Development of a Demonstration Tool for  
Bone Anchored Hearing Aids 
 
Master of Science Thesis in the Master Degree Programme     
Industrial Design Engineering, MPDES

ELLEN HULTMAN 
SAMANTHA LÜTKEMAN PUKALA

Department of Product and Production development
Division of Design & Human Factors
CHALMERS UNIVERSITY OF TECHNOLOGY
Gothenburg, Sweden, 2013



Development of a Demonstration Tool for  
Bone Anchored Hearing Aids

ELLEN HULTMAN & SAMANTHA LÜTKEMAN PUKALA

Published and distributed by: 
Chalmers University of  Technology 
Department of  Product and Production Development 
SE-412 96 Gothenburg 
Sweden

Telephone: +46 (0)31-772 1000



ACKNOWLEDGEMENTS

Carrying out this master thesis project and developing the final concept demonstration tool have involved meeting 
several persons and receiving their input. The master thesis group is very thankful for their time and engagement, as 
this thesis could never have been taken this far without them.

We would like to thank the team at Cochlear for initiating this project. Primarely Pernilla Pettersson for supervising 
us throughout this time and giving great guidance and engagement. We are also grateful to Göran Björn, Henrik 
Fryklund, Fredrik Breitholtz and Rom Mendel for their time and input during the evolvement of  the demonstration 
tool.

From the healthcare sector we give our greatest appreciation to Ann-Charlotte Persson for the hospitality and for 
always taking time to let us learn and attend at the Hearing and Deafness department at Sahlgrenska hospital. We 
also want to thank Maria Rosengren, Lisa Sundström and Annika Eliasson at Hörselcentralen, Sunderbyns hospital, 
Luleå, for sharing their experiences and thoughts around the Baha consultations and working as audiologists. 

Acknowledgements should also be made to Galantplast, Gothenburg and Kvarnby Textil, Mölndal for supporting 
us with materials during model making.

From Chalmers we want to thank our supervisor Sara Renström and our examiner Ralf  Rosenberg for supervising 
and supporting us during these 20 weeks and never hesitating to help us analyze our problems and challenges.

Ellen Hultman & Samantha Lütkeman Pukala

Gothenburg, 2013



ABSTRACT

The master thesis project “Development of  a Demonstration Tool for Bone Anchored Hearing Aids”, by Ellen 
Hultman and Samantha Lütkeman Pukala, was carried out at the department of  Product and Production Development 
at Chalmers University of  Technology. The project has been performed in collaboration with Cochlear BAS situated 
in Mölnlycke, Sweden.

Bone conducted hearing is an alternative when single sided deafness, conducted hearing loss or a mixture of  the 
two occurs. The bone anchored hearing aid provided by Cochlear, called Baha, consists of  three parts and require a 
surgical procedure to be implemented. 

The project to come up with a new design of  a demonstration tool was initiated as Cochlear defined a number of  
barriers to why patients refrain from the aid even though perceiving improved hearing. In addition new solutions to 
the Baha system will soon enter the market, which is why the company requested a new way to promote the Baha 
system options.

The final concept is a handheld product facilitating the conversation between the audiologist and patient. By interaction 
opportunities the tool promotes the patient to take a more active role during the counseling situation, aiming to 
create an understanding and build a relationship to the product. To overcome preconceptions the demonstration 
tool clearly and simply presents the different parts of  the Baha system in relationship to placement by an ear. A soft 
asymmetric grip creates attention and subtle colors and shapes support the presentation of  hearing aid. 

Research for the design was done through interviewing audiologists working with the Baha system and observing 
patients during Baha consultations. Analyzing company core values, communication strategy and competitors in 
addition resulted in a context analysis. The analysis set the foundation for an idea generation to meet all needs and 
move design focus from being technology driven to softer values. Several concept evaluations together with Cochlear 
representatives resulted in a final result where materials, manufacturing, use experience, and visual appearance have 
been accounted for. 

Keywords: Industrial Design Engineering, Product Development, Demonstration Tool, Bone Anchored, Bone Conducted, Hearing 
Aids, Baha, Audiologist, Cochlear





CONTENT



1. Introduction           1

1.1. Bone Conducted Hearing       1
1.2. Commissioning Company        1
1.3. Purpose          2
1.4. Goal          2
1.5. Constraints          2
1.6. Project and Report Outline       3

2. Background           4

2.1. Baha – Product and Function       4
2.2. Reasons for Baha        6
2.3. How to get a Baha        6
2.4. Living with Hearing Loss and Hearing Aids     8
2.5. Design Theory – Experience and Healthcare     8
2.6. Materials         9
2.7. Manufacturing         10

3. Methods – What and Why        12

3.1. Method Categorization        12
3.2. Planning         12
3.3. Data Collection          13
3.4. Analysis Tools         14
3.5. Creativity Methods        15
3.6. Visualization Methods        16
3.7. Evaluation Methods        17

4. Research and Analysis         18

4.1. Collection of  Data        18
4.2. Context Description        21
4.3. Analysis Conclusions        26

5. Concept Development          35

5.1. Ideation Execution        35
5.2. First Generation Concepts       39
5.3. Second Generation Concept       43



6. Further Development         46

6.1. Further Development Process       46
6.2. Refinement Results        49

7. Final Results           52

7.1. Concept Idea         52
7.2. Counseling         54
7.3. Construction         57
7.4. Verification         60
7.5. Context, Color and Shape        63
7.6. Life Cycle Estimation         64

8. Discussion           65

8.1. Sustainability         65
8.2. Final Result         67
8.3. Sub-Result         68
8.4. Method Execution        69
8.5. Overall Project         70
8.6. Recommendations        71

9. Conclusion           72

 References           73



I 1

1. Introduction

Ground for this Master Thesis project is given in this chapter by history of  bone conducted hearing as well as information about the 
company collaborated with. Furthermore, a detailed project scope description is accounted for.

1.1. Bone Conducted Hearing

This project regards developing a tool to demonstrate 
bone anchored hearing aids, known as Baha. The tool 
aims to create an understanding of  bone conducted 
hearing and promote bone anchored solutions as an 
equal option to conventional hearing aids.

Hearing through bone conduction could seem like a 
new technology but has been known for long, since 
Antiquity. During the years 1700 and 1800 scientists 
and musicians experimented with bone and teeth 
conducted hearing aids in the form biting onto rods 
or strings attached to the sound source. During the 
1950’s the development of  bone conduction was 
applied to eyeglasses, yet the use declined and further 
development was needed. The first bone anchored 
hearing solution, with a fitted implant, was done in 
1977 at the Sahlgrenska University Hospital by Swedish 
doctors who had developed the technology and 
products ultimately becoming the Baha hearing system 
(Kompis, 2011).

Since then the Baha system has been refined through 
the years. It is not a relatively common solution 
compared to conventional hearing aids like behind the 
ear aids (BTE) or in the ear aids (ITE) (hrf, 2013). A 
bit negligently the bone-anchored hearing aid has been 
seen as a bit of  a last solution when BTE or ITE aids 
have not been enough (Pettersson, 2012). 

1.2. Commissioning Company 

Cochlear Limited, which was established in 1983, has 
their head quarters in Sydney Australia. The company 
has three product categories regarding hearing aid, 
the cochlea implant hearing system Nucleus, the bone 
anchored hearing system Baha and the electro acoustic 
hearing system Hybrid. Cochlear has had Baha in their 
product range since 2005. (Acquisition, 2005)

Cochlear was for long the major supplier of  the Baha 
solution, which is also the registered trademark of  the 
their product. In recent years a few other companies 
have entered the market with equivalent solutions. In 
addition to the competition for customers the target 
group is also seen as possible to broaden. Baha does 
not have to be a last alternative but instead an equally 
functional solution which could improve hearing to 
many more than who are subjected to the solution 
today (Pettersson, 2012). 

In order to tackle the competition and gain customers 
choosing Baha, Cochlear has set up a communication 
strategy. Focus is to be shifted from facts and technology 
orientation to instead put softer values and the 
emotional engagement first. By tools communicating 
company core values Cochlear wants to enhance the 
user experience, increase the conversion of  people 
choosing Baha and create a long lasting customer 
relationship.

Today the sound of  using a Baha hearing system can 
be experienced prior to surgery, yet from a potential 
candidate perspective little information about life with 



Development of a Demonstration Tool for Bone Anchored Hearing Aids

the Baha as a product and the surgery is given. The 
existing demonstration tool, see image 1, informative 
texts, illustrations and pictures do not reach all the way 
so a new demonstration tool to fill the gap is desired.

1.3. Purpose

The purpose of  the Master Thesis project is to design a 
new physical demonstration tool to be used during the 
audiologist counseling. 

Research questions:

• How could a new demonstration tool 
communicate an understanding of  the surgery 
and daily care with the Baha system?

• How could a new demonstration tool facilitate an 
attractive presentation of  the products through; 
display of  the Baha system, explanation of  
features and benefits, functional use by snap-
training and communication of  the company 
core values?

1.4. Goal

The goal is to, as result of  the thesis project, have 
developed a concept possible to implement in the near 
future. This concept should consider aspects like price, 
(material, production volume, manufacturing methods 
etc.), usability and cognitive ergonomics. The longterm 
perspective of  this project is to establish Cochlear’s 
position as leading in providing reliable products and 
optimized solutions that will last and function well with 
future innovations.

1.5. Constraints 

The project does not focus on the detailed aspects of  
the Baha itself  in terms of  technology or design. 

The market for the demonstration tool is global yet 
restrictions will apply on how much the project can be 
validated in other countries’ contexts than Sweden’s.

The project will be brought as close to manufacturing 
as possible. Yet academic aspects will be prioritized and 
preparatory work for manufacturing such as collecting 
ultimate quotes cannot be obtained within the master 
thesis scope.

Although the target group of  people with hearing loss 
is diverse, this project is directed towards adults as the 
parents make the decisions for their children.     

Image 1. The demonstration tool of  today



I 3

1.6. Project and Report Outline

Two students hereafter referred to as the master thesis 
group conducted this project. The project contains six 
main phases, image 2, that have been conducted using 
an iterative process. This means that even though they 
are described separately in this report they have been 
processed and developed several times as the project 
proceeded. For a more detailed process flow chart see 
appendix 1.

