Surgery Section - Implantable Bone Conduction Hearing Aids

IMPORTANT REMINDER

This Medical Policy has been developed through consideration of medical necessity, generally accepted standards of medical practice, and review of medical literature and government approval status.

Benefit determinations should be based in all cases on the applicable contract language. To the extent there are any conflicts between these guidelines and the contract language, the contract language will control.

The purpose of medical policy is to provide a guide to coverage. Medical Policy is not intended to dictate to providers how to practice medicine. Providers are expected to exercise their medical judgment in providing the most appropriate care.

Description

Implantable bone conduction (bone-anchored) hearing aids are used in patients with the following types of hearing loss:

• Conductive hearing loss, which occurs when sound is not conducted efficiently through the outer ear canal to the eardrum and the tiny bones, or ossicles, of the middle ear
• Sensorineural hearing loss, which occurs when there is permanent damage to the inner ear (cochlea) or to the nerve pathways from the inner ear (retrocochlear) to the brain.
• Mixed hearing loss, this is a conductive hearing loss which may occur in combination with a sensorineural hearing loss. In other words, there may be damage in the outer or middle ear and in the inner ear (cochlea) or auditory nerve.

The implantable bone conduction hearing aids are bone-anchored devices implanted near the ear with hearing loss.  This transmits digital sound processing across the bones of the skull to the ear with normal hearing via transcranial contralateral routing of signal (CROS).

The BAHA® and Audiant™ are the only two current implantable bone conduction hearing aids with FDA approval.  The Audiant device is no longer marketed.

Note: Cochlear implants, which are prostheses and not hearing aids, are used for the treatment of severe to profound deafness.  These are addressed in Surgery Policy No. 8.

Policy/Criteria

Note: There may be specific contract language addressing coverage of hearing aids. Any specific contract language supersedes medical policy. Unless otherwise specified, the contract language addressing coverage of hearing aids applies to both surgically implanted bone conduction hearing aids and externally worn air conduction hearing aids.

Position Summary

Conductive, Sensorineural or Mixed Hearing Loss

Reported studies have suggested that the BAHA device is associated with improved hearing outcomes compared to external bone conduction hearing aids, and additionally with equivalent outcomes compared to a conventional air conduction hearing aids. (2-5) Use of unilateral or bilateral devices has been evaluated in patients with conductive or mixed hearing losses. This device has also been evaluated in patients with unilateral sensorineural hearing loss.  Published studies have demonstrated a consistent improvement in speech recognition, noise, and sound localization with these devices. (2-12)

Bilateral Sensorineural Hearing Loss

References

1. BlueCross and BlueShield Association Medical Policy Reference Manual, Policy No. 7.01.03
2. Snik AF, Mylanus EA, Cremers CW. The bone-anchored hearing aid compared with conventional hearing aids. Audiologic results and the patients’ opinions. Otolaryngol Clin North Am 1995;28(1):73-83
3. Wazen JJ, Caruso M, Tjellstrom A. Long-term results with titanium bone anchored hearing aid: the U.S. experience. Am J Otol 1998;19(6):737-41
4. van der Pouw CT, Snik AF, Cremers CW. The BAHA HC200/300 in comparison with conventional bone conduction hearing aids. Clin Otolaryngol 1999;24(3):171-6
   Granstrom G, Tjellstrom A. The bone-anchored hearing aid (BAHA) in children with auricular malformations. Ear Nose Throat J 1997;76(4):238-47
5. Granstrom G, Tjellstrom A. The bone-anchored hearing aid (BAHA) in children with auricular malformations. Ear Nose Throat J 1997;76(4):238-47
6. McLarnon CM, Davison T, Johnson IJ. Bone-anchored hearing aid: comparison of benefit by patient subgroups. Laryngoscope 2004;114(5):942-4
7. House JW, Kutz JW. Bone-anchored hearing aids: incidence and management of postoperative complications. Otol Neurotol 2007;28(2):213-7
8. Baguley DM, Bird J, Humphriss RL et al. The evidence base for the application of contralateral bone anchored hearing aids in acquired unilateral sensorineural hearing loss in adults. Clin Otolaryngol 2006;31(1):6-14
9. Lin LM, Bowditch S, Anderson MJ et al. Amplification in the rehabilitation of unilateral deafness: speech in noise and directional hearing effects with bone-anchored hearing and contralateral routing of signal amplification. Otol Neurotol 2006;27(2):172-82
10. Stenfelt S. Bilateral fitting of BAHAs and BAHA fitted in unilateral deaf persons: acoustical aspects. Int J. Audiol 2005;44(3):178-89
11. Snik AF, Mylanus EA, Proops DW et al. Consensus statements on the BAHA system: where do we stand at present? Ann Otol Rhinol Laryngol Suppl 2005;195:2-12
12. Bergeron F. Bone-anchored hearing aids. Montreal: Agence d’Evaluation des Technologies et des Modes d’Intervention en Sante (AETMIS) 2006. English summary accessible at www.aetmis.gouv.qc.ca/site/download.php?f=0c0b7b64123cca3dfcffda4457982115  (Verified 04/28/08)
13. American Speech-Language-Hearing Association; http://www.asha.org/public/hearing/disorders/types.htm (Verified 05/01/08)

Cross References

Cochlear Implant, Regence Medical Policy Manual, Surgery Policy No. 8

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