a woman with a bone conduction headphone and soundwaves overlaying the picture

All About Bone Conduction

Contributed by Dr. Eleni Santarelli

3/15/2024 12:00:00 AM • 6 min read

Tags • Research

As humans, we can hear through two different pathways, the first is via air conduction. This more traditional way of hearing utilizes the ear canal, middle ear and inner ear. The second way is through bone conduction. This type of hearing skips the ear canal and goes to the middle ear by vibrating the bones of the skull and directly stimulating the cochlea.


During a hearing assessment, both air conduction and bone conduction hearing are checked.


How does bone conduction testing work?


Bone conduction testing is a standard procedure during a hearing assessment. When testing for air conduction, hearing care providers use inserts or headphones to aim the sound at the eardrum. When we test bone conduction, we use a bone oscillator. A bone oscillator is a plastic casing over a diaphragm placed on the mastoid portion of the skull. The mastoid bone is right behind the ear lobe. While this oscillator is in place, we play tones to the patient in the sound booth, and if they hear the beep, they press a button, and we know their conductive hearing level. This test is painless. 


What if someone has hearing loss with conductive components?


When someone has a sensorineural hearing loss, the bone conduction scores on the audiogram will line up with the air conduction scores. If the bone conduction scores don’t line up, it can mean they either have conductive hearing loss or mixed hearing loss.


Conductive hearing loss may occur for many reasons. One example is if someone with normal hearing has built up earwax. In this case, the air conduction scores may show that there is a hearing loss, but the bone conduction scores fall within the normal range. Another example is someone with an abnormality of the outer or middle ear, such as Atresia or a perforated ear drum. Learn more about conductive hearing loss.


Mixed hearing loss is when an individual has both sensorineural and conductive components to their hearing loss, such as a patient with Otosclerosis or someone who has certain types of ear surgery.


Treatment for Conductive Hearing Loss

For someone who has conductive or mixed hearing loss, there are usually two treatment options. The first is with traditional hearing aids, the second treatment option is with devices called Bone Anchored Implants (BAI), formerly known as BAHAs (Bone Anchored Hearing Aids).


Bone anchored implants require special evaluations and surgery if someone is a good candidate. Once given the green light, recipients will be implanted by an Otolaryngologist and after healing, an Audiologist will then activate and program the BAI.


Traditional hearing aids are a more common treatment for those with mixed or conductive loss that cannot be treated with medical interventions.


Are bone conduction headphones better than traditional headphones or ear buds?


Bone conduction headphones (like the ones the woman in the photo on this blog is wearing) are neither better nor worse than traditional headphones. It is really going to depend on the individual’s preference. If you are someone who tends to have chronic ear infections (i.e. drainage), bone conduction earphones are likely a better option for you because the device sits behind your ear, rather than in the ear canal.


No matter what kind of headphone or ear bud you use, be sure to follow the 60:60 rule: listen for a maximum of 60 minutes at a time, at 60% of maximum volume.



If you are ready to schedule a complimentary hearing assessment* to find out how your hearing health is doing, book your appointment today at a HearingLife near you!



Source: Bone Conduction Hearing Aids | Johns Hopkins Medicine

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Dr. Eleni Santarelli
Audiologist Lic #A.02315

Eleni Santarelli grew up in Cleveland, Ohio, and obtained her bachelor's degree in speech-language pathology & audiology from the University of Akron in 2017. She then went on to pursue her doctorate in Clinical Audiology at the Northeast Ohio Au.D Consortium. She did her fourth-year externship at the Columbus VA before completing her doctorate in May of 2021. Dr. Santarelli also obtained her certificate in Animal Audiology from the University of Cincinnati. She is licensed in the State of Ohio and is a member of the American Academy of Audiology and the Ohio Academy of Audiology. As a person who loves animals and sports, Dr. Santarelli can be found volunteering at the Cleveland Zoo, coaching basketball and cheering on Cleveland's pro teams in her free time. 

Dr. Santarelli wants to help people hear better because it allows them to have full and meaningful social interactions with their friends, family and keeps them safe in unfamiliar environments. When she helps someone to hear better it makes her feel like she has made a positive difference in their life.

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