Baha Candidate Selection Guide - Cochlear

A Bone ConduCtion HeAring Solution 

Candidate 

Selection Guide 

FOR PROFessiOnals

Candidate selection Guide 

Products in this manual are protected by the following patents: US 5 735 790, US 5 7 935 170, EP 0715839, EP 0715838 and corresponding patents in other 

countries and pending patent applications. All products can be subject to change without notice. No part of this publication may be replaced, stored in a retrieval 

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Caution: Federal law (USA) restricts this device to sale by or on the order of a medical practitioner. 

© Cochlear 2011. All rights reserved. 

Contents 

5 Introduction 

6 PART 1: Identifying candidates 

11 PART 2: Candidate evaluation 

14 PART 3: Counseling 

17 PART 4: Pediatric candidacy 

20 PART 5: Device considerations 

23 PART 6: Case histories 

28 PART 7: Clinical results 

29 References 

30 Notes 

Candidate selection Guide 

2 3

introduction 

Introduction 

This Candidate Selection Guide provides detailed information 

on how to select candidates who will benefit from Cochlear 

Baha ® 3 System. With bone conduction, sound bypasses the 

outer and middle ear, and goes directly to the nearest good 

inner ear. Baha is an effective implantable hearing solution for 

people with conductive hearing loss, mixed hearing loss, or 

single-sided sensorineural deafness (SSD). The Baha System 

works by enhancing natural bone conducted sound. 

the advantages of Baha 

The main advantage of Baha is that it bypasses the conductive element of a hearing loss 

through direct bone conduction and only needs to compensate for the sensorineural element. 

Therefore, for conductive or mixed hearing loss with an air-bone gap >30 dB, measured at 

500, 1000, 2000, and 4000 Hz (PTA 4 ), Baha should be the amplification method of choice. 1-6 

For people with SSD the Baha is worn on the deaf side. When worn on the deaf side, the Baha 

device transfers sound directly to the healthy cochlea, which reduces the effects of the head 

shadow effect, enables 360˚ sound awareness, and improves speech understanding in noise. 7-9 

There are also several medical indications where Baha could be the best solution for the 

candidate. Read more about this on page 10. 

Getting Baha for your candidate 

When you have identified a candidate for Baha, the candidate will need to be referred 

to an ENT surgeon for consultation. Candidates considered suitable for surgery will then 

have a small titanium implant placed in the mastoid bone behind their ear. 

The Baha 3 System consists of a high-performance sound processor, an abutment and a 

titanium implant which is located in the bone behind the ear. The surgical procedure 

may be performed under a local anesthesia and is generally regarded as minor surgery from 

both the surgeon’s and candidate’s point of view. The Baha Sound Processor is easily 

connected and disconnected once the implant has fused with the bone (a process known 

as osseointegration). 

4 5 

introduction 

advantages of Baha 

Compared to conventional air 

conduction (aC) hearing aids: 

• Less need for amplification 

because the conductive 

element of the hearing 

loss is bypassed 

• No occlusion of the 

ear canal10,11 Compared to middle ear surgery: 

• Safe and reliable means 

of restoring hearing 

• A reversible intervention 

• No risk of additional 

hearing impairment 

• The Baha can be evaluated 

prior to surgery

PaRT 1: identifying candidates 

PART 1 Identifying candidates 

There are three main audiological indications for the Baha ® System : 

• Conductive hearing loss 

• Mixed hearing loss 

• Single-sided sensorineural deafness (SSD) 

For each type of hearing loss there are specific criteria that will indicate who 

is a Baha candidate. There are also a range of other medical indications that may 

identify an individual as a Baha candidate. For details please see page 10. 

Conductive hearing loss 

Most candidates with a conductive hearing loss will benefit from Baha. As Baha sends 

sound directly to the cochlea via bone conduction, the conductive element of the hearing 

loss is effectively bypassed. This means that very little amplification is required. 

6 7 

Criteria: 

Size of conductive hearing loss 

Studies suggest that candidates with an air-bone gap of more than 30 dB (PTA 4 ) 

will experience significant advantages with Baha compared to an air conduction 

(AC) hearing aid. 1-6 

Hearing Level (dB HL) 

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Possible causes of 

conductive loss: 

• Cholesteatoma 

• Chronic otitis media 

• Congenital aural atresia 

• External otitis 

• Genetic causes 

• Ossicular disease 

• Other middle ear 

dysfunctions/diseases 

• Otosclerosis


Possible causes 

of mixed loss: 

Mixed loss refers to a hearing loss 

that has both conductive and 

sensorineural elements. The 

sensorineural element of a 

hearing loss can stem from: 

• Cochlear otosclerosis 

• Disease related factors 


• Noise trauma 

• Ototoxicity 

• Presbycusis 

For additional etiologies, see also 

Possible causes of conductive loss, 

page 7 and Medical indications, 

page 10. 

Mixed hearing loss 

Many individuals with mixed hearing loss are suitable candidates. Baha® sends sound 

directly to the cochlea via bone conduction, bypassing the conductive element of 

the hearing loss and providing amplification to compensate for the sensorineural 

component of the hearing loss. 

