by Kyle Longwell

Clinical Quick Tips: Introducing Baha® Active Bilateral Directionality

April 17, 2019

With the recent update of Baha® Fitting Software (BFS), Cochlear is pleased to introduce several new features and improvements to make BFS 5.4 more user-friendly, especially for bilateral fittings.

In a conventional bone conduction system, bilateral sound processors work independently with no exchange of information between the pair and effectively splitting the soundscape into two listening environments. This usually results in symmetrical directionality listening modes.

However, listening environments can be complex and noisy with speech coming from multiple directions and surrounding background noise. In these situations, an asymmetric directionality mode may help the patient’s hearing performance.

Active Bilateral Directionality is switched on by default for bilateral fittings. It can be turned off if desired in the software in each program independently (except in Softband).

If you would like more information about the recent fitting software update, please reach out to your local Cochlear Americas representative or visit the “Software Support” resource section in myCochlear Clinic for the link to register and download the new BFS 5.4 software.

©Cochlear Limited 2019. All rights reserved. Hear now. And always and other trademarks and registered trademarks are the property of Cochlear Limited or Cochlear Bone Anchored Solutions AB. The names of actual companies and products mentioned herein may be the trademarks of their respective owners.

Interview with Melissa Tumblin: Advocating for Ally’s Act

March 5, 2020

Introducing Ally’s Act, H.R. 5485

Interview with Melissa Tumblin, Founder and Executive Director of the Ear Community Organization

Cochlear: Who is Ally?
Melissa Tumblin: My daughter, Ally Tumblin, is a 10 year-old girl from Broomfield, CO who was born with microtia and aural atresia of her right ear. Ally wears a bone anchored hearing device to help restore her significant conductive hearing loss. She is now an advocate for the deaf/hard-of-hearing (D/HOH) community, especially for the microtia and atresia community.

Wanting to advocate during Better Hearing and Speech Month in May 2019, she wrote to Congressman Joe Neguse (D-CO) asking for help and he responded! As a result, Congressman Neguse introduced Ally’s Act, H.R.5485 honoring Ally and her advocacy to help others obtain hearing device insurance coverage for hearing implants through private insurers.

Cochlear: What is Ally’s Act?
Melissa Tumblin: Ally’s Act, H.R. 5485 is a bipartisan national bill that would ensure that private insurance companies provide coverage for hearing devices including osseointegrated hearing devices (OIDs) like bone anchored hearing aids and cochlear implants as well. Ally’s Act is not a state-level bill, which means the legislation would help children and adults by ensuring that these hearing devices have coverage in every state, unlike the current situation where hearing device coverage varies from state to state. In fact, only half of our states have legislation in place to cover hearing aids. Even with this coverage in place, bone conduction hearing aids and cochlear implants are not always included in these coverage plans.

Once passed, Ally’s Act may allow or enhance access to these important devices by covering:

1. A bone conduction hearing aid or cochlear implant
2. An upgrade replacement of these hearing devices every five years
3. Accessories including Soft Band headband, hard headband and adhesives
4. Repairs for these devices
5. One comprehensive hearing assessment per year
6. One preoperative assessment per year
7. Implantation surgery
8. Postoperative medical appointments for purposes of ensuring appropriate recovery from surgery
9. Postoperative audiological appointments for activation, fitting and programming
10. Aural rehabilitation services related to the use of this device

Congressman Neguse, who introduced H.R. 5485, states, “This bill would ensure that insurance coverage for hearing devices such as [hearing implants] be consistent and fair, to ensure every child can thrive and obtain the hearing healthcare they deserve.” Ally’s Act, H.R. 5485 would help these individuals obtain consistent hearing device coverage in every state through private insurers identified in the Affordable Care Act.

Cochlear: How do you wish to partner with professionals and how can they support Ally’s Act?
Melissa Tumblin: Many medical professionals have encountered patients who have had claims denied by private insurance providers when trying to obtain hearing implants. These professionals now have the chance to take action – hearing health professionals such as ENTs/otolaryngologists, audiologists, speech and language pathologists, teachers of the D/HOH, school district educators and interpreters have the opportunity to write and call their local representatives about Ally’s Act.

They can also reach out to their professional organizations to support this important piece of legislation. Lastly, these medical professionals and supporting organizations who have endorsed Ally’s Act can also schedule appointments and speak with their local representatives in person to support passage of the legislation.

Cochlear: How could Ally’s act impact the hearing industry as a whole?
Melissa Tumblin: Ally’s Act helps raise awareness of implantable solutions and advocates for the insurance coverage needed to increase access to these devices. This impacts the accessibility of hearing implants in general.

Moreover, Ally’s Act educates law makers about what is needed to improve hearing health care by hearing directly from medical professionals, the impacted families and adults who wear hearing implants. In fact, this could also educate the involved insurance companies. Ally’s Act may even pave the way for better hearing health care bills down the road!

Cochlear: What do you need from the public to help get Ally’s Act approved?
Melissa Tumblin: After introduction, this piece of legislation must pass through the House and the Senate and be signed by the President of the United States before becoming law. To aid this process, we must rely on the community to support this bill. I encourage anyone with a vested interest in healthcare to write to and call their local representatives, asking them to co-sponsor Ally’s Act.

