Making a decision about bone conduction implants

Deciding to get bone conduction implants is a big decision as it's a life-long commitment, and there's a lot to consider. This page highlights some of the factors to consider, but it may not answer all your questions. 

Getting balanced information and speaking to others with experience of the process may help you make your decision. If you have any questions about the tests, surgery or living with an implant, speak to the professionals working with you. 

If, at any point, you change your mind, you can always say so. The implant team will understand if you need more time to decide. 

Most bone conduction implant users adjust well to their implants and continue to use them as adults. If in the future a young person decides not to continue using their implant, they can choose to explore other communication methods.

Implants vs hearing aids

Before getting an implant, your child will need to first trial bone conduction hearing aids (BCHAs). BCHAs do not require any surgery and are often kept in place on a child's head by a soft headband.

You may be wondering what benefits your child would get from having an implant as opposed to continuing to wear BCHAs. Many deaf children wear BCHAs without any issue, but there are some advantages to getting implants.

• Better sound quality. The sound processor for an implant is in direct contact with the bone, meaning the sound vibrations are not reduced by skin and tissue behind the ear. This means implants give better sound quality than BCHAs, and this is particularly true for higher frequency sounds.
• More comfortable. Softbands for BCHAs can be uncomfortable because they put pressure on the skull. Whereas implant sound processors are clipped onto the abutment or held on with a magnet, which makes them feel weightless and more comfortable to wear.
• Less noticeable. Implants are smaller and less noticeable than BCHAs. Some deaf children and young people may prefer this.
• More consistent. Implants provide more consistent sound for children with fluctuating hearing levels.

If your child has used conventional hearing aids before (typically behind-the-ear aids), there are some advantages to using an implant over these as well.

• Less feedback. Conventional hearing aids need to use more amplification for conductive deafness than for a similar level of sensorineural deafness. This can cause some issues, such as more feedback (whistling). An implant needs much less amplification, and therefore may be more comfortable.
• Better fit. For children with absent or underdeveloped external ears, conventional hearing aids can be very difficult to fit comfortably.
• Less chance for infection. With an implant, there is no earmould blocking the ear canal, so the ear is kept clear. For children who have ears that discharge or other skin conditions, this can help prevent infection.

Surgery

Getting bone conduction implants requires surgery. The surgery is done under either local or general anaesthesia. For local anaesthesia, the surgery area is numbed, but your child will stay awake. For general anaesthesia, your child will be given medicines to send them to sleep during the procedure.

Older children and young adults usually only need one surgery procedure. However, some children need to have the operation in two stages: the initial implant will be fixed in one operation, with the abutment or magnet inserted 3 to 6 months later.

The surgery usually takes about an hour per implant, and most children can go home the same day. However, some children may need to stay overnight at the hospital.

As with all surgeries that require general anaesthetic, there are some risks. However, these are generally rare. Any risks would be discussed with you as part of the implant assessment process.

Find out more about the surgery process and risks for bone conduction implants.

Changes in technology

The magnet or abutment is unlikely to need upgrading unless there are problems.

Sometimes device failure can happen. If the internal part of the device fails, your child would need a further operation to take out the broken implant and reinsert a new implant.

The external sound processor can be changed as technology develops and improves, but this shouldn’t mean further surgery. Currently, the NHS upgrades sound processors every 5 years and when clinically appropriate, for example, where there’s evidence that the upgrade will offer additional benefit over your child’s current device. How often processors are upgraded may change in the future depending on NHS funding.

Long-term commitment

After the implant is fitted, your child will need long-term support from you, the implant team and local professionals.

It’s important before making a decision that you know and understand the level of commitment that will be needed, particularly in the early years following implantation.

Your child will need to attend lots of appointments at the implant centre during the first year. This means you may need to take time off work and be away from the rest of your family. You can ask your implant centre for a schedule of expected visits, both before and after the implant operation.

Children will need ongoing audiology appointments to "fine-tune" their implants, as their hearing levels and needs may change over time, and these appointments are crucial for optimal hearing and language development.

It’s important to keep abutments implant sites clean. This area can be prone to infection if not properly looked after.

When your child is young, you will need to perform daily checks to maintain the external part of your child’s implants. For example, batteries need to be changed or recharged regularly. If your child’s implants use button batteries, you’ll also need to make sure the battery lock is kept on as it’s extremely dangerous if your child swallows a battery.

Learn about maintaining bone conduction implants.

Getting balanced information

When you start looking into bone conduction implants, you’ll come across different opinions, especially about implanting children at a young age.

It’s helpful to speak to deaf people, both with and without bone conduction implants, as well as to families and deaf children about their experiences.

Your local deaf children’s society is a good place to start. You can also explore these resources:

• Ear Community: Supportive community for individuals born with microtia or atresia.
• Microtia UK: Support for families with children who have microtia, including life stories.
• Goldenhar UK: Support for families with children who have Goldenhar Syndrome.
• Cochlear Family: A supportive community of people who have different types of hearing implants.
• Ask your audiologist or Teacher of the Deaf about local support groups for people who have bone conduction implants.

Making decisions together as a family

Deciding on hearing technology can be a deeply personal choice and can sometimes cause tension in families, especially when family members have differing views. To navigate this, it's helpful to explore information together, meeting with professionals and seeking second opinions when necessary. 

Parents should involve their children in the decision-making process, ensuring they have all the facts to form their own opinions. 

To resolve disagreements, try to understand each other’s perspectives. Ask questions that explore personal experiences, concerns, and the potential impact on daily life. If necessary, seek support from resources like family counselling, child counselling, or family mediation. You can also contact our Helpline for advice and support. 

It's important to respect the rights of children and young people in these decisions. According to the UN Convention on the Rights of the Child, children capable of forming their own views should have a voice in decisions affecting their healthcare. They should be given information in a way they understand, and they have the right to consult with healthcare providers privately, with or without a trusted advocate.