Criteria: 

the air-bone gap 

The air-bone gap is a good indicator of how suitable Baha will be for a candidate. 

The greater the air-bone gap, the more the candidate will benefit from Baha. Studies 

suggest that candidates with an air-bone gap of more than 30 dB (PTA 4 ) will benefit 

more from Baha than from a hearing aid. 1-6 

Extent of the sensorineural hearing loss 

Patients with a mild-to-moderate sensorineural component to their hearing loss 

are suitable candidates. The Baha Sound Processor can compensate for some degree 

of the sensorineural loss but, as the conductive part of the loss is bypassed, little 

amplification is required. Compared to conventional hearing aids, the Baha uses much 

less amplification. The most powerful Baha Sound Processor makes it possible to 

compensate for a sensorineural element of up to 65 dB HL (averaged across 500, 

1000, 2000, 3000 Hz) in a mixed hearing loss. For more information, please see the 

section on Device selection, page 21. 


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Single-sided deafness (SSD) 

Candidates with SSD and normal hearing in the good ear will benefit from Baha. 12 

The Baha Sound Processor picks up sound on the deaf side and sends it via bone conduction to 

the contralateral intact cochlea to overcome the head shadow effect, which leads to improved 

speech understanding and 360° sound awareness. 7-9 

8 9 

Criteria: 

normal hearing in the good ear 

Candidates must have normal hearing in the good ear defined as thresholds of less than or 

equal to 20 dB HL (averaged across 500, 1000, 2000, and 3000 Hz). If a patient later develops 

some hearing loss in the good ear, fitting of a more powerful Baha Sound Processor may be 

useful to supply needed amplification. 

Candidate motivation 

As SSD patients may have specific expectations due to their type of hearing loss, it is important 

that their expectations are realistic and that they perceive hearing from the deaf side as a need. 


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Single-sided deafness (SSD) 


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Possible causes of 

single-sided deafness: 

• Acoustic neuroma tumors 


• Ménière’s disease 

• Neurological 

degenerative disease 

• Ototoxic drugs 

• Sudden deafness 

• Surgical interventions 

• Trauma 

advantages of Baha 

Compared to CRoS aid: 

• No occlusion of the hearing ear 

• No need for cables to transmit 

sound from the deaf side 

• Better sound quality


advantages of Baha ® 

Compared to conventional 

bone conduction hearing aids: 

• Direct bone conduction 

• Better amplification – no 

weakening of the signal as it 

passes through skin 

• Superior sound quality 

• Improved comfort – no constant 

pressure to the skull 

• Discretion and improved 

cosmetic appearance13,14,15,16 Compared to middle ear surgery: 

• Safe and reliable means 

of restoring hearing 


• No risk of additional 

hearing impairment 

• Results can be evaluated 

prior to surgery 

Medical indications 

Besides the type and degree of hearing loss, there are several medical indications that 

identify an individual as a potential candidate for Baha. These indications are: 

Skin allergies 

Patient allergies may be aggravated by the placement of an ear mold. A Baha device 

maintains an open ear canal. 

Congenital malformations 

For most candidates with congenital ear malformation, surgical intervention or a 

conventional bone-conduction hearing aid is often prescribed because an AC hearing 

aid is simply not an option. Baha has several advantages over conventional BC hearing 

aids and, compared to surgical reconstruction, the Baha System provides a reliable 

and cost efficient solution. 13,14 In cases where an auricular prosthesis or surgical 

reconstruction is planned, the position of the Baha Implant in relation to these 

procedures should be considered. 

Draining ears 

One common problem for otologists when treating candidates with middle ear 

disease is getting a dry ear with good hearing. If the candidate uses an AC hearing aid, 

the ear mold in the ear canal will aggravate the condition. When using the 

Baha System, the ear canal is left open, thus allowing the ear to dry. 1 

Ear canal stenosis 

Individuals with stenosis of the ear canal are not suitable for surgical intervention, 

and the use of conventional hearing aids can be difficult when fitting an ear mold. 

With Baha, the ear canal is bypassed using Direct Bone Conduction. 

Previous ear surgery 

Candidates who have had previous surgeries using, for example, a canal wall down 

technique, may find it difficult to wear an ear mold without feedback problems. 

As no ear mold is required, Baha is a good solution. 

Radical cavity 

Individuals treated for chronic mastoiditis with a radical cavity may be precluded from 

the use of a conventional AC aid because such aids may occlude the ear canal thus 

aggravating the condition. The Baha System allows the ear canal to be left open. 

Syndromic hearing losses 

Individuals with syndromes such as Downs, 15 Goldenhar 17 and Treacher Collins 18 

can be suitable candidates for Baha. Treatment of these individuals often requires 

special consideration and counseling. A personal counseling plan that considers the 

type of syndrome, the severity of the condition, and general abilities is suggested. 

