Bone Anchored Hearing Aid
A bone anchored hearing aid is a surgically implanted device that transmits sound vibrations by direct bone conduction to the inner ear. The titanium prosthesis is embedded into the skull with a small support on the skin and functions as a bypass to the external auditory canal and middle ear.
A bone anchored hearing aid is an alternative to a regular hearing aid for people with conductive or unilateral hearing losses or single-sided deafness. Some people with mixed hearing losses cannot wear hearing aids in or behind the ear.
How a bone anchored hearing device works is through the use of two parts: a titanium bone implant and an external sound processor, which gathers sounds and converts them into vibrations to the embedded implant that can then vibrate the surrounding bone setting up sound waves in the inner ear resulting in the firing of the auditory nerve.
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What Happens During Surgery
During an outpatient surgical procedure, an ear-nose-throat doctor or other surgical specialist places a small titanium implant into the mastoid bone behind the ear. The implant may have a small abutment that sticks out through the skin for attaching the external part of the device. Over time, the titanium implant integrates with the bone. The removable microphone and sound processor can then be attached via a built-in magnet or by clipping onto the abutment.
The goal is that all parts fit snugly together, as a snug fit helps hearing implants convey vibrations through the bone more effectively.
The kind of operation you receive will be different depending on which manufacturers system you choose. For example, Oticon Medical utilizes MIPS , which takes an average of 15 minutes to perform and usually only requires local anesthesia. MIPS reduces the likelihood of complications because it doesnt require suturing, which eliminates scarring and fosters rapid healing.
MIPS also reduces the likelihood of complications because it leaves more of the skin, blood vessels, and nerves intact. The operation was designed to create the smallest incision possible, leaving the skin and hair follicles around the new abutment intact. Recovery typically requires only a day or two of rest before you can return to your normal activities. With few exceptions, most candidates for a bone-anchored hearing device can safely undergo MIPS.
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Results Of The Literature Search
The search yielded 141 citations articles. One researcher reviewed the abstract of each citation and determined whether the article has met the inclusion criteria and exclusion criteria. The full texts of eligible studies were reviewed to confirm eligibility. The Level of evidence was assigned according to the following scale that is based on the hierarchy by Goodman. An additional designation g was added for preliminary reports of studies that have been presented to international scientific meetings.
Thirty-six articles met the inclusion criteria. One hundred and five articles were excluded for the following reasons:
|Foreign language articles|
Seven review articles, one consensus guideline and one reference on level of evidence were also used for background information or methodology bringing the total bibliography to 45.
Who Can Benefit From A Baha
Patients with chronic middle ear conditions or outer ear problems or congenital defects of the ear who cant wear hearing aids may be candidates for a Baha as long as one ear has a cochlea that can hear at a moderate hearing level or better.
A second category of candidates are patients with single sided deafness. This includes patients who have lost all or most hearing in one ear, in which a conventional hearing aid is not helpful, but have good hearing in the other.
A Baha may provide an excellent hearing alternative for patients who cannot benefit from a traditional hearing aid, or in other words, for an ear that is un-aidable with a conventional hearing aid.
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About The Ontario Health Technology Assessment Series
To conduct its comprehensive analyses, the Medical Advisory Secretariat systematically reviews available scientific literature, collaborates with partners across relevant government branches, and consults with clinical and other external experts and manufacturers, and solicits any necessary advice to gather information. The Medical Advisory Secretariat makes every effort to ensure that all relevant research, nationally and internationally, is included in the systematic literature reviews conducted.
The information gathered is the foundation of the evidence to determine if a technology is effective and safe for use in a particular clinical population or setting. Information is collected to understand how a new technology fits within current practice and treatment alternatives. Details of the technologys diffusion into current practice and input from practicing medical experts and industry add important information to the review of the provision and delivery of the health technology in Ontario. Information concerning the health benefits economic and human resources and ethical, regulatory, social and legal issues relating to the technology assist policy makers to make timely and relevant decisions to optimize patient outcomes.
Cochlears Baha Attract Device
The Baha Attract device requires, a longer scalp incision. A fixture is inserted into the skull in the same way as in the Connect surgery, but a magnet is screwed on to the conical connection of the fixture instead of an abutment. The skin is brought over the magnet and sutured and a dressing is applied. This procedure takes approximately 60-90 minutes. Possible complications include skin problems and discomfort from wearing the processor as the magnet pressure has to be high for optimal hearing with this device.
