BAHA – Bone Anchored Hearing Aids Patients Information

Hearing restoration by osseointegrated auditory implants

Mr James W Fairley BSc MBBS FRCS MS

Consultant ENT Surgeon


© 2006 – 2017 JW Fairley Content Last updated 11 October 2017


Background

What is a BAHA?

A BAHA (Bone Anchored Hearing Aid) is an auditory implant and sound processor.

Who can be helped by BAHA?

BAHA is a treatment option for people with moderate to severe hearing loss who don’t benefit from normal (air conduction) hearing aids. The commonest reasons for considering BAHA are

  • chronic ear infection – when wearing normal hearing aids makes the infection worse
  • single sided deafness due to tumours, surgery or trauma
  • children born with abnormal ears

How does a BAHA work?

baha-directboneconduction

A small titanium screw is implanted behind the ear. Sounds are conducted directly through bone to the cochlea, bypassing any problem in the outer or middle ear. You need at least one working cochlea for a BAHA to help you hear. The sound processor is normally hidden in the hair.

Three components of the BAHA system

The BAHA system consists of 3 parts:

  1. The sound processor
    baha-compact-grey-insitu250pxhi
    is a detachable electronic hearing aid with a snap-fit coupling to the abutment. The user takes the sound processor on and off as required, for example for hair washing or swimming.
  2. The abutment
    baha-abutmentsite-healthy-250pxhi
    is a socket attached by an internal screw to the fixture. The abutment penetrates the surface of the scalp and is shaped to hold the snap-fit coupling of the sound processor. The abutment can be unscrewed from the fixture for maintenance or replacement by the specialist audiologist.
  3. The fixture (or implant)
    baha-components-250pxhi baha-components-schematic
    is a small titanium screw, four millimetres long, implanted into the bone behind the ear. The fixture is permanent, it is not adjusted or removed. The metal becomes firmly anchored to living bone by the process of osseo-integration.

Pre-operative assessment

You will need both audiological and surgical assessment to find out whether the BAHA will be a suitable treatment for you.

Audiological assessment

The audiologist will do two main hearing tests to help decide if the BAHA will help you.

  • Pure Tone Audiometry (air conduction and bone conduction)The BAHA works by conducting sound directly to the cochlea by bone conduction. It doesn’t matter how much damage has been done to the outer ear, eardrum or ossicles (small bones of the middle ear). The BAHA will still work even if these structures are missing altogether. But you do need at least one working cochlea (inner ear). The hearing ability of the inner ear is measured by the bone conduction thresholds of the pure tone audiogram. The BAHA will still work with some damage to the inner ear. Depending on the results of the bone conduction audiogram, you may be suitable for a head mounted sound processor, or you might need the more powerful body-worn sound processor. If you are very deaf with poor cochlear function in both ears, a BAHA might not help you. You might need another treatment such as a cochlear implant.
  • A headband test (simulation of wearing a BAHA)baha-headband
    You will have the opportunity to “try out” a BAHA on a headband. The sound quality you will get from the headband is not nearly as good as the real thing, because the sound is muffled by having to pass through the soft tissues of the scalp. If you can hear reasonably well with the headband BAHA, you will hear better with the implant proper.

audiologistamandabanham3

Mrs Amanda Banham BSc MSHAA is a qualified independent hearing aid audiologist with over 20 years experience. She is trained in assessment and fitting of Cochlear Corporation and Oticon Medical Sound processors for bone anchored hearing systems, including Cochlear BP100, BP110, Cordelle, Oticon Ponto and Ponto Power Pro, as well as continuing to look after legacy systems including Compact, Intenso and Divino sound processors. Contact details:

Hearing Aid Consultancy
Wellington Cottage
Main Road
Sellindge
Ashford Kent TN25 6EQ

tel 01303 813531
mobile 07775 952609
website: HearingAidsInKent

Surgical assessment

microsuction-ear4

BAHA is commonly used to treat conductive hearing loss due to chronic ear infections. It can also be used to treat single sided sensorineural deafness, where one cochlea (inner ear) is no longer working.

Before recommending BAHA as a treatment, you will need a specialist assessment to confirm your diagnosis. Microsuction of the ear may be needed.

Is BAHA the best treatment for you? Other treatment options

Even if you are suitable for BAHA, there may be reasons why another treatment is better in your case. It is important to know what you hope for and expect from treatment, we can then tell you whether the BAHA is likely to achieve that.

Lifelong commitment

Having any form of implant surgery is an important decision with a lifelong commitment. We do not want hasty decisions, you should not feel under any pressure, we prefer you to have the chance to consider things carefully.

Help with best choice of treatment

We provide you copies of the written report on your assessment as a matter of course, and often advise you to think things over at home. On the other hand, we do not expect you to shoulder the burden of treatment choices alone, we are there to help. If the best choice of treatment is clear, we will tell you so. We will do our best to help you understand the pros and cons of all the treatment options.

Operation

Note: The detailed description below was the standard procedure up until summer 2013, we are now carrying out the much simpler linear incision without soft tissue reduction, with a much faster healing time and now aim to fit the sound processor after 2-3 weeks rather than 2-3 months.

bahabandage

Surgery to implant a BAHA fixture is not an ear operation, your ear itself is not operated on.

