features advanced signal processing, wireless connectivity and water resistance.  With a fitting range up to 55 dB SNHL the Osia is an option for patients with CHL, MHL or SSD. 

Baha Connect System

For patients who may not be suited for an active surgical solution (like the Osia System), the Baha Connect System may be an optimal alternative. This system transmits sound vibrations through an abutment which connects the sound processor to the implant through the skin. The benefit of the Baha Connect is direct and efficient transmission of vibrations into the bone. The Baha Connect System uses a Baha 6 Max Sound Processor, with additional options available if even more power (up to 65dB) is desired. 

Cochlear’s Lend An Ear Program

There’s no time to waste when it comes to maximizing hearing during the critical period of language development in children.  Cochlear’s Lend an Ear programwas created for children 12 and under who need early access to sound through a bone conduction solution. This unique program provides a Baha 6 Max Sound Processor while the insurance approval process is taking place.  Reach out to your local Cochlear representative for more information about the Lend an Ear program.

For more information about bone conduction solution candidacy and choosing the right system for your patients, please see our AudiologyOnline courses.

References:

  1. de Wolf MJ, Hendrix S, Cremers CW, Snik AF. Better performance with bone‐anchored hearing aid than acoustic devices in patients with severe air‐bone gap. Laryngoscope. 2011;121:613-616.
  2. Cochlear Bone Anchored Solutions AB, Mölnlycke, Sweden. Long term stability, survival and tolerability of a (novel) Baha implant system. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). [Cited 2016 Jan 6]. Available from: https://clinicaltrials.gov/ct2/show/NCT02092610. NLM Identifier: NCT02092610.
  3. Vanaelst B. Literature review and Evaluation: BI300 Implant years and survival rate. Cochlear Bone Anchored Solutions AB, Sweden 2019. 

In the United States and Canada, the Baha Connect Implant System is contraindicated in children below the age of five. In the United States, Osia 2 System is cleared for children ages twelve and older. In Canada, the Osia System is indicated for those ages five and older.

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Cochlear Guest Author

In an effort to keep our content fresh and reflective of a diverse industry, Cochlear Americas features a mix of employees and professional partners to contribute to Cochlear ProNews as Guest Authors.

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Celebrating 10,000 Osia® Systems Worldwide

July 19, 2023

Together, Cochlear™ and hearing health professionals around the world have helped more than 10,000 ears get back on air with the Cochlear™ Osia® System, since the first clinical trials began in 2017. This is an achievement we wouldn’t have reached without you.

The Osia System is the world’s first and only active bone conduction implant system using Piezo Power™ technology. It is designed to help people live their lives and provide the performance needed to hear in noisy situations where they tell us they struggle most, with the goal to effectively treat the hearing loss of patients with conductive hearing loss, mixed hearing loss and single-sided sensorineural deafness (SSD).

The first patient to receive the Osia System was implanted with the OSI100 Implant in a clinical trial that included 12-month post-operative data on 51 patients in 2017. In 2019, the first patients were implanted with the OSI200 Implant in a multi-center study, and in the same year, the Osia System (with OSI200 Implant and Osia 2 Sound Processor) was approved in the US and other countries. In 2021, Cochlear began reporting on the reliability of all registered OSI200 Implants, and in 2023, the Osia Implant demonstrates 99.92% reliability.1

“Through productive collaboration, Cochlear has helped our patients with hearing loss more easily understand speech so they can enjoy a higher quality of life,” an Osia System surgeon from Germany said. “Bone conduction hearing solutions, such as the Osia System, are a promising technology that can help people with different types of hearing loss.”

The recipient of the 10,000th Osia Implant, Regina, said: “What I really appreciate about the Osia sound processor is that it leaves the ear canal free. The feeling of it being clogged, when wearing hearing aids for example, was always very unpleasant.” Regina recently had her Osia 2 Sound Processor fitted, and she now enjoys the small, everyday sounds that she was missing before.

“You don’t even notice yourself anymore what sounds you’re missing,” she said. “Getting the Osia has definitely been worth it to me.”

“For us at Cochlear, it’s always been about putting the patient at the center of what we do: to provide them with the best solution possible, and at the same time, for our professional partners to have confidence in the system from counseling to fitting,” says Adi Nilson, VP Acoustic Product Portfolio at Cochlear. “Reaching 10,000 ears with the Osia System in the few years since we first commercially launched it tells us that we have achieved what we set out to do.”

Want to learn more about the Osia System? Contact your local Cochlear representative or visit us at www.cochlear.com. 

References:

  1. Cochlear Limited. Osia Reliability Report Flyer. Cochlear Limited, 2023; D1841762.

Views expressed are those of the individual. Consult your health professional to determine if you are a candidate for Cochlear technology. Any testimonial featured is not intended for a New Zealand audience.

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Interview with Dr. Jacob: Initial Cochlear Osia System experience

May 21, 2020

Abraham Jacob, MD

Medical Director, Ear & Hearing

Center for Neurosciences in Tucson, Arizona

Dr. Jacob discusses the new Cochlear™ Osia® System, the world’s first and only Active Osseointegrated Steady-State Implant (OSI).  Selected for the Osia System control market release (CMR), he  uses 13 years of surgical cochlear implant/bone conduction experience to review his initial experience with the system.

What initially attracted you to the Cochlear™ Osia® System? 

