Bone Conduction
by Cochlear Guest Author

Hearing loss related to chronic otitis media can directly impact patient quality of life

November 2, 2021
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By Natasha McDougald, Director, Acoustics Product Management and Marketing

Chronic otitis media (COM) affects up to 330 million people across the globe and an estimated 200 million of these have a disabling hearing loss* that requires treatment.¹ The World Health Organization estimates that chronic otitis media may contribute to more than half of the global burden of hearing impairment.2 It’s clear that COM and related hearing loss are global issues. Patients here in North America are also directly impacted and can suffer degradation to their comfort and quality of life as a result.

Bone conduction systems can provide COM patients with effective and stable hearing improvement during standard disease treatment, making the case that bone conduction solutions may be the ideal supplement to treat hearing loss.3,4,5

“Given the need to provide adequate treatment options that address the hearing loss component of chronic otitis media, Cochlear™ bone conduction solutions offer treating clinicians and patients suffering from COM a hearing loss treatment option that has potential for good outcomes and patient satisfaction especially in cases of hearing loss where there is a 30dB or greater air-bone gap.”

 – George Cire, Au.D Clinical Technical Project Manager at Cochlear

Treating chronic otitis media disease and hearing loss together

It’s important to focus on treating the disease to give your patients a safe, dry and healthy ear. It’s also crucial to consider that COM-related hearing loss can also impact a patient’s quality of life. Hearing rehabilitation can be accomplished through multiple means, including reconstructive middle ear surgeries; however, multiple factors influence the final postoperative hearing result, and the most important determinant of long-term hearing outcomes is the environment of the middle ear.6 We know that 29% of patients can have a conductive hearing loss of > 20 dB after tympanoplasty7 and these patients may require an additional hearing intervention as part of their treatment. Additionally, during the treatment pathway for COM, many patients may not have access to reliable hearing while waiting for an upcoming surgery or treatment.

Cochlear bone conduction solutions can improve your patients’ quality of life

Bone conduction systems are a safe, reliable and effective treatment for COM-related hearing loss.3 Patients with COM that require additional hearing intervention or amplification to obtain reliable hearing can experience a significant improvement in their quality of life after bone conduction solution.5In addition to improving hearing, the Cochlear™ Osia® System and Cochlear Baha® Systemkeep the ear canal open, unlike hearing aids, which can reduce the frequency of chronic ear infections.8,9

“Patients who have chronic otitis media tend to benefit [from bone conduction solutions] rather than wearing a traditional hearing aid.”

– Kristan Alfonso, MD Children’s Healthcare of Atlanta

You can also consider bone conduction as a hearing intervention earlier in the treatment pathway with the non-surgical Baha Start, which gives patients access to reliable hearing during the treatment pathway between surgeries.

Click here to find out more about Cochlear Bone Conduction Solutions.

References:

  1. World Health Organization. Chronic suppurative otitis media: burden of illness and management options. 2004; https://apps.who.int/iris/handle/10665/42941. Accessed January 16 2020.
  2. Acuin J and the Department of Child and Adolescent Health and Development, and the Team for Prevention of Blindness and Deafness of the World Health Organization. World Health Organization, Geneva; 2004.
  3. Gillett D, Fairley JW, Chandrashaker TS, Bean A, Gonzalez J. Bone-anchored hearing aids: results of the first eight years of a programme in a district general hospital, assessed by the Glasgow benefit inventory. J Laryngol Otol. 2006;120(7):537-542.
  4. Watson GJ, Silva S, Lawless T, Harling JL, Sheehan PZ. Bone anchored hearing aids: a preliminary assessment of the impact on outpatients and cost when rehabilitating hearing in chronic suppurative otitis media. Clin otolaryngol. 2008;33(4):338-342.
  5. McLarnon CM, Davison T, Johnson IJ. Bone-anchored hearing aid: comparison of benefit by patient subgroups. The Laryngoscope. 2004;114(5):942-944.
  6. Dornhoffer J and Walker D. Ossicular reconstruction. ENT & Audiology News2020;29(1).
  7. Lewis A, . Vanaelst, B. Hua, H. Choi, B. Hol, M. Jaramillo, R. Kong, K. Ray, J. Thakar, A. Järbrink, J. Success rates in restoring hearing loss in patients with chronic otitis media: a systematic review. Eur Arch Oto-Rhino-L. 2020:Submitted manuscript. Funded by Cochlear Bone Anchored Solutions AB.
  8. Medical Advisory Secretariat (2002). Bone anchored hearing aid: an evidence-based analysis. Ontario health technology assessment series, 2(3), 1–47.
  9. Macnamara M, Phillips D, Proops DW. The bone anchored hearing aid (BAHA) in chronic suppurative otitis media (CSOM). J Laryngol Otol Suppl. 1996;21:38-40. doi: 10.1017/s0022215100136254. PMID: 9015447.