Throughout the phases input and guidance have been 
given from mainly two stakeholders. Pernilla Petterson, 
who is a senior product manager of  Implant and 
Surgery at Cochlear Bone Anchored Solutions, initiated 
the project and has been the primary support. Along the 
evolvement of  the project she has involved employees 
with relevant expertise to support development and 
make decisions. Ann-Charlotte Persson, authorized 
audiologist at Sahlgrenska hospital in Gothenburg, 
has been providing information and support of  the 
patients and the healthcare context. Regular contact 
and meetings have been held with both stakeholders 
and the proceedings of  the project have been done in 
consensus.

Each chapter in the report start with an introduction of  
what the chapter will discuss. An execution will follow 
and then the chapter will finish with the main results 
and outcomes of  the particular phase. This means that 
sub deliverables of  the phase might be mentioned in 
the execution as they lead forward to the main result. 
Thus the reader can move straight to the result for 
quick review of  the phase outcome or go through the 
execution for a deeper insight. For less experienced 
readers within the subject, methods and theory is a 
good start, while more experienced readers might find 
the research phase a more interesting beginning. 

Image 2. Project Outline



2. Background

The background chapter covers several areas, ranging from the Baha system and hearing loss to Cochlear’s market position and strategy 
as well as design experience and manufacturing. An understanding of  these areas are needed to set a foundation for this thesis as they 
all play a part in the demonstration tool being designed. The Baha system needs to be understood in order to know what is important 
to communicate with the tool and finding out more about hearing loss will direct who the tool is for. Understanding Cochlear’s market 
strategy and the creation of  an experience through design will give input on how to communicate in order to reach the best outcome.

2.1. Baha – Product and Function

The Baha hearing aid consists of  an implant, an 
abutment and a sound processor. The titanium implant 
is ossiointegrated (Brånemark, 2010) in the skull bone, 
meaning the bone cells are attached directly to the 
implant. The titanium abutment is connected with the 
implant and will be surrounded by tissue as it comes 
out of  the skin layer to connect to the sound processor,  
image 3 and 4. The sound processor has an exterior of  
the biocompatible plastic PEEK.

Image 4. Baha System (Baha system, 2013)

Image 3. Baha integration (Baha integration, 2013)



I 5

In usual hearing, see image 5, vibrations in the air 
travel through the outer ear putting the eardrum in 
movement. This forwards the vibrations via the small 
bones in the middle ear to finally be received by the 
cochlea, also known as the inner ear.

If  the outer and/or middle ear are somehow damaged 
a Baha system transmits the airborne vibrations 
through the sound processor and onto the abutment 
and the implant, see image image 6. The implant makes 
a vibrating connection via the skull bone directly to the 
Cochlea, and thereby hearing is created (University of  
Maryland, 2012, Audio bone 2008). 

The Baha sound processors, image 7, picks up 
frequencies up to 8000Hz where normal speech is 
within 1000 to 3000 Hz. There are three different 
strengths of  sound processors that make up for 45, 55 
and 65 db hearing reduction, see appendix 2.

To facilitate for different environments the user might 
be in, the sound processor has three different programs 
to alter between. These programs can be individually set 
to fit the specific user. Yet there is a standard program 
making automatic switches to suit the most commonly 
used environment (Persson, 2012). The programs used 
to be set by an analog interface, but new processors 
have digital software. 

To further suit the individual the sound processor 
comes in different colors to either blend in with e.g. 
the recipients hair color, or to stand out in brighter 
colors. Also different accessories, see appendix 2, will 
facilitate certain activities and environments like an 
audio streamer for television, FM receiver for noisy 
environments, telecoil for public buildings supplied 
with loop and for talking on the phone and a safety 
line. These accessories vary for the different processors. 
Samples of  these accessories are shown in image 8.

Image 5. Normal sound transmition Image 6. Transmition with the Baha system

Image 7. Baha sound processors lined up by increasing strenght (Baha Sound processors, 2013)

Hammer
Anvil

Stirrup
Semicurcular 
Canals

Cochlea
Auditory
Nerve

Eardrum

Auditory canal

Temporal 
bone

Outer ear

Middle ear Inner ear



Development of a Demonstration Tool for Bone Anchored Hearing Aids

2.2. Reasons for Baha

Bone conducted hearing through the Baha system 
can be a solution for in general three different types 
of  hearing loss; conductive hearing loss, single sided 
deafness and a mixture of  the previous two (Pettersson, 
2012). Basically one cochlea or inner ear needs to be 
intact, meaning there has to be a sensorineural function 
in order for Baha to work as a hearing aid.

Conductive hearing loss can have many different 
causes. The issue is that the sound vibrations cannot 
travel as normal in the outer and middle ear to reach 
the cochlea of  the inner ear. Deformity of  the ear canal, 
otosclerosis and chronic otitis among other issues can 
be reasons for conductive hearing loss (Dillon, 2007) . 
The Baha system is placed behind the impaired ear to 
improve the perceived hearing. 

Single sided deafness, sensorineural hearing loss, means 
that one ear has significantly or totally reduced hearing. 
The impairment regards the inner ear meaning that the 
cochlea is damaged. To solve this sort of  hearing loss 
the Baha system is placed behind the impaired ear and 
sound vibrations reaching the malfunctioning ear are 

via the skull bone redirected to the better ear (SSD, 
2013). 

Mixed hearing loss is where both conductive hearing 
loss and single sided deafness occurs (Pettersson, 
2012). When both ears are affected a Baha for each ear 
is a solution.

It is estimated that 5000-6000 people in Sweden 
have bone anchored hearing aids at the present time 
(Persson, 2012).

2.3. How to get a Baha

The healthcare systems way of  providing hearing aids 
have within this project only been studied in Sweden 
due to time and economical limitations, although the 
Baha solution is provided in several other countries 
around the world.

Companies providing hearing aids do offer self-
counseling information most commonly via their 
homepages. Self  counseling is an estimative first step 
to use by the individual to see what type of  hearing 
loss the person might have and what hearing aid would 

Image 8. Samples of  Baha accessories and color options (Baha accessories, 2013)



I 7

be suitable. Yet to get a hold of  the aid, contact with a 
healthcare professional is needed.

Within Sweden and the different county councils there 
is no common structure of  how to provide patients 
with hearing aids. Since the use of  Baha is very low, the 
process of  how to get this particular aid is even less 
structured.

Counseling 

Due to the development of  the technology behind 
Baha occurring in Gothenburg, the healthcare sector of  
Västra Götaland has been leading in the handling and 
knowledge of  the Baha solution. Recently healthcare 
professionals in Gothenburg working with different 
aspects of  the Baha solution have developed a care 
program of  how patients will receive a Baha, ranging 
from initial counseling to activation of  the sound 
processor (Cochlear Workshop 2012, Eeg-Olofsson ).

Hearing diagnostics and rehabilitation are done in 
following steps according to the program.

1. Examining hearing diagnostics with standardized 
tone and speech audiometry.

2. Referral briefing in Bone Conduction Team 
(BCT). Decision if  patient is appropriate for 
bone anchored hearing aid.

3. Evaluative appointment at audiologist prior to 
hearing rehabilitation.

4. Hearing rehabilitation is planned individually 
based on patient needs, prerequisites and wish 
for interventions. Patient is informed about 
existing bone anchored hearing aids. Patient gets 
to try bone-anchored hearing aid on softband/
headband during a minimum of  four weeks.

5. Revisit and evaluation of  bone anchored hearing 
aid on softband/headband at audiologist.

6. When outcome is positive, doctor’s appointment 
for surgery and medical evaluation. Patient is 
there informed about the operation and the side 
effect that can arise from it.

Surgery

Moving forward with a bone anchored hearing aid will 
involve surgery. The operation takes about 40 minutes 
and the patient can usually return home the same day. 
The surgery is generally performed in the following 
steps (Surgery Baha, 2013, Cochlear Counseling 
Software, 2008).

1. The hair is shaved around the area. The insertion 
point for the implant is marked out approximately 

50-55 mm from the ear canal, on a relatively 
flat bone area in line with the upper part of  the 
pinna. Commonly used hats or helmets can be 
brought to make sure there is no interference 
with the Baha system location. Yet if  the implant 
is placed too far up it will be farther from the 
cochlea and the amplification will not be as good. 
If  the implant is placed too far down the bone 
will be more porous, which will make the implant 
less stabile.

2. The patient is locally anaesthetized down to the 
periosteum layer and the pinna is bent over the 
ear canal to make room for the operation area.

The surgery can now continue in two different ways 
either using:

The linear incision Technique

3. A linear incision is made trough the soft tissue 
and periosteum. The implant hole is drilled 3-4 
mm into the skull bone. The implant is placed.

4. Approx. 40x60 mm of  soft tissue is removed and 
skin is sewn together. This leaves the patient with 
an as small scar tissue as possible

Or The Baha Dermatome Technique

3. A dermatome, a razorblade like tool, is used to 
create a 40x60 mm skin flap. The implant hole is 
drilled 3-4 mm into the skull bone. The implant 
is placed.

4. Approx. 40x60 mm of  soft tissue is removed and 
skin is sewn together. The technique is easier to 
use yet takes longer to heal and leaves a bigger 
scar.

The surgery can also be done in one or two stages. 
For patients with good bone quality and thickness 
the FAST method is recommended. This procedure 
involves soft tissue reduction and insertion of  an 
implant with a premounted abutment. For people with 
soft, compromised or bone less than 3mm in thickness 
the first stage is performed as mentioned above for an 
implant and cover screw. Later at a second stage the 
abutment is fastened on to the implant.

Care and Complications

After the surgery the abutment is left with a dressing 
and healing cap until the stiches are removed. After 5-6 
days the audiologist will check the healing process and 
after 5-6 weeks the fitting of  the sound processor can 
take place. Adjustments and sound processor programs 
will then be set for the individual.



Development of a Demonstration Tool for Bone Anchored Hearing Aids

Living with Baha demands aftercare. The abutment is 
mainly cleaned with toothbrush-like brush e.g. during 
a shower. An after care kit is ususally provided by 
the company behind the bone anchored hearing aid 
(Procedure Baha, 2013).

The surgery is relatively harmless yet as with all medical 
interventions here can be complications (Breitholtz, 
2009). 

• Numbness can occur round the abutment area 
where soft tissue has been removed.

• Infection around the abutment and soft tissue 
area can arise during the healing process and in 
the event of  lacking after care. 

• Skin overgrowing the abutment. (Can be helped 
with a longer abutment).

