Cochlear Implants vs. Bone Anchored Systems - An Interview with Dr. Anna Grashoff

One of the many things we do at Professional Hearing Center is evaluations for cochlear implants (CI) and bone anchored systems (BAS).  Dr. Anna Grashoff is our go-to audiologist for most of these evaluations, so we’ll discuss a few things with her in today’s blog.

1. Hi there!  To start this off, can you please tell me the difference between a cochlear implant and a BAS?

Cochlear implants and BAS are very different devices that treat different types of hearing loss.

A. A cochlear implant is an electronic device that can help to provide a sense of sound to a person who is severely hearing impaired or profoundly deaf. The implant consists of an external portion that sits behind the ear and a second portion that is surgically placed under the skin. CIs allow for electric hearing rather than acoustic hearing like with a traditional hearing aid.

B. A bone anchored system is a device that can transmit sound directly to the cochlea (organ of hearing) by stimulating the mastoid bone (large bony mass behind the ear) instead of directing sound at the eardrum like a traditional hearing aid. These devices are recommended for patients with hearing loss that originates in the outer or middle ear. The BAS allows sound to bypass those areas of the ear and stimulate the cochlea directly. BAS are also recommended for patients with single sided deafness (i.e. severe to profound hearing loss in one ear and normal/near normal hearing in the other). The BAS consists of an external device that attaches to a titanium anchor that is surgically placed behind the ear.

2. How does a patient end up seeing you - what makes them a candidate for a CI or a BAS and not a traditional hearing aid?

Everything begins with a hearing test. An initial hearing test will determine the type and degree of hearing loss. From there, the audiologist will recommend how best to treat the hearing loss whether it be a traditional hearing aid, CI, or BAS. If a CI or BAS is recommended, a candidacy evaluation appointment will be scheduled with me or one of our qualified audiologists to further determine what the best option is and if insurance will cover the cost.  

3. What does a typical evaluation include, and then what happens next?

A. In order to qualify for a CI, certain criteria must be met. Insurance will completely cover the cost of surgery and devices if we can prove that a person receives limited benefit from traditional hearing aids. This is proven by completing a battery of tests with hearing aids on in the sound booth. Testing involves repeating words and sentences in the presence of background noise. If all criteria is met, the patient is sent to meet with the surgeon and his team.

B. The initial hearing test is the only testing required to determine if a patient qualifies for a BAS. The surgeon will confirm that a patient is a good surgical candidate. Once a candidate is identified and the surgeon agrees, the patient will begin a trial period with a clinic demo device. Upon completion of the trial period, surgery will be scheduled.

4. Does insurance cover these surgeries?  I know many don’t offer full, or any, coverage for hearing aids.

A. If criteria is met, Medicare and private insurances will cover the complete cost of a cochlear implant surgery and the external components.

B. If criteria is met, Medicare and private insurances will cover the cost of a BAS surgery. A flat out of pocket cost of $1000 is due for the fitting and dispensing of the external component of the BAS. This dispensing cost is non-negotiable and is to be paid in full at the time of fitting of the external sound processor (1-3 months post-op).

*It is important to note that there is some “down time” between surgery and fitting of external components with both CI and BAS. For a CI recipient, this is approximately one month. For a BAS recipient, this is between one and three months. Down time means you will not have or wear your external sound processors.

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