Bone conduction implants (BCI) are alternatives when the use and benefit of conventional, prosthetic equipment is limited or contraindicated in patients who suffer from conductive, mixed and single-sided deafness. They are broadly divided into two main groups delivering vibration directly to the skull bone or through the skin to the skull. This study aims to compare surgical and audiological outcomes of Sophono (SP), a skin driven system device to Bone Bridge (BB), a bone driven system device in order to assess and further differentiate the indication criteria. Fourteen patients with conductive and mixed hearing loss were evaluated pre- and postoperatively. Implant use per day, levels of bone and air conduction, and functional gain were recorded. A significant improvement from pre- to post-implantation was observed (p <0.05) in both the devices. The functional gain did not differ significantly between the two devices. Both BB and SP decreased auditory thresholds at 1 and 2 kHz (< 0.01), respectively. Interestingly, BB even significantly decreased thresholds at 0.5 kHz and 4 kHz. The SP wearing time was significantly lower than that of the BB (SP = 7–10h / day, BB = 8–12h / day). No relevant surgical complications were noted in both. It appears from the study that the BB bone conduction device has certain advantages over the Sophono. However the numbers recruited are small (BB – 10, SP – 4).