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Can't Wear Hearing Aids? A Surgeon explains your next Option: Bone Conduction Implants in 2025 — Transcript

by Joe Manjaly - @earsurgeonjoe · 4,878 words · 742 segments · language en · Watch on YouTube

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0:00If you've been unable to get on with
0:01hearing aids, your team may have talked
0:03to you about the option of bone
0:05conduction technology. It's a great time
0:07for patients as there are now more
0:08choices than ever before. But that also
0:10means a challenge. How do you figure out
0:12which is best for you? I'm a hearing
0:14implant surgeon at University College
0:16London. And in 2023, I made a video for
0:19my own patients comparing each bone
0:21conduction device to help them navigate
0:23this choice. It ended up being shared
0:25and used by colleagues in a number of
0:27different cities. But technology also
0:29moves fast and it's now 2025. The
0:31landscape has changed and it's time for
0:33an update. So, this is your complete
0:36unbiased and unsponsored guide to bone
0:38conduction hearing devices. We're going
0:40to cover the fundamentals of bone
0:42conduction hearing, a full review of all
0:44the main options available today, a
0:46head-to-head comparison of how they
0:48differ in terms of surgery, visibility,
0:51power, and MRI compatibility, and
0:53finally, the key further questions that
0:56you might choose to ask to help you
0:57decide. I've included chapters in the
0:59timeline so you can easily find what
1:01you're looking for. And if spoken
1:02English isn't your first language, then
1:04there are also different language
1:06captions available if you're watching on
1:08YouTube. Right, let's get started.
1:10Hearing is precious and yet the impact
1:12of hearing loss and deafness is often so
1:14underestimated because it is so
1:16invisible. It's so easy to be mistaken
1:18for being rude when you've not actually
1:20heard something. And people are maybe
1:22just less likely to adjust for your
1:23needs in a way that's so different to if
1:25you, for example, had two broken legs
1:28where people would be clearly showing
1:29you empathy and holding doors open for
1:31you. But we know that unmanaged hearing
1:33loss has direct impact on social
1:36isolation, on marriage and relationship
1:38strain, employment prospects and overall
1:40daily listening effort and the mental
1:42fatigue that that brings. Even more
1:44underestimated even by us ENT surgeons
1:47than the previous generation is the
1:49impact of even having hearing loss in
1:51just one ear. Even if the other ear is
1:52fine in a quiet room, it's going to be
1:54far less noticeable to the doctor
1:55looking after you. But single-sided
1:57hearing loss will particularly make
1:59difficult noisy environments. And to
2:01localize where a sound is coming from,
2:03it also leads to what we call a head
2:05shadow effect where you miss one half of
2:07your environment. Think about the car
2:08coming down the street or someone
2:10calling you from that side. And of
2:12course that high listening effort again
2:14and the tiredness that comes with it. So
2:15what can we do about all of this in
2:172025? Well, to understand the solutions,
2:20it's first worth understanding how
2:22exactly hearing works. Each of your ears
2:24delivers sound to your brain via, if you
2:26like, a conduction system connected to a
2:29microphonic system. The conduction
2:31system is made up of your outer ear,
2:33including your ear canal, and also your
2:35eard drum and three bones behind the
2:37eardrum that carry sound vibrations and
2:39concentrate them onto a small window
2:41into the inner ear, the microphonic part
2:43of the ear, the coccleia as we call it,
2:45which converts mechanical vibrations
2:47into electrical signals that are then
2:49delivered to the brain. Now, people can
2:51lose hearing as a result of problems
2:52anywhere along that pathway. But if we
2:54focus in on that conduction system,
2:56problems can include scarring up of the
2:58ear canal, damage to the eardrum itself,
3:00or damage to the hearing bones behind.
3:02And some people are even born with some
3:04of those components missing. Now, in
3:06these cases, a surgeon will first ask
3:08the question whether some of this can be
3:10reconstructed and recreated with
3:12microscopic surgery. So, you might hear
3:14the terms canal plasty or tempanoplasty
3:16or stapecttomy used for this type of
3:19surgery. And these should generally be
3:20considered first where possible and this
3:23is something your surgeon will usually
3:24discuss with you. Now in some cases
3:26though these procedures are either not
3:28technically possible or deemed too risky
3:31or have already even been tried and in
3:33this case the next step is to then ask
3:36is a conventional hearing aid an option.
