Bone Conduction
by Cochlear Guest Author

4 tips to sharpen your Baha surgical skills

September 10, 2020
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Cochlear™ Baha® abutment length

Selecting the appropriate abutment length based on the measured tissue thickness is an essential step during the surgical procedure. 

Skin thickness measurement: It’s vital to measure the skin tissue thickness at the expected implant site.  Further, it’s important to note that body mass index (BMI) is not a good predictor of skin tissue thickness.  When measuring, use a small gauge needle and a clamp; do not depress the skin tissue while measuring, doing so may skew the measurement.  Local anesthetic should be administered AFTER skin tissue measurement.   

After confirming the approximate tissue thickness against a ruler, add 3mm to determine the abutment length.  When the measurement yields an uneven number, round up to the larger abutment to ensure a positive outcome.  The hydroxyapatite (HA) coating (white portion) is intended to be in contact with the tissue.  In some patients the HA coating may be slightly visible.  This will not impact the outcome.

Because the tissue thickness is not known until the time of surgery, it is advisable to have multiple abutment lengths available for each surgery to accommodate individual anatomies.

The importance of DermaLock™

The Baha® Connect System is a percutaneous bone conduction implant system allowing direct, single-point sound transmission via a minimally invasive skin-penetrating abutment. 

Conventional titanium abutments have been used for 40 years, but despite the metal’s well established ability to osseointegrate with bone, it does not integrate with the surrounding tissue. As a result, bone conduction implant surgery previously involved substantial soft tissue reduction to facilitate successful outcomes. Consequently, viable structures of the soft tissue were permanently removed, affecting the healing capacity of the local immune system. The Baha BA400 Abutment with DermaLock™ technology features a plasma-sprayed hydroxyapatite (HA) coating and concave design that promotes soft tissue adherence and stability.1 

Hydroxyapatite (HA) provides enhanced dermal adhesion, diminishing epidermal downgrowth and pocket formation, thus allowing for preservation of the soft tissue during surgery. This technology helps preserve the hair and skin around the abutment which not only leads to improved aesthetics and reduced numbness, but also dramatically reduces surgery time and benefits healing through increased vascularization of soft tissue.2

What is implant stability and why does it matter?

Dating back to the 1950s, Swedish Professor Branemark pioneered the study of titanium and its osseointegration qualities.  His research was advanced by Dr. Anders Tjellstrom’s work on bone conduction hearing implants.  Throughout the decades, titanium has served as the metal of choice for hearing implants. 

The BI300 implant utilizes the TiOblast™ surface for faster/stronger osseointegration and secondary stability when compared to previous implants. It has small threads at the neck of the implant for optimal load distribution and a wider profile of 4.5mm to optimize strength of the system.  These attributes allow clinically proven long-term stability.3, 4 The chart below shows 5-year follow up data of primary and long-term strength of osseointegration with the Baha 300 Series implant. 3, 4   

Primary and long-term strength of osseointegration with the Baha 300 Series implant

Figure 1: Primary and long-term strength of osseointegration with the Baha 300 Series Implant

The data on the graph (Figure 1) supports that patients with Connect or Attract benefit the most from our most advanced titanium bone conduction implant available, the BI300. The “Test” implant represents the BIA300 abutment with the BI300 Implant, and the “Control” implant is a previous generation  titanium flange fixture from Cochlear.

Cochlear drill handpiece cleaning and maintenance

The proper cleaning and maintenance of your Cochlear drill handpiece will ensure the smooth operation of your Cochlear Drill and avoid the inconvenience of any unneeded repairs. The recommended cleaning and lubrication is consistent with a properly functioning Cochlear drill and may extend the life of your drill.

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References:

  1. van Hoof M, Wigren S, Duimel H, Savelkoul PH, Flynn M, Stokroos RJ. Can the Hydroxyapatite-Coated Skin-Penetrating Abutment for Bone Conduction Hearing Implants Integrate with the Surrounding Skin? Front Surg. 2015;2:45.
  2. Iseri M, Orhan KS, Yariktas MH, Kara A, Durgut M, Ceylan DS, Guldiken Y, Keskin IG, Deger K. Surgical and audiological evaluation of the Baha BA400. J Laryngol Otol. 2015;129(1):32-37.
  3. den Besten CA, Stalfors J, Wigren S, Blechert JI, Flynn M, Eeg-Olofsson M, Aggarwal R, Green K, Nelissen RC, Mylanus EA, Hol MK. Stability, Survival, and Tolerability of an Auditory Osseointegrated Implant for Bone Conduction Hearing: Long-Term Follow-Up of a Randomized Controlled Trial. Otol Neurotol. 2016;37(8):1077-1083.
  4. Sennerby L, Gottlow J, Rosengren A, Flynn M. An experimental evaluation of a new craniofacial implant using the rabbit tibia model: Part II. Biomechanical findings. Otol Neurotol. 2010;31(5):840-845. 
Author

Cochlear Guest Author

In an effort to keep our content fresh and reflective of a diverse industry, Cochlear Americas features a mix of employees and professional partners to contribute to Cochlear ProNews as Guest Authors.

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Celebrating 10,000 Osia® Systems Worldwide

July 19, 2023

Together, Cochlear™ and hearing health professionals around the world have helped more than 10,000 ears get back on air with the Cochlear™ Osia® System, since the first clinical trials began in 2017. This is an achievement we wouldn’t have reached without you.

