Bone Conduction
by Jamie Schwartz

Adults with mixed or conductive hearing loss: solutions all clinicians need to know

January 30, 2018
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As a treatment option for hearing loss the Baha system is more successful than middle ear surgery or hearing aids.1

For adult patients with mixed or conductive hearing loss a bone conduction hearing solution may be the best treatment option. Through bone conduction, sound is conducted naturally through the bone directly to the cochlea, independent of the outer and middle ear. The Cochlear™ Baha® System leverages this natural process by amplifying sound signals, converting them into vibrations and transmitting them to an implant anchored in the temporal bone. Implantable bone conduction is, therefore, an effective hearing solution for people with conductive or mixed hearing loss because it bypasses any problems associated with the outer or middle ear. Many hearing care professionals agree that for these types of problems, the Baha system is a more effective solution than air conduction devices.2 Part of what makes the Baha System unique is that patients can test it out before they commit to surgical implantation.

Candidacy

Candidacy evaluation for an implantable bone conduction system includes audiological testing as well as a personal trial with the Baha System. The patient’s air-bone gap can be a guide to the benefits that can be expected from choosing a Baha System. Comparing the results of speech testing in sound field, with and without the sound processor, can also be useful.

Some recommended tests for mixed and conductive hearing loss include:

  • Pure tone audiometry
  • Listening test
  • Speech audiometry

Evaluation

When evaluating adult patients with mixed or conductive hearing loss, an important consideration is the type of medical condition that has caused the hearing loss. For some indications, such as chronic otitis media and allergies, an implantable bone conduction may be the only feasible solution,3-5 regardless of the size of the air-bone gap.

Some common causes of mixed and conductive hearing loss include:

  • Atresia/Microtia
  • Allergies (serous otitis media)
  • Cholesteatoma
  • Chronic mastoiditis/mastoid cavity
  • Chronic Suppurative Otitis Media
  • Congenital aural atresia
  • Draining ears
  • Ear canal stenosis
  • External otitis
  • Genetics
  • Otosclerosis
  • Other middle ear dysfunctions

Treatment

When treating a patient with mixed or conductive hearing loss, the first line of treatment is middle ear surgery and/or hearing aids. If the first line treatments are not successful, the suggested second line treatment is an implantable bone conduction system. A recent research survey of 29 clinicians that use the Baha system as a treatment option for hearing loss shows that the Baha system is more successful than the first line of treatment.1

Patients with mixed or conductive hearing loss may benefit from a Baha System. Patients with mixed or conductive hearing loss performed better in noise with a Baha system than an acoustic hearing aid and 82% (27/33) of users prefer a Baha sound processor to a power hearing aid.6

If you are interested in bringing the Baha system into your clinical practice, please reach out to your Cochlear Field Team today. Don’t know who your Field Team members are?  Call: 1-800-523-5798 or 303-790-9010 and we can connect you today!

If you are already a Baha provider, please right-click and save the infographic below to use during counseling.

Hearing Loss Baha

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References:
  1. Cochlear Baha: Patient Research [Data on file] 2017 June.
  2. Snik AF, Mylannus EA, Proops DW, et al. Consensus statements on the BAHA system where do we stand at present? The Annals of Otology, Rhinology & Laryngology 2005; 195:1-12.
  3. Hol MK, Snik AF, Mylanus EA, Cremers CW. Long-term results of boneanchored hearing aid recipients who had previously used air-conduction hearing aids. Archives of Otolaryngol Head Neck Surg. 2005;131(4):321-5.
  4. McDermott AL, Dutt SN, Reid AP, Proops DW. An intra-individual comparison of the previous conventional hearing aid with the boneanchored hearing aid: The Nijmegen group questionnaire. J Laryngol Otol. 2002;116 Suppl. 28:15-9.
  5. De Wolf MJ, Hedrix S, Cremers CW, Snik AF. Better performance with bone anchored hearing aid than acoustic devices in patients with severe air-bone gap. Laryngoscope. 2011;121:613-16
  6. Mylanus EAM, van der Pouw KCTM, Snik AFM, Cremers CWRJ. Intraindividual Comparison of the Bone-Anchored Hearing Aid and Air-Conduction Hearing Aids. Arch Otolaryngol Head Neck Surg. 1998;124(3):271–276. doi:10.1001/archotol.124.3.268
Author

Jamie Schwartz

Jamie is the Associate Marketing Manager in the Product and Professional Marketing Department at Cochlear Americas. Jamie is responsible for ProNews blog content as well as professional social posts and calendars. If you are interested in being a guest author for the ProNews blog please contact Jamie by email at jschwartz@cochlear.com.

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Clinical Case Study: Hearing Loss Due to Bilateral Microtia and Atresia

April 12, 2019

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Clinical History and Description

Sam was born with bilateral atresia and microtia and was adopted at four years of age. His family history and previous audiological information are unknown. His adoptive mother did report previous imaging to her knowledge was consistent with missing ossicles. He did arrive to his adoptive family wearing a bone conduction hearing device fit to a Softband. This device was fit unilaterally and was a loaner device from a charity organization. It is unknown when an Audiologist had fit the loaner Softband on Sam. He was placed in a total communication (TC) classroom when he started school. His mother reports that he had no intelligible words at the time of his adoption.

