Bone Conduction
by Jamie Schwartz

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

December 11, 2018
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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.
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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Dr. Ebelhar

Osia implant hearing rehabilitation in a patient with a chronically draining mastoid cavity

August 10, 2022

By Andrew J. Ebelhar, MD

The chronic mastoid cavity can present an additional obstacle for implantable hearing device rehabilitation of severe hearing loss.  Endoscopic management of a radical mastoid cavity can be helpful in offering patient’s implantable solutions by limiting surgical incisions and reducing operative time.

Case Study

A 33 year-old female with a history of a canal wall down mastoidectomy as a child presented for evaluation of a chronically draining mastoid cavity and hearing loss. The patient stated that her ear had persistent purulent drainage since the operation.  She had been evaluated by previous Otolaryngologists and had failed medical therapy at rehabilitating the mastoid cavity. She had never been able to wear a hearing aid due to the extensive drainage. Examination showed a very high facial ridge and deep mastoid cavity with purulence and granulation tissue present.  The neotympanic membrane was retracted with no aerating of the middle ear space (Figure 1). Audiogram showed right ear masked bone conduction pure tone average of 21dB with air pure tone average at 93dB (Figure 2).  The patient was offered right endoscopic subtotal petrousectomy and ear canal closure with second stage Osia® implant placement for hearing rehabilitation.

Figure 1 – Endoscopic view, right ear

The deep mastoid bowl with granulation is seen outlined with the thick black line.  The high facial ridge is marked with the yellow “x” and the middle ear space with retracted squamous epithelium is outlined by the thin yellow line.

Figure 2 – Audiogram

Maximal conductive loss present on the right

An endoscopic transcanal technique was used to removal of all skin and squamous debris from the ear canal, mastoid cavity, and middle ear space.  The bony surfaces were drilled to ensure all removal of skin and mucosal tissue.  A modified Rambo flap was used to close the ear canal in a cartilaginous layer and then a skin layer.  The patient had no postoperative issues and presented three months later for an endoscopic mastoidotomy and middle ear exploration and Osia implantation.

A post-auricular incision was used and the subcutaneous tissues elevated out of the mastoid.  The endoscopic was introduced into the mastoid cavity and adhesions were lysed and the middle ear space visualized.  Thorough inspection did not reveal retained squamous material.  The Osia implant was then placed posterior to the mastoid cavity and the incision closed.  The patient had an uneventful postoperative course and underwent activation of the Osia device four weeks after implantation.  Follow up at one year showed a stable ear canal closure. She was very pleased with hearing results and the resolution of her persistent drainage!

For Osia surgery tips & tricks check out our professional webinars.

About the author: Dr. Ebelhar is originally from Owensboro, Ky., and attended Western Kentucky University for his undergraduate studies. He graduated from the University of Louisville School of Medicine in 2012 and completed his Otolaryngology (ENT-Head and Neck Surgery) in 2017 at the University of Kentucky. He is board certified in Otolaryngology-Head and Neck Surgery. He started the Med Center Health ENT Implantable Hearing Solutions program in 2017, offering both Cochlear Implants and Bone Anchored Hearing Aid implants. In 2020, he became one of the first surgeons in the country implanting the new Osia device.

man and woman looking in eyes

Baha Dermalock and Implant Stability

January 8, 2019

Baha

What is implant stability and why does it matter?

By Shawn Enter

Dating back to the 1950s, Swedish Professor P-I 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.  Today, Cochlear offers the most advanced titanium implant in the Baha® 300 Series implant.  The BI300 implant boasts the TiOblast™ surface for faster/stronger osseointegration and secondary stability when compared to previous implants. It has small sized threads 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.1, 2 The chart below shows 5-year follow up data of primary and long-term strength of osseointegration with the Baha 300 Series implant. Baha implant stability

Whether a sound processor is actively loaded on a Baha Connect system or passively loaded on a Baha Attract system, your patients will benefit from the most advanced titanium bone conduction implant available; the Baha 300 Series implant.

The Importance of DermaLock™

By Kelly Crettol

Kelly Crettol

 

The Cochlear® Baha® Connect System is a well-proven 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 titanium’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 Cochlear® Baha® BA400 Abutment with DermaLock™ technology features a plasma-sprayed hydroxyapatite (HA) coating and concave design that promotes soft tissue adherence and stability.3 

Hydroxyapatite (HA) has been shown to provide enhanced dermal adhesion, diminishing epidermal downgrowth and pocket formation, and 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.4

Dermalock microscopic comparison

Download our Baha Connect and Attract Systems 2-pager to learn more about Baha Systems.

About our guest authors:

Shawn Enter, Regional Surgical Training Manager at Cochlear Americas

Shawn is responsible for training surgeons and OR staff in the Cochlear Implant, Baha and Vistafix product lines.  He also supports complicated surgical scenarios and assists in new product launches.  Shawn joined Cochlear as an Area Business Manager and has worked in the Surgical Specialist role over the last five years.  Prior to joining Cochlear in January of 2010, Shawn provided surgical training and support in the Orthopedic industry for DePuy Mitek and Stryker.

Kelly Crettol, Surgical Education Manager at Cochlear Americas

Previously, she was a RSTM for the West Region and has been with Cochlear since February 2016. In her new role, Kelly is responsible for the development and execution of Cochlear’s surgical and fellowship education programs which includes development of educational content, implementation, promotion and assessment of surgical education programs.  She is also responsible for the coordination and collaboration with both internal colleagues and professional partners, including KOLs.

Kelly has over twelve years of experience in pharmaceutical and medical devices sales from prior organizations. Kelly graduated from Pennsylvania State University with a B.S. in Psychology.

 

References:
  1. 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.
  2. 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.
  3. 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.
  4. 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.
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