• Flap necrosis can occur for the skin flap when 
healing with no underlying soft tissue. 

• If  the implant fails to osseointegrate it can fall 
out of  the skull bone.

2.4. Living with Hearing Loss  
and Hearing Aids

Hearing, as one of  the five senses, plays a great role in the 
perceptions of  a context and the personal experience. 
Orientation when sight is reduced, communication 
with other people and reflex reactions as a response to 
warning signals are all made through hearing. 

Realizing the sense of  hearing is being reduced can be 
an overwhelming experience. Usually linguistic sounds 
are lost and the nuances in conversations disappear. 
Also listening to a group conversation is difficult 
and much more attention is required which is tiring. 
Telephone and doorbell signals are missed out on as 
well as sounds or name calling from afar.  The healthcare 
sector in the county council of  Västra Götaland 
working with hearing loss has compiled several advices 
on communication strategies for persons with hearing 
loss. The advices also includes strategies for relatives 
and friends (Leaflet, Hörsel- och Dövverksamheten). 
Considering position in a room, having the better ear 
towards the sound source, speaking towards the person 
with hearing loss and not covering the mouth so lips 
can be read are just a few advice given.

To ease hearing loss there are many different hearing 
aids. Many individual factors play a part in what specific 
aid it is that will suit each and every person. A hearing 

aid can never replace a normally functioning ear, but it 
can come very close to a natural sound experience if  it 
is used the right way. 

Deaf  communities and hearing loss associations exist 
all over the world. Living with hearing loss can involve 
a lot of  challenges so the exchange of  information 
and experience is of  great value, both from healthcare 
professionals and between individuals. In Sweden 
HRF, Hörselskadades Riksförbund, is a large national 
association that has sub groups e.g. towards children, 
relatives and regional offices. 

Communities and associations function as a gathering 
point and can create a sense of  belonging to those 
who identify themselves with it. In helping people and 
introducing hearing aids to them there also has to be 
humbleness, showing that the interventions towards 
hearing loss are made on the premises of  the individual. 
Only if  and to the extent the personal engagement 
stretches, aids should be provided. (UR dövidentitet 
och hörande, 2007, UR dövkultur och identitet, 2007) 

Many factors have to match during the consultation 
of  hearing aids and hearing loss. The audiologist has 
a theoretical knowledge that has to be applied in a 
personal way to meet the patient. Facts and results 
have to be presented in a clear way and the patient has 
to be willing and ready to take in the information. If  
the diagnostics of  hearing loss becomes too emotional 
to handle the patient is most likely not able to handle 
problem solving at the moment and a softer approach 
to the consultation is needed. (Clark, 2010,  Gailey ) 

2.5. Design Theory –  
Experience and Healthcare

Design has generally been connected to function and 
aesthetics. Function in a more mechanical meaning 
where the design should e.g. provide a specific use 
or optimization. The functions and the aesthetics are 
strong factors playing a role in users perception of  
the product and the desire to use it. Together a user 
experience of  the product is created.

The experience perspective especially comes into 
play when products are not directly aimed towards a 
purchasing consumer but when the product is mainly 
handled or involved in a certain context or situation, 
e.g. receiving oxygen at hospital involves the experience 
of  an oxygen mask, which is the central product. The 
uprise of  services, involving products, replaces contact 
with just the actual product. Services are strongly 



I 9

connected to experience, e.g. getting service at a car 
mechanic, where the consumer pays for the service of  
getting the car repaired as to buying tools and fixing it 
by oneself. 

An experience involves the perception and although 
the perception of  an object can be very clear the 
experience can be less obvious (Schifferstein, 2008). 
The state of  mind or the mood the perceiver is in as 
well as what context the object is placed in will matter 
for the experience and interaction.

In the design of  a product there is a relationship 
between the concrete, e.g. that the object has a sharp 
angle, which can be perceived by sight or touch, and 
the symbolic, that it is experienced as e.g. aggressive. 

To achieve a stronger experience one theory is that 
people prefer an optimal level of  arousal when it comes 
to perceiving the symbolic in an object. Asymmetric 
shapes are said to give greater arousal as the object 
becomes more expressive and dynamic (Ibid.) 

In the experience of  an object, metaphors are a way to 
reduce the cognitive workload by making users relate 
to something they already know. Relating to a product 
and associating it with something can, when it is in a 
positive matter, enhance the experience of  emotional 
attachment. This will be fruitful for a company over 
time, as it will make customers loyal wanting to stick 
with e.g. the brand.

Product attachment can be determined by four factors 
(Ibid):

• Pleasure – provided to the user by the product. 
Here surprise can enhance the pleasure by the 
physiological effect of  e.g. increased heart rate 
that makes the user focus more on the object. A 
surprise effect also tends to more likely be stored 
in the memory.

• Self-expression – connects and shows ones 
personality and differentiates the individual 
from others. Product and meaning need to be 
intertwined to be less likely to replace.

• Group affiliation – the product make the user a 
part of  a group, which it identifies itself  with or 
wants to be identified with.

• Memories – the product brings out positive 
memories, effective ways to this can be by odors 
and making the object age gracefully. 

Yet to predict the meaning of  a product in advance is 
hard and is also highly dependent on the individual.

2.5.1. Design Experience  in a   
Healthcare Context

Experience is well connected to the context and 
environment. In a healthcare context extra attention 
should be given to supportive design, helping the user 
to cope with the situation as they are usually dealing with 
a condition to improve (Koblanck, 2004). Design for 
everyone (Bohgard, 2009) is also an important aspect 
as patients, especially of  hearing loss, is a very diverse 
group. The design needs to be considerate towards the 
difference in mental and physical conditions, cultural 
backgrounds and so on.

The healthcare sector includes many areas, towards the 
patient these could primarily be quality, security and 
service in the care provided. All of  this makes up one 
experience for the patient. Feeling seen and listened 
to and understanding the treatment and care about to 
be given are important aspects in the communication 
between the patient and professionals. E.g. time 
limitations and terminology can shift focus from 
professionals to patients point of  view (Wolf, 2013).

2.6. Materials

This section will account for materials suitable for the 
demonstration tool to be designed.

2.6.1. EVA (Ethylene-Vinyl-Acetate)

EVA is an elastomer build around PE, see chapter 
2.6.2. It has properties like being soft, flexible and 
tough, which are kept even in lower temperatures. EVA 
has good chemical resistance and can be processed 
by usual thermoplastic processes e.g.: blow molding, 
rotational molding, extrusion, injection molding and 
transfer molding. EVA is applied e.g. as dispensers, 
cable insulation and in running shoes (Ashby, 2010).

2.6.2. PE (Polyethylene)

PE is very resistant to food and most water-based 
solution, thereby it is commonly used for household 
products (Ashby, 2010). It is a cheap material, easy to 
mold and can be produced in the form of  rods, films, 
sheets, foams and fibers. PE can come in various colors 
or be transparent, translucent or opaque. It has a bit 
of  a waxy feel to the surface of  it, the surface can be 
textured or coated but is difficult to print on.

PE can be made from renewable sources and is 
classified as highly recyclable. The longer and less 



Development of a Demonstration Tool for Bone Anchored Hearing Aids

branched the molecule chains of  PE are, the stiffer 
and stronger the material gets (HDPE). Exposing the 
surface of  PE (LLPE in particular) to fluorine gas 
makes the surface a fluoro-polymer, know as “Super 
PE”, which is resistant to organic solvents like petrol, 
cleaning fluids and cosmetics. Very low density PE 
(VLDPE) is similar to EVA.

2.6.3. PLA (Polyactide)

PLA is made from corn maize or milk and is a 
biodegradable thermoplastic. It is glossy and clear but 
stiff  and brittle. It can be processed into fiber or films, 
be thermoformed, extruded or injection molded. Being 
a biopolymer PLA is expensive costing about twice as 
much as PP.

PLA is commonly used for food packaging, cups, 
plastic bags etc. Since it is made out of  renewable 
sources it can be recycled but one good appropriate 
option is industrial composting at end of  life (Ashby, 
2010). 

2.6.4. PMMA (Ploymethylmathecrylate)

PMMA or Acrylic is also known under the trading 
name Plexiglass. It is stiff  and hard as a polymer, and 
similar to glass transparent and fragile. PMMA comes 
as sheets, rods or tubes by casting or extrusion. PMMA’s 
transparency can be colored, the surface scratches more 
easily than glass, but coatings can help that. 

PMMA is used for all type of  lenses, windows, CDs 
etc. Acrylics are non toxic and recyclable and not very 
resistant to solvents, acetone and strong acids and 
bases (Ashby, 2010).

2.6.5. PP (Polyproylene)

PP is very similar to PE in aspects regarding price, 
process methods and areas of  use. PP properties are 
similar to HDPE yet is stiffer, more rigid and tolerates 
higher temperatures. PP is water resistant and comes in 
various colors. When drawn into fibers PP has a great 
strength and resilience exceeding the ones of  PE, this 
is why ropes and fabric are popular applications. Like 
PE, PP is recyclable and is made by processes relatively 
energy efficient (Ashby, 2010). 

2.6.6. Polymer Foams

Foams are cellular materials originating from solid 
polymers. Foams can range from soft and flexible 
to hard and stiff  by expansion and solidification or 

by melting through an either physical, chemical or 
mechanical blowing agent. Polymer foams will cushion 
and insulate energy, e.g. expanded EVA and PVC with 
small cell sizes and an intact surface is used to absorb 
shock and vibration for running shoes.

The polymer foam can be created in place, by injection 
molding, extrusion, thermo-formed, laminated or 
casted (Ashby, 2010).

2.6.7. SBS (Styrene-Butadiene Elastomers)

SBS is a synthetic rubber with hard and soft segments. 
The styrene provides the thermoplastic properties and 
the butadiene the rubber properties (TPS, 2010). The 
elastomer is low in strength, which usually demands 
reinforcement. SBS has a low cost but a low recycle 
potential as well (Ashby, 2010).

2.6.8. TPE (Thermoplastic Elastomers)

TPE has the properties of  vulcanized rubber yet can 
be processed as thermoplastics by being molded or 
extruded (Ashby, 2010). There are variations of  TPE. 
TPE is highly recyclable and can be reused during 
process. TPE can range from gel-like to stiff  (TPE, 
2010).

2.7. Manufacturing

This section will account for manufacturing methods 
suitable for the demonstration tool to be designed.