3:38However, there are a number of reasons
3:39why this might also not be suitable.
3:42Whether that be because of the ear size
3:44and shape causing recurrent infections
3:46or if the hearing levels are too low for
3:48even the strongest hearing aid. Now for
3:50those that have reached this scenario,
3:52we can potentially use the magic of bone
3:54conduction to provide good hearing.
3:56Again, now to establish whether your
3:58hearing might be suitable for a bone
4:00conduction device, we look at your
4:01aiogram. And rather than looking at your
4:04overall hearing levels, usually the
4:05lower line or what we call your air
4:07conduction thresholds, we instead pay
4:09particular attention to where your bone
4:11conduction thresholds are. In many
4:13cases, people with outer and middle ear
4:15problems can have quite poor hearing,
4:16but their bone conduction thresholds are
4:18actually still quite good. And this is
4:20then a route we can utilize in a way
4:22that we can't with a regular hearing
4:24aid. With bone conduction, instead of
4:26sending sound vibrations through a
4:28poorly functioning ear canal and middle
4:30ear, we bypass that part entirely. The
4:32device picks up sound and vibrates it
4:34through the skull directly to the inner
4:37ear. The vibrations reaching the inner
4:39ear are then converted to electrical
4:40signal to the brain as normal. In fact,
4:42a fascinating fact about this is that
4:44the composer Beethoven, as he became
4:47deaf, found that he could bite on his
4:49conductor's batn and press the other end
4:51to his piano to hear the music through
4:53the bones in his jaw. Now, we can also
4:55use this route for people that have no
4:58even microphonic hearing on one side.
5:00You might hear this term single-sided
5:02deafness or more accurately unilateral
5:05profound deafness. This is because if a
5:07device is placed on the deaf side, the
5:09vibration it creates travels across the
5:11entire skull and stimulates the ear on
5:14the other side, the side that does have
5:15hearing, it effectively rroots that
5:17sound, overcoming that head shadow
5:19effect and stops you missing an entire
5:22hemisphere's worth of sound. Whether
5:23that's someone calling you from your
5:25deaf side or traffic coming down the
5:27road without warning. Now, before any
5:29discussion of surgery, a trial with a
5:30non-surgical device is important. It's
5:33the only way for you to experience this
5:35unique way of hearing and for your
5:36aiology team to measure the potential
5:38benefit. And actually, this kind of
5:40device can even be a long-term solution
5:42for some people who actually want to
5:44avoid surgery altogether. The classic
5:46non-surgical bone conduction solution is
5:48the Baja on softband. A processor, the
5:51same one that you would use with a
5:52surgical implant, actually instead
5:54clicks onto a plastic plate and an
5:56elastic headband holds it firmly against
5:58the mastoid bone behind the ear. This is
6:00the starting point for babies and young
6:02children where time is precious to give
6:04them access to sound. The BHM contact
6:06mini is a further available device used
6:08by a number of aiology units now that's
6:10very low in cost. For many older
6:12children and adults, the cosmetic
6:13element to these devices may be a
6:15drawback. And so the sound arc made by
6:18the company Cockia seeks to address this
6:20with a more stylish lightweight frame
6:22that you can wear a bit like a pair of
6:24glasses holding that vibrating component
6:26in just the right place. Now for some
6:28this is a more cosmetically acceptable
6:29option but there are still some
6:31limitations in terms of headaches and
6:33whistling feedback from any non-surgical
6:35device. Now to avoid that pressure there
6:37is also an adhesive solution out there.