For these candidates, parents or caregivers will often take an active role in the care 

of the sound processor, abutment and abutment area, and they will need special 

instructions early on in the candidate selection process. 1 

PART 2 Candidate evaluation 

PaRT 2: Candidate evaluation 

In addition to the audiological evaluations, the candidate should have the opportunity 

to listen to a Baha Sound Processor. Several Baha products can be used for this purpose: 

test rod, testband, headband, and Baha Softband. The main difference between these 

products is that the testband and test rod are for short-term testing, while the 

headband and Baha Softband are for longer trials. 

10 11


Recommended 

audiological tests: 

• Pure tone audiometry (average 

bone thresholds at 500, 1000, 

2000, and 3000 Hz) 19 

• Speech audiometry with PB word 

lists/HINT/QuikSIN (for instance, 

maximum speech intelligibility) 

• Sound field testing (Baha® device 

on a testband, or a Baha Softband) 

Practical points 

to consider: 

• Manual dexterity 

• Cosmetic aspects 

• Driving (if the candidate is a taxi 

driver, then the side facing the 

passenger is a good alternative) 

• Telephone use (if the candidate 

uses the telephone frequently, the 

opposite side to the “writing hand” 

may be the best choice) 

Adult candidates 

The Baha System works independently of the severity of the conductive part of the hearing 

loss because sound bypasses the outer and middle ear. The bone conduction threshold 

is therefore the most relevant measurement in the audiological assessment. Use the 

candidate’s air-bone gap as a guide to the benefits that can be expected from choosing Baha 

instead of an AC hearing aid. Comparing the results of speech measurements in sound field, 

with and without the sound processor, will also be useful. 

Sound field testing of a Baha Sound Processor allows the candidate to hear the sound 

of a Baha device before surgery. For a realistic experience, allow the candidate to test a 

sound processor in different sound environments (for example by taking a walk around 

the hospital/clinic or surrounding area). For candidates with SSD, a longer trial, which allows 

testing of a Baha Sound Processor at home or work, is crucial. 

nOTe: In candidates with bone defects or other problems where the testband/headband 

is not suitable, the Baha Softband may provide a better testing solution (see Listening 

with a Baha Softband, page 19). 

Selection of implant side 

Bilateral fitting 

For candidates with binaural hearing loss, a bilateral fitting of Baha, which may lead to 

binaural hearing, should be considered as this improves speech understanding, sound 

localization, and general candidate satisfaction. 20-22 For bilateral fittings, bone conduction 

thresholds must be symmetrical (defined as less than 10 dB difference on average (PTA 4 ) 

or less than 15 dB at individual frequencies). 

unilateral fitting 

For SSD, implantation is made on the deaf side. For conductive or mixed losses the general 

recommendation is to choose the side with the best cochlear function (the best bone 

conduction thresholds). The side the candidate perceives as having the greatest handicap 

should, however, be taken into account. 

Listening with a Baha Testband 

1. Attach the sound processor to the plastic snap connector disc 

on the testband. 

2. Test that the Baha Sound Processor works by putting on the 

testband, plugging your ears and introducing sound. 

3. Put the testband on the candidate’s head placing the plastic snap 

connector disc against the selected mastoid. 

4. Position the sound processor behind the ear. To avoid feedback, 

make sure the processor doesn’t touch the ear or skin. 

Sound processor considerations 

Due to weakening of the sound signal as it passes through skin (attenuation), 

the gain from a Baha device is reduced by 2-15 dB* during sound-field testing 

compared to a sound processor fitted to an osseointegrated implant. 23,24 

Therefore, we recommend using a stronger processor for the test than the 

candidate’s audiogram would indicate. A stronger processor is most noticeable 

at higher frequencies because higher frequencies are weakened to a greater 

extent than low frequency signals. 25 For SSD, use a head worn sound processor. 

A body worn device will not help alleviate the head shadow effect due to its 

microphone placement. 

The new Baha Fitting software offers features such as BC Select and BC Direct 

that may help to optimize a Baha 3 Sound Processor demonstration with a 

headband or a Baha Softband. 

*Depending on the patient and the frequency, sound is weakened by 2-15 dB as it passes through skin. 


12 13 

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PaRT 3: Counseling 

PART 3 Counseling 

Before they are treated, candidates should be motivated, well informed and counseled 

to have realistic expectations. Baha ® Counseling tools will be helpful for these purposes. 

The main points that should be covered during counseling are: 

• Benefits of Baha to the patient 

• The process of getting Baha 

• Expectations 

• Aftercare 

• Reimbursement/funding 

PART 3: 

Benefits of Baha for the patient 

Conductive/mixed hearing loss 

The use of direct bone conduction to transmit sound gives Baha several unique advantages 

over other treatments for conductive/mixed hearing loss. 