Several things attracted me to the Osia System, including an added implant portfolio option.  The operation was easy to learn since site placement is similar to the Baha® System, but with many added benefits including:

  • Exceptional mid and high-frequency gain1
    • No external abutment required
    • Lightweight and cosmetically appealing external sound processor
    • Passive processor with active internal device

How does implanting the Osia System compare to the Baha Connect and Baha Attract?

The Osia System combines the cosmetic appeal and easy aftercare of Attract with substantially improved mid- and high-frequency gains. Our patients comment that the Osia System sounds fuller and more natural than what they experienced in their Baha Softband simulations prior to surgery.

The operation itself is more involved and scenario-based, typically taking about twice as long in patients getting an incision anterior to their implant and about three times as long in patients whose incisions are posterior to their implant. Overall, the operation takes 30-45 minutes in most patients. Positioning the head correctly is particularly important in Osia surgery where one has a larger body habitus or limited neck mobility.

What does the Osia System mean for patients with single-sided deafness (SSD)?

For SSD patients, the Osia System offers improved cosmetics, no external abutment and improved mid/high frequency gain.  The latter translates to improved sound quality, as described by the four patients whose devices have already been activated at our facility.

These patients have reported benefits such as immediate audibility at activation. This initial experience is fulfilling for the patient, surgeon, audiologist and all involved.

How is the Osia System changing your practice? What makes you excited about the system?

The powered internal device is a paradigm shift for delivering audibility through bone conduction. If there are no patient-specific or financial barriers to accessing this technology, I believe active implants would be first choice. It all comes down to thinking about patient benefit.

How many Osia Systems have you scheduled and/or implanted so far?

I have performed six operations in the past two months and have a list of 12 other patients interested in the device. Indications for surgery in my first six patients ranged from SSD to mixed-conductive hearing loss, some receiving anterior incisions and others requiring posterior incisions. It is all very exciting.

What are some best practices you’ve developed, or lessons learned through Osia System surgeries?

As mentioned, I have implanted some patients with SSD and some with mixed-conductive hearing losses.  Those without prior history of ear surgery received incisions anterior to their implant while posterior incisions were used in those with pre-existing mastoid cavities or history of acoustic neuroma resection. 

The posterior approach takes longer and can be a bit more difficult in patients having limited neck mobility and/or those with short necks. It’s important to gain more visibility to the site with these patients.  It’s important to position the head more deliberately in such patients to ensure adequate visibility.

With posterior incisions, I think being 10 mm from the posterior margin of the implant is fine.  With the anterior incision, it is important to be 10-15 mm anterior to the implant’s anterior margin. Lastly, I advise starting with a smaller incision and leaving markings if you need to expand during the course of the surgery.

What is the average time is takes you to surgically implant an Osia device? 

Implant time really depends on the patient and the incision.  With the anterior incision, it takes about 20-30 minutes from incision to implant in place.  Patients requiring the posterior incision take 30-50 minutes from incision to implant in place.  Closure is shorter for those requiring an anterior incision.  The longest operative time was for a posterior incision patient with thick neck and limited neck range of motion.

How does the addition of the Osia System to your armamentarium transform how you counsel patients?

We performed a total of 38 Baha Attract implants, Baha Connect implants and other bone conduction solutions in 2019 prior to Osia; therefore, our practice and our patients are very open to bone conduction as a viable and effective means of aural rehabilitation. Devices with an external abutment offered improved audibility while potentially sacrificing cosmesis and aftercare. With Osia, we now have the best of all worlds – great audibility and a small, light & comfortable sound processor.

As the one of first surgeons to implant the Osia System, do you have anything else to add?

Our initial impressions from the patients’ activated so far had improved gain, quality of the sound and cosmetics. Without barriers to access if bone conduction is the right option, the Osia System’s gain is a game-changer for both surgeons and patients.

For more information about the Osia System, subscribe to Cochlear ProNews or visit our website.

References:

  1. Dotevall M. Technical Report: Available gain in Osia vs Baha 5 Power. D1664198. Cochlear Bone Anchored Solutions AB, Sweden 2019

The Osia 2 System is intended for the following patients and indications: • Patients 12 years of age or older. • Patients who have a conductive or mixed hearing loss and still can benefit from sound amplification. The pure tone average (PTA) bone conduction (BC) threshold (measured at 0.5, 1, 2, and 3 kHz) should be better than or equal to 55 dB HL. • Bilateral fitting of the Osia 2 System is intended for patients having a symmetrically conductive or mixed hearing loss. The difference between the left and right sides’ BC thresholds should be less than 10 dB on average measured at 0.5, 1, 2, and 3 kHz, or less than 15 dB at individual frequencies. • Patients who have profound sensorineural hearing loss in one ear and normal hearing in the opposite ear (i.e., singlesided deafness or “SSD”). The pure tone average air conduction hearing thresholds of the hearing ear should be better than or equal to 20 dB HL (measured at 0.5, 1, 2, and 3 kHz). • The Osia 2 System for SSD is also indicated for any patient who is indicated for an air-conduction contralateral routing of signals (AC CROS) hearing aid, but who for some reason cannot or will not use an AC CROS. • Prior to receiving the device, it is recommended that an individual have experience with appropriately fitted air conduction or bone conduction hearing aids.

This article expresses the experience and opinions of Dr. Abraham Jacob. Please see Cochlear’s surgery recommendations as well prior to performing an Osia System surgery.

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This material is intended for health professionals. If you are a consumer, please seek advice from your health professional about treatments for hearing loss. Outcomes may vary, and your health professional will advise you about the factors which could affect your outcome. Always read the instructions for use. Not all products are available in all countries. Please contact your local Cochlear representative for product information.

 

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