Bone Anchored Hearing Aid

A Bone-Anchored Hearing Aid is a type of hearing aid based on bone conduction. It is primarily suited to people who have conductive hearing losses, unilateral hearing loss and people with mixed hearing losses who cannot otherwise wear 'in the ear' or 'behind the ear' hearing aids. The acronym BAHA is a trademark.

Use and Operation

Bone-anchored hearing aids use a surgically implanted abutment to transmit sound by direct conduction through bone to the inner ear, bypassing the external auditory canal and middle ear. A titanium "post" is surgically embedded into the skull with a small abutment exposed outside the skin. A sound processor sits on this abutment and transmits sound vibrations to the external abutment of the titanium implant. The implant vibrates the skull and inner ear, which stimulate the nerve fibers of the inner ear, allowing hearing.

The titanium fixture bonds with the surrounding tissue in a process called osseointegration. The hearing aid can be used once osseointegration is complete, usually two to six months after implantation.

Cochlear's BAHA hearing aids have a patented [US Patent 4,498,461. Coupling to a bone-anchored hearing aid [http://patft.uspto.gov/netacgi/nph-Parser?Sect2=PTO1&Sect2=HITOFF&p=1&u=%2Fnetahtml%2FPTO%2Fsearch-bool.html&r=1&f=G&l=50&d=PALL&RefSrch=yes&Query=PN%2F4498461] ] snap-lock coupling which allows it to clip into the abutment. The BAHA is then treated as a regular hearing aid, running on small circular batteries which last approx 6 to 14 days. The snap-lock coupling is designed to detach upon impact as a safety feature to prevent damage to the implant or surrounding tissues.

uitability

Bone-anchored hearing aids can help:
* people who have chronic inflammation or infection of the ear canal and cannot wear standard 'in the ear' air conduction hearing aids.
* people who have malformed or absent outer ear and ear canals as is common in medical conditions such as Treacher Collins syndrome or Microtia.
* people who have single-sided deafness.

Bone-anchored hearing aids have also been offered successfully to people with bilateral conductive loss due to ossicular disease e.g. Otosclerosis and for hearing impairments related to other congenital syndromes such as Down’s Syndrome.

In Canada, stage one surgery for BAHA has been implanted into children as young as 13 months at the Hospital for Sick Children in Toronto. Stage two surgery has been done as early as 22 months. For infants, an interim measure young infants can be provided with a BAHA softband allowing them to use a BAHA. This is a tight headband which the infant wears to hold a BAHA against the skull.

urgical Procedure

In recent years improvements to the surgical procedures have resulted in most patients being able to have a single stage procedure carried out under local, or a short general anaesthetic. Most patients are able to leave hospital within a few hours, or the day after their procedure with many not even requiring analgesia in the following days.

Osseointegration is the process of the titanium fixture bonding to the bone. There is a high success rate for osseointegration above 95% according the latest studies in medical journalsFact|date=March 2007. Occasionally infection and other problems will prevent osseointegration from being successful. In these cases the patient will be given time to heal and further more cautious attempts at the surgical procedure can be made.

In many cases, the surgeon will implant a second "sleeper" receptacle for use should the initial receptor fail or be damaged.

A double stage procedure is sometimes carried out for small children / babies or other medical reasons. The first stage involves peeling back a small 1 by 1 cm section of skin behind the ear, then drilling one or more holes for the fixture. (Some surgeons will place a "sleeper" receptor.) The skin is then grafted back and the child waits for the skull to continue to thicken and for osseointegration to occur properly. After osseointergration (can be 6 to 8 months) the second stage is performed. The second stage is another surgery in which the "post" is attached, and the skin is grafted around the "post" This will require healing for several weeks, at which point the BAHA would be fitted.

Dangers, Risks, Durability, Repairs

The titanium screw of the BAHA is screwed from outside into the bone. Because of this open wound, there will always be a risk of infection.

Daily care is required. This consists of using a very soft toothbrush like tool to scrub around the post and skin area to keep it clean and not infected. Daily use of an antibiotic ointment such as Polysporin assists in minimizing infection.

Although designed to come off the post should they be contacted, the units are quite fragile if impacted only slightly.

Cochlear has a warranty and repair policy. The audiologist or Cochlear may provide "loaner" units during the repair period.

Costs

In America the cost of the Baha device is approximately $ 4000. In The Netherlands the cost of the device is approx € 3000 (in 2008).In America surgery cost can cost as much as $ 30,000 including the device and can vary depending upon the type and hospital.

Manufacturers

At present Cochlear Limited (up to 2005 Entific Medical Systems, a Swedish company) is the only manufacturer of bone-anchored hearing aids. It has registered the acronym BAHA as a trademark [Trademark 783134 registered in Sweden on 11 June 2002 [http://www.wipo.int/cgi-mad/guest/ifetch5?ENG+MADRID-FULL.vdb+11+1184765-KEY+256+0+746354+BASICHTML-ENG+1+2+1+25+SEP-0/HITNUM,PN,MAR,,,IMAGE+MAR%2fbaha+] ] .

Models

There are different types of systems. The BAHA Classic and Compact will not be manufactured anymore. In 2008 the following types are available: the BAHA Cordelle, Divino and Intenso.
* [http://www.cochlearamericas.com/Products/1980.asp BAHA Cordelle II] . A bodyworn BAHA for people with a severe hearing loss who need more amplification than the other BAHAs available. The Cordelle II consists of a transducer which snaps onto the abutment and a bodyworn unit. This is the only BAHA to have an induction telecoil receiver built in.

* BAHA Classic 300. This is the older BAHA device which has been mostly superseded by the Compact and Divino but is still worn by those with more severe and mixed hearing losses. This will be discontinued in February 2007, with repairs ceasing to out of scheme models after that.

* BAHA Compact. Rated as identical to the Classic but found to be slightly less powerful by a few users. The Compact is 33% smaller than the Classic and has added AGCo and improved shielding from mobile telephone signals. Until July 2005 the Compact was the latest model.
* [http://www.cochlearamericas.com/Products/1978.asp BAHA Divino] . Newly released in July 2005 this is the long awaited digital BAHA which has a built-in directional microphone. While some people are disappointed that the digital options were not very flexible, new users are said to be very happy with it. Even though the Divino takes a while to get used to for adolescents, in the long run it has been proven to be successful for most ages.
* [http://www.cochlearamericas.com/Products/2209.asp BAHA Intenso] . More power and clearer sound quality in all types of listening environments plus far less irritation from feedback.

References

External links

* [http://www.cochlear.com/ Cochlear] . The manufacturer of the BAHA device. Free registration required to get full access to information.
* [http://www.baha-users-support.com/ Patients' BAHA site] . "Run by baha users, for baha users".
* [http://advocacy.letthemhear.org The Let Them Hear Foundation] . A 501(c)(3) non-profit who provides free insurance appeal assistance to individuals who have been turned down by their insurers for BAHA devices. A conference concerning Microtia treatment options is sponsored by the Let Them Hear Foundation and held in Palo Alto, California. The conference is always the first Saturday in October. Conference attendees will be able to see presentations on both medpor and rib graft microtia reconstruction, atresia repair, prosthetics, jaw distraction and Baha devices.
* [http://forumbaha.discutforum.com/ Les curieux de la prothese BAHA] . A French BAHA forum for the users by the users.
* [http://www15.ocn.ne.jp/~bahanet/ BAHA Network Japan] . Japanese BAHA network.
* [http://www.single-sided-deafness.com/ Single-Sided Deafness (SSD)] . A Dutch website about the Baha device for people having single-sided deafness.