The most notable benefits of Baha for a candidate with conductive or mixed hearing loss, 

compared to conventional hearing aids, are: 

• Need for less amplification as the conductive element of the hearing loss is bypassed 

• No occlusion of the ear canal 

• Excellent sound quality as very little amplification is required 

When compared to middle ear surgery Baha will provide: 

• A safe and reliable way to restore the candidate’s hearing 

• No risk of additional hearing impairment 


• The opportunity to test the Baha before surgery is performed 

In comparison to conventional bone conduction hearing aids Baha will give the candidate: 

• Better sound quality due to direct bone conduction 

• Increased wearing comfort, as there is no constant pressure to the skull 

If the candidate has frequent ear infections Baha can provide: 

• Reduced incidence 

• A dryer ear canal as the ear canal is left open 

SSD 

As SSD candidates may have specific expectations due to their type of hearing loss, it is 

important to ensure that these expectations are realistic. The audiologist or physician can 

help the patients to understand their perceived handicap, and more importantly, their 

motivation for hearing. 

nOTe: Restoration of directional hearing should not be expected after fitting as all 

sounds will be processed by the remaining functioning cochlea. 8 Some patients, however, 

report a rudimentary form of directional hearing resulting from a difference in the 

perceived quality of the Baha processed sound. 

For candidates with SSD, Baha provides several benefits when compared 

to a conventional CROS aid: 

• No occlusion of the hearing ear 

• No need for cables to transmit sound from the deaf side 

• Better sound quality 

• Only one device is worn, versus two with the CROS aid 


14 15


The process of getting Baha ® 

Review the process of Baha treatment with the candidate: 

• Inform the candidate about the different audiological evaluations that will be performed. 

• Tell the candidate that they will need to have surgery. Emphasize that the surgical 

procedure is considered minor and may be performed in an outpatient setting under local or 

general anesthetic. 

• Explain that a small titanium implant will be placed just behind the chosen ear. Clarify that 

the implant will be connected to an abutment and that it is the abutment that will protrude 

through the skin. At this point showing an actual implant and abutment may reduce the 

candidate’s anxiety. 

• Tell the candidate that after surgery they will have a small hair-free area around the 

abutment and that they may experience some numbness in that area. The numbness may 

or may not pass with time. 

• Inform the candidate that they will have a dressing and pressure bandage over the 

abutment when they come from surgery and that the dressing will be changed (5-7 days 

post-operatively) and removed (10-14 days post-operatively). 

• 

Explain how long the implant will take to fully osseointegrate (usually up to 3 months) 

and how the sound processor will be fitted. 

nOTe: Emphasize that there is no risk of further damage to the candidate’s hearing from Baha 

surgery. More detailed information on the surgical procedure should be provided by the surgeon. 

Expectations 

Ensure the candidate has realistic expectations. Preoperative testing is essential for keeping 

candidate expectations reasonable. Listening to a Baha Sound Processor on a testband/Baha 

Softband provides a practical experience close to that of the post-surgical outcome In this 

context, it is important to note that true directionality will not be restored for SSD candidates. 

Aftercare 

Candidates must be able to maintain and clean the area around the abutment (either 

themselves or with help from others). Careful consideration must be given to the candidate’s 

ability to maintain proper hygiene. With children, responsibility for maintaining hygiene falls 

on the parents or caregivers. 

Reimbursement and funding 

PART 4 Pediatric candidacy 

Patient selection 

The Baha Sound Processor can be fitted to infants and children in need of amplification 

via bone conduction. The indications for a Baha device are generally the same as for 

adults, except in the US and Canada, Baha implantation is indicated for children five 

years of age and older. Younger children may be fitted with a Baha using the Softband. 

PaRT 4: Pediatric candidacy 

16 

As reimbursement for Baha is an important factor for the candidate, this should be discussed 

during the preoperative evaluation. Terms and conditions of reimbursement and funding for 

Baha differ from area to area. For information about the terms and conditions applicable in 

your area, please consult your local Cochlear representative. In the U.S.A., please refer to 

the Baha reimbursement guide. 

17


use age appropriate 

tests to evaluate 

audibility and speech 

understanding: 

• Auditory Brainstem Response 

(ABR): Infants 

• Auditory Steady State Response 

(ASSR): Infants 

• Otoacoustic Emission (OAE): 

Infants (requires normal middle 

ear function) 

• Behavioral Observational 

Audiometry (BOA): 

Infants from 7-8 months 

• Visual Reinforcement Audiometry 

(VRA): Children from about six 

months up to 2-3 years 

• Play audiometry: Children 

between 3-5 years of age * 

• Listening with a Baha® Softband 

* Play audiometry can be done with 

warble tones, speech or animal sounds. 

Evaluation 

As in an adult patient evaluation, the bone conduction threshold is the most relevant in 

the audiological assessment. Use the air-bone gap as a guide to the benefits that can be 

expected from choosing the Baha System. There may also be medical indications why Baha 

will be the solution of choice for the child. If possible, obtain speech measurements in the 

sound field with and without the sound processor. 

We recommend fitting infants and children who are too young or not ready for implantation 

with the Baha Softband. This will instantly improve the child’s hearing and is a very good 

introduction to the advantages of Baha, both for the child and for the parents/caregivers. 

The decision to implant the child can then be postponed to a later date and is usually easy, 

once the benefits to the child have been observed. 

Selection of implant side 

Clinical research suggests that children with binaural conductive hearing loss should be 

fitted with bilateral Baha Sound Processors on a Baha Softband preferably before the age of 

6 months. 1 If bilateral fitting is contraindicated, fit the side with the best bone conduction 

thresholds and skull thickness. For children with SSD, the Baha Sound Processor is placed 

on the deaf side. 