6:39The one that is medically available is
6:41the adhair made by Medel and this uses a
6:43sticky adhesive pad each day on the skin
6:46behind your ear onto which you can click
6:48an external processor. Now, the benefit
6:50of that is that there is no pressure and
6:52headaches, but the limitation is that
6:54there is only so much volume you can
6:56possibly deliver through a device held
6:58on by a band or stuck to bone with an
7:00adhesive. The key takeaway here is that
7:02while these devices are absolutely
7:04fantastic for a trial, they do have
7:05limitations in terms of wearability and
7:08power. And so if a trial has been a
7:09success and you find yourself thinking,
7:11well, I love the sound, but I don't
7:13really want to wear this device or you
7:14need higher levels of clarity or
7:16stronger amplification. Then that's when
7:18you're ready to start considering a
7:20permanent surgical solution. So let's
7:22move on to surgical implants. And
7:24broadly speaking, these fall into two
7:26categories, perccutaneous and
7:28transcutaneous. Let's start with the
7:30original. And in terms of pure sound
7:32transmission, the most direct method
7:34that is perccutaneous implants.
7:36Perccutaneous means an implant that
7:38shows through the skin. These are often
7:40known as bone anchored hearing aids or
7:43baras for short. The surgery involves
7:45placing a small titanium implant into
7:47the skull bone. Attached to this is a
7:49connector called an abutment which
7:51passes through a tiny opening in the
7:53skin. Once healing is done, the sound
7:55processor just clicks directly onto this
7:57abutment. And this direct connection is
7:59the system's greatest strength. There's
8:00no skin or soft tissue to dampen those
8:03vibrations. It's pure efficient energy
8:05transfer. This provides exceptional
8:06sound quality and gives it the most
8:08power, making it suitable for people
8:10with more significant hearing losses.
8:12The current most powerful perccutaneous
8:14bara is even suitable for patients with
8:16bone conduction hearing levels as low as
8:1965 dibels on that aiogram and that makes
8:21it the strongest category of bone
8:23conduction implant. Now, in terms of
8:25commercial brands, there are two brands
8:27of perccutaneous bara. The bara system
8:29made by coccleia and the ponto made by
8:32Oticon Medical. And they both work in
8:34the same way with an abutment showing
8:36through the skin. Now the surgery itself
8:37for perccutaneous bara has evolved
8:39hugely over the years. Prior to 2012 it
8:42involved a big operation usually under a
8:44general anesthetic and patients could
8:46usually expect to lose quite a bit of
8:47hair around the implant. Since around
8:492012 that changed quite significantly
8:51and the operation was done under local
8:53using a small incision and very recently
8:55we've moved on even more of a leap and
8:57Ottoon medical have designed a technique
8:59called mono which we use for all our
9:02adult patients and this has great
9:03potential because it actually uses a
9:05tiny circular skin biopsy punch rather
9:08than making a cut at all and that has
9:10the benefits of faster healing and
9:12better cosmetic results. So for adults,
9:15both Ponto and Bara can be performed as
9:17an outpatient procedure and this takes
9:19as little as 10 to 15 minutes per side.
9:21Now, now with all that said, the idea of
9:23a permanent metal screw showing through
9:25your skin isn't for everyone. It's going
9:27to require daily cleaning. And although
9:29much more uncommon compared to previous
9:31generations, there is still a risk of
9:34skin irritation and even a risk of the
9:36implant falling out. And this has led to
9:38the development of our second category,
9:40transcutaneous implants. Now, in a
9:42transcutaneous implant, the vibrating
9:43part of the implant is actually buried
9:45under the skin. And since 2025, we now
9:48have three options available in this
9:49category that I'm going to show you.
9:51With a transcutaneous device, an
9:52internal implant is secured to the bone
9:54with an external processor worn outside
9:56of the head, held through the skin via a
9:59magnetic connection. When you take the
10:00processor off, the skin is completely
10:02intact, and so it's therefore invisible
10:05to the outside world. There's no
10:07cleaning, no wound. And there is a huge
10:09lifestyle and cosmetic advantage for
10:11many because of that. Now these devices
10:13are termed active meaning the part that
10:15creates the vibration is the internal
10:17part under the skin and this makes them
10:19more effective than some of the older
10:21passive magnetic systems that you might
10:23have heard of such as Bajar attract and
10:25sophono. So let's get into those three
10:27options that I said we have available.
