Swapping my Cochlear Osia200 for Med-el Bonebridge (BCI 602) after 4 years!

[Davo]

Hi all, as the title says: I'm finally jumping the Cochlear ship for Med-el.

I'll be able to report back with my comparative findings soon in the coming weeks - hoping for some improvement from the Bonebridge. 
Has anyone else also tried both? 

My key reasons for swapping to the Bonebridge are essentially lackluster performance from both the  Osia200's sound processor and subdermal implant's piezo-electric transducer.  Piezo transducers are already limited in their ability to produce a wide spectrum of sound (typically they are programmed to only play 1 (usually higher) frequency in industrial applications). Coupled with the meh microphone array and onboard sound processing in the external unit, I found it to be of little improvement to my current situation of SSD. 

My assumptions from studying the Bonebridge offering are as follows:

1. The Floating Mass Transducer in the Med-el BCI602 is an electromagnetic transducer, the same found in speakers, headphones, sound systems etc. The assumption is that the FMT will do a better job reproducing the audio frequencies completely missed by the Osia200, specifically lower freq's. The assumption is that the reproduced sound will be more natural. 
2. The anchoring with 2 screws and recession into the skull should result in a better transmission of the sound through the bone than the single-screw surface-mounted Osia200.
3. The smaller transducer of the Bonebridge allows implantation closer to the ear, almost directly behind the outer ear. This one is also important to me as I can genuinely hear the distance between my ear and the position of my current Osia200 (about 50-60mm). The sound felt faint and outside the proximity of my right ear. Closer should feel more natural - hopefully. 
    

I'd love to hear your thoughts on it if you have any to share. 

 

[MED-EL Moderator]

@Davo, thank you for starting this forum and sharing a bit about why you decided on BONEBRIDGE. Best wishes on your upcoming journey! 

You may be interested in reading a recent blog from MED-EL's Professionals Blog regarding a young recipient who, together with their family and professional team, decided to switch from BAHA to BONEBRIDGE: https://blog.medel.pro/surgical/bonebridge-instead-of-baha-case-study-and-surgical-video/

We hope some other users on the forum will jump in to share their experiences with you! 

Kind Regards 
Alicia 

[Tim]

I used a Oticon Ponto Plus Power bone conduction system off and on (but mostly off!) for about 6 years for sensorineural hearing loss. 

I'm not criticizing the technology though since I wasn't really the ideal fit.  It was trying to relay the sound from the bad side to my good cochlea.  The skin issue of having an abutment sticking out were a constant irritant as well.  Never really worked out for me as the sound quality was not good, didn't provide spatial awareness since it collapses all sound to just one cochlea, and didn't alleviate tinnitus at all for me since my bad cochlea was still not getting a useful signal. 

I switched to a CI last year after the US FDA approved CI for SSD. 

It sounds like your situation is a much better match to the technology and I look forward to reading your future updates and technical perspective!  

Great that the bone conduction systems are "non-destructive" treatments relative to a CI, you can continue finding the best path on your hearing journey.  No matter what happens, you will still have all options open for future treatment alternatives.

 

[Davo]

1 hour ago, Tim said:

I used a Oticon Ponto Plus Power bone conduction system off and on (but mostly off!) for about 6 years for sensorineural hearing loss. 

I'm not criticizing the technology though since I wasn't really the ideal fit.  It was trying to relay the sound from the bad side to my good cochlea.  The skin issue of having an abutment sticking out were a constant irritant as well.  Never really worked out for me as the sound quality was not good, didn't provide spatial awareness since it collapses all sound to just one cochlea, and didn't alleviate tinnitus at all for me since my bad cochlea was still not getting a useful signal. 

I switched to a CI last year after the US FDA approved CI for SSD. 

It sounds like your situation is a much better match to the technology and I look forward to reading your future updates and technical perspective!  

Great that the bone conduction systems are "non-destructive" treatments relative to a CI, you can continue finding the best path on your hearing journey.  No matter what happens, you will still have all options open for future treatment alternatives.

 

Thank you for sharing your perspective and experience Tim. I quite agree with your perspective on the capability to change and chop options regarding bone conduction, and only wish that cochlear implants will one day follow suit if possible. 

[Davo]

17 hours ago, MED-EL Moderator said:

@Davo, thank you for starting this forum and sharing a bit about why you decided on BONEBRIDGE. Best wishes on your upcoming journey! 