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How Does A Bone Conduction Hearing Device Work
A bone conduction hearing device has two parts: an external part and a surgically implanted fixture placed in the bone behind the ear. There are two types of bone conduction implant. The first is a fixture that protrudes through the skin so that the processor can attach onto it. The second is fully implanted under the skin, with the processor attached using a small magnet inside the processor. The diagram below shows the magnet version.
Image: Thanks to MED-EL
Are You A Good Candidate For A Bone Anchored Hearing Aid
You are a good candidate if you have single-sided deafness or have conductive hearing loss . If you suffer from any of the following conditions, you can benefit from a BAHA device:
- Acoustic neuroma
- Infection of the ear canal
- Malformation of the ear canal or middle ear
- Menieres disease
- Middle ear dysfunction
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How Do You Find Out If You Or Your Child Should Use A Bone
The decision-making process involves several appointments and thorough testing by several specialists. You or your child may need some or all of the following evaluations:
- Hearing test: Your hearing is measured to accurately assess hearing loss and to discuss the most helpful follow-up services and/or technology.
- Sensory device evaluation: Youll meet with an audiologist to discuss your hearing device options, and you may have the opportunity to trial a demo device in the office.
- Computerized tomography scan or magnetic resonance imaging : These images will help your surgeon evaluate if you are a candidate for surgery
- Medical/surgical consultations: The surgeon will meet with you to see if youre medically able to have the needed procedures. They will talk with you about instructions, the procedure and what to expect after surgery in terms of healing and possible hearing outcomes.
- Communication evaluation: Auditory, speech and language skills are evaluated.
In general, bone-anchored auditory implants are appropriate for adults and children with conductive or mixed hearing loss in one or both ears, or certain cases of single-sided deafness . Its crucial you or your child take part fully in the rehabilitation process, have family support and a clear understanding of the benefits of bone-anchored auditory implants.
The Advantages Of The Baha
The BAHA system uses an osseointegrated titanium implant to propagate sound directly to the inner ear through the skull, bypassing the impedance of the skin and subcutaneous tissues. Most patients express a clear preference for the BAHA over conventional bone-conduction hearing aids. The device has been thoroughly evaluated by various implant groups. Since its introduction in 1977 until 2004, more than 15,000 patients have been fitted with BAHAs worldwide.
A key advantage of the BAHA is that the ear canal is not occluded by ear-moulds, preventing humidity build up and skin irritation. Certainly, there are obvious advantages of the BAHA over air conduction hearing aids when there is no external ear canal, such as in cases of congenital or acquired external canal absence. The expected outcome of BAHA surgery can be assessed preoperatively by using the head-band or test rod , tremendously helping patient selection. Moreover, the absence of the interposed soft tissues in BAHA results in a better sound quality, requires less energy, and offers greater comfort than the traditional bone conduction hearing aids. Hakansson summarized the audiometric results from 122 patients with an average follow-up time of 5.6 years. They found the improved quality of life reported by their patients is a combination of improved audibility and quality of sound , improved comfort, and relief from middle ear and ear canal diseases occasioned by conventional hearing aids.
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What Is A Bone
A bone-anchored hearing aid is a medical device used by people with hearing loss. This type of hearing aid conducts sound directly through the bone to the inner ear. People may be candidates for such devices if they cannot wear conventional hearing aids in the ear. A minimally invasive surgery is required to wear a bone-anchored hearing aid, and the patient will need several appointments to fit and adjust it for comfort.
This device includes a titanium screw used to conduct sound from a fixture attached to a fitting at the top of the screw. In the initial implant procedure, the screw will be placed just behind the ear in the patient’s hairline. The bone will eventually grow around the screw in a process known as osseointegration, holding it firmly in place and allowing it to support the external attachment. Sound is conducted along the length of the screw to the patient’s cochlea, allowing the patient to hear.
Predicting Hearing Ability With The Baha
The BAHA introduces the sound into the mastoid bone directly , bypassing the damping effects of the skin and subcutaneous tissues . The BAHA is expected to be better in many respects since the titanium screw delivers sound directly to the skull without soft tissue interference. The headband or test rod, although crude in many ways, still offers an easy, fast and objective way of assessing bone conduction capacity which allows the patient to directly experience bone conducted sound, and so helps in decision making for him/her.
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Type Of Bone Anchored Hearing Aids
There are three main options for bone anchored hearing aids.
- Cochlear Baha® Implant System This device is held onto the head with a metal studabutment , but there is also a version that uses a magnet . It works well and is unobtrusive for patients with unilateral hearing loss.
- Sophono This device is held onto the head with a magnet, and another magnet is implanted into the skull. It performs best with speech frequencies and is designed so that the bone implant is not visible. Its ideal for patients with less severe hearing loss at the inner ear level.