10:28First we have the bone bridge from the
10:30company Medel. Now, Medel brought the
10:32first active transcutaneous implant to
10:34the market when they bought out the bone
10:36bridge. And the internal implant here
10:38uses what we call a bending wave
10:40transducer, which is secure to the bone
10:42with two screws. The external processor
10:45is called the Samber, and we've used it
10:46reliably and successfully for a number
10:48of years now. We've been doing a slimmer
10:50version two of the bone bridge implant
10:52since 2019, and this is when it first
10:54became mainstream. It was an exciting
10:56technology because it was the first
10:58mainstream active transcutaneous bone
11:00conduction implant available for
11:02patients who until that point hadn't
11:04really wanted a perccutaneous device.
11:06Now to have a bone bridge you need to
11:08have bone conduction hearing levels on
11:09your aiogram of at least 45 dibels. It's
11:12also worth noting that streaming to your
11:14phone with this implant will require a
11:16separate additional device worn on a
11:18pendant known as the sambber to go. And
11:20we typically also need a CT scan to
11:22assess the volume of bone required to
11:24house the implant in the skull. And
11:26because of that, this may affect the
11:28positioning of the implant. Because the
11:30amount of bone needed to house the
11:31actual implant in the skull is more than
11:34compared to a perccutaneous bara. There
11:36are a few patients, particularly those
11:37who have had previous extensive surgery
11:40for whom fitting this implant in the
11:42place we want within the skull is a bit
11:43tight. And that brings us on to our next
11:46implant option, the coccleia oia. The
11:48OIA has been pretty popular since we
11:50started offering it in 2021. It aims to
11:52provide greater transcutaneous
11:54amplification whilst only requiring the
11:57same bony footprint in the skull as the
11:59perccutaneous bara. The internal implant
12:01uses what's known as pizzo electric
12:04power and so instead of a motor
12:05vibrating, it uses material that expands
12:08and contracts creating vibration. Now
12:10this is thought to have some benefits in
12:12terms of being able to provide more
12:13power in a given size implant and
12:15amplify some higher frequencies more
12:17effectively and we see this in the
12:19candidacy range which includes patients
12:21with bone conduction thresholds as low
12:23as 55 dibels compared to 45 dibels for
12:26the bone bridge. The external oio sound
12:29processor has direct streaming
12:30capabilities without an additional
12:32device and we've had very good feedback
12:34from patients for its performance
12:36particularly in noise. The main caution
12:38to mention with regards to the OIA is
12:40that with all that power, it is the
12:42largest of all transcutaneous implants.
12:44Now, with patients who have thin skin,
12:46this can manifest as quite a notable
12:48bump on the side of the head that
12:49recipients sometimes say they can see
12:51and feel. The size of the OIA also
12:53brings some limitations in where we can
12:55position it on the skull. And what we've
12:57noticed is that this is leading to us
12:59needing to position it higher and more
13:01noticeably when compared to some of the
13:03other implants. And that brings us on to
13:05our final transcutaneous implant, the
13:08newest on the block, which we started
13:09offering in 2025. This is the Centio
13:12from Oticon Medical. Now, we are very
13:14early into our experience with this
13:16device, but I think it's going to be
13:17pretty popular because it has the same
13:19amplification power as the bone bridge
13:21and is also noticeably slimmer in size
13:23compared to the OIA. This is a sweet
13:25spot for surgeons as the size of the
13:26implant combined with shallower bony
13:29depth needed means less uncertainty over
13:31positioning during the operation. The
13:33processor looks stylish and Ottoon I
13:35guess like all manufacturers are very
13:36proud of their sound processing
13:38technology which they say has benefits
13:40in terms of sound clarity and
13:42conversation in noise. Now at the moment
13:44we're offering this implant to adults
13:45and older children who have bone
13:47conduction hearing of at least 45 dibels
13:50or better. However, with that said,
13:52Ottoon Medical have made us aware that
13:54the internal component is built with
13:56capability for more power in the future,
13:58and there is definite talk of a future
14:01larger external processor being
14:03compatible and being able to offer
14:04greater power and reserve for patients
14:06with worse levels of bone conduction
14:09hearing thresholds on their aiogram. I
14:11also suspect the age licensing will drop
14:13to younger ages as more studies are
14:15completed. As we gather more long-term
14:17data, I'll aim to post updates via
14:19social media. So do feel free to
14:21subscribe for that and for other videos
14:23about hearing loss treatments and
14:25general insights as an ENT surgeon. Now
14:27the surgery for all these active
14:28transcutaneous devices is more involved
14:30than for a perccutaneous implant. Most
14:32will require a general anesthetic
14:34meaning you'll spend most of the day in
14:35hospital and typically the surgery can
14:37take 45 to 60 minutes or less.
