Bone conduction devices
Bone conduction devices send sound vibrations through the bones in the skull to the inner ear.

Bone conduction devices may be an option for children with conductive, mixed or single-sided deafness who don't benefit from wearing a behind-the-ear hearing aid. Conductive deafness is when sound cannot pass effectively through the outer and middle ear to the cochlea and auditory nerve.
Types of bone conduction devices
There are two different ways that bone conduction hearing devices can be worn: they may be held in place on the head by a softband or similar, or attached to a surgically implanted abutment or magnet.
Bone conduction hearing aids (non-surgical)
Bone conduction hearing aids (BCHAs) are a non-surgical type of bone conduction device. The vibrating sound processor for BCHAs is held in place on the mastoid bone by:
- a metal or soft fabric headband (also known as a softband)
- an adhesive adaptor (sticky pad)
- the arms of glasses.
They may be an option for children who are too young for bone conduction implant surgery.
Children who are getting bone conduction hearing implants usually trial softband BCHAs first.
Bone conduction implants (surgical)
A bone conduction implant requires one or two surgical procedures to fit the device. These implants are sometimes known as ‘bone anchored hearing aids (BAHAs)’, ‘direct drive bone conduction devices’ or ‘skin drive bone conduction devices’.
Implants may be suitable for children with permanent or long-term conductive deafness. Typically, children are considered for surgery around age of 5, when there is enough bone thickness to safely insert the implant. However, the age a child is ready for surgery can vary depending on the child.
There are two different types of bone conduction implants:
- Percutaneous (abutment), where the fixture protrudes through the skin and directly stimulates the bone. This system requires surgery to place a titanium implant and an abutment fitting, which penetrates the skin. The sound processor connects to the abutment and transmits vibrational sound directly to the skull bone. Examples include:
- Transcutaneous (magnetic), where the skin remains intact, and the vibrations are transmitted through the skin to the implant. An operation is needed to insert a magnet, and the external sound processor is held against the head through magnetic attraction to the internal equipment. Examples include:
Who can use bone conduction devices
Bone conduction hearing aids or implants may be suitable for children with:
- perforated eardrums
- atresia or microtia (underdeveloped ear canal and outer ear)
- glue ear or persistent ear infections
- cholesteatoma
- conditions that affect the middle ear bones (such as osteogenesis imperfecta)
- mixed deafness (a combination of conductive and sensorineural deafness)
- single-sided (unilateral) deafness
- certain syndromes including Down’s syndrome and Treacher Collins syndrome
How bone conduction works
Bone conduction devices send sound in the form of vibrations directly through the mastoid bone (the large bone behind your ear) to the inner ear, bypassing the outer and middle ear. This is unlike conventional hearing aids which use air conduction to amplify sounds and send them directly to the ear canal.
Here's how it works:
- The device's microphone picks up sound which is turned into vibrations.
- The vibrations travel through the bones of the skull to the cochlea (inner ear).
- The cochlea converts the vibrations into electrical signals which the brain interprets as sound.
How sound is perceived
Bone conduction devices can make sounds clearer and sometimes louder. While it’s difficult to fully understand the experience, you can get a rough idea for what a bone conduction hearing aid sounds like by plugging your ears and holding the hearing aid to your mastoid bone.
It's important to remember that bone conduction devices do not restore typical hearing. Children may still struggle to hear if a speaker is not facing them, if they’re too far away, or if there’s background noise.
Making a decision about bone conduction implants
While bone conduction hearing aids can be worn temporarily and removed at any time, implants require surgery and are a life-long commitment. Choosing implants is a big decision, as there are many things to consider.
What to consider when making a decision about implants.
Connecting with other technology
Most modern bone conduction devices have Bluetooth and can connect wirelessly to phones, computers, alerting systems, radio aids and more.
Some bone conduction devices also connect to compatible technology using a streamer or other device. Find out more about assistive technology.
Additionally, some modern bone conduction devices are compatible with a smartphone app, which you can use to track the sound processors using GPS. This can be especially useful if your child has a habit of removing their device while out and about, as you can then use the app to find them. Your audiologist or implant team will tell you if your child’s device can connect to an app and can help you download the app to your smartphone.
For advice about your specific device and its compatibility with other technology, you can ask your implant centre or contact our Helpline.
Full references for this webpage are available by emailing
informationteam@ndcs.org.uk