You may be interested in reading a recent blog from MED-EL's Professionals Blog regarding a young recipient who, together with their family and professional team, decided to switch from BAHA to BONEBRIDGE: https://blog.medel.pro/surgical/bonebridge-instead-of-baha-case-study-and-surgical-video/

We hope some other users on the forum will jump in to share their experiences with you! 

Kind Regards 
Alicia 

Thanks very much Alicia I look forward to providing as much detail as I can in the coming days and weeks. 

I also appreciate the recommendation to that particular study and enjoyed the read. 

[Davo]

Hi everyone. 

So it's been about 36hrs since I had the surgery yesterday. The extraction of the Osia 200 and the implantation of the BB BCI602 went well. 
I advocated strongly for placement preferences, including recessing the unit as much as possible into my mastoid in order to reduce the appearance under my skin. This was important as I shave my head.

The new implant required an additional incision closer to the Pinna of my right ear, and I had to repeatedly confirm with the surgical team that I had no intention of reconstructing my right ear or having any cosmetic surgery (incisions can't approach too close to an area that is intended to be cosmetically reworked down the line).

At my request, the team did a great job limiting the length of the new incision to keep it hidden behind the Pinna, but at the cost and compromise of lots of pressure and  bruising during the retraction of the skin and tissue in the procedure.

My sound processor activation is March 15th, and I will be meeting with my audiologist and a Medel Rep. 

Apologies to those a bit squeamish - here's a photo of the aftermath 36hrs later. The surgical team used many sutures and copius amounts of surgical superglue to seal the skin up - with the goal of reducing the appearance of the scars (which will be quite prominent with my particular haircut - or lack thereof).

• The incision marked "1" is where the Osia was initially inserted through in 2020, and subsequently extracted from yesterday. The surgical team also intended to revise the first scar and make it smoother to reduce issues with my shaving. 
• The incision marked "2" is the new incision for the Bonebridge Implant.
• The green circle is the location of the transducer
• The blue circle is where the sound processor/magnet are located. You can see the strategic positioning to allow my glasses to be worn without skin pressure issues. 

I'm confident the scars will heal without much trouble and fade in appearance, as the first scar did so quite nicely before it was reopened yesterday. 

I will update as things progress. 

[Kylie]

Seems like a great start to this phase of your hearing!

[Travis]

I don't have a visible scar at all. Same side too. 😛

I hope you're happy with it come activation day! FWIW I find the sound very natural, with great direction finding. That was my biggest annoyance before getting it...could't tell where anything was coming from. 

Def recommend using the safety line while you get used to not knocking it off...I swapped the weird fishing line thing out for a delicate black titanium chain, I think it's cooler and much less noticeable. 

[Travis]

Edit: Nevermind re-read your post. 😛

Is the left incision where they pulled out the Osia? I only had the incision behind the pinna for my surgery...🤔

[Travis]

The titanium chain weighs like...nothing. NGL my mom bought it for me (yes I'm a grown-ass man she asked me for a Christmas present lol), not sure where she got it but I can ask if you're interested. 

You would THINK people would notice it more than the clear fishing line but I got asked almost every day about the fishing line and still no one yet has noticed or asked about the chain. Kinda weird.

[Travis]

No scar really...the transducer is directly in front of my index finger.  

[Travis]

Couple more things! The batteries last roughly a week, less in very noisy environments (airplane flights annihilate the battery...makes me wonder if it's the thinner air). Opening the door at night seems to make them last a bit longer.

I get big packs of 675s at Costco for cheap 👍 Amazon has similar prices tho. I keep an extra lil wallet too in my front pocket for spare batteries and to have the ID card on me (even though I've never set off a metal detector) 🤷. 

Chums Surfshorts Wallet - Lightweight Zippered Minimalist Wallet with Clear ID Window - Water Resistant with Key Ring https://a.co/d/77NqXMd

Finally, be careful pulling the covers off. Do exactly as the directions say, and be gentle, make sure the two little "snap" spots disconnect using your fingernails. You can accidentally start to pull the two halves of the case apart if you just yank on it.