14:39Technically all of the implants could be
14:41installed with local anesthetic alone.
14:44But this is something to discuss with
14:45your surgeon based on your individual
14:46factors. And it's fair to say that most
14:48of these are put in under general
14:50anesthetic. Okay, so now for the most
14:52important part of the video. Which
14:53should you choose? Perccutaneous or
14:56transcutaneous? A direct abutment or a
14:59hidden magnet? All of the devices I've
15:00mentioned are fully funded on the UK
15:03National Health Service, and you can
15:04have one or two implants depending on
15:06what you need. All the implant
15:07processors have a range of colors to
15:10choose and customize, and there are
15:11third party stickers that you can
15:13accessorize with, too. So, what else is
15:15important when making the decision?
15:17Well, I'm now going to give you what I
15:18think are the five biggest
15:19considerations that I think will help
15:21you choose your category. Let's break
15:23down the pros and cons in details.
15:25Number one, power and future proofing.
15:27This is about your aiogram. A
15:29perccutaneous systems direct link will
15:31give it the widest fitting range. It can
15:34handle more severe conductive and mixed
15:36hearing losses. Now, this also gives you
15:38more reserve. Now, as we age, our inner
15:41ear function tends to slowly decline
15:43naturally. And so, a more powerful
15:44implant means it's more likely to still
15:47be sufficient for your needs in 10, 15,
15:50or 20 years time. Now, with that said,
15:52the transcutaneous implants we have are
15:54still very powerful and quite suitable
15:56for the vast majority of candidates. But
15:59if the bone conduction hearing levels on
16:00your aiogram are close to that line, you
16:03might want to consider choosing the
16:04device that's going to offer you a
16:06little room for your hearing to worsen
16:08and give you the maximum longevity.
16:10Number two, lifestyle, cosmetics, and
16:13daily care. Now, on the face of it, the
16:14obvious question might be, why would I
16:16want an implant showing through my skin
16:18if I could qualify for one that's not
16:20visible? With a transcutaneous implant,
16:22after all, no one knows you have an
16:23implant when the processor is in your
16:25pocket. There's no daily cleaning
16:27routine. However, there is a trade-off.
16:29The external processes for
16:30transcutaneous implants are inherently a
16:33bit thicker and bulkier to house the
16:35magnet, and that can create a bit more
16:37of a bulge under the hair. What we found
16:39through doing these is that we've had to
16:41end up sighting the processor slightly
16:43higher on the skull rather than tucked
16:45away behind the ear. And so, a solution
16:47that you may have chosen for being more
16:49discreet actually becomes more
16:51noticeable when the implant is being
16:53worn. Now, a perccutaneous abutment is
16:55always there, of course, but the
16:56processor itself can be smaller and more
16:59discreet. The downside to perccutaneous
17:01implants is that they do require more
17:03daily care. And this is simple enough. A
17:05quick clean with a soft wipe like
17:07cleaning around a piercing, but it is a
17:08daily commitment and neglecting this can
17:11run the risk of perpetual wound issues
17:13and even visits to the hospital for
17:15nursing attention, creams, and even the
17:17risk of needing it removed. Number
17:19three, retention and skin issues. Now,
17:21this is the other side of the coin. A
17:23perccutaneous device clicks on. It's
17:25incredibly secure. It's very difficult
17:26to knock off, whilst a transcutaneous
17:28device is held on by a magnet. Now,
17:31magnets are strong, but even a hard
17:32knock or even pulling a jumper over your
17:34head can sometimes dislodge it. Now,
17:36this can be a concern for very active
17:38people or for children, and processor
17:40loss is an issue for some. Now, we can
17:42adjust the magnet strength, but a magnet
17:43that's too strong can cause pressure and
17:46redness and pain on the skin. So, it is
17:48a fine balance. Number four, having
17:50surgery and the recovery afterwards. As
17:52we've said, perccutaneous surgery is
17:54quicker and can often be done under
17:56local anesthetic. It's less invasive,
17:58and because of this, it's a popular
17:59option for people who have been on a bit
18:01of a difficult journey through multiple
18:03surgeries for chronic middle ear disease
18:05and just simply want a solution that's
18:07one and done, minimally disruptive to
18:09their schedule, minimal time off work.
