Baha: Another Pathway to Sound

While most of us involved in hearing loss are familiar with hearing aids and cochlear implants, the benefits of the Baha system are less known despite the fact that the device has now been in use for over 30 years with over 35,000 users worldwide.  Developed in Sweden utilizing the same principle used in implants for teeth, Baha consists of three parts: (1) a titanium implant (which is placed during surgery into the temporal bone behind the external ear), (2) an external abutement, and (3) a sound processor that snaps onto the abutement.  Baha relies upon “osseointegration,” a process by which the titanium implant becomes integrated with the skull bone after a period of time—usually three months for adults and approximately six months for children.

The three component parts work together and allow the Baha to transfer sound vibrations in the environment—whether speech or other sounds—from the sound processor through the abutement and then directly into the temporal bone bypassing the middle ear.  The vibrations of sound are then carried to the cochlea.  The process is simple and efficient with Baha providing sensitive hearing for individuals who previously had untreatable conditions of the ear canal, middle ear and mastoid

Who can benefit from Baha?

The Baha is designed to help adults and children (over age 5) who have conductive or mixed hearing loss and do not derive sufficient benefit from traditional air conduction hearing aids.  The Baha Softband may be used in children younger than age 5 until the bones in the head become hard enough for surgical placement of the implant.  While the Softband does not provide as much power as the implanted Baha, it allows early access to sound, facilitating language development in babies and young children who are appropriate candidates for the Baha System.

Conductive hearing losses are often the result of either malformations of the middle ear or otosclerosis affecting the tiny bones of the ear.  Sometimes surgery can be undertaken to successfully open up the ear canal to address such conditions, a procedure which can be very beneficial for some people.  For others, surgery is not helpful or there is a need for repeated surgeries.  One young person recently profiled in Voices magazine (May/June, 2007) had undergone 27 ear surgeries by the time she was 15 years old.  She had one more surgery—for Baha—which then provided her with consistent access to sound as well as an end to her chronic ear infections.  For some individuals, including the 15 year-old referenced above, conductive ear conditions are negatively impacted by the fact that the hearing aid mold closes up the ear canal and exacerbates chronic ear infections and/or malformations of the middle ear.  Baha provides a more effective way of reducing infection and improving hearing. 

Unlike candidates for a cochlear implant, Baha recipients must have at least one functioning cochlea (or inner ear).  In the past, children who had a conductive hearing loss and did not benefit sufficiently from air conduction hearing aids were fitted with bone conduction devices that transferred the vibrations caused by sound to bones of the head via a tight-fitting headband.  Textbooks on deaf education described a well-fitting conduction device as one which caused a groove or furrow that could be felt on the child’s head.   Baha provides access to sound without the pain and headaches children often endured while utilizing conductive hearing aids.

Does health insurance cover Baha?

While still better known in Europe, Baha is now coming into its own in the United States aided by FDA actions and a Medicare coverage change to include Baha for appropriate candidates.  FDA clearances include use for conductive or mixed hearing loss (1996), use for children over age 5 (1999), and use for Single-Sided Deafness (2002). 

Cochlear implantation is now covered by approximately 90% of private or commercial health insurance carriers.  Although Medicare has covered the Baha System for appropriate candidates since 2002, the majority of private health insurance carriers still do not recognize Baha as a medical prosthesis.  Among those carriers that do not cover Baha is UnitedHealthcare, the largest commercial insurer in the United States, serving more than 18 million people.  This means that a family needing this intervention with UnitedHealthcare insurance must either pay for Baha out-of-pocket (total cost of approximately $18,000 including the device, surgery and related services) or forgo providing their child with the appropriate hearing device.  We were particularly appalled to learn that the family of a Fort Worth, TX child with Treacher Collins Sydrome was rejected for Baha coverage by UnitedHealthcare.

Help us Improve Access to Baha

Hands & Voices is committed to achieving health insurance coverage for whatever hearing technology a child may need—whether that be hearing aids, cochlear implants, or the Baha System.  We will be working with other organizations representing children and adults with hearing loss to pressure private insurers to change their coverage policy to include Baha.  We are seeking Hands & Voices member support from around the country but we would especially like to encourage our families living in Minnesota—headquarters of UnitedHealthcare—to join with us to bring about change by that large carrier.  By exposing UnitedHealthcare’s refusal to address the hearing health of children and adults and by asking tough questions of America’s largest health insurer, we think can help change their coverage policy on Baha and encourage discussions about hearing health generally. 

For information on how to support this effort, please contact us at parentadvocate@handsandvoices.org ~