Counseling 

Parents of hearing-impaired children will have a great need for counseling. Parents may 

have questions about the hearing loss and how it will affect their child’s development. They 

need information on how to help their child achieve the best possible results, especially in 

speech and language development. They will want to know why Baha is the best solution 

for their child. In addition, counseling should cover the Baha treatment process from both 

a short- and long-term perspective. Therefore, both Baha Softband and surgery should 

be discussed. 

Device selection 

The Baha Softband is a preoperative hearing solution and does not provide the full benefits 

of a sound processor connected to an implant (see page 13). This must be taken into 

consideration when choosing an appropriate sound processor. 

CauTiOn: the older Baha Softband contain natural rubber latex 

that may cause allergic reactions. the newer generation 

Baha Softbands are latex free. 

Listening with a Baha Softband 

Try to make the first moments with the Baha Softband as pleasant for the child as possible. 

It is very important that the child has positive associations with using the Baha Softband. 

1. Program the sound processor for patient’s individual bone line using the Baha Fitting 

Software. Optimize the sound processor fitting for use with Baha Softband by selecting 

suitable parameters in the BC Select screen. Also, whenever possible, conduct BC Direct 

measurements, which are in-situ bone conduction thresholds, using patient’s processor. 

2. Attach the sound processor to the plastic snap connector disc on the Baha Softband. 

3. Test that the Baha Softband works by putting it on yourself, plugging your ears 

and introducing sound. 

4. Put the Baha Softband around the child’s head, quite loosely at first. 

5. Place the plastic snap connector disc against the mastoid or another bony location 

of the skull. Avoid placing it on the temple bone, as this may be uncomfortable. 

Check that the entire snap connector disc is in contact with the skull bone. Turn on 

the sound processor. 

6. Tighten the Baha Softband until it is close-fitting enough to ensure effective sound 

transmission but loose enough not to cause the child any discomfort. 

7. Have the parent or caregiver talk to the child, sing a song, or another pleasant sounding 

experience. Watch for the child’s reaction. 

TiP: Make sure your finger fits between the skull and Baha Softband – this will ensure 

that the Baha Softband is not too tight. 

nOTe: Once the Baha Softband is tight enough to transmit sound effectively, 

additional tightening will only increase the sound marginally. 

Additional considerations 

Early amplification 

Early access to amplification is crucial for a child’s speech, language and educational 

development. Yoshinaga-Itano reports that children who receive hearing rehabilitation 

before the age of 6 months perform significantly better on language tests at the age of 

3 to 4 years than do children fitted later in life. 26 The Yoshinaga-Itano study concludes 

that a delay in intervention may lead to a permanent language deficit. 


Recommended age for implantation 

Implant placement must wait until the child has sufficient bone volume and bone 

quality. This can vary from child to child but, based on studies, the child should 

have a skull bone at least 2.5 mm thick. 

18 19 

27,28,29 Note in the US and Canada, the 

Baha implant is indicated for children five years of age or older. Younger children can 

5 

use a Baha sound processor on a Softband. 

2 

3 

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PaRT 5: Device consideration 

PART 5 Device considerations 

When calculating the amplification needs of a Baha ® candidate, the bone conduction thresholds in 

the audiogram provide the most important information. The Baha Sound Processor will have to 

produce sufficient power to compensate for any sensorineural element to the hearing loss. To 

help your candidate select the correct sound processor, follow these guidelines. Please note that 

the new generation Baha 3 Sound Processors are programmable. The factory setting may be 

a starting point for a quick demonstration in some cases but it is suggested that a processor is 

custom programmed using Baha Fitting Software for the best candidate experience. 

Device selection based on hearing loss type 


For candidates with a purely conductive loss, we recommend focusing on which sound 

processor has the most useful features for the candidate. Any Baha device will provide 

sufficient amplification. 


The fitting range of the selected sound processor must cover the size of the sensorineural 

loss as the device will need to compensate for the degree of sensorineural impairment. 

Similar to other hearing devices, the clinical rule of thumb is: if the hearing loss is in the 

lower third of the fitting range, a more powerful sound processor may result in better 

outcomes for the candidate. Providing a second device for situations where more power 

is required could also be considered. 

SSD 

For most candidates with SSD, the choice of sound processor can be based on which device 

has the most useful features. In some cases, however, the sound processor may need to 

deliver added amplification to provide sufficient audibility to the contralateral ear. 

SSD candidates may benefit from a more powerful head worn Baha in the following situations: 

• Larger than expected interaural attenuation. Extra amplification may be required to 

ensure audibility in the good ear. 

• Sensorineural hearing loss developing in the ‘normal’ ear over time for instance due to 

presbycusis or noise exposure. Extra gain may be required to amplify the sound above 

the candidate’s thresholds. 

To evaluate the benefit of Baha for SSD candidates, a longer trial or testing – that occurs 

outside of the sound booth – is crucial. Usually a two-week trial will provide a good 

indication of what the candidates may expect from Baha. 

nOTe: Due to weakening of the sound signal as it passes through the skin, the gain 

from a Baha Sound Processor will be reduced by 2-15 dB during demonstration on a 

Softband or Headband. Therefore, we recommend using the most powerful head worn 

device for this process. 


