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Bone Conduction Implantable Devices
When hearing aids are not a suitable option, bone conduction devices provide access to the hearing that is necessary for our busy lives.
What is a Bone Conduction Implant?
A bone conduction implantable device (BCID) is an electronic medical device designed to restore the ability to hear and understand speech by individuals who cannot use conventional hearing aids. The majority of people who use such a device have a conductive hearing loss where the outer or middle part of the ear is damaged and sounds are not effectively transmitted to the cochlea. This may be due to chronic infection, surgical interventions, or anatomical reasons preventing sound from being delivered effectively. Some people with single sided deafness (SSD) may also use a BCID.
In Australia, there are three manufacturers of bone conduction implant systems that are registered for use with the Australian Register of Therapeutic Goods;
How does a Bone Conduction Implant work?
A BCID takes advantage of the excellent conductive properties of bone. Hearing through bone conduction uses your body's natural ability to conduct sound by picking up the sound from the environment and transferring the vibrations to an implant inserted into the bone behind your ear. These vibrations are then sent directly through the bone to the inner ear through a process called bone conduction. Unlike traditional hearing aids, where the sound is amplified in order to compensate for the damaged outer or middle ear structures, a bone conduction device simply bypasses them.
A BCID is divided into two parts - an external sound processor and an internal implant:
The external sound processor detects sounds in the environment via microphones. These sounds are then analysed by a tiny computer and then amplified or transformed into digital signals. These signals are then transmitted to the internal implant.
The internal implant is surgically placed into the skull by a specialised Ear, Nose, and Throat surgeon. There are a number of different implant types for bone condition devices. These include 1. a small titanium screw with an abutment that sits through the skin, 2. a small titanium screw with a magnet, or 3. an implant that has a receiver stimulator package that converts the digital signal from the external sound processor into vibrations which are then hear via bone conduction. The videos below demonstrate this in more detail.
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How do I know if I am a candidate?
Generally speaking, you should consider a BCID if;
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You have a conductive hearing loss in either ear;
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You have traditional hearing aids and/or are unable to wearing them (e.g. recurrent ear infections, atresia/microtia, significant irritation);
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You have good speech understanding when sounds are comfortably loud;
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Your hearing loss significantly impacts daily interactions either socially or professionally.
The best first step is to discuss this option with your current hearing professional, or get in touch with us to facilitate a referral to a specialized provider experienced in BCID.
How do I get a Bone Conduction Implant?
At a minimum, to determine if someone is a candidate they require an assessment with an audiologist with specialist training in BCID as well as an ENT surgeon who performs the operation. Given the range of potential options with a BCID there is likely to be an optimal solution for your hearing and lifestyle needs.
Fortunately, the benefit with BCID's is that there are a range of non surgical fitting options allowing you to trial this kind of device and establish if you get sufficient benefit prior to having any surgical intervention.
The Bone Conduction Implant Journey
While not everybody's bone conduction implant journey is the same, there is a typical pathway that an adult follows to getting a bone conduction implantable device.
1. Candidacy Assessment
The first step is referral for a candidacy assessment. Often your usual audiologist will refer you for an assessment or they may have training in BCID's. A candidacy assessment typically includes;
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Comprehensive case history and diagnostic testing
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Functional and Quality of Life assessment
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Ensuring optimisation of hearing aids
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Assessment of aided speech perception
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Counselling regarding outcomes and expectations
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Discussion of funding pathways
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Trial of BCID device
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Referral to ENT specialist for one or both ears
If you are determined to be a candidate you will then be referred for a medical review with a specialist ENT.
2. Pre-Op Medical assessment
The second step is a specialist evaluation with an ENT specialist that performs bone conduction device implantation. This typically includes;
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Medical and hearing case history
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Physical ENT examination
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Radiological investigations (e.g. MRI & CT scans)
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Counselling about expectations and outcomes
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Counselling about BCID surgery and related costs
3. Surgery
If you are an audiological and medical candidate then the next step is surgery. Typically during surgery;
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The implant is inserted into the skull
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The implant is tested to ensure functionality
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Post operative recovery
4. Post-Op Appointments
Following successfully surgery;
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Post op review with ENT Specialist
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sound processor fitting and counselling with audiologist approximately 4 weeks after surgery
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Ongoing device management and appointments
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Annual follow-up appointments and with regular wound care
5. Ongoing management and Care
Holistic patient care will be ongoing;
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New technology and review of external speech processors including non-implanted ear
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Replacement of batteries
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Additional listening devices and equipment
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Quality of Life and functional outcome reviews
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Holistic patient review with primary communication partners
Funding Pathways in Australia
for bone conduction implants
How much does a bone conduction implant cost?
Bone conduction implantation includes a number of necessary medical services and procedures that are provided over time by a team of clinicians. The overall cost is made up of different components;
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Audiologist appointments
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ENT specialist appointments and associated medical imagining
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Surgery expenses and post-operative care
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Bone conduction implant device cost
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Post-operative appointments and sound processor activation
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Ongoing care and maintenance of a bone conduction implant sound processor
In Australia, Medicare helps to fund the consultations with all specialists and in some instances may cover the entire appointment. Medicare however does not cover the cost of a bone conduction implant system.
The cost of a bone conduction implant is generally funded in the following ways;
1. Private Health Insurance
If you have a private health insurance (hospital) policy covering implantation of hearing devices, the bone conduction implant system may be fully reimbursed. Exact coverage of hospital and surgical procedures will depend on your level of cover and it is best to ask the following questions to your fund directly:
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Does my policy cover bone conduction implant surgery and the prosthesis?
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Are there any restrictions or waiting periods?
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Are there any known out of pocket costs?
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What is the sound processor replacement policy?
2. State Government Funding
A very limited number of bone conduction implants are funded some states per calendar year. There are usually more restrictive eligibility criteria due to the limited funding as well as a waiting list. For more information please speak to your hearing care professional directly or contact Hearing Implants Australia.
3. Department of Veterans Affairs
DVA may cover the costs associated with bone conduction implants, including implantation and sound processor upgrades. For more information please contact Hearing Implants Australia or DVA for further information (www.dva.gov.au)
4. Self-Funded
You may be able to self-finance the cost of a bone conduction implant system, as well as the associated specialist and surgical costs. It is important that you discuss this option with your clinical team so you are aware of all of the costs involved.
Ongoing care and maintenance
Bone conduction implant sound processors will require ongoing maintenance and repairs. External speech processors are generally covered by a standard manufacturer warranty, however it is recommended that the sound processor is insured against loss through your home and contents insurance.
As technology improves and new innovations become available the external sound processor will be able to be upgraded without any additional surgery.
There are a number of potential funding pathways for this which may include;
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Private health insurance
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DVA
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Self funding
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National Disability Insurance Scheme (NDIS)
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N.B. The NDIS does not cover the costs of a bone conduction implant system or surgery. However, funding may be allocated for ongoing auditory rehabilitation, assistive listening devices or for upgrades of speech processors. For more specific advice please talk to your hearing health provider.
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