The Bone – anchored Hearing Aid (BAHA) is an implantable hearing aid based on the principle of cranial sound transmission, which was introduced to China last year. applied to a deaf patient and achieved good results. To date, more than 10,000 patients worldwide have undergone BAHA implantation, and after long follow-up observations, safety and effectiveness are recognized and BAHA is now considered to be a relatively mature hearing aid technology. What exactly is a BAHA device? The BAHA is actually composed of three parts: (1) a titanium implant: surgically implanted into the skull behind the ear, which is fused with the bone tissue over time to act as a fixed scaffold; (2) a titanium bridge base: connected through the skin to the titanium implant inside the skull and an external transducer; and (3) a sound processor: placed outside the body, which receives and amplifies sound and is connected to the titanium bridge base. The sound vibrations are transmitted directly to the cochlea and brain through the external sound processor, the titanium bridge base, and the titanium implant in the skull via the bone conduction pathway, so that sound can be heard again. There are many causes of deafness and some patients can be treated by traditional surgery and other means, but some patients need to wear hearing aids. Hearing aids are further divided into air-conduction hearing aids (the usual common type) and bone-conduction hearing aids, and some patients have to wear bone-conduction hearing aids. Traditional bone-conduction hearing aids transmit sound into the ear through a vibrating pad placed behind the ear and secured with a headband or by attaching the pad to glasses. Because the vibrating pad must be tightly fixed to the head, wearing this type of bone-conduction hearing aid is extremely uncomfortable. If worn for too long, they can cause headaches or localized skin damage; the sound is attenuated as it passes through the skin, resulting in a decrease in the quality of the sound it transmits, and patients complain of inaudibility; the unstable sensors can move during strenuous movement, which can affect speech recognition; and the easy-to-see appearance of ordinary hearing aids can discourage some patients from wearing them. In view of these problems, scientists have developed the BAHA, which is a titanium implant that is fixed to the skull and fuses with the surrounding bone over a period of about three months to ensure a safe and secure fusion with the skull. Compared with traditional bone-conduction hearing aids, BAHA has high sound transmission efficiency, good sound quality and low power consumption; moreover, since the processor outside the body is fixed directly on the skull, it can transmit sound without pressing the skin, so it is safe and comfortable to wear. What kind of deaf patients is BAHA suitable for? After years of clinical application and summary, BAHA is currently considered suitable for patients with conductive deafness, mild to moderate mixed deafness, and unilateral total deafness. For example, patients with severe external middle ear deformity (commonly known as microtia) who are not suitable for traditional hearing reconstruction surgery; patients with hearing loss caused by chronic otitis media who have poor hearing results after surgery; patients with sudden deafness who have poor results from conservative treatment; patients with complete unilateral hearing loss caused by postoperative hearing neuroma, etc. In China, since BAHA just passed the approval of the State Food and Drug Administration in 2010 for initial clinical application, the corresponding work in China was carried out late. Mr. Miao, the first BAHA implantation patient in China, underwent the left BAHA implantation on December 18, 2010 due to congenital left outer middle ear malformation and bilateral hearing impairment caused by total deafness after trauma to the right ear. The patient is very satisfied with the hearing aid effect and the sound processor does not need to be turned to the maximum gear to achieve satisfactory hearing effect. The BAHA implantation was performed in a hidden area behind the ear, in the mastoid region, where the skin is relatively thin. A hole is made in the skull behind the ear with a special electric drill and a 3 to 4 mm long titanium implant is placed. The surrounding skin is then thinned as much as possible and the titanium bridge base is screwed through the skin into the internal threads of the titanium implant. The titanium implant is kept unweighted for at least three months after surgery to allow complete fusion with the surrounding bone. Complications can occur with any surgery. Complications of BAHA surgery include bleeding and meningeal injury, mainly in pediatric patients with craniofacial anomalies, who are prone to these complications due to the anterior location of the great vessels (sigmoid sinus) and the low location of the meninges. A common long-term complication is local skin infection, which is reported in the literature to occur in only 8% of cases and is mostly mild, requiring further surgical management in only 2% of cases. In addition, some patients have dislodged titanium implants, with an incidence of about 0.6%, mostly due to improper handling when the patient removes the processor. Therefore, it is important to take care of the local area after surgery. We should care for the BAHA as we care for our teeth and keep the local skin clean and hygienic; moreover, attention should be paid to avoid trauma to the implant site, especially in pediatric patients with craniofacial anomalies; in addition, since the BAHA’s extracorporeal speech processor is an electronic device, external damage and flooding can cause damage to the instrument. As long as the above details are paid attention to, overall BAHA is a safe implantable hearing device. As for the cost of the procedure, the cost of BAHA implantation is about 10-20,000 RMB, which is comparable to or even lower than the cost of general otitis media surgery and has reached a generally acceptable level. At present, the resistance to the promotion of BAHA is mainly due to the concept of deaf patients: in general, it is a normal thing to wear glasses for bad eyesight; however, many people think that wearing hearing aids for bad hearing is a disgrace and have a lot of worries. In addition, it is the price issue: the current price of the device is about 60,000 yuan, and it has not yet entered the reimbursement scope of China’s employee health insurance. In the long term, if the cost of BAHA devices can be further reduced, it will be more beneficial for the promotion of the popularity. We are currently conducting pre-clinical work on BAHA and hope to start promoting it next year. We hope that the promotion of this new technology can better help the majority of deaf patients enter to improve the quality of life and enjoy a better life.