20 21


Additional considerations for device selection 

• Improved clarity of speech in difficult listening situations 

A sound processor with directional microphones will prioritize sounds coming 

from the front versus sounds coming from behind, which may make it easier 

to hear speech in noise. 

• Better comfort in noisy listening situations 

Directional microphones provide less gain for lower pitched sounds which may 

making it easier to hear in noisy situations. In addition, a directional microphone 

prioritizes sounds from the front versus those from behind, which may improve speech 

understanding in noise. 

• Improved audibility in difficult listening situations 

There may be situations where additional audibility is needed. A more powerful 

Baha® device may make sounds (especially those in the higher frequencies, e.g., 

‘s’ and ‘sh’) easier to understand. A Baha with a specific noise program helps 

ensure audibility and comfort. 

• Listening from a distance 

A more powerful sound processor will amplify soft sounds more so they may become 

more audible. This may enable better hearing from a distance (e.g., in church). 

• Music appreciation 

A sound processor with a Music Program provides a flatter frequency response which is 

best for enjoying music. 

Benefits of providing different programs 

within the sound processor 

Each program within the programmable sound processors may provide different 

performance advantages, depending on the specific listening environment. Therefore, some 

candidates may benefit from having different listening programs. This gives the candidate 

the unique opportunity to select the best listening program for a given situation. 

PART 6 Case histories 

Patient: Male 

age: 36 

occupation: Salesman 

type of hearing loss: Unilateral mixed hearing loss 

Diagnosis: Congenital facial paraesthesia and 

malformation of outer and middle ear 

aided side: Left 

unaided audiogram: 

Frequency(Hz) 

History: The patient received a Vistafix ear prosthesis in his 

late teens and was later fitted with a Baha device in 2006. 

He had never used a hearing device before. The benefits of 

Baha have been many and the patient considers it a useful 

solution for his hearing loss. 

Pta 4 improvement: 64 to 26 dB HL 

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B = Aided threshold with Baha in soundfield testing 

PaRT 6: Case histories

PaRT 6: Case histories 

Patient: Female 

age: 46 

occupation: Homemaker 

type of hearing loss: Binaural conductive hearing loss 

Diagnosis: Treacher Collins syndrome 

aided side: Right 


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History: The patient received her first Baha ® 27 years 

ago and still uses the same implant. She changed the 

abutment to the snap coupling when she upgraded 

her Baha Sound Processor. 

Pta 4 improvement 71 to 21 dB HL 

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Patient: Female 

age: 13 

occupation: Student 

type of hearing loss: Binaural Conductive hearing loss 

Diagnosis: Treacher Collins syndrome 



History: The patient has used Baha since she was a child. 

She experiences great benefit from the Baha in 

classroom situations. 



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PaRT 6: Case histories


Patient: Male 

age: 53 

type of hearing loss: Binaural mixed hearing loss 

occupation: Nurse 

Diagnosis: Chronic otitis media, middle ear 

bones removed after osteomyelitis, tympanic 

membranes ruptured bilaterally 

aided side: Right 


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History: The patient has had hearing problems his entire life. 

The patient received his Baha ® in 2004. In 2007 he received a 

new implant after losing the original due to trauma. He uses 

his Baha constantly and is extremely pleased with the sound. 




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Patient: Male 

age: 52 

type of hearing loss: Single-sided deafness (SSD) 

occupation: Nurse 

Diagnosis: Acoustic Neuroma (AN) left ear 

AN surgery took place in 1998 



History: The patient was offered a CROS aid following 

acoustic neuroma surgery. He used the CROS aid for one 

month but felt more handicapped with it, than without it. 

An implant for the Baha System was placed in May 2003, and 

in August of that year, a Baha was fitted. At clinical follow-up 

one year later he reported using the Baha Sound Processor for 

14 hours a day, seven days a week. 

26 27 


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B = Aided threshold with Baha in soundfield testing

PaRT 7: Clinical results References 

PART 7 Clinical results 

The Baha® System has proven to be an effective hearing solution and several clinical studies demonstrate patient benefits. 

Mixed/conductive hearing loss 

“The Baha provides a reliable and predictable adjunct for auditory rehabilitation in appropriately selected patients, offering a 

means of dramatically improving hearing thresholds in patients with conductive or mixed hearing loss who are otherwise unable 

to benefit from traditional hearing aids.” 6 

“It can be stated that patients with an acquired unilateral air-bone gap benefited from using the Baha. This was not only reflected 

in the audiological results, but also in the patients’ opinions.” 30 

SSD 

“Subjects found Baha amplification to be consistently more useful [compared to CROS] in a variety of listening environments 

experienced in daily life. On HINT testing the Baha provided clinically significant benefit in several noise conditions.” 31 

“The speech-in-noise measurements demonstrated the efficacy of the Baha [...] to lift the head shadow. 

patients were still satisfied at 1-year follow-up, according to the four questionnaires*. ” 8 