18:11Transcutaneous surgery typically
18:13requires a general anesthetic, although
18:15do discuss this with your individual
18:17surgeon. With a perccutaneous abutment,
18:18we will usually wait between four and
18:20eight weeks for the skull to fully
18:22integrate with the titanium implant.
18:24With a transcutaneous implant, on the
18:26other hand, you can sometimes be
18:28switched on from as little as 2 to 4
18:30weeks following the operation. And
18:31finally, number five, and perhaps a big
18:33one, the MRI shadow. Now, this is an
18:35important consideration. You will read
18:36and be told that all of these devices
18:38are safe if you're needing an MRI scan,
18:40but that transpires in different ways.
18:43With a perccutaneous implant, you just
18:45take the processor off and you're good
18:46to go. The tiny titanium screw is safe
18:49in an MRI scanner up to three Tesla. It
18:52creates a very small artifact or shadow
18:53on the scan and this is unlikely to
18:55interfere with any diagnosis on a future
18:57brain scan that you might need. Now,
18:59with the transcutaneous implant, things
19:00are different. The internal magnet is an
19:03issue. The Bonebridge, OIa, and Centio
19:05all enable the ability to have an MRI
19:07safely. For Bonebridge and Centio, you
19:09can have an MRI up to 1.5 Tesla. And for
19:12the OIA, it's three Tesla. And sometimes
19:14radiographers will employ special
19:16headband protections just for extra
19:18measure. But critically, and perhaps
19:19more importantly, all of these magnetic
19:21implants create a significant shadow, an
19:24MRI brain scan, which can obscure the
19:26view of your brain on that side. Now,
19:28this is a vital consideration if you
19:30have a condition that might require a
19:32future MRI brain scan. It's particularly
19:34crucial for patients who have had
19:36chronic middle ear disease, for example,
19:37who may be relying on future MRI
19:40scanning to detect a recurrence of the
19:42disease. Now, in a way, that immediately
19:44cuts the decision in half for a large
19:46number of people who are choosing a bone
19:47conduction device after having what we
19:49call cholesttoma surgery. So, I've given
19:52you the five most important factors that
19:54I think will influence your
19:55decision-making over a bone conduction
19:57implant. And armed with that knowledge,
19:58hopefully you're going to have a clearer
19:59idea of which implant is going to fit
20:02with your specific preferences and
20:03priorities. Now, hopefully I've given
20:05you the tools to now have a really
20:07highquality discussion with the team
20:09looking after you. However, there is
20:10more. And for those of you that really
20:12like doing your research, I'm now going
20:14to run through eight other frequently
20:16asked questions that sometimes influence
20:18patients when figuring out which bone
20:20conduction implant is best for them.
