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‘Bone Anchored Hearing Aid’ Case Studies involving BAHA

Wendy Mackey, APRN, CORLN 7 th Annual Pediatric Otolayrngology Symposium October 4, 2012. ‘Bone Anchored Hearing Aid’ Case Studies involving BAHA. DISCLOSURES. What is BAHA. BAHA- Bone Anchored Hearing Aid Provides treatment of hearing loss that works through direct bone conduction

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‘Bone Anchored Hearing Aid’ Case Studies involving BAHA

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  1. Wendy Mackey, APRN, CORLN 7th Annual Pediatric Otolayrngology Symposium October 4, 2012 ‘Bone Anchored Hearing Aid’ Case Studies involving BAHA

  2. DISCLOSURES

  3. What is BAHA • BAHA- Bone Anchored Hearing Aid • Provides treatment of hearing loss that works through direct bone conduction • Sound is conducted through bone bypassing the outer and middle ear and stimulating the cochlea • May be surgically implanted or worn with a ‘soft-band’

  4. How does it work? • Osseointegration • Composed of three parts • Sound processor (detachable) • External Abutment • Titanium Implant • Preoperative testing possible

  5. FDA Clearance • First used in 1977 • FDA clearance • 1996-conductive and mixed hearing losses • 1999- use in children > 5yrs • 2001- bilateral placement • 2002- unilateral profound SNHL and introduction of softband for children < 5yrs

  6. Indications for BAHA • Conductive hearing loss • Anatomical abnormalities (e.g. atresia) • Draining ear • Large Conductive Hearing Loss • Mixed hearing loss • CHL > 30dBHL • SNHL < 60dBHL • Single Sided Deafness • Normal hearing on contralateral side

  7. Case NG • Treacher Collins • Cleft palate, retrognathia • Microtia and bilateral canal atresia • Newborn hearing screen identified maximal conductive hearing loss • Parental concerns (twin) • BAHA softband at 3months of age

  8. Audiogram ] ] ] ] o x o o o x x x o B SRT 75 SRT 75

  9. AudiogramsBilateral BAHA Softbands Br Br Br BL BL BL BL SRT 20 (bodyparts) SRT 25 (bodyparts) Age 2, Aided

  10. Softband

  11. Case: GF • Goldenhar Syndrome (currently 9yo) • Bilateral auditory canal atresia • Maximal conductive loss bilaterally • Options for hearing • Softband placement • Surgical placement

  12. AudiogramsLeft BAHA, Soundfield testing [ ] [ [ ] ] ] [ B B B B o o o o o o x x x x x x Unaided- SAT 65, WR 100% at 85dB HL Unaided- SAT 80, WR 100% at 85 dB HL Unilateral left Aided- SAT 20

  13. BAHA and Conductive Hearing Loss • To close the air-bone gap • BAHA bypasses conductive element • No additional amplification force is required

  14. Case: ED • 16 yo boy presents for ear check • Recently moved from out of state • long standing middle ear disease and chronic otorrhea • Complex medical history • Syndromic appearance • seizure disorder (depacote) • long term hospitalization as infant due to fragile respiratory status • Surgeries including UDT, hip dysplasia, bronchs, PE tubes x6 • PE Exam- mucopurulent drainage from left ear, t-tubes, cranial asymmetry • Treatment

  15. Audiogram ] ] ] o o ] ] ] ] ] o o ] o o B x x x B SRT 50 at 100m, disc 92% at HL 80/ 60m Flat tymp, lg canal volume SRT 20, disc 100% at 50HL flat tymp, large canal volume

  16. CT Temporal Bones • Fluid opacity within the left middle ear and mastoid • Bilateral t-tubes • Mastoid air cells are not developed

  17. Options for Hearing • School accommodations- FM system • Air Conduction Hearing Aids • BAHA

  18. Audiogram with BAHASoundfield testing, BAHA on left side with soft bandBoth ears plugged B B B B B Aided SRT 10, discrimination 100%/45db, Stable with background noise

  19. Management • 3/30/12 • 1st stage BAHA – left side with sleeper • Left tympanomastoidectomy • Severely sclerotic mastoid--essentially no air cells • Severe and complete middle ear polypoid change, no evidence of cholesteatoma • Left tube removal with tympanoplasty • 8/2/12 • 2nd stage BAHA (abutment placement) • Right tympanostomy tube • Left ossicular prosthesis

  20. BAHA and Mixed Hearing Loss • Close the air-bone gap • Compensate for remaining SNHL • Additional force is required to overcome sensorineural component

  21. Baha System Mixed and Conductive Hearing Loss

  22. Case: NM • 5yo girl presents with concern regarding hearing • Adopted from the Ukraine in January 2011 • Mom noted difficulty hearing from her left ear (phone) • Struggling in school, inattention in class, difficulty focusing • Since entry in US- no AOM or fluid, no medical issues • No meds, NKDA • FH and PMH- unknown • Exam in office- normal ear exam

  23. Audiogram ] o ] ] o o o ] ] ] ] SRT 5, disc 100% at 50HL Normal tymp SRT NR at 100m, disc 0% at 110HL Normal tymp

  24. SNHL Workup • EKG- normal • Ophthalmology • left sided amblyopia • Genetic consultation • CT temporal bones • left dysmorphic cochlea • right appears normal

  25. Options for Hearing • School accommodations- FM system • Cross amplification hearing aids • CROS- Contralateral Routing of Signals • BAHA

  26. Difficulties Encountered with SSD • Understanding in group conversations • Difficulty with background noise • Difficulty with distance • Localizing sounds • Understanding sound on the deaf side

  27. Audiogram with BAHASoundfield testing, BAHA on left side, Earplug on right B B B B B SRT 20, discrimination 100%, HL 60/50(m)

  28. BAHA: Single Sided Deafness • Normal hearing in contralateral ear • Functions by transcranial routing of the signal

  29. SSD ‘Aided’ Outcomes Unaided Audiogram Aided Audiogram

  30. Summary • BAHA bypasses the conductive element of hearing loss through direct bone conduction of sound • BAHA is an excellent option for conductive and mixed hearing loss and single-sided deafness

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