That being said, my old one took SEVERAL hard falls (toddlers man) before it was like...ok this thing isn't working right anymore. I had super glued it all back together. 😅

[Davo]

8 hours ago, Travis said:

I don't have a visible scar at all. Same side too. 😛

I hope you're happy with it come activation day! FWIW I find the sound very natural, with great direction finding. That was my biggest annoyance before getting it...can't tell where anything is coming from. 

Def recommend using the safety line while you get used to not knocking it off...I swapped the weird fishing line thing out for a delicate black titanium chain, I think it's cooler and much less noticeable. 

That scar is really well settled - thanks for sharing! And Im due for activation on Friday so will be anxious until then haha, but your feedback is good to know.

In the past I've used a clear nylon line with my Osia, except I ran mine to the arm of my glasses which made it pretty much invisible. The Bonebridge is even closer now (as you can see in my photo above) so the safety tether may only end up being about 20mm long.

Ironically it was on one of the rare occasions I wasn't wearing the tether and my glasses that I lost the Osia sound processor. And when faced with the decision and cost to buy a replacement, I realized I wasn't happy enough with it to fork that money out. Fast forward 2 years on the waiting list and here we are with the Bonebridge (of which the surgery and unit was free under the public system here in Sydney, Australia). 

[Davo]

1 hour ago, Travis said:

Is the left incision where they pulled out the Osla? I only had the incision behind the pinna for my surgery...🤔

Yep absolutely. They did an incredible job going back through the old scar. It's healed up really nicely this time around - with no ingrown hair trouble like I had the first time. New incision is also doing well - Im quite keen for the healing to be done on the though - it's so itchy in this last stage of skin knitting together. 

 

 

For scale - the magnet used to show position in these images is 25mm wide - so I'll likely make a very very short clear tether that connects to the end of the glasses arm.

[Davo]

51 minutes ago, Travis said:

Couple more things! The batteries last roughly a week, less in very noisy environments (airplane flights annihilate the battery...makes me wonder if it's the thinner air). Opening the door at night seems to make them last a bit longer.

I get big packs of 675s at Costco for cheap 👍 Amazon has similar prices tho. I keep an extra lil wallet too in my front pocket for spare batteries and to have the ID card on me (even though I've never set off a metal detector) 🤷. 

Chums Surfshorts Wallet - Lightweight Zippered Minimalist Wallet with Clear ID Window - Water Resistant with Key Ring https://a.co/d/77NqXMd

Finally, be careful pulling the covers off. Do exactly as the directions say, and be gentle, make sure the two little "snap" spots disconnect using your fingernails. You can accidentally start to pull the two halves of the case apart if you just yank on it.

That being said, my old one took SEVERAL hard falls (toddlers man) before it was like...ok this thing isn't working right anymore. I had super glued it all back together. 😅

Thanks for this info - fortunately I still have about 300x of the 675 cells, provided for free with the Osia 200 trial that I took part in. I'm happy they can be used in the BB. 

[Travis]

Sounds like you've got things figured out! 🙃

After the accident that caused my deafness I got by fairly well for a few years with an eardrum tube, but that eventually fell out and the glue ear returned. Then COVID happened, and everyone covering their mouth with a mask made me realize had bad the deafness had gotten (I was lip-reading without really realizing it).

I'm military so I have government healthcare as well (known as TRICARE). After I decided to get a hearing aid, I discovered the Bonebridge, and that TRICARE covers the bone conduction hearing aids. I've heard that several years ago it was still too new of a technology yet. They even cover a lost/broken processor so that's a nice peace of mind. 

[Davo]

14 minutes ago, Travis said:

Sounds like you've got things figured out! 🙃

After the accident that caused my deafness I got by fairly well for a few years with an eardrum tube, but that eventually fell out and the glue ear returned. Then COVID happened, and everyone covering their mouth with a mask made me realize had bad the deafness had gotten (I was lip-reading without really realizing it).

I'm military so I have government healthcare as well (known as TRICARE). After I decided to get a hearing aid, I discovered the Bonebridge, and that TRICARE covers the bone conduction hearing aids. I've heard that several years ago it was still too new of a technology yet. They even cover a lost/broken processor so that's a nice peace of mind. 

That's fantastic cover. I'll be sure not to lose this new one. Best I can do is put it under Home&Contents Insurance. 

[Davo]

IVE GOT IT ACTIVATED!!!  WALL OF TEXT INCOMING BELOW....