2.7.1. Laser Cutting

Laser cutting is done by the material being vaporized 
due to the high-energy intensity. Usually continuous 
carbon dioxide lasers are used, except for small details 
where Nd-YAG lasers are more sufficient. The lasers 
output effect, focus, added gas and the absorption 
ability of  the material make up the function of  the 
process effect. Plastic thickness up to 50 mm can 
be processed and caution has to be taken regarding 
possible toxic gases being emitted (Hågeryd, 2002). 

2.7.2. Milling

A milling cutter is appropriate for processing of  flat 
materials and small to medium sized pieces. As with all 
types of  cutting machining a milling cutter processes 
a material by chip removal. The tools and types of  
milling cutters can have large variations. The tool can 



I 11

have a vertical or horizontal placement, and in addition 
to its rotating movement it also needs to move in a 
vertical or horizontal direction. The material of  the 
tool needs to be hard and strong at high temperatures, 
though to not chip itself  against the processes material 
and wear resistant (Hågeryd, 2002).

2.7.3. Expanded Foam Molding

Expanded foam molding creates a three-dimensional 
solid shapes and the foam material at once. Beads of  the 
desired material are placed in a mold. Being exposed to 
heating and pressure these beads expand by a foaming 
agent. The shape will get a smooth closed surface when 
in contact with the mold. Thermoplastics are easy to 
mold like this and the method is cheap, which is why 
many single-use articles and disposable products are 
manufactured this way (Ashby, 2010).



Development of a Demonstration Tool for Bone Anchored Hearing Aids

3. Methods – What and Why

Several methods have been used in this master thesis project to get a thorough development and to have helping tools for the different project 
stages. Methods can be categorized after their properties and thereby be matched to suit the purpose of  the data collected (Bohgard, 2010).

3.1. Method Categorization

The origin of  the data makes a method analytical or 
empirical. An empirical method studies the users of  
an actual system. In an analytical method no user is 
studied, instead people with specific knowledge make 
evaluations of  the system.

The type of  data collected makes a method objective or 
subjective. Objective data is gained from measurements 
that are not dependent on a specific individual. 
Subjective data is collected from personal experiences. 
Methods can have both objective and subjective 
elements.

The type of  results makes a method quantitative or 
qualitative. Quantitative results are usually in figures 
from objective methods observing or measuring. 
Semi-quantitative results origin from rankings or 
categorizations on e.g. a scale. Qualitative results are 
more detailed and arise from questions like who, what, 
why, where, when and how. When using a qualitative 
methods caution must be taken on how influence is 
made on participants. 

The extent of  user involvement makes a method 
participative or expert (Bohgard, 2010). In participative 
methods there is a high level of  user involvement in 
implementing and controlling data collection and 
analysis. In an expert method only the implementer 
controls the data collection. Most commonly the user 
acts as an information source and the implementer 
controls the implementation (ibid.). 

3.2. Planning

Planning was done during the project initiation and 
followed up throughout the process.

3.2.1. Gantt Chart 

A Gantt chart is a tool to represent time committed 
to certain tasks. A horizontal timeline is made for the 
entire project scope. Tasks are listed vertically and 
horizontal blocks mark their time consumption and 
when during the project they are to be done. The chart 
also shows which tasks can be performed in parallel 
(Ulrich, 1995). 

Structuring this project as a whole and tasks to be 
performed was important to optimize time and 
resources used. The Gantt chart was a good way to 
overview and visualize time and planning aspects.

3.2.2. Backwards Planning

Backwards planning means starting from the desired 
result or project goal, setting out the starting point and 
then structure the space in between.

As the goal of  a new demonstration tool was pre-
identified, backwards planning was a good way to set 
up the planning and schedule for the project, to keep 
to focus on the outcome and plan effectively according 
to that.



I 13

3.2.3. Diary Notes

Daily diary notes were kept during the entire thesis 
project to document accomplishments, activities, 
decisions and thoughts in writing.

Daily diary was chosen in order to see progress and 
also as the continuous documentation.

3.2.4. Process Flow Chart

A process flow chart describes a project process from 
start to end by symbols and links. The symbols and 
links mark out the elements of  the process and what 
is included in the different stages of  the process. The 
flow chart gives an overview easy to communicate, 
creates an understanding, documents and describes 
how the project should be done (Mindtools, 2013). The 
symbols are to some extent standardized, see image 9, 
making the communication and understanding even 

more clear (Cinergix, 2013).

3.3. Data Collection 

Data collection methods have given necessary 
theoretical knowledge about various areas in the 
project. The methods were more intensely used in the 
beginning of  the project.

3.3.1. Literature Studies 

A way to get background information or more insight 
in a subject is by literature studies (Bohgard, 2009). 
Articles, research studies, books and many other written 
documents can add knowledge. In addition to written 
documents  similar information gathering can be done 
by watching documentaries and online seminars.

Depending on the vastness of  the literature study it 
can be defined differently. In this case the method has 
come to be subjective and qualitative considering the 
difficulty in disregarding the subjectivity of  the authors 
and the relatively low amount of  sources.

The method was in the project used to get background 
information and an understanding for the area of  the 
thesis.

3.3.2. Interviews

Interviewing is primarily a subjective qualitative method 
where people state their experience, opinion, thoughts, 
values and so on. Interviews can be categorized into 
structured, unstructured or semi-structured (Bohgard, 
2009). 

During this thesis project unstructured and semi-
structured interviews were performed where open 
questions were asked and there were a possibility to 
direct the discussion towards what evolved as interesting 
during the interview. Unstructured interviews gave 
qualitative data, which is harder to compile but 
useful for explorative studies. The method was used 
as background information and setup was chosen to 
allow the experts to tell and acknowledge important 
parts that the project team was not initially aware of. 

3.3.3. Observations

To find out how people act in a given actual situation 
observations can be used to collect data. Behavior is 
noted which the users might not even be aware of  
themselves. On the other hand, the natural environment 
might not automatically provide natural acts if  people 
know they are being studied (Bohgard, 2009). 

For this project direct unsystematic observations were 
done, meaning they occurred in a real environment 
with no specific aim, thereby being empirical and 
participative. They were also performed as an objective 
and qualitative method. Underlying reason for 
behaviors during observations was not gained, unless 
complemented with an interview. The observations 
were conducted to get initial knowledge and see actual 
behavior. Observations were also used as a comparison 
to verify theory with practice.

3.3.4. Benchmarking

Benchmarking is a way of  comparing primarily 
processes and not products specifically even though 
products might be improved by improving processes.  
Looking at other companies within the same segment 

A rounded rectangle symbolized a start or end of  a 
process

A rectangle defines an action or operation to be done.

The parallelogram contains data to be collected as input 
or output of  a process.

A diamond states a decision to be made or question to 
be answered.

Image 9. Standardized Process Flow Chart Symbols



Development of a Demonstration Tool for Bone Anchored Hearing Aids

is a way to see differences and trends on the market 
(Bohgard, 2009).

The benchmarking was conducted mainly to see how 
other hearing aid companies promote their solutions 
and what message they are sending as well as to identify 
the current trends in the field.

3.4. Analysis Tools

As a continuing phase to the theory studies, analysis 
methods have been used to evaluate the data collected.

3.4.1. SWOT

SWOT stands for Strenghts, Weaknesses, Opportunities 
and Threats. The areas are usually divided into four 
blocks in a rectangle. SWOT is used to identify and 
easily list these areas for an organization and it 
separates and gets participants to start thinking of  
how the organization or system e.g. looks or functions. 
Strenghts and weaknesses are seen as internal factors 
to the organization while opportunities and threats are 
depending on external factors. (SWOT, 2013)

SWOT was used as a quick way to state these factors for 
the company and the tool to be developed in relation 
to the market but also internally within the company. 
It breaks down what to enhance and what to improve.

3.4.2. Design the Box

This is a method useful to start off  a project and make 
the team get a common view of  what the result will 
be when the project might not be fully tangible, e.g. 
implementing a new organization system (Spolsky, 
2002). The idea is for the team to together shape and 
design a physical box to represent the core of  the 
project, e.g. with color, size, texture, name, slogan and 
so on (McMullin, 2007). 

For this project the method was modified to instead 
explore expressions during a workshop. The box was 
to be redesigned to represent a certain expression.

Design the box was used to get a more tangible 
starting point when exploring expression in design. 
The method was considered very useful as it created 
something physical to work around.

3.4.3. User Profile 

Studying users involved in the products or system, 
data can be compiled into user profiles stating specific 

characteristics and relationships amongst the user 
groups. User profiles should be made early in the project 
to set the foundation and reasons for development, 
redesign and evaluation (Bohgard, 2009).

Users are usually divided in to four groups (Ibid);

• Primary users are interacting with the product or 
system due to its actual purpose, e.g. user using 
a tool

• Secondary users use the product but not for its 
primary purpose, e.g. selling or repairing the tool.

• A side user is affected by the product but do not 
fit in the first two categories, e.g. a person being 
in the room next to where the tool is being used 
and thereby hearing or feeling the use of  it.

• Co-users work together with the primary or 
secondary user but is not interacting with the 
product directly, e.g. using another tool in the 
same construction work.

Several persons can qualify as primary users for a 
product and one person can fit several user roles. A 
user profile is made up by six elements (Ibid);

• Background: user type, age, language and place 
of  residence and educational background.

• Use: knowledge, mental model, experience, 
frequency of  use.

• Influence and responsibility: opportunity to 
choose product used, influence on the situation 
and responsibility for the product.

• Emotional relationship: ownership, social aspects, 
products mental influence on the user.

• Type of  interaction: cognitive interaction, 
physical handling, opportunity to use the product 
with disabilities.

• Activities, goals and motives: what the user do 
with the product, its goal and motivation behind 
the usage.

User profiles was compiled as a good way to define 
the different people connected to the product being 
developed. Besides it structured and sorted out who 
the product really is being designed for.

3.4.4. Clustering

Clustering is an effective way to structure large amounts 
of  data to see common denominators and sort out 
relevant elements to be considered.

Clustering helped in sorting out the content of  articles 



I 15

in the literature study and it was used to find interest 

areas and structure the key aspects.

3.5. Creativity Methods

Creative methods have been used mostly during the 
ideation phase to start the product development and 
bridge over from analysis to concept and further 
evaluation.

3.5.1. Issue Cards

Issue cards are used as a way to freely draw or write 
insights, ideas or any other type of  issue that comes 
to mind. They are used to trig interactivity amongst 
group members and are a simple way to work around 
something tangible than just having a verbal discussion 
(Tassi, 2009).