In addition, community members can write to the House Committee for Energy and Commerce and call the members who sit on this committee. If there is not a House member who sits on this committee representing your state, they can then write to and call Chairman Frank Pallone. Even though the act may need 290 co-sponsors, this number is not always the deciding factor that could help move this bill out of the House Committee. The quality of letters and calls, along with following up with the offices of the representatives that have been contacted make a difference.

To stay updated on the status of Ally’s Act, H.R. 5485 please visit the Congressional website.

About Melissa Tumblin:

Melissa founded Ear Community ten years ago after her youngest daughter, Ally, was born. Ear Community is the first parent-driven nonprofit organization that directly helps children and adults who are born with microtia and aural atresia. It cultivates a community focused on education, awareness and support. Ear Community donates bone anchored hearing devices to individuals who have been denied coverage for these devices and awards college scholarships.

In the United States and Canada, the placement of a bone-anchored implant is contraindicated in children below the age of 5

Baha 6 Max Sound Processor case study with Dr. Moyer

August 30, 2021

By Catherine Moyer, AuD

In our geographic area we serve many military families who relocate from other towns and cities across the country and internationally. Recently, a family transferred to us from the east coast. Their 5-year-old son had been fit with binaural Baha® 5 Sound Processors via a Softband in his first year of life. His history included bilateral microtia/atresia, cleft palate, velopharyngeal insufficiency and bilateral moderate to moderately-severe hearing loss.

While he was doing very well with his devices, the family was looking forward to taking the next steps with their son, so they discussed surgical options with ENT and Plastic Surgery professionals for both bone conduction solutions and microtia repair/reconstruction options. The family first hoped that he would be able to undergo both of these surgical procedures at the same time for first one ear to be followed by the second. The family initially wanted to proceed with an Osia® placement. However, given the current FDA guidelines (12 years of age and older) the family chose to defer surgery and continue use of the Softband.

Baha 6 Max Sound Processor

An audiologist and surgeon at our center discussed other surgical options such as a Baha Connect (abutment) or Baha Attract (magnetic) surgery. The family decided to defer any surgery with their son and opted to continue utilizing his devices on the Softband. There was a further complication in that both of his current devices were not functioning up to manufacturer specifications due to age: one was intermittent and the other exhibited excessive battery consumption. Our center submitted a request to replace the devices with two new Baha 5 devices. As luck would have it, at the same time that we received authorization, Cochlear announced the release of their Baha 6 Max Sound Processor.

We utilized Cochlear’s upgrade technology program so that the child could receive bilateral Baha 6 Max devices on a Softband. We are proud to announce that he was the first child in California fit with Baha 6 Max devices! After a seamless initial fit, both the audiologist and the family were very excited as the average maximum power output of the Baha 6 Max is seven dB higher than the Baha 5, and higher output has been linked to increase speech understanding in noise.^{1, 2,3} In addition, the frequency range extends to 9850 Hz, which is 2850 Hz higher than the Baha 5.*^2,3 Once again, research has shown that the larger frequency range can improve recognition of high frequency consonants in both quiet and in noise. He will be starting the first grade this fall and the increased maximum power output and increased frequency range should provide him greater access to speech sounds, particularly if he is in a noisy classroom.

Outcomes

Prior to fitting him with the Baha 6 Max devices, his speech pathologist had reported to our team that he was having trouble discriminating between /f/, /s/, /sh/, and /k/ consonants. At his first follow-up visit, which occurred three weeks after his initial fitting, his mother reported that she had witnessed an improvement in his speech articulation. She believed that his ability to discriminate and produce high frequency consonants had improved. At this appointment he scored in the 90 percentile for phonemic scoring of the CNC word list when testing each device individually at a normal conversation level. He could also detect all Ling 6 sounds at 25 dB HL or softer with each of his new devices. While he has not yet seen his speech pathologist, we expect that these improvements will translate into improved discrimination ability.

He now has a few months of device use under his belt, and his mother sent us a message recently which describes how well he continues to function. We hope to see him in a few months after school starts in the fall for additional testing. Both our center and the family look forward to the near future where next year the plan is to complete surgical reconstruction and bone conduction surgery.

Learn more about the Baha 6 Max Sound Processor!

About the author: Catherine Moyer is as a pediatric audiologist at Rady Children’s Hospital of San Diego. She is a member of the Auditory Evoked Potential and Hearing Aid Management teams. She has specialized experience in working with bone-conduction devices and provides support to the Craniofacial and Cleft Palate teams. She earned her clinical doctorate in audiology in 2007 from the joint San Diego State University/UC San Diego program.

References:

Hua H. Baha 6 Max fitting range. Cochlear Bone Anchored Solutions AB, Sweden. 2020; D1725632.
Leung B. Baha 6 Max Connect Datasheet. Cochlear Bone Anchored Solutions AB, Sweden. 2021; D1760797.
Land J. Baha 5 Sound Processor Connect System Datasheet. Cochlear Bone Anchored Solutions AB, Sweden. 2019; 630908.

In the United States and Canada, the placement of a bone-anchored implant is contraindicated in children below the age of 5.

In the United States, the Osia 2 System is cleared for children ages twelve and older. In Canada, the Osia 2 System is approved for children ages five and older.

*With the Baha Connect System.