The switch on occurred a few days ago and I wanted to really give it a proper go before making some comments about it.
Ive worn it for almost 3 days now and I've got some key takeaways, ordered roughly in chronological order when I realized them.  
 

1. PRO - The quality and overall 'flavour' of the BCI200's  sound is indeed more natural than the Osia 200's offering. I am greatly relieved to report that my hopes about the intrinsic characteristics of the BoneBridge's electromagnetic FMT is correct, and overall reproduces sound with greater resolution and depth compared to the piezo-electric transducer of the Cochlear's Osia200.
            a) PRO - It feels like the BCI-200 sound reproduction meshes better with my use-case of single-sided-deafness. It's impossible not the compare the implant to your naturally hearing ear, so this is important. They need to work together. I'm not sure if it's the better placement of the implant closer to my ear, or the superior sound quality contributing to this improvement - perhaps it's the combination of both. This sound quality difference is really helping me ignore/deal with some of the other frustrations I've listed below. 
   
            b) CON - I still need to stress that it's still not perfect by any means, and still falls greatly short of many other devices I've tested and heard in the past. For example, using my fully-functional left ear I've been able to test and compare the ambient pass-through features on the Apple AirPods Pro, the Jabra Elite earbuds series, and a few from Sony and Microsoft and ALL OF THEM have a more natural reproduction of sound pass-through than Medel or Cochlear's devices. If these devices can accurately detect and reproduce the sound around me, surely devices from Medel (and indeed Cochlear) who are dedicated hearing-restoration companies  should be able to do much better. 
                      i) NOTABLE - Understandably I'm going to attribute this performance difference to much larger budgets in R&D from the likes of Apple, Sony etc, and less of the complex and bureaucratic restrictions that accompany medical device product development. Medel and Cochlear need to jump through many more hoops and conduct clinical trials etc. before a product can enter the market. 
                     ii) CON - The microphones on the Apple/Sony/Jabra devices are likely larger than the Samba2, and have more instances spread out over the device, resulting in better audio in, which means better audio out. 
                    iii) CON - The software-hardware integration is likely much tighter with Apple/Sony/Jabra devices, with battery-intensive audio-scrubbing and conditioning software to optimize the sound. Honestly - this should be much much better on both the Samba and the Osia, and it's just not yet where it should be. 
                    iv) NOTABLE - I genuinely would trade the Samba2's 8-10day battery-life for a 1-2 day battery life if it meaningfully addressed the above issues of sound quality and onboard-processing. Perhaps this can be a worked into the prospective Samba3 with a "High-Performance" or "HD Audio" mode. 
   
            c) PRO - I found that the piezo-electric transducer of the Osia-200 could hit most of the same frequencies, particularly in the mid-high frequencies, but the sound could be described as 'flatter' and less natural across the board. The BCI-200 is just less fatiguing to listen to compared to the Osia-200. This is a big win for the BCI-200 and Samba 2. 
    
2. PRO - There are more magnet variations in the BB (6 differing strengths), with the #6 being the strongest and the one I'm currently using. #6 also feels stronger than the strongest magnet for the Osia 200, giving me more confidence in the secure attachment on my head.
            a) CON - Unfortunately I wasn't able to take the magnet kit or swap-tool home with me. The Medel rep (who was lovely by the way) said Medel preferred users not have access to the magnet. I can understand this with younger users for sure - but not with fully aware and competent adult users. With my Osia I was able to take my magnets home from the activation, making it easy to adjust depending on how long I wore the unit each day, which would vary week-to-week.  I'd prefer to have autonomy over a device that is essentially an extension of my body. 
    
3. PRO - The kit I received in my activation session came with the Samba2Go - a great relief as the purchase/replacement cost is quite high ($750 for the Samba2Go unit, $45 for the neckloop alone). 
            a) PRO - The neckloop is indeed cumbersome, but less so than I imagined. If you regularly wear necklaces it will be a simple swap-in for your usual feeling around the neck.
                    i) NOTABLE - I'm not a fan of the silicone coating on the neckloop. Whilst I'm sure it's resilient and chosen for smoothness, a fine-textured braided cable sheath would have been more comfortable and less grippy on the skin.  I plan on replacing it with a braided neckloop ( as far as I can tell it's simply a standard 2.5mm-to-2.5mm audio cable).
   