*Disabling hearing loss refers to hearing loss greater than 40 dB in the better hearing ear in adults (15 years or older) and greater than 30 dB in the better hearing ear in children (0 to 14 years).

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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Baha smart app

5 Clinical Quick Tips for bone conduction solutions

June 29, 2020

Fitting a Baha® SoundArc™

The Baha® SoundArc™ System is a modern and discreet over-the-ear non-surgical solution for children and adults struggling with conductive hearing loss, mixed hearing loss or single-sided deafness (SSD).  The Baha SoundArc System provides a high quality, non-surgical option for both children and adults.  Children who have outgrown the Softband but are not yet ready for a surgical solution are perfect candidates for the SoundArc .  It can be fit quickly and easily and can be used with any of the Baha 5 series of processors.  Want more help fitting the SoundArc?  This video gives clinicians the tools to correctly fit a SoundArc on their patients to maximize hearing performance:

Why is MFO important in a bone conduction sound processor?

Maximum Force Output (MFO), which is similar to Maximum Power Output (MPO) in hearing aids, defines the overall gain that can be made available to the device through the vibrating transducer.  Maximum gain will be dictated by the MFO in a device and the range between these two curves is called “Headroom.”

When using a bone conduction device like a Cochlear™ Baha Sound Processor, the higher MFO figure will allow for better hearing in noise by allowing the sound processor to produce more gain for a given input. This allows the signal to be amplified above the noise and will improve the signal-to-noise ratio.  The Baha 5 SuperPower has the greatest MFO available to the patient on the market today.1 

Evaluating outcomes with Cochlear Baha solutions

Outcome measures are of increasing importance in healthcare today.  Patients (and insurance companies) want to know they’re getting their money’s worth and want to be sure that the recommended treatment option was beneficial in a measurable way.  So how can outcomes be measured with the Baha System?

For all recipients, subjective outcome measures such as the Client-Oriented Scale of Improvement (COSI) or Abbreviated Profile of Hearing Aid Benefit (APHAB) are easy to administer and helpful in assessing performance.  Objective speech perception tests can also be useful – they will be set up slightly differently depending on the type of hearing loss:

-SSD: Set up the booth with noise coming to the “good” side and the speech signal coming to the “bad” side, then test with and without Baha.  Any test materials that include speech in background noise can be used – the Quick Speech in Noise test (SIN), BKB-SIN and CNC are good examples.  Test with and without Baha to show the benefit the Baha System provides. 

-Mixed or conductive hearing loss:  Set up the booth as you normally would for any sound-field speech perception testing (i.e. speech and noise through one speaker or both).  Any speech perception measures can work – consider single word tests such as W-22’s or NU-6 or sentence tests in noise such as the Quick-SIN or AzBio in background noise.  Test with and without the Baha System to show the benefit it provides. 

Regardless of the specific tests used, both subjective and objective outcome measures are important to establish outcome status for your patients.

What is the easiest way to demonstrate hearing with a bone conduction device to a candidate?