Issue cards were used to start interactions with people 
new to the project that was only spoken to for a short 
while. The issue stated on the card was used as a way to 
trigger thoughts and discussion.

3.5.2. Assumption Bursting

To define assumptions drawn about the situation the 
idea is to list and challenge them. Some things might 
be obvious or not even considered as possible to 
overcome or change. Listing assumptions and bursting 
them might loosen the limitations of  the situation and 
give a new perspective on things (Assumption Bursting, 
2010).

The method starts with setting the situation, and then 
listing the assumptions about it. Then the assumption is 
challenged by a bursting and step by step this continues 
(Ibid.). Eg.

Situation: we cannot sell our products over the Internet.

• Assumption: we do not have the technology

• Burst: we could buy it

• Assumption: it is too expensive

• Burst: we could learn or look if  there is a good price to get 
the service for.

• Assumption: learning will take too long and too much 
effort

• Burst: we do not know until we try and it might generate 
more value in the long-term perspective.

The assumption bursting was good to challenge the own 

prejudgments and assumptions to not unconsciously 
limit or block certain aspects.

3.5.3. Moodboards

Boards can have many functions. It is a way to show what 
visual aspects are desired. It can be as a more detailed 
specification of  elements to include or more loose as 
a source of  inspiration and creativity. Moodboards 
connect to the main impression and atmosphere that 
one wants to achieve.Various things can be included in 
a board, e.g. details, surface materials, textures, colors, 
shapes, graphics and so on (Österlin, 2010).

The method was selected mainly as moodboards were 
a good communication tool when working with others, 
e.g. in a workshop or within the thesis group.

3.5.4. Personas 

A more fictive variant of  a user profile is a persona. A 
persona is a fictive person corresponding to the needs 
and requirements of  the product, simply defining the 
person the product is being designed for. Collected 
data set the basis for the persona and several personas 
can be created to match the entire target group, which 
might not be homogenous. A good strategy is to 
focus on one persona at the time. The description of  
a persona should be complemented with a picture or 
illustration to get a visual description as well (Österlin, 
2010).

Personas were used as it was a good way to combine 
all information sources and user aspects into a fictive 
person to discuss around. The personas were also used 
as a creative tool.

3.5.5. Storytelling and Scenarios

A way to connect the persona to the product is by 
storytelling. Storytelling brings out the personas 
experiences with the product throughout its lifecycle, 
it could be from watching a commercial to buying and 
using the product until it is discarded. The scenario 
should bring out the products effect on the persona, 
how is it experienced, what emotions does it arouse, in 
what situations is it used, what alternatives might be on 
the market and so on (Österlin, 2010).

The methods were used to put the product and its user 
in a context and situation, which is fruitful to tangibly 
see how, when and where the concept can be used and 
what purposes it actually serves.



Development of a Demonstration Tool for Bone Anchored Hearing Aids

3.5.6. Design by Analogy 

Using analogies in design is taking inspiration from 
other things, situations, systems etc. to move forward 
in development processes. Inspiration from nature 
is a common example, e.g. looking at different types 
of  wings when creating a sail. Other already existing 
products can be sources of  inspiration also regarding 
material properties, expressions and so on (Linsey, 
2007).

The analogy was a good way to make attributes or 
expressions more tangible and communicative for a 
specific product.

3.5.7. DFA

Companies providing a range of  products need to have 
consistent design elements in order to create a strong 
identity within the product families. Connecting them 
to the company is important for customers’ recognition 
and for enhancing the company brand identity. Also 
when developing new products it is important to 
consider existing design elements and product design 
history (Warrell, 2001 ).

Design Format Analysis, DFA, compares products to 
identified design elements and ranks them in order of  
consistency.  The products to be analyzed are placed 
on one axis and the defined design formats on the 
other. The intersection of  product and design format 
is then market for a filled circle for a strong correlation 
between product and element and a circle for a weaker 
correlation. The summed score will then tell which 
products have a strong identity and which formats best 
represent the company design (Ibid.).

DFA was done to identify the Baha design elements to 
make the coming demonstration tool fit well with the 

Baha system.

3.6. Visualization Methods

Visualization methods have helped to illustrate and 
develop concepts as well as to set a foundation and to 
build material for discussions with stakeholders.

3.6.1. Sketching

Sketching is a method to be used in several different 
levels of  detail. Quick small sketches can be done in 
thumbnail size and these can be evolved to more detailed 
concept sketches in larger formats. By sketching, ideas 

can be illustrated and described visually in a way that 
words may not fully do (Österlin, 2010).

In the development process of  a physical product 
sketching functions well to combine with other 
methods. It is also a great way to discuss around ideas.

3.6.2. Sketch Modeling

Making a sketch model is a quick way of  sketching 
in three dimensions. Besides it is a useful way to try 
functions, shapes, structure, etc. The sketch model 
can be made full scale as a mock up to be tried in the 
thought of  environment or in scaled versions (Österlin, 
2010).

As the end result was to be a physical product, sketch 
modeling was a great method during the development 
process. Both in order to try grip dimensions and 
construction in early stages and realizing things simple 
to improve early in the process.

3.6.3. CAD

Using CAD-tools (Computer Aided Design) is a 
helpful way to visualize a product before making a 
physical model. CAD-tools also facilitate easily made 
drawings, three-dimensional views, calculations and 
movements of  mechanical systems among other things 
(Johannesson, 2004). 

In this thesis project Autodesk Inventor Professional 
has been used to make the final product as realistic 
as possible, both in terms of  construction and 
visualization.

3.6.4. Rapid Prototyping

Rapid prototyping is a quick way to turn CAD-models 
into physical objects. By  3D-printing geometries no 
machining is needed which makes the process fast 
when trying out designs (Johannesson, 2004). 

In this project the 3D-printing was done by layering that 
melts together in to the desired shape. Rapid prototype 
was used to quickly try out the interaction with the 
demonstration tool and to evaluate the physical and 
emotional aspects of  the handling.

3.6.5. Function Modeling

A function model aims to test possible operations and 
tasks to be performed with the product. It is also a 
good way to verify construction and assembly. Focus 
is not put on visual aspects instead the functionality is 



I 17

explored (Österlin, 2010). 

The thesis group used function models to try out 
appropriate materials and assembly. The function model 
also showed how well the final product would suit the 
intended context and worked as a communication tool 
for explaining the project result.

3.7. Evaluation Methods

Evaluation methods have thoroughly been used to 
review content  and served as a framework for the 
decisions made.

3.7.1. Morphological Matrix

Morphology is the study of  shape structure and shape 
development. Having many factors and combining 
these will generate a large amount of  variations. 
These variations can be sorted in a matrix to evaluate 
combinations (Österlin, 2010). 

A morphological matrix was a good way to sort out 
which factors are met through each solution.

3.7.2. Pugh Matrix

Concept evaluation can be done with a Pugh matrix 
as it reduces the numbers of  concepts in a quick and 
easy way and the selected concepts can be improved 
and refined. The concepts are listed on one axis and 
the criteria of  the evaluation on the other. Besides a 
reference concept is listed which all other concepts are 
evaluated against (Ulrich, 1995).

The concepts are ranked as better (+) than the reference 
concept, the same as (0) or worse (-). This rather simple 
manner is done to get a hint of  the ultimate solution. 
The scoring is summed and controlled to see that all 
concept features have been evaluated in a sensible way 

against the criterions. The concepts to take forward are 
finally selected based on score (ibid.).

A Pugh matrix was used as it was an effective way 
to include the current solution in the evaluation and 
make sure that the most valuable concepts are the 
ones brought forward. It is also a good method to go 
through concept features.

3.7.3. The Customer Journey Canvas

Marc Stickdorn and Jakob Schneider have developed 
the Customer Journey Canvas, which aims to give 
support when designing services. The tool maps 
not only the studied service, but also the pre-service 
and post-service stages. The tool should be used as 
a template, which could be modified to suit specific 
uses. The reasons for using the canvas could vary from 
mapping the overview picture of  service processes to 
the exploration and evaluation of  services, taking the 
customers’ or other stakeholders’ perspectives (CJC 
forum). 

The tool was useful for mapping the insights from the 
analysis and supports in keeping the perspective of  
the candidate throughout the counseling experience.  
Besides it provided a summary and overview to the 
readers of  the report.

3.7.4. User Tests

User tests are subjective and have been done in both  
participative and expert ways.  In user tests people get 
to try out a system or product and give their opinion 
that is noted and considered e.g. under the further 
development phase.

User tests, in particular of  sketch models, were done to 
establish the further development of  the demonstration 
tool and to evaluate the product from a patient and 
professional user perspective.



4. Research and Analysis

As described in chapter 2.3, the process of  getting a Baha is a non-standardized process employed by numerous clinics with different 
organizational structures. Thus the context of  the bone anchored hearing aid care procedure is rather complex to define and describe. 
However, by gathering information from observations and interviews with professionals from different Swedish clinics, this chapter aims 
to provide a general understanding of  the context and the requirements for a future demonstration tool.

4.1. Collection of Data

Several methods have been used to identify the 
requirements for a new demonstration tool. 
Information about the counseling situation, the 
Baha system and the expressions consistent with the 
company communication strategy have been collected 
and analyzed.  The main part of  the data collected 
have been of  the qualitative type where deeper 
understanding have been gained trough fewer but more 
intense collection occasions. 

4.1.1. Literature Studies

The literature studies have supported the work 
throughout the entire research phase. Initially 
literature studies were used in order to build up the 
understanding for a life with hearing loss and then 
the studies academically supported insights during 
the stage of  analysis. The literature studies included 
reading journal articles, exploring books about design 
for experience, communication strategies and watching 
online seminars and educational materials regarding the 
Baha surgery and life with hearing loss. Findings from 
the articles were clustered to sort out relevant aspects 
to consider and to condense the information. 

4.1.2. Interviews 

Two interviews conducted at Sahlgrenska University 

Hospital in Gothenburg the 15th of  November 2012, 
see appendix 3, and Sunderby Hospital in Luleå the 
23rd of  November, see appendix 4, set the foundation 
for the study of  the context. In total four audiologists 
have been interviewed; a single audiologist working 
with adult patients was interviewed at Sahlgrenska, 
Gothenburg and a group of  audiologists, one working 
with adults and two working with children, were 
interviewed at Sunderbyn Hospital, Luleå.  