            b) CON - The connectivity and streaming experience is not as intuitive or easy as the True Wireless Phone Clip offering from Cochlear, with particular frustrations around limited range (I haven't gotten it to reliably stream past my shoulder). I hope the prospective Samba3 and accompanying Samba3Go uses a more forgiving, longer-range and robust connection method in the future. 
   
            c) CON - I've also noticed that the magnetic induction connection is quite fussy and seemingly fragile, and prone to disconnection. After some trial and error I was able to narrow down a possible cause:
                      i) CON - If the Samba 2 Sound Processor is misaligned on your head and not orientated perfectly vertical then there will be regular drop-outs, particularly when turning my neck left or right. I guess the positive side-effect of this is a "helpful" reminder when the microphone array on the Samba2 is not optimally positioned. 
                      ii) CON - I suspect this connection fragility resultant of the Samba Sound Processor moving through the magnetic induction field of the neckloop antenna and the signal fluctuating. Had I never tried the Osia and known it's sound quality, or known about these Samba connectivity frustrations, I would have likely opted for the Osia offering as a first-time patient. User experience matters. 
    
4. CON - The lack of a visual cues or a physical button on the device designed for hearing-impaired users really frustrates me. It means I require either my Samba2Go on my neck, or the app on my phone (which only works in a quiet room) to change the volume, switch the program, or mute the microphones.
            a) CON - The Osia200 had a simple button to change programs, and it also had a LED which turned on to tell me when it was active. 
   
            b) CON - Contrary to any sensible assumption, the 'Samba 2 Remote' smartphone app does not connect to the Samba 2 via your phones bluetooth connection. Instead it controls the Samba 2 "acoustically" by sending a series of high-frequency tones (above human hearing range) which are heard by the Samba 2 and acted on.
                      i) CON - You can see how this immediately fails in many scenarios. Frustratingly, the app refuses to function when you're connected to your phone via bluetooth - necessitating a disconnection and pausing of streaming media/phone call in order to use the app. The result is one of the most counter-intuitive and limited use-case scenarios I've ever come-across. 
                     ii) CON - As a Industrial Designer and someone who's designed many consumer products, I'm baffled that this was considered a satisfactory solution. I don't know about you, but the primary reason a user is likely to use the app is to adjust the volume, and that's typically because they are in too loud an environment - which obviously renders the app control useless. I am guessing this is another limitation of using the magnetic induction connection - as opposed to the 2.4ghz wireless connection that was SO effective on Cochlear's True Wireless Phone Clip
   
            c) CON - The simple instruction to partially open the battery door to turn the Samba 2 off or mute the sound is not so easy when the door is actually quite tough to open without 2 hands. I'm a pretty strong dude with decent dexterity and it was still a challenge for me. Opening and closing the door also resets the device back to Program #1, and to the volume default of #1 - which is compoundingly frustrating because of the aforementioned points about requiring a remote or the app - see points 4a/b above.
    
5. PRO - The Samba2 can store more Programs (6 total) and it appears that the control over each of the Programs is finessed (at least from my observations during activation).
            a) PRO - I genuinely feel like we got closer to my correct tuning in the first activation session of the Samba2 than we ever got with the Osia200, even after months of repeat tuning visits. Thank you Ashni from NextSense and Benedict from Medel!
    
6. PRO - The tether accessory is more removable than the Osia, which is particularly useful for me since I have the tether attached to the end of the right arm of my glasses which I wear 24/7. Sometimes I want to wear just my glasses (typically after a long day of Samba2 wear and my scalp is tender). 
            a)  NOTABLE - I've modified one of the shorter security tethers but am not sure how robust and durable the silicone line is compared to the nylon tethers offered by Cochlear for their Osia. Only time will tell. 

- 

Look I could probably go on and on and on, and I'm sure in the coming weeks and months I'll have even more to report on, but for now I think this will do for initial feedback.

@MED-EL Moderator please let me know if I've made some incorrect conclusions or misunderstood any processes/instructions during my use. I'd love for this feedback to be given to the team, or better yet would love the opportunity to discuss and deliver it to them directly. I also welcome any corrections or tips for overcoming some of the shortfalls I've listed. 