Pediatric 

“Bone-anchored hearing aids provide an exceptionally effective method of rehabilitating the child with conductive hearing loss 

or inability to wear AC aids due to chronic otorrhea.” 29 

“The Baha is an effective hearing aid for children with congenital hearing loss, whether they were previous air-conduction 

or bone-conduction aid wearers. The majority was overall more satisfied with their Baha than their previous aid.” 17 

“Fixture survival rates equivalent to those seen in an adult population. Also significant improvements seen in aided 

thresholds with Bahas demonstrate the safety and efficacy of the Baha.” 16 

* The Abbreviated Profile of Hearing Aid Benefit, the Glasgow Hearing Aid Benefit Profile, 

the International Outcome Inventory for Hearing Aids, and the Single-Sided Deafness questionnaire. 

References 

1. 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(195):1-12. 

2. 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. Archives of 

Otolaryngology-Head & Neck Surgery 2005 Apr;131(4):321-5. 

3. McDermott AL, Dutt SN, Reid AP, Proops DW. An intra-individual comparison of the 

previous conventional hearing aid with the bone-anchored hearing aid: The Nijmegen 

group questionnaire. The Journal of Laryngology and Otology 2002 Jun;116 Suppl 28:15-9. 

4. Mylanus EA, Snik AF, Cremers CW. Patients’ opinions of bone-anchored vs. conventional 

hearing aids. Archives of Otolaryngology-Head & Neck Surgery.1995 Apr;121(4):421-5. 

5. Mylanus EA, van der Pouw KC, Snik AF, Cremers CW. Intra-individual comparison of the 

bone-anchored hearing aid and air-conduction hearing aids. Archives of Otolaryngology- 

Head & Neck Surgery 1998;124(3):271-6. 

6. Lustig LR, Arts HA, Brackmann DE, et al. Hearing rehabilitation using the Baha 

bone-anchored hearing aid: results in 40 patients. Otology & Neurotology 

2001;22(3):328-34. 

7. Wazen JJ, Spitzer JB, Ghossaini SN, Fayad JN, Niparko JK, Cox K, et al. Transcranial 

contralateral cochlear stimulation in unilateral deafness. Otolaryngology-Head & Neck 

Surgery 2003;129(3):248-54. 

8. Hol MK, Bosman AJ, Snik AF, Mylanus EA, Cremers CW. Bone-anchored hearing aids in 

unilateral inner ear deafness: an evaluation of audiometric and patient outcome 

measurements. Otology & Neurotology 2005 Sep;26(5):999-1006. 

9. Bosman AJ, Hol MKS,Snik AFM,.Mylanus EAM Cremers CWRJ, Bone-anchored hearing 

aids in unilateral inner ear deafness. Acta Oto-Laryngologica 2003;123(2):258-260. 

10. Burell SP, Cooper HC, Proops DW. The bone-anchored hearing aid-the third option for 

otosclerosis. Journal of Laryngology and Otology 1996 Dec;110 Suppl 21:31-37. 

11. Snik AFM, Mylanus EAM, Creemers WRJ. The Bone-anchored hearing aid – A solution for 

previously unresolved otologic problems. The Otolaryngologic Clinics of North America 

2001;34(2):365-72. 

12. Lin LM, Bowditch s, Anderson MJ, May B, Cox K, Niparko JK. Amplification in the 

rehabilitation of unilateral deafness: speech in noise and directional hearing effects 

with bone-anchored hearing aids Baha Compact and Divino. Otology and Neurotology 

2006 Feb;27(2):172-82. 

13. Hol MK, Cremers CW, Coppens-Schellekens W, Snik AF. The Baha Softband. A new 

treatment for young children with bilateral congenital aural atresia. International Journal 

of Pediatric Otorhinolaryngology 2005 Jul;69(7):973-80. 

14. Evans A.K, Kazahaya K. Surgery or implantable hearing devices? The experts question 

revisited. International Journal of Pediatric Otorhinolaryngology 2007 Mar;71(3):367-374. 

15. Sheehan PZ, Hans PS. UK and Ireland experience of bone-anchored hearing aids (Baha) in 

individuals with Down syndrome. International Journal of Pediatric Otorhinolaryngology, 

2006 Jun;70(6):981-6. 

16. Tietzle L, Papsin B. Utilization of bone-anchored hearing aids in children. International 

Journal of Pediatric Otorhinolaryngology 2001 Apr;58(1):75-80. 

17. Powell RH, Burell SP, Cooper HR, Proops DW. The Birmingham bone-anchored hearing 

aid programme: Pediatric.experience and results. The Journal of Laryngology & Otology, 

1996;110:21-9. 

18. Marres HA, Cremers CW, Marres EH. The Treacher Collins syndrome. Management of 

major and minor ear anomailes. Revue de laryngologie otolologie rhinologie. 

1995:116, 2;105-108. 

19. Catlin FI. Guide for evaluation of hearing handicap. Otolaryngologic Clinics of North 

America. 1979 Aug: 12(3):655-663. 