The intention with the interviews was to confirm the 
counseling process, how it was described in theory to 
how it was experienced by the professionals. Moreover 
the interviews with audiologists aimed to describe the 
general work and show the tools that are used during 
counseling sessions. Besides, the interviews aimed to 
develop the understanding of  the different situations 
occurring, as well as an understanding of  the main 
objectives, needs and preferences of  the audiologist.

4.1.3. Observations

Two observations were conducted at Sahlgrenska the 
6th and 20th of  December, see appendix 5 and 6. The 
first observation was at a candidate’s first time visit to 
the audiologist. The second observation was a revisit 
of  a candidate who had tried the Baha on a softband 
for a month. 

The observations aimed to provide information on how 
the audiologist actually works. The observed audiologist 



I 19

was the same person as was interviewed, thus it was 
possible to compare how the session actually was 
held to what was told during the interviews.  Besides, 
the observation was the main source of  information 
concerning the candidates. Watching them indeed 
confirmed the by Cochlear predefined barriers, which 
the project aimed to address. 

4.1.4. Workshop for Audiologists

Informal discussions with several audiologist and 
other professionals at a workshop for audiologists, 4th 
of  December 2012, have contributed to the research 
and analysis of  the counseling sessions. Through the 
day thoughts and reflections from audiologist with 
different levels of  experience were collected. Thus the 
understanding of  the professional users were further 
developed. The method of  Issue Cards was used during 
the workshop to get in contact with the participants 
and initiate discussion around the topic of  needs for a 
new demonstration tool.

Another reason for attending the workshop was a 
seminar by a Baha recipient, explaining his thoughts 
and journey from getting a Baha to living with it for 
many years.

4.1.5. Study of Expression

In parallel with the context exploration, a workshop 
on expression was prepared and held at Industrial 
Design Engineering department at Chalmers, the 
13th of  December 2012, see images 10 to 14.  The 
workshop aimed to bring out ideas on how to generate 
an expression in line with the company strategy. From 
which, the desired expressions had been identified 
through use of  the design analogy method on the core 
values; ease of  use, reliable performance and aesthetic 
design.

The workshop was held to involve a larger crowd 
in exploring what was associated with the desired 
expressions and participants were asked to modify a 
white plain box by shape, material or by other means 
in order to match the requested expressions.  The 
workshop structure sprung from the method “Design 
the Box” but here participants worked individually. The 
participants were furthermore asked to explain their 
ideas through illustrations or descriptions on small 
paper sheets. 

The expressions looked for were inviting, honest, and 
selected. In the room three boxes where placed with 
an expression and additional moodboard each. The 

question asked to the participants was “How would you 
make the box more…?”, followed by each expression. 

The workshop was open during three hours over 
lunchtime where participants could casually walk in 
and join. The participation required about five to ten 
minutes and was conducted anonymously and all ideas 
were gathered in a big carton box. The setting was 
neutral and relaxed with white walls, music and color 
pens at disposal. When closing, 25 individuals had 
taken part in the workshop and their answers where 
compiled in an excel sheet. For each expression the 
ideas where listed in a table and it was noted how many 
times they reoccurred.

In addition to the workshop on expression, a Design 
Format Analysis (DFA) was conducted to analyze 
Cochlear’s current product portfolio. The products 
studied were the sound processors and not the current 
supportive tools. Firstly, the sound processors were 
selected to assure that the demonstration tool would 
fit with the Baha system. Secondly due to lack of  
supportive tool offerings and consistency in supportive 
tool portfolio. 



Development of a Demonstration Tool for Bone Anchored Hearing Aids

Images 10-14 clockwise: workshop participants, the set up of  expressions and boxes, honest, inviting and selected, drawing, and writing 
thoughts and ideas with color pens on note paper.



I 21

4.2. Context Description

The following chapters will sum up the research and 
data collection and account for the obvious result 
outcome and also be a subjective analysis of  how the 
context as a whole comes together and builds up a need 
of  a new demonstration tool. The research shows that 
the general candidate journey consists of  four phases, 
see image 15. The context description will focus on the 
counseling phase.

4.2.1.  Users

Medicine technical equipment generally has two 
primary users:

• The patient who gets the treatment  

• The health care personnel who direct the machine 

Accordingly, for the development of  a new Baha 
demonstration tool both the candidate and the 
audiologist will be considered primary users. The 
candidate interacting with the tool in order to get an 
understanding of  the Baha system and the audiologist 
using the tool in order to facilitate the explanation to 
the candidate. Parents to children who might get a 
Baha will also be considered primary users but are not 
considered in this particular project.

Secondary users will for the demonstration tool be 
Cochlear who tries to get the Baha solution more 
desired. Potential co-users are interpreters, friends or 
family who might have joined the counseling meeting. 
Friends and family could also at times be considered 
side users.

Baha Audiologists

• Background

The audiologists are one of  the two primary user 
groups. In Sweden the audiologist educational program 
is held at four various universities. The program holds 
180 credits, which means three years of  fulltime studies.  
The audiologist program is cross-disciplinary including 
technical, medical and behavioral sciences as described 
by the national admission office in Sweden.

Like in several other professions the level of  experience 
of  the audiologist working with Baha solutions 

depends on the numbers of  patients treated. Some 
in the profession only work with the Baha solution 
while others have it as one solution among many other 
hearing aid solutions for patients. 

The Swedish Baha audiologists are specialized in either 
Baha for adults, people above 18 years old, or children 
with their parents attending the counseling meeting, 
see appendix 3 and 4. When not having Baha patients 
frequently it is likely that the counseling procedure 
has to be reviewed before each new appointment, see 
appendix 4.

The audiologists could work at hearing clinics and 
hearing centers, in private or public sector. They could 
also work for the developers or within the industrial, 
school or children health services (KI, 2013). 

• Use

The counseling work includes getting an understanding 
of  the patient, explanation and display of  the Baha 
system, individual adjustments, evaluation and journal 
writing. 

The hearing experience is always tried out by allowing 
the candidate to experience hearing through the skull 
bone by wearing headbands or softbands, which the 
audiologist provides the candidate with during the 
meeting.  The work of  the audiologist also includes 
setting individual programs on the sound processor 
through computer software provided by Cochlear and 
feedback given by the candidate. 

The frequency of  performing Baha counseling varies 
greatly from audiologist to audiologist.  E.g the 
interviewees from Sunderbyn Hospital had a patient 
frequency of  approximately five candidates a year 
whereas the audiologist interviewed at Sahlgrenska 
claimed to have two counseling appointments a day. 
Depending on the frequency, the mental model of  the 
counseling and Baha solution differ from rather vague 
to very clear.

The arrangement at the specific clinic also seems to 
vary. For instance, as overheard during the workshop 
for audiologists some clinics used to have special days 
only treating Baha counseling and Baha surgeries, 
however, due to re-organizations this set up was not 
longer possible wherefore a close collaboration and 
dialogue between the audiologists and surgeons were 
more difficult to sustain.

• Influence and Responsibility

The details on the counseling content depend on the 
candidate involved,  current knowledge, interests as well 
as the preferences of  the specific audiologist. Factors 

Image. 15. Counseling Phases



Development of a Demonstration Tool for Bone Anchored Hearing Aids

like children being too young to explain their own 
situation with the presence and behavior of  parents, 
as well as a potential presence of  an interpreter to help 
language barriers effect the set up of  and emphasis 
during the meeting.

• Emotional Relationship

The emotional relationship to the Baha system 
and counseling vary depending on experience. The 
interviewed audiologist at Sahlgrenska was confident 
and experienced in handling the Baha system and 
counseling procedure whereas the audiologists 
interviewed at Sunderbyn Hospital had a less confident 
relationship.

• Type of  Interaction

The interaction to the system includes both cognitive 
use and physical handling. 

• Activities, Goals and Motivation 

The main objective for the audiologist during counseling 
is to help the candidate in gaining knowledge of  the 
options available, which could improve one’s hearing. 
The guidance is likewise to inform and provide facts 
and options and definitely not to sell the Baha solution. 
As a result of  that, the trial of  the hearing experience 
through head- or softband is the main argument for 
the Baha system. The goal is to give the patient an 
accurate picture how he or she would find the solution 
if  moving forward in the process.   

Baha Candidates

• Background

The candidates are the other primary user group. 
The group is heterogeneous, ranging from very 
young children to elderly people far above the age 
of  retirement. Not only the age but also the previous 
experience of  hearing is extensively diverse. In 
counseling of  very young candidates, the parents are 
also considered primary users and are treated almost 
like candidates, although they are not.

• Use 

Some candidates have lived for several years with other 
hearing aids, experiencing similar hearing as would 
be obtainable by the Baha. Other candidates have no 
previous experience from living with hearing aids and 
have only lived with impaired hearing without using 
any aids at all.

• Influence and Responsibility

For an adult the reflection and furthermore decision 
upon the hearing is done for oneself. For a child it 

is the parent, who tries to understand the effect the 
offered solution will have on the quality of  life of  his 
or her child, who mainly makes the decision. 

• Emotional Relationship

Currently the Bahas are often considered when no 
other options are available. Either it could be due to 
that sufficient hearing cannot be obtained with other 
aids or that the candidate has tried other aids but 
experienced lots of  issues so the situation has to be 
improved. Please see chapter 2.2 for information 
regarding the causes.

• Type of  Interaction

The interaction with the Baha system is physical when 
trying the hearing experience on a softband. For getting 
an understanding of  the system, the current interaction 
is mainly cognitive. For a parent, the counseling would 
be mainly cognitive; although one can try the hearing 
experience itself  the hearing experience of  its child 
cannot be completely obtained.

• Activities, Goals and Motivation

The counseling is for the candidate a step in deciding if  
something should or could be done in order to improve 
the hearing or the current situation living with hearing 
loss. Besides, as was identified during the observation 
at Sahlgrenska 6th of  December 2012, see appendix 5, 
the main intension during a counseling session is for a 
candidate to understand why their current situation is 
as it is. That could be that the candidate mainly searches 
for an answer that lies in the diagnosis done by a doctor 
rather than the audiologist.   

The main reason for getting a Baha is for a candidate 
to improve the hearing and the life quality e.g. when the 
candidate cannot live without hearing aids anymore or 
when having issues with other hearing aids.