In the clinic, with a limited amount of time, the best way to help your patients to understand what an Osia or Baha Sound Processor can do is through a demonstration or “demo” of bone conduction.  A demo can be done quickly with a Softband or test rod and an attached Baha 5 Power device.  The advantage of using the Baha 5 Power device is that you can adjust the volume to the most comfortable loudness for a given patient.  For conductive hearing loss and SSD patients, it might be best to increase the volume on the Baha 5 Power to provide that extra gain beyond the default (i.e. “out of box”) settings.  If desired and if time permits, the sound processor can be customized and fit for the patient using the Baha System fitting software.  If the device is set for an individual, be sure to reset the sound processor to the factory settings for any subsequent patients.

The best demos are done in real world situations where there is speech and noise present and the candidate may contrast their hearing with and without the device turned on.  A more formal evaluation can be done with the use of a pre-recorded speech test like the Quick-SIN or the BKB-SIN presented in a calibrated sound field. 

Remember that this type of demonstration is NOT an exact prediction of how someone will do after surgery, especially for the Osia System.  Research shows that hearing thresholds with the Osia System will be better in the high frequencies than hearing with Baha on a Softband, but the demo can be a useful counseling tool to help a candidate understand what the bone conduction hearing experience.2

Baha 5 smart app FAQs

What is my patient adjusting when using the volume slider in the Baha 5 Smart App?

A: When using the volume slider in the Baha 5 Smart App the patient is adjusting the sound processor microphone level, which is the volume level of your surroundings. To adjust the wireless accessory volume, change to a wireless accessory program and a separate volume bar will appear in the app.

Can my patient use the Baha 5 Smart App to adjust sound processor volume during phone calls or while streaming audio?

A: Yes, they can adjust the sound processor volume by turning the volume slider up and down in the Baha 5 Smart App. Also, if a patient has an Apple® device and would like to adjust the volume of the phone call or the streamed audio, they can use the hard keys or volume rocker of the side of the smartphone.

If the volume rocker on the Baha 5 Power sound processor is disabled, can my patient adjust volume using the Baha 5 Smart App?

A: Yes, they can adjust the volume of the sound processor using the volume slider in the Baha 5 Smart App even if the volume rocker on the Baha 5 Power Sound Processor is disabled.

How does ‘add location’ actually work?*

A: Once they have created a Program+ they can choose to link it to a specific location. After arriving at the location, the app will ask if the user wishes to switch to the linked Program+. The same Program+ can be linked to several locations.

How many locations can my patient add?*

A: They can add up to 20 locations. These 20 unique locations can be distributed among your Program+. For example, they can use all 20 for the same Program+, or 1 location for 20 Program+.

What does the treble and bass adjust?

A: Adjusting treble and bass allows your patients to customize their hearing experience. The treble/bass can be adjusted by +6 dB to -6 dB where each step equals a change of 1dB. The cross-over frequency between low frequency (bass) and high frequency (treble) adjustment is 1000Hz.

With the Baha 5 Smart App your patients can:

1) Quickly and easily change programs, activate streaming and adjust the volume

2) Adjust treble and bass to customize their sound processor settings

3) Receive assistance and get handy operating tips and

4) Locate a lost or misplaced sound processor

*iOS only

For more information, subscribe to the revamped Cochlear ProNews or check out these AudiologyOnline resources.

References:

  1. Professional Marketing Department. (2018, February 28). Cochlear Americas. Retrieved from https://pronews.cochlear.com/mpo-available-to-the-patient/
  2. Data on file Windchill Document D147847

Cochlear™ Baha 5 sound processors are compatible with iPhone®, iPad® and iPod touch®. The Cochlear Baha 5 Smart App is available on App Store and Google Play. For compatibility information visit www.cochlear.com/compatibility

App Store is a service mark of Apple Inc., registered in the U.S. and other countries. Apple, the Apple logo, FaceTime, Made for iPad logo, Made for iPhone logo, Made for iPod logo, iPhone, iPad Pro, iPad Air, iPad mini, iPad and iPod touch are trademarks of Apple Inc., registered in the U.S. and other countries.

Boy drawing

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

April 12, 2019

Wearyourway

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.
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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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