20. Bosman AJ, Snik AF, van der Pouw CT, Mylanus EA, Cremers CW. Audiometric evaluation 

of bilaterally fitted bone-anchored hearing aids. Audiology 2001 May-Jun;40(3):158-67. 

21. Burrell SP, Cooper HR, Reid AP, Proops DW. Patient satisfaction with bilateral 

bone-anchored hearing aids: the Birmingham experience. Journal of Laryngology 

& Otology Suppl 2002 Jun 1;116 Suppl 28:37-46. 

22. Dutt SN, McDermott AL, Burrell SP, Cooper HR, Reid AP, Proops DW. Speech 

intelligibility with bilateral bone-anchored hearing aids: the Birmingham experience. 

The Journal of Laryngology & Otology 2002 Jun 1;116 Suppl 28:47-51. 

23. Håkansson B, Tjellström A., Rosenhall U. Hearing thresholds with direct bone 

conduction versus conventional bone conduction. Scandinavian Audiology 

1984;13(1):3-13. 

24. Gründer I, Seidl RO, Ernst A, Todt I. Relative value of Baha testing for the postoperative 

audiological outcome. HNO 2007 Sep 20. 

25. Eeg-Olofsson M. Transmission of bone conducted sound in the human skull measured 

by cochlear vibrations. Proceedings of the first International Symposium of Bone 

Conduction Hearing and Osseointegration; 2007 Jul 12-14; Halifax, Canada. 

26. Yoshinaga-Itano C. Early Intervention after universal neo-natal hearing screening: 

impact on outcomes. Mental Retardation and Developmental Disability Research 

Reviews 2003;9(4):252-66. 

27. Tjellström A, Håkansson B, Granström G, Bone-anchored hearing aids: current status in 

adults and children. Otolaryngologic Clinics of North America 2001 Apr;34(2):337-64. 

28. Davids T, Gordon KA, Clutton D, Papsin BC. Bone-anchored hearing aids in infants and 

children younger than 5 years. Archives of Otolaryngology-Head & Neck Surgery, 2007 

Jan;133(1):51-5. 

29. Papsin BC, Sirimanna TKS, Albert DM, Bailey M. Surgical experience with bone-anchored 

hearing aids in children. The Laryngoscope, 1997 Jun;107(6):801-6. 

30. Hol MKS, Snik AFM, Mylanus EAM, Cremers CWRJ . Does the bone-anchored hearing 

aid have a complimentary effect on audiological and subjective outcomes in candidates 

with unilateral conductive hearing loss?, Audiology & Neurotology 2005 May-Jun; 

10(3):159-68. 

31. Niparko JK, Cox KM, Lustig LR. Comparison of the bone-anchored hearing aid 

implantable hearing device with contralateral routing of offside signal amplification in 

the rehabilitation of unilateral deafness. Otology & Neurotology, 2003 Jan;24(1):73-78. 

28 29

notes 

Notes Notes 

30 31 

notes

this is the Cochlear promise to you. As the global leader 

in hearing solutions, Cochlear is dedicated to bringing the 

gift of sound to people all over the world. With our hearing 

solutions, Cochlear has reconnected over 250,000 cochlear 

implant and Baha ® recipients to their families, friends and 

communities in more than 100 countries. 

Along with the industry’s largest investment in research 

and development, we continue to partner with leading 

international researchers and hearing professionals, ensuring 

that we are at the forefront in the science of hearing. 

For patients receiving any Cochlear hearing system, our 

commitment is that for the rest of your life we will be 

here to support you. 

As your patient’s partner in hearing for life, Cochlear believes it is important to convey 

not only the benefits, but also the potential risks associated with a Baha procedure. 

Not everyone with hearing loss is a candidate for a Baha. Baha is contraindicated in 

patients with inadequate bone quality or quantity to provide stability and support for 

the implant, or in patients who will be unable to maintain and clean the skin around 

the abutment. In the U.S., use of the implanted fixture is also contraindicated in children 

under age 5 years. 

All surgical procedures include an element of risk, and it is impossible to guarantee success. 

The device may fail to osseointegrate for a number of reasons, including physiological 

and surgical issues as well as traumatic impact to the implant site. On rare occasions the 

skin around the abutment may become inflamed from a mild infection or the skin may 

grow back towards its original thickness. For complete information regarding the risks and 

benefits of a Baha procedure, please refer to the instructions for use for the Baha implant 

available at ww.CochlearAmericas.com/Bahaindications 

www.Cochlearamericas.com 

Cochlear americas 

13059 East Peakview avenue 

Centennial Co 80111 

uSa 

tel: 1 303 790 9010 

Fax: 1 303 792 9025 

Cochlear Canada inc 

2500-120 adelaide Street West 

toronto, on M5H 1t1 

Canada 

tel: 1 416 972 5082 

Fax: 1 416 972 5083 

Baha and Baha Divino are trademarks of Cochlear Bone anchored Solutions. Cochlear and the elliptical logo are 

trademarks of Cochlear Limited. the names of actual companies and products mentioned herein may be the 

trademarks of their respective owners. © Cochlear Bone anchored Solutions 2011. 

Bun070 iSS1 DEC11

Baha Candidate Selection Guide - Cochlear

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