The Osia System is the world’s first and only active bone conduction implant system using Piezo Power™ technology. It is designed to help people live their lives and provide the performance needed to hear in noisy situations where they tell us they struggle most, with the goal to effectively treat the hearing loss of patients with conductive hearing loss, mixed hearing loss and single-sided sensorineural deafness (SSD).

The first patient to receive the Osia System was implanted with the OSI100 Implant in a clinical trial that included 12-month post-operative data on 51 patients in 2017. In 2019, the first patients were implanted with the OSI200 Implant in a multi-center study, and in the same year, the Osia System (with OSI200 Implant and Osia 2 Sound Processor) was approved in the US and other countries. In 2021, Cochlear began reporting on the reliability of all registered OSI200 Implants, and in 2023, the Osia Implant demonstrates 99.92% reliability.1

“Through productive collaboration, Cochlear has helped our patients with hearing loss more easily understand speech so they can enjoy a higher quality of life,” an Osia System surgeon from Germany said. “Bone conduction hearing solutions, such as the Osia System, are a promising technology that can help people with different types of hearing loss.”

The recipient of the 10,000th Osia Implant, Regina, said: “What I really appreciate about the Osia sound processor is that it leaves the ear canal free. The feeling of it being clogged, when wearing hearing aids for example, was always very unpleasant.” Regina recently had her Osia 2 Sound Processor fitted, and she now enjoys the small, everyday sounds that she was missing before.

“You don’t even notice yourself anymore what sounds you’re missing,” she said. “Getting the Osia has definitely been worth it to me.”

“For us at Cochlear, it’s always been about putting the patient at the center of what we do: to provide them with the best solution possible, and at the same time, for our professional partners to have confidence in the system from counseling to fitting,” says Adi Nilson, VP Acoustic Product Portfolio at Cochlear. “Reaching 10,000 ears with the Osia System in the few years since we first commercially launched it tells us that we have achieved what we set out to do.”

Want to learn more about the Osia System? Contact your local Cochlear representative or visit us at www.cochlear.com. 

References:

  1. Cochlear Limited. Osia Reliability Report Flyer. Cochlear Limited, 2023; D1841762.

Views expressed are those of the individual. Consult your health professional to determine if you are a candidate for Cochlear technology. Any testimonial featured is not intended for a New Zealand audience.

Close the Gap: Hear how the Cochlear™ Baha® System helped Michelle close her air-bone gap

December 11, 2018

Baha

The Cochlear™ Baha® System has the power to close the gap between the air and bone line for mixed and conductive hearing loss candidates with a 30 dB or greater loss.1 

Hear from Baha recipient, Michelle, about how she closed her air-bone gap with the Baha System.

“My hearing loss journey has been a long process of embarrassment, frustration and denial. During childhood, I had tubes in my ears, many painful ear infections and drank multiple prescriptions of pink bubblegum flavored amoxicillin (medicine used to treat ear infections).

Michelle

Fast forward to my 20s when the chronic ear infections continued onward! Just whispering the word ‘water’ in my ear would prompt an infection. My ENT at the time was at a loss, and I was tired of all the antibiotics, so she referred me to a doctor who diagnosed me with a cholesteatoma (the scar tissue from the excessive ear infections trapped the moisture and bacteria behind my eardrum and caused more growth of tissue). My first surgery removed the tissue, and my doctor inserted a T-tube; the procedure bought me two years of no infections and having hearing in my left ear.

Unfortunately, my hearing began to deteriorate again, I was in denial over my hearing situation. I felt depressed when I could not hear properly, but continued to let it go. One day, my daughter was whispering something into my ‘bad ear,’ and I could not hear her. I had reached my limit, so I returned to my doctor, and he recommended I try the Cochlear™ Baha® System.

Initially I was afraid of the surgery, but the second my audiologist placed the demo Baha 5 Sound Processor on me, WOW! I could not wait to get it! We opted for the abutment because the doctor had much success with the product. Surgery was about 45 minutes long and went incredibly well, I had minor pain, but never enough to use the prescribed pain medicines. The day the healing cap came off was amazing; the abutment and area around it looked so good. I had a small strip of hair shaved, but I had a huge support group around me to make me feel confident in my decision. We even joked that if people stared at me, I could touch the abutment and act like I was a secret agent.

Michelle's Audiogram

I am a mail carrier and the Baha 5 Implant System has given me a new joy in all the sounds I hear outside throughout the day on my route. The sound of crinkling leaves and pine needles under my feet is so amazing; I never realized how noisy the world is.

I now feel more confident in conversations and cannot wait to continue on my hearing journey. I actually enjoy using my device as a demo for my friends to hear the sound I hear. Having the surgery and getting the Baha 5 Implant System has changed my life, and I truly wish I had done it sooner.”

Download our Close the Gap two-pager for more information on closing your patients’ air-bone gap.

 

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1. Watson, G., et al. (2008). Bone anchored hearing aids: A preliminary assessment of the impact on outpatients and cost when rehabilitating hearing in chronic suppurative otitis media. Clinical Otolaryngology, 33(4), 338-342.
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This material is intended for health professionals. If you are a consumer, please seek advice from your health professional about treatments for hearing loss. Outcomes may vary, and your health professional will advise you about the factors which could affect your outcome. Always read the instructions for use. Not all products are available in all countries. Please contact your local Cochlear representative for product information.

 

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