Audiological Testing

At five years and seven months of age, Sam was seen at Cook Children’s Medical Center in Fort Worth, Texas by Audiology and ENT. His ENT physician ordered an updated CT scan and the results were as follows: bilateral microtia and atresia, bilateral dysplastic ossicular chain, bilateral lateral SCC/vestibular abnormalities, mild narrowing basal turn right cochlea, and abnormal location of facial canal. Audiological results were consistent with a moderate conductive hearing loss for both ears (See Table 1). Audiological recommendations were to fit Sam with a bilateral Cochlear™ Baha® 5 on a Softband until further surgical/medical decisions were made.

 Table 1. Unaided Test Results Initial Audiological Evaluation

250 Hz 500 Hz 1000 Hz 2000 Hz 4000 Hz 8000 Hz
Right Ear Air 60 dB 65 dB 65 dB 65 dB 65 dB 45 dB
Left Ear Air 70 dB 75 dB 55 dB 55 dB 65 dB 50 dB
Right Ear Bone 5 dB 10 dB 10 dB 10 dB
Left Ear Bone 10 dB 10 dB 5 dB 5 dB

Sam was fit with two Baha 5 processors on a bilateral Softband two months after initial audiological testing at Cook Children’s Medical Center. Aided testing for Sam utilizing the bilaterally fit bone conduction devices revealed thresholds within the slight hearing loss to normal hearing range in sound-field.

Sam was evaluated again at a one-month follow-up appointment (See Table 2). During this follow up appointment, Sam’s mother reported a vast change in hearing and listening abilities after the bilateral fitting. The family reported that Sam could now say all his family members’ names and follow many auditory commands at home. Sam was given a SoundArc during this appointment after his mom reported that he complained about his hair sticking out with the Softband.

Table 2 – Aided Results at 1 Month

250 Hz 500 Hz 1000 Hz 2000 Hz 4000 Hz 6000 Hz
Right Ear Aided 20 dB 20 dB 20 dB 20 dB 25 dB 20 dB
Left Ear Aided 20 dB 15 dB 15 dB 15 dB 15 dB 20 dB
Bilateral Aided 20 dB 15 dB 15 dB 15 dB 20 dB 15 dB

At four months after initial fitting of the Baha, Sam’s mother reports a “HUGE improvement using two Bahas versus one Baha” and he continues to use two Baha 5 sound processors with his SoundArc daily. After the improvements seen by the family, Sam was moved from a total communication hearing impaired program into a regular public school. Sam’s family reported this school transition has been amongst the biggest issues they have worked through over their first year with Sam. In the new school, Sam is required to use his voice and not depend on sign language for communication. His mom reported ‘second guessing’ their decision to move Sam as they had gone against the advice of his previous school. However, they have seen Sam excel so quickly they are now very proud of their decision. Sam has had a huge improvement in his speech and his family reports that he seems more confident and happy at home also. They also report that at home Sam has begun to initiate conversations with his family independently now.

Thoughts for the Reader

  • For what patients would you consider a bilateral fitting over a unilateral fitting?
  • What families and patients would you consider a SoundArc over a Softband?
  • What are some additional educational or speech considerations needed for patients with delayed access to amplification?
  • When there are slightly poorer aided results at 4000 Hz or otherwise with Softbands or SoundArc, what would be the impact on the child’s speech and language development? How can this be addresses audiologically?
  • At what point would you consider suggesting a surgical option for Sam now that he is over 5 years of age? What clinical and social factors might play into this decision? At what point would you start discussing a surgical option with the family? How would you explain the potential benefits of transitioning to a surgical option to Sam and his family?

Learn more about Cochlear’s bone conduction solutions including the Baha 5 portfolio!

About our guest author: Lisa Christensen, AuD, is the Audiology Program Manager at Cook Children’s Medical Center in Fort Worth, Texas and currently serves as President of the American Academy of Audiology.

In the United States and Canada, the placement of bone-anchored implant is contraindicated in children below the age of 5 years.
Views expressed are those of the individual. Consult your hearing health provider to determine if you are a candidate for Cochlear technology. Outcomes and results may vary. Click here to view more.
©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.

TECH Talk: How Cochlear’s Baha® 5 System Features Transform, Empower and Innovate to Improve Patient Outcomes

July 16, 2019

TECH Talk Baha 5 to Improve Patient Outcomes

Rom Mendel, President of Cochlear Acoustics, reaffirms Cochlear’s promise to help patients hear now and always.

Highlighting Baha 5® System features, Cochlear continues to transform, empower and innovate through redesigned external sound processors, innovative implant technology and simplified surgical procedures.

Further, the Mini Microphone, Phone Clip and TV Streamer, which are Bluetooth compatible, afford patient access to ultimate wireless connectivity.

Mendel emphasizes how preference and personalization are readily available to each patient through Baha’s single implant, two-system setup. Patients can choose from a wide range of discreet sound processors or opt for non-surgical opportunities such as Baha® Softband and SoundArc.

Mendel concludes with potential benefits of bilateral Baha usage including reduced listening fatigue, improved directionality and improved overall quality of life.

Want to learn more? Watch now!

For more TECH Talk videos from industry experts, subscribe to the ProNews blog and visit our TECH Talks page.

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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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