20:21Number one, my anatomy. Based on my bone
20:24thickness and the position of the vital
20:26structures, am I a candidate for all
20:28implant types? And will there be any
20:30implications on where it's positioned? A
20:32CT scan is sometimes needed to answer
20:34this question, especially for the
20:35transcutaneous devices which have a
20:37larger internal footprint. Furthermore,
20:39if I need implants for both ears, am I
20:42able to have both during the same
20:43operation or does it need to be done one
20:45at a time? Your surgeon may have a
20:47reason for recommending one or the
20:49other. Number two, connectivity. If I
20:51use an iPhone, Android, will this device
20:54stream directly to my phone? And if not,
20:56which extra streaming device will I need
20:59and what will it look like? Other
21:00questions include, what is the app like
21:03to use? Do I have any more niche
21:04requirements? For example, like if I'm a
21:06musician in a band for this, it's worth
21:08going to the manufacturer's websites
21:10yourself as there willistically be
21:12limited time in your aiology
21:13appointments for this. And do check the
21:15latest compatibility list for your exact
21:17phone model and operating system. Number
21:19three, the other ear. If I already wear
21:22a hearing aid in my other ear, will this
21:24device be compatible with a conventional
21:26hearing aid in my other ear if I ever
21:28need one? Your aiologist will help you
21:30answer that question. Number four,
21:31dexterity and batteries. Can I try
21:33holding and attaching dummy versions of
21:35the processor? How easy is the battery
21:37change? Is it rechargeable or
21:39disposable? What's the typical battery
21:41life for children? Is the battery
21:43compartment tamperproof? Number five,
21:45helmets and headwear. I regularly wear a
21:47cycling helmet, hard hat, headscarf. How
21:50will I know which processor type will
21:51work with this? Can we trial a position?
21:53Number six, age licensing. Are there any
21:55age restrictions on some of these
21:57devices? Some are not licensed for very
21:59young children, and are there any
22:00circumstances that would necessitate an
22:02offlic decision? Number seven,
22:04accessories. What accessories come as
22:07standard? Things like a remote
22:09microphone or a TV streamer can make a
22:11huge difference, and the bundles offered
22:13by each company can vary. And finally,
22:15number eight, could a middle ear implant
22:18be an option? Now, an active middle ear
22:20implant is a different type of implant,
22:23but there is often some overlap, and
22:25many patients could have either a bone
22:27conduction implant or this as an
22:29alternative. Now, if you think this
22:30might be the case for you, then it's
22:32worth asking if that type of implant
22:34might be suitable. It's particularly
22:36good for people who have hearing
22:38problems related to their ear canal, but
22:40do still have a healthy middle ear
22:42space. The currently available option we
22:44have is the vibrant soundbridge made by
22:47Medel and I've covered that implant in
22:49an entirely separate video which I'll
22:51link to. The final important thing I
22:52should say is to remember that your
22:54recommendation will come from a
22:56multidisciplinary team. This isn't just
22:58a surgeon's decision or an aiologist
23:01decision. It's a big deal for you which
23:02means it's important to us that we get
23:04it right and it's sometimes a complex
23:06weighup. As a minimum for a bone
23:08conduction implant decision, the
23:10recommendations will need to be from at
23:12least both a surgeon and an aiologist,
23:14but may also involve a speech therapist,
23:16a teacher of the deaf, a psychologist,
23:19and a radiologist. The role of your team
23:21will be to help you understand what's
23:23technically suitable. The whole process
23:25is then enriched if you're able to help
23:27your team understand what works best for
23:29your life and your individual
23:31circumstances. Now, I've spent a lot of
23:32time putting together all of this
23:34information into a single comparison
23:37table, which I hope will be useful for
23:39both patients and clinicians around the
23:41world that work with these devices. So,
23:43that's a complete deep dive into the
23:45world of bone conduction hearing
23:46implants in 2025. This tech evolves
23:49almost every year, and the challenge is
23:51to make sure patients are given access
23:53to all the devices that might be
23:55suitable. Now, as you can see, there's
23:57no single best device, but there is
23:59almost certainly a best device for you
24:02based on your hearing, your lifestyle,
24:04and your priorities. So, I hope this
24:06video helps patients and also helps
24:08teams around the country save time and
24:10enhance their pre-operative counseling.
24:12Hearing is precious, as I'm always
24:14saying, and it can be the window to your
24:15social life, professional life, family
24:17life, and mental health. And that is
24:19something definitely worth investing in.
24:21So, please do share this video and
24:23please do leave a comment letting me
24:25know how you came across this video and
24:28also let me know of all the key factors
24:30we've discussed which do you think is
24:32the most important? Thanks for watching.
24:37[Music]

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