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‘Bone Anchored Hearing Aid’
Case Studies involving BAHA
Wendy Mackey, APRN, CORLN
7th Annual
Pediatric Otolayrngology Symposium
October 4, 2012
DISCLOSURES
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’
How does it work?
• Osseointegration
• Composed of three parts
– Sound processor (detachable)
– External Abutment
– Titanium Implant
• Preoperative testing
possible
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
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
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
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Audiogram
oo
SRT 75
o o o
x x
x
x
B
SRT 75
Audiograms
Bilateral BAHA Softbands
Br Br
Br
BL B B B
L
L
SRT 20 (bodyparts)
SRT 25 (bodyparts)
Age 2, Aided
L
Softband
Case: GF
• Goldenhar Syndrome (currently 9yo)
– Bilateral auditory canal atresia
– Maximal conductive loss bilaterally
• Options for hearing
– Softband placement
– Surgical placement
Audiograms
Left BAHA, Soundfield testing
[
[
[
] ] ] ]
B B B
B
[
o o o o
o
o
Unaided- SAT 65, WR 100% at 85dB HL
x x x x x x
Unaided- SAT 80, WR 100% at 85 dB HL
Unilateral left Aided- SAT 20
BAHA and Conductive Hearing Loss
• To close the air-bone gap
• BAHA bypasses conductive
element
• No additional amplification
force is required
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
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Audiogram
o o
]
o
]
o
SRT 20, disc 100% at 50HL
flat tymp, large canal volume
o
o
] ] ]
xBB
xx
SRT 50 at 100m, disc 92% at HL 80/ 60m
Flat tymp, lg canal volume
CT Temporal Bones
• Fluid opacity within
the left middle ear
and mastoid
• Bilateral t-tubes
• Mastoid air cells are
not developed
Options for Hearing
• School accommodationsFM system
• Air Conduction Hearing
Aids
• BAHA
Audiogram with BAHA
Soundfield testing, BAHA on left side with soft band
Both ears plugged
B B B B B
Aided SRT 10, discrimination 100%/45db, Stable with background noise
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
BAHA and Mixed Hearing Loss
• Close the air-bone gap
• Compensate for
remaining SNHL
– Additional force is required
to overcome sensorineural
component
Baha System
Mixed and Conductive Hearing Loss
Case: NM
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•
•
•
•
•
•
•
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
Audiogram
]
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]
o o o o
] ] ] ]
SRT 5, disc 100% at 50HL
Normal tymp
SRT NR at 100m, disc 0% at 110HL
Normal tymp
SNHL Workup
• EKG- normal
• Ophthalmology
– left sided amblyopia
• Genetic consultation
• CT temporal bones
– left dysmorphic cochlea
– right appears normal
Options for Hearing
• School accommodations- FM system
• Cross amplification hearing aids
– CROS- Contralateral Routing of Signals
• BAHA
Difficulties Encountered with SSD
• Understanding in group
conversations
• Difficulty with
background noise
• Difficulty with distance
• Localizing sounds
• Understanding sound on
the deaf side
Audiogram with BAHA
Soundfield testing, BAHA on left side, Earplug on right
B B
B
B B
SRT 20, discrimination 100%, HL 60/50(m)
BAHA: Single Sided Deafness
• Normal hearing in
contralateral ear
• Functions by
transcranial routing
of the signal
SSD ‘Aided’ Outcomes
Unaided Audiogram
Aided Audiogram
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