I also do recognize that I make many comparisons to other devices, including non-medical-grade devices like earbuds from Apple/Sony etc.. but it's actually critically important that this comparison is made, because the potential for improvement in Medel/Cochlear isn't just obvious due to the points I listed above - it's also already been achieved by other companies. The bar has been set, and it's continuing to be improved every time new products come out.  If consumer devices like the Apple AirPod Pro earbuds can do it and still be sold for $400AUD, then surely a medical device worth 10-20x that cost can do it too (even accounting for the cost-advantages of scale manufacturing).

Before embarking on this journey of implants I desperately wished someone had shared this kind of detailed feedback with me, but there's actually such little information out there for users of bone-conduction implants, and even less so for users with Single-Sided-Deafness like myself. How the implant's "sound" meshes and integrates with our "working/naturally hearing" ear plays a big role in whether or not we decide to continue using these devices. It was what stopped me from using Cochlear's Osia200. 

Fortunately it seems I've gotten a bit luckier this time around with the Bone-Bridge. Let's see how it continues in the days and weeks ahead. 

Congrat's - you made it through all that reading - here are some photos. 

[MED-EL Moderator]

@Davo, thank you very much for sharing such detailed feedback about BONEBRIDGE and SAMBA 2. We have shared this information with our product experts here at MED-EL. Additionally, we have sent you a private message. Could you please have a look? 

Kind Regards,

Alicia 

[Davo]

You're very welcome Alicia.
Thanks for the feedback - I've seen and responded to the private message. 

[Travis]

I'm glad you're happy with the sound quality! Good to know I'm not crazy. 

All the other stuff is pretty spot-on, but I am overall still very happy with the system after three years of wear. My wife can totally hear the ultrasonic signals from my phone btw. 😅 I think I agree, I would rather have half the battery life but a higher quality digital link. 

[Travis]

Also the silicone line is super noticeable and I also had doubts about durability so I switched to the black titanium chain...blends in really well and obviously super strong.

https://www.titaniumkay.com/Black-Titanium-1MM-Rolo-Necklace-Chain-P104787.html

[Tim]

@Davo I really like your wall of text even though it doesn't directly apply to me.  It is well organized and thoughtful. Interesting to see the commonalities and the differences between the BB and CIs from Med-El. 

The current generation of customers includes a lot more tech savvy people and SSD than in the past for various technologies.  Your feedback will help people in the future. 

Looking forward to your future updates on your hearing journey.

 

[Davo]

Hi everyone.
Been a little while but I wanted to do a longer run in with the device before following up my initial impressions.  This will be another wall of text, though shorter and much more positive towards the Bone-Bridge.

The first thing to note is how well integrated into hearing and everyday sound it has become. For unrelated reasons I needed to postpone my followup with my audiologist, but I have had almost no drive or urgency to re-schedule. This really surprised me when I realized, especially since I had almost 10 appts for adjusting the Osia 200, and still didn't feel like it was the right sound in the end. 

The Samba 2 Go remote device is growing on me - and it's convenience around the neck is fast overcoming my concerns around being cumbersome etc. The buttons do get accidently pressed when getting a hug or holding my son, but those are minor things I plan to fix with a small 3D printed case that adds some protection to the front facing surface and should prevent accidental program changes. 

Speaking of Programs - I now share the same sentiment most you wearers have shared; which is that there's almost no need for the additional programs. I find the auto-program to be sufficient 95% of the time, with only occasional manual adjustments to volume. 

The app remote is more applicable than I first gave it credit for. Ive found it able to function in louder environments than anticipated (provided you hold the phone closer to the Samba 2). 

The silicone tether was indeed not strong enough for my use,  and snapped quite quickly after a few weeks. I've swapped it out for a thin braid of sewing thread (mainly for it's lightness and pliability and relative tensile strength doubled over 4 times). It also means that I can easily remove the plastic tether attachment from the battery door and unloop/loop it easily to my glasses.  

Though I complained about the finnicky nature of the magnetic induction connection between the Samba 2 and Samba2Go,  what's become clear is that the the processor/implant pairing is fully utilising the available bandwidth much better than the Osia200 ever did with it's 2.4ghz wireless connection. In short - the BoneBridge makes better sound via bluetooth streaming regardless of the bandwidth or connection style. 

The battery life really is about 8 days! It's kind of crazy but definitely not complaining. 

I'm really glad I made the switch from Cochlear to Medel.