4.2.2. Barriers – why refraining from Baha

When patients classify within the three types of  
hearing loss, previously mentioned in chapter 2.2, they 
become candidates for the Baha system, meaning Baha 
is a sufficient aid to their hearing loss. When patients 
choose to take on the Baha system they become 
recipients. Some persons might qualify for Baha but 
still chose not to move forward with the aid. There can 
be various reasons why possible candidates for a Baha 
do not end up with the solution. Refraining factors can 
origin from the healthcare sector or from the patient 
itself.

Professionals not being too familiar with bone anchored 



I 23

hearing might not know when to recommend the 
solution or even think of  it as an option. Bone anchored 
hearing aids are not as common as conventional hearing 
aids and therefore sufficient knowledge and comfort 
of  providing information about Baha might not be 
available by the individual audiologist.

Regarding the patient there are five identified barriers 
by Cochlear (Appendix 2 and Design Research Report 
2012). These are reasons for why the patient itself  
refrains from the Baha solution.

1. Aesthetics is a barrier to choose the Baha system 
as the candidate is concerned about size of  the 
sound processor, that it always shows (especially 
with shorter hair) and is placed at different place 
than conventional hearing aids.

2. The surgery can be a barrier for patients that for 
some reason fear it, possibly based on previous 
experiences or assumptions made regarding its 
complexity and risks.

3. The implant is identified as a barrier as some 
candidates find it troubling that it comes out of  
the head and that something is implanted into the 
head.

4. Funding can be a barrier for candidates in some 
countries as insurance approval can be difficult 
to get. Policies can also vary in different counties 
in Sweden.

5. Perceived hearing outcome can be a barrier if  the 
candidate is not convinced when trying on the 
softband. The softband experience is not good 
enough to make the candidate follow through 
with the Baha solution.

4.2.3. Observational Study

Two observations of  the work of  an audiologist at 
Sahlgrenska were arranged along the research and 
analysis., see appendix 5 and 6 The observations 
provided insights about the actual behavior of  the 
audiologist and candidates during the counseling 
sessions. 

The first observation was done on a first time meeting 
between the audiologist and a middle-aged woman 
experiencing issues with runny ears when using her 
conventional hearing aids.  The woman had visited her 
medical doctor prior to the counseling.  

It was recognized that the audiologist, during the 
counseling, uses gestures, shows brochures and 
one or more product samples in order to convey an 

understanding of  the bone anchored hearing aid 
system. The discussion was general and no brand 
specific clarifications were done. 

Although the by the audiologist explained intension is to 
provide an objective presentation of  all the appropriate 
sound system choices, the observations at Sahlgrenska 
showed that the candidate might only get one option 
presented before the test period on a softband. Latter 
stated by the observed audiologist, there could be 
several reasons for only displaying one option initially. 
Relevant factors such as time restraints, e.g. when 
using an interpreter, the amount of  processors in 
stock and if  a right or left placed processor is required, 
effect the amount of  displayed system options. The 
audiologist moreover explained that e.g. the competitor 
Oticon offers different processors for each distinctive 
placement side, whereas the Cochlear processor is 
universal for both sides of  the head. The actual reason 
for only exposing and suggesting one processor at the 
observation was not clarified. 

The dialogue during the 40 minutes counseling was a 
bit pushed and there was not much time for discussion. 
Potential reasons could be the delayed start of  the 
meeting, the element that an interpreter was used or 
it did simply expose the general behavior of  this very 
experienced audiologist. 

At the second observation a revisit was observed. The 
patient, a middle aged woman, had tested a softband 
for a month and basically came back to explain that 
she was not ready for the bone anchored solution. The 
candidate could clearly see that her hearing benefitted 
from using the device, yet she was not ready to welcome 
a solution that penetrates the skin and is implanted in 
the skull. She further explained to the audiologist that 
it was not the surgery that frightened her. Instead it was 
simply the fact that something would stick out from 
her head. 

Conversely to previous observation, the patient was 
the one leading the conversation during the counseling. 
The audiologist, the same one as during the first 
observation, primarily listened to the candidate and 
confirmed the feeling of  the candidate by nodding 
and letting the candidate continue to talk. When the 
patient had finished her explanation and handed back 
the softband, the audiologist asked if  she wanted to 
try it for a longer period. The audiologist furthermore 
explained that a doctor at Sahlgrenska holds tests on 
a new magnetic solution that would not go through 
the skin. Instead a magnet under the skin would make 
it possible to attach the processor. The candidate got 
very positive to the idea and instantly wanted to join 



Development of a Demonstration Tool for Bone Anchored Hearing Aids

the study group. As she had experience from clinical 
studies, she knew that these are nothing to worry 
about, she said.

The meeting was very short and the audiologist 
clarified, directly after the meeting, that it is not her 
task to convince the candidates, solitary to display 
the options available. This correlated well with the 
perceptions gained during the conducted observations. 

4.2.4. Demonstration Material   
During Counseling

The companies trading the bone anchored systems 
have each developed several demonstration tools 
that aim to be used during the counseling, see image 
16. Observations at Sahlgrenska University Hospital 
have shown that besides facilitating the work of  the 
professionals, the demonstration tools that are used 
try to enhance the candidate’s understanding of  the 
product offerings and their likely results. In addition to 
the mentioned functions, these tools also promote and 

certify the quality in which the audiologists present the 
companies’ product offerings.

At the place for the observational studies, there were 
two product brands available. The two companies 
offered similar demonstration tools for product display 
and practicing use of  the system, see the illustration 
and explanations in image 16(E). The cylindrical tool, 
shown in image 1, by Cochlear is the main reference 
product for this Master’s Thesis.

The two demonstration tools are both made in 
Plexiglass. They offer a possibility to attach and detach 
the sound processors to abutment, yet they give neither 
tactile nor visual resemblances to the actual placement 
and visual appearance on a recipient. Simple shapes, 
a cylinder and a triangular prism, are used. Although 
none of  the two tools give resemblance to the real use, 
the inclination on the triangular prism gives a slightly 
more truthful angle of  display than the horizontal 
position on the cylindrical shape. 

As seen from the observations and interviews, the 

Softbands and headbands (A and B) are used to 
give the possibility to try the hearing experience prior 
to surgery. This to further evaluate the individual 
hearing need and to get a good understanding of 
what hearing experience to expect.

Brochures (C) supplement with visual samples of 
how the system will look on the patients after having 
a surgery. The audiologist does not necessary show 
neither the same brochure as sound processor, nor 
the latest brochure provided by the companies. The 
main objective of the audiologist is to show true 
illustrations of how the patient could expect the 
results to look. 

Product samples (D) are available at the counseling 
in order to see the included components and 
available choices.

Demonstration tools (E) are supposed to be used for 
displaying and practicing attach- and detachment of 
the sound processor.

Image 16. Demonstration material used at counseling

A

B

C

D

E



I 25

reference tools are currently not actively used except 
for storing and occasionally showing product samples 
to the candidates.

4.2.5. Market Competition

Cochlear has identified the market competition as the 
following image 17, which includes companies and 
solutions that can be alternatives to their own Baha 
system (Pettersson, 2012). 

Percutaneous bone anchored hearing aid is what the 
current Baha solution is today. The abutment goes 
through the skin and the sound processor above the 
skin receives sound vibrations. 

Passive transcutaneous bone anchored hearing aid has 
the abutment part under the skin and thus the skin is 
never pierced. Sound vibrations are led through the 

skin, which muffles the sound.

Active transcutaneous bone anchored hearing aids have 
the abutment part under the skin and thus the skin is 
never pierced. The audio processor picking up sounds 
is placed above the skin. The vibrating part transferring 
sound vibrations is placed under the skin.

Non-surgical aids are indirect competition as e.g. 
CROS and BiCROS hearing aids can be used for the 
some types of  hearing loss that Baha can improve as 
well. CROS hearing aids treats single sided deafness by 
transmitting sounds from the poorer hearing ear to the 
better ear. BiCROS does the same but also amplifies 
the sound if  the better ear suffers from conductive 
hearing loss.

Percutaneous 
Baha

Transcutaneous 
Baha
Passive

Transcutaneous 
Baha
Active

Non-surgical
Hearing Aids 

Implant goes through the skin.
Vibrates above skin layer

Oticon

Implant does not go through the skin.
Vibrates are led through skin layer

Shophono

Less softer values due to new technology

Implant does not go through the skin.
Vibrates under skin layer

Bone Bridge

No bone conduction

CROS hearing aids

Market competition

Image 17. Market Competition



Development of a Demonstration Tool for Bone Anchored Hearing Aids

4.2.6. Cochlear Strategy

By use of  three core values; Reliable Performance, 
Aesthetic Design and Ease of  Use, Cochlear wants to 
build a customer centered strategy built on meeting 
the customer needs within guiding principles such 
as simplicity, aesthetics, reliability and value creation 
(CBAS Communication Strategy, 2012). The strategy 
aims to increase the trust and love to the Cochlear 
brand and products, as shown in image 18. 

The end users are the primary target group, whose 
needs all communication should build on. However the 
company speaks to the end users through professionals 
being Baha audiologists and surgeons. The target 
groups are divided as follows in image 20.

The strategy claims that the Cochelar’s products are 
not sold through features. Instead the softer values and 
benefits that emphasize the company core values will 
build the foundation in the communication to all the 
addressed target groups, see image 19.

4.3. Analysis Conclusions

The conclusions of  the analysis have been drawn with 
focus in identified needs and requirements for the new 
demonstration tool. The findings are subjective yet 
verified with company representatives. All analysis areas 
are considered and finally concluded in a requirements 
list for the new demonstration tool. 

4.3.1. Counseling Journey

As explained in chapter 2.5 Design Theory, numerous 
perceptions build up to one entire experience.  The 
Counseling Journey Canvas, image 21 maps the 
main insights from the counseling context study 
and concludes the overall counseling journey as it is 
designed today. The Journey is divided in three phases; 
Pre-Counseling, Counseling and Post-Counseling. 

Image 18. Trust vs Love

Image 19. From Features to Message

Image 20. Target Groups



I 27

Image 21. Counseling Journey



Development of a Demonstration Tool for Bone Anchored Hearing Aids

4.3.2. Personas

The user profiles and observations set the foundation for three personas. Each represent a user segment for which 
the demonstration tool could balance up their drivers in regarding helping aids for hearing loss. Anna wants to stay 
herself, Kent wants to keep his harmony in life and Ruth wants her patients to be satisfied with their decisions.

