Each of the systems discussed above have advantages and disadvantages. Transcutaneous abutments (Baha and Ponto) occasionally develop minor infection around the implant site. On the other hand, they most efficiently couple the signal to the bone. The Sophono is attractive because there is no transcutaneous component, thus eliminating the possibility of infection. Because of the magnetic transcutaneous coupling, however, there is a very slight loss of signal power. The SoundBite is attractive because it requires no surgery and is removable. A dentist must be involved, however, and insurance coverage may require more effort. A deep in the canal hearing aid concept is attractive cosmetically, but comfort and efficiency are the issues. The CROS hearing aid is a nonsurgical option, but it requires bilateral devices to be worn, with some patients objecting to a "hearing aid" in the good ear. As noted previously, if more than a mild hearing loss exists in the intact ear, the BICROS system is an excellent option.

Although sound localization is not possible with any of these devices, hearing in background noise is improved since the "head shadow effect" is eliminated. The shadow of the head attenuates sounds, particularly high frequency ones, from reaching the opposite side. Low frequency (long wavelength) sounds can "bend" around the head and reach the contralateral, intact ear. The high frequency (short wavelength) sounds, such as constanants, tend to be reflected by the head and are therefore less audible and clear. The head shadow effect is less a problem in face to face, one on one conversations. Talking primarily into the deaf ear (i.e., driver of a car with a right single sided deafness attempting to listen to a passenger) is more difficult. In a crowded environment a listener must hear conversation(s) from multiple spatial locations, and thus the head shadow effect becomes even more problematic. All the devices listed above ameliorate this problem to some degree.