Many patients with hearing loss benefit from conventional (non-implantable) hearing aids. However, there are situations in which hearing aids are insufficient or cannot be worn—such as chronic otitis externa, recurrent ear canal infections, skin reactions, anatomical abnormalities of the ear canal, or congenital atresia. In such cases, an implantable hearing solution may be appropriate. Implantable systems bypass the limitations of traditional hearing aids and, with proper patient selection, offer excellent sound quality and long-term comfort.

When Are Implantable Hearing Systems Considered?

In short: whenever conventional hearing aids no longer provide a satisfactory solution. Typical scenarios include:

Chronic infections or injuries of the ear canal that are aggravated by wearing a hearing aid
Anatomical malformations or atresia of the ear canal (e.g., microtia with canal closure)
Repeated middle ear surgeries with altered anatomy
Mixed or conductive hearing loss components that traditional hearing aids cannot adequately compensate
Patients seeking higher sound quality, feedback reduction, or improved aesthetics
Situations in which an earmold or canal device can no longer be worn at all

In such cases, we work with patients to evaluate whether an implantable system—such as the Vibrant Soundbridge, Bonebridge, or Osia—is a suitable option.

Overview of Implantable Systems

Vibrant Soundbridge (Active Middle Ear Implant)

The Vibrant Soundbridge (VSB) is an active middle ear implant that converts acoustic signals into mechanical vibrations and transmits them directly to the middle ear structures. Unlike bone conduction implants, the VSB does not stimulate via bone, but via the ossicular chain—allowing precise, side-specific stimulation.

The VSB is suitable for patients with sensorineural, combined, or conductive hearing loss. For medium to elevated bone conduction thresholds (e.g., > 35 dB), the VSB may offer audiological advantages over bone conduction implants. Studies also show benefits in directional hearing.

The system is partially implantable: the internal components lie beneath the skin; the external speech processor attaches magnetically and is usually discreet and barely visible.

Images courtesy of MED-EL.

Bonebridge (Active Transcutaneous Bone Conduction Implant)

The Bonebridge is an active, transcutaneous bone conduction implant. Its internal actuator (BC-FMT) is embedded in the skull bone and transmits vibrations through bone conduction directly to the cochlea.

A key advantage: the skin remains intact (no open abutment as with older “BAHA” systems), reducing the risk of skin complications. Studies demonstrate high reliability and patient satisfaction.

Bonebridge is indicated for conductive or mixed hearing loss, especially when the external ear canal is not suitable for wearing a hearing aid. The external processor is worn magnetically on the skin and transmits signals wirelessly to the implant.

Images courtesy of MED-EL.

Osia (Active Bone Conduction System with Piezo Technology)

The Cochlear Osia System is an active bone conduction implant based on piezoelectric technology. It converts sound into mechanical vibrations that are transmitted through the bone directly to the cochlea.

The system is approved for patients with conductive hearing loss, mixed hearing loss up to 55 dB HL, and single-sided deafness.

Osia offers a slim implant design and a modern external sound processor with wireless connectivity. Clinical studies report excellent speech understanding and high wearing comfort.

Images courtesy of Cochlear. © Cochlear Limited 2025.

Are These Systems Large or Noticeable?

No. Modern implantable hearing systems are designed to be as discreet as possible in daily life.
The implant is completely under the skin and is not visible.

Only the external sound processor is worn outside—either behind the ear like a small hearing aid or as a flat magnetic module on the skin. With multiple color options and subtle designs, these processors can be matched to hair color and personal style.

Images courtesy of Cochlear / Johan Westerlind Photography.

What About Cochlear Implants — Do I Need One?

A cochlear implant (CI) may be indicated when conventional hearing aids or implantable middle ear/bone conduction systems are no longer sufficient—typically in severe or profound hearing loss where the cochlea is too damaged for acoustic amplification to be of benefit.

A CI bypasses the damaged inner ear and directly stimulates the auditory nerve electrically. Outcomes are generally excellent but depend on factors such as duration of hearing loss, language development, and individual motivation. Children and adults with post-lingual hearing loss often achieve outstanding results, regaining speech understanding and daily communication abilities.

After surgery, a structured rehabilitation program begins, including regular processor adjustments, hearing therapy, and speech training. This phase is essential to achieve the full potential of the implant.

What Does This Mean for Your Individual Case?

In our practice, every decision begins with comprehensive diagnostics:

Pure tone audiometry (air and bone conduction)
Speech audiometry
Imaging (CT/MRI)
Anatomical assessment of the middle and inner ear
Evaluation of bone structure and nerve integrity

We assess together whether the inner ear and auditory nerve are sufficiently intact—an essential requirement for implantable solutions.
Based on your hearing profile, anatomical findings, and personal priorities (e.g., sound quality, surgical considerations, aesthetics, MRI compatibility), we determine whether a VSB, Bonebridge, Osia, or a cochlear implant is the most suitable option.

Conclusion

Implantable hearing systems such as the Vibrant Soundbridge, Bonebridge, and Osia offer excellent alternatives when conventional hearing aids reach their limits—whether due to anatomical issues, skin problems, or insufficient amplification. Each system has specific strengths and indications; the optimal choice depends on your hearing profile, anatomy, and personal preferences.

With our expertise and clinical experience, we support you in finding the best possible solution for your hearing.

Your contact person for implantable hearing systems and hearing aid–related issues in our practice is Prof. Lüers.