Anna is 29 years old and works with sales at a company 
providing applications within construction. In her free time 
she likes to go out and spend time with her friends. Fashion 
and trends are one of  her great interests.

Almost a year ago Anna was caught in a serious car accident. 
She got severe injuries onto the ear canal and the middle 
ear bones got damaged. This caused her hearing to become 
very reduced on one ear. Her profession involves customer 
meetings at noisy construction sites, which now are obstructed 
mainly because of  her hearing reduction, restaurant visits with 
friends are also difficult.

Her hearing is reduced to such a degree that conventional 
hearing aids are not sufficient. Baha, a bone anchored hearing 
solution, would give Anna a much more improved hearing 
experience, which she has also experienced at a try out. Her 
hesitation concerns the aesthetics that comes with the sound 
processor and implant. To live with Baha would constantly 
remind her of  the accident. She is afraid that she will not feel 
and look herself  with an implant coming out and the sound 
processor attached to the head. She is also worried that people 
might treat her differently seeing her hearing aid.



I 29

Kent is 70 years old and as retired he spends most of  his 
time at the house, in the garden or out on walks with his dog. 
With age his hearing has become reduced on both ears, yet a 
bit more on one ear so today he uses CROS hearing aids. He 
notices that he has a hard time keeping up in conversations 
with a group of  people and that he does not hear when 
somebody calls his name or the doorbell rings.

Since the hearing reduction has occurred gradually Kent has 
partially adapted to it and developed own communication 
strategies. He turns his better ear to the sound source, reads 
on lips and avoids certain contexts he experiences as difficult. 
It is hard for him to have a reference as the reduction has 
occurred over time, his family and friend on the other hand 
notices and have spoken of  the difference.

For Kent the Baha solution would be implanted on both 
ears. Yet there are some worries to deal with before Kent 
feels comfortable with particularly the surgery. Some years 
ago Kent had meningitis, which was experienced as very 
unpleasant, and he is now worried about what complications 
might arise from this needing to operate on the skull bone. 
Furthermore he has done a knee surgery where the outcome 
was less than expected and healing took longer than planned. 
With these experiences he is afraid that also this operation will 
not heal properly and that he might find it difficult to take care 
of  the implant as the side of  the head is hard to reach and see.



Development of a Demonstration Tool for Bone Anchored Hearing Aids

Ruth is 41 year old and has educated herself  further to work 
as an audiologist after several years within the healthcare 
sector. She is located in a smaller county region where patients 
with all kinds of  problems related to hearing loss visit her. 
Her role thereby involves knowledge of  various hearing aids 
and possible interventions to pursue, from conventional aids 
to CROS, Baha and Cochlea implants. 

Due to her long career within the healthcare sector she feels 
confident meeting patients and judging their emotional and 
physical state. Ruth thinks it is the rewarding part of  her work 
as she is good at handling the patients core problem making 
them feel seen and heard, and she often gets positive feedback 
from the ones she meet.

Although she finds it exciting to develop a new knowledge area 
growing in the role as an audiologist it is also a bit nervous. 
Most types of  hearing loss results in conventional hearing 
aids but when patient problems require other solutions she 
feels a bit lost. Ruth appreciates the neutral role she has as 
a healthcare professional and does not want to come off  as 
selling products to the patient.

She does not work with the Baha system that often, and when 
she is to meet a potential Baha candidate she has to take 
extra time to prepare herself. She uses the company provided 
material when discussing with patients, but she feels like it 
is mostly a monologue by her during counseling. Trying to 
explain the system to patients she feels like she does not come 
through with the information and she feels pressured as the 
consultation time is only set to one hour at the most. 



I 31

4.3.3. Trends 

Throughout the analysis several trends important for 
developing a new demonstration tool, were identified. 
Considering the counseling in particular, the trend of  
communication characterized by emotion is growing. 
It was noticed that competitors successfully use soft 
values in their argumentation towards the candidates, 
e.g. on their websites. Besides, as identified by Cochlear 
(Design Research Report, 2012), ergonomic feel drives 
user preference to the design as has been shown e.g. 
in the Ponto solution by Oticon, in which the curves 
and ear-like shape suggest harmony. In comparison, 
the Cochlear BP 100 was perceived less ergonomic and 
more old-fashioned.

Another trend is the rapid technology development, 
particularly concerning the implant and abutment. 
Technology inventions have resulted in new competitors 
entering the field and will moreover make firms offer 
more than one type of  option regarding implant and 
abutment combination to the candidates. Thus the 
candidate’s number of  options increase, which makes 
the work of  the audiologist a bit more difficult.

Today the audiologists “sell” the Baha solution primarily 
by the “try before you buy it” approach, which by 
now only includes the trial of  the hearing experience 
through a test period on a head- or softband.

Re-organizations of  the healthcare clinics combined 
with the individual´s professional interests have  
increased the distance between the anatomical, audial 
and surgical knowledge and thus probably impaired 
the prospects for the candidates to get a holistic 
understanding of  the system offer.

4.3.4. SWOT

Launching new products and tools, Cochlear’s strengths 
concerns them having the most experience in the field 
of  Baha, see image 22. In combination with their 
quality assurance thanks to throughout assessment 
before releasing new innovations, the Cochlear choice 
should come through as very safe to the recipients. 
New surface treatments also make the Cochlear surgical 
outcome less visible. 

A potential weakness identified is that the design 
seems to be considered rather stiff  compared to the 
more organic shapes in some of  the competitors’ 
designs. The stiffness can be difficult to incorporate 
with softer values aimed for in the company strategy 
and come through as friendly when presented with 
supporting products. Regarding the development of  a 
new demonstration tool, economical limitations might 
also affect the number of  concepts possible to realize.  

Whilst many barriers make candidates refrain the Baha 

Image 22. SWOT Analysis



Development of a Demonstration Tool for Bone Anchored Hearing Aids

solution, the actual operation is very safe and although 
one could get infections, one could not actually worsen 
the hearing. Thus there is a gap to fill in explaining the 
surgery and life with Baha, then changing the perception 
of  the action of  getting a Baha from frightening to fairly 
inviting. As there would be a need for filling the gap, 
there is an opportunity to be the first one with a new 
tool, thus increasing the attention during counseling. 
Through development of  a multifunctional tool, there 
would also be an opportunity to replace several minor 
sources of  information, like different pictures and 
brochures in order to better bond to the candidate. 

The general threats for introducing new tools for the 
counseling sessions are that although a new Cochlear 
tool is used, the candidates might not get committed 
to the solution. Secondly a threat would be that the 
audiologists do not use the new tool at all. It has 
been noticed, at the workshop for audiologists, that 
the audiologists do actually not use numerous tools 
offered by the producers and even if  the audiologists 
do use the tool, Cochlear has no control of  the actual 
conversation at the session. The lack of  control over 

the middlemen might have great effects on the success 
of  new inventions. At last, one threat is that the 
highly technical mindset at Cochlear might affect the 
audiologists’ attitudes when talking to the candidates. 
Thus the softer argumentation expressed in the 
strategy threats to be dissolved through the deeply 
rooted technical mindset in the company.

4.3.5. Design Format Analysis (DFA)

Table 1 shows that in general the Cochlear sound 
processors have very clean cuts and rectangular sharp 
shapes. No patterns or textures are used. Looking at 
the design format analysis it shows that the BP 100 
and the BP 110 are the most consistent products. Least 
consistent is the Baha Cordelle mainly because it is 
body worn.

The most consistent design elements are sharp radius 
from side to front, four cornered shape, buttons only at 
side, decentralized division line at sides and symmetry 
of  entire product.

The sound processors basically come in four different 

Table 1. DFA



I 33

colors (blonde, black, grey and brown) to match the 
hair. The surface is matte and shimmery. For the BP 
100 a broader range of  different colored side covers 
and fronts are available, the colors are not only natural 
but also include brighter shades.

Preferably the demonstration tool will use similar 
design elements as defined in the DFA, yet the tool 
need to have a subtle shape to enhance the importance 
and display of  the actual Baha system and come 
through as pleasant. 

4.3.6. Strategy alignment

In order to increase the strategy alignment the sound 
processor ought to be perceived more ergonomic and 
aesthetically up-to-date. Regarding the performance, 
the current products are perceived as reliable.

To better align the product offers to the Company 
Core Values, the new demonstration tool must try to 
progress the candidates’ view of  the sound processor 
experience to an ergonomic and preferred choice, 
whilst the design format still comprises sharp cuts and 
rectangular shapes.The interpretation of  the company 
core values to the demonstration tool expression 
resulted in the requirement of  the tool being inviting, 
honest and selected in its expression referring to the 
company core values ease of  use reliable performance 
and aesthetic design.

4.3.7. Workshop Outcome

The conducted workshop on expression resulted in 
several characteristics complementing each requested 
expression, explained in previous chapter. The most 
frequently mentioned thoughts are listed in table 2 and 
some collected idea sheets are shown in image 23.

Expression Characteristic Occurrence

Inviting

Round shape 10

Smooth shape 7

Chiseled out/Concave 6

Selected

Nice to hold 5

Elevated 10

Indicated 7

High-class material 6

Precise form 6

Beveled edges 6

Honest

Transparent material 12

Organized dimensions 7

Homogenous coloring 5

Clean surface areas 5

Table 2. Workshop Outcome

Image 23. Workshop on Expression



Development of a Demonstration Tool for Bone Anchored Hearing Aids

4.3.8. Need and Potential in a   
New Demonstration Tool

The impression is that there is an opening for a new 
tool that would be used by the audiologist for showing 
the Baha system location on the head. Especially for 
showing the visual looks and for explaining the ear 
anatomy and sound travel. Yet the group is sensitive to 
material that could be perceived like commercial. Their 
main interest lies in the hearing experience and they are 
not employed for convincing the candidates. Instead 
they are employed to inform and show the options that 
could help the candidate to improve their hearing and 
experienced quality of  life.

Today the explanation of  the Baha system is according 
to the research exclusively done through the display of  
real example pictures and sample products. Thus no 
tactile feedback and relation to the body is conveyed 
to the candidate, who does not build up any further 
relationship to the system than the one conveyed 
through the hearing experience trial via the head- or 
softband. Use of  tactile stimuli in addition to audio 
and visual stimuli would certainly be an opportunity to 
address the reasons for refraining the Baha system and 
instead build a relationship and affection for the aid. 

The interviews and observations show that the 
reference product, the plexiglass s