- Ponto System This device is attached to a stud located behind the ear. It has many programmable features and has a higher frequency response than the Sophono.magnetic implants.
Indications And Contraindications For Use Of Baha
No clinical guidelines for the use of BAHA were found. However, the inclusion and exclusion criteria for patient selection in the BAHA studies shed light on which patients may achieve optimal benefits from BAHA.
Patient selection criteria of the Nijmegen BAHA program indicates that the patients
Be at least 6 years old
Have bilateral conductive or mixed hearing loss but still can benefit from sound amplification.
May have a sensorineural hearing loss component that did not exceed 65 dB hearing level.
Are not eligible for reconstructive surgery of the middle ear to improve hearing because of ear canal atresia or a chronically draining ear
Have already tried a conventional bone conductor and rejected it because of pain or skin irritation owing to the pressure of the bone conduction transducer or because of serious problems with the appearance of this often disfiguring device.
The audiological criteria of the Birmingham BAHA program were that patients have the following:
Average bone conduction thresholds less than 40 dB HL and less 60 dB HL
Speech discrimination score greater than 60%
Realistic expectations about BAHA.
The Canadian Program used the following selection criteria :
Patients are prioritized from 1 to 4 in decreasing order of urgency:
Bilateral congenital atresia
Bilateral chronic ear disease resistant to medical and surgical therapy and failed conventional hearing management.
Unilateral congenital atresia.
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Hearing Aid Brand Reviews
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What Is The Post Operative Care Required
The abutment needs to be cleaned on a twice weekly basis with a small very soft “toothbrush” . In addition, the implant is best cleaned with a baby wipe or alcohol wipe each day. The hearing aid must be removed for showering and swimming. A small cover is available for the abutment, if desired, when the hearing aid is not being worn.
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Can You Hear Right Away
The skull and skin have to heal before the external device can be clipped on or magnetically connected. The time needed for healing is specified differently by each manufacturer, from 3 weeks to 3 months. Once the external device is attached, it can be programmed for the patient’s specific hearing loss. Wearing a bone-anchored hearing system would be similar to wearing an acoustic hearing aid at this pointthere may be some adjustments needed as the patient gets accustomed to hearing and listening to amplified sounds.
Are You A Good Candidate For Baha
Only your doctor, together with your audiologist, can determine if you are a good candidate for Baha. Possible Baha candidates may have hearing loss from:
- Malformation of the ear canal or middle ear
- Infection of the ear canal resulting in chronic draining ears
- Chronic otitis media
- Menieres disease
Is it right for me?
Now, you may be wondering if a Baha solution is right for you. Ask yourself these questions and if you answer yes to any of them, then you may be a good candidate for the Baha system.
- Are you deaf in one ear?
- Do you have trouble getting sufficient loudness when using hearing aids?
- Do you battle feedback or distorted sound quality when using hearing aids?
- Do you suffer from sore or irritated ears due to your hearing aids?
- Do you have draining ears?
- Do you have malformed ears or ear canals?
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Bone Anchored Hearing Aids Market 2021
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The MarketWatch News Department was not involved in the creation of this content.
Mar 15, 2022 –According to the latest report by IMARC Group, titled “Bone Anchored Hearing Aids” the global bone anchored hearing aids market grew at a CAGR of around 6% during 2015-2020. Looking forward, IMARC Group expects the global bone anchored hearing aids market to exhibit moderate growth during 2021-2026. Also known as an osseointegrated mastoid implant, bone anchored hearing aids refer to surgically implanted devices utilized by individuals experiencing different types of hearing loss. They represent an acceptable alternative if an air-conduction hearing aid is contraindicated. They comprise a titanium bone implant and a sound processor that conducts sound vibrations and assists in propagating sound directly to the inner ear. As compared to the traditional bone conduction hearing aids, BAHA provides better sound quality, greater comfort, and lesser chances of infection.
We are regularly tracking the direct effect of COVID-19 on the market, along with the indirect influence of associated industries. These observations will be integrated into the report.
Adverse Skin Reaction Rates
Adverse skin reaction is a major complication of BAHA that impacts on implant survival. The proportion of patients that experienced adverse skin reactions ranged from 8 to 30%. Most of the reactions were mild and responded to treatment with antibiotic ointment. About 1% to 2% of adverse skin reactions required revision surgery, and less than 1 % required removal of the fixture. Personal hygiene, care of the abutment, and careful follow-up by surgeons informed in the care of these patients make critical impact on adverse skin reaction rates.
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