The titanium fixture is implanted into the skull behind the ear under local anaesthetic in the operating theatre. The procedure is similar to dental treatment, and takes less than an hour.

  • Hair is shaved above and behind the ear.
  • After cleaning with antiseptic solution, you will receive several injections to numb the area.
  • You will then hear the sounds of the dermatome raising a skin flap, and the soft tissues of the scalp being removed.
  • The actual drilling of the bone takes less than a minute and is painless.
  • The titanium fixture and abutment are screwed into place, and the skin flap is stitched down.
  • A dressing is positioned over the abutment. It is held in place by the temporary white plastic healing cap, which snap-fits into the abutment.

Dressings

baha healing cap

You will be able to take off your head bandage the day after surgery. You should leave the plastic healing cap alone, we will remove that at your first follow-up visit some two weeks following surgery.

Follow up

StSavioursHospital

We normally see you two weeks after surgery to remove the plastic healing cap and dressings. Your next follow up will be around 2 months. You will see the surgeon and, if the condition of the skin graft, abutment and fixture is satisfactory, will be able to proceed to fitting of the sound processor.

Fitting of Sound processor

Mrs Banham will show you how to take your sound processor on and off, and how to adjust it. You will also receive written information from the manufacturers of the sound processor, Cochlear or Oticon Medical.

Hygiene and cleaning of site

baha-hygiene

You have a lifelong commitment to cleaning and hygiene around the abutment. The BAHA is based on the same titanium technology used for dental implants. If you don’t clean your teeth every day, you will develop gum disease. Infection will set in and loosen the tooth and it will fall out. The same will happen with the BAHA unless you look after it. You may need daily cleaning with a baby toothbrush around the abutment, though some patients do not seem to need to clean so often.

MRI Scans and BAHA

MRI scans are OK with a BAHA – just take off the sound processor

MRIwarning280x400

It is OK to have an MRI scan with a BAHA. All patients undergoing magnetic resonance scans are asked whether they have any metallic implants. Strong magnetic fields inside the scanner could cause ferrous metal to move, and this could injure the patient. Patients with stainless steel wires, clips and pacemakers cannot safely have an MRI scan. But the BAHA fixture and abutment are made of titanium. Titanium is non-magnetic. It will not be affected by the magnetic field, and there is no problem with having magnetic resonance imaging with your BAHA implant. There are ferro-magnetic parts in the sound processor. You will need to take off the sound processor to go into the scanner.

Costs for private patients

Chaucer-reception2250pxhi

The total cost of a BAHA is made up of two main parts:

  1. The surgical procedure – the operation to fit the titanium screw and abutment
  2. The sound processor

The current cost of a single-stage BAHA surgery, carried out by Mr Fairley as a day case under local anaesthesia at the Chaucer Hospital Canterbury, is £4,249

(Note: The figure of £4,249 is for the operation, this does NOT include the sound processor, which is billed separately by the audiologist)

The fee of £4,249 for the operation is made up of

  • Surgeon’s fees £1,000
  • Chaucer Hospital Charges £3,249

Nearly all our patients prefer local anaesthesia. If you choose to have the operation done under a general anaesthetic, there will be an additional fee for the anaesthetist

What is included in the price

  • Day case surgical admission to the Chaucer Hospital, Canterbury
  • Operation to fit a single Oticon Wide ® BAHA fixture and abutment,performed by Mr Fairley under local anaesthetic
  • One Oticon Wide ® BAHA fixture and abutment (the Oticon abutment has a universal, open standard fit, is backwardly compatible and will accept all current sound processors from both Oticon and Cochlear, leaving you and your audiologist with the freedom of choice to purchase the sound processor that best suits your needs and budget)
  • All hospital consumables, dressings etc
  • First follow-up outpatient visit with Mr Fairley, whent the healing cap will be removed
  • Telephone and email support from Mrs Sylvia Fairley, Registered Nurse, before, during and after surgery

What is not included in the price

  • Audiologist’s Charges (including supply of sound processor) typically around £3,500 for Oticon Ponto Plus, Cochlear BP100 or BP110 advanced digital ear level sound processors, £2,900 for Cochlear Cordelle (body worn)
  • Pre-operative assessments by surgeon
  • Pre-operative assessments by audiologist (audiologist assessment fee £100)
  • Treatment for any underlying medical or ear condition
  • In particular out-patient microsuction treatment, if required, will incur further hospital and surgeons fees
  • Replacement / repair due to loss or accidental damage* to sound processors or abutments
  • Further out-patient consultations beyond initial follow-up to remove the healing cap.

*We strongly recommend that you take out insurance on your sound processor under the “all risks” section of your house contents policy

Ongoing Costs

A BAHA is not a one-off purchase, it is more like buying a car – you know you will have running costs, petrol, servicing, and will eventually need a replacement. With the BAHA you will need to pay for batteries, maintenance and allow for replacement of the sound processor in future years. It is not possible to know how any individual sound processor will behave, but most of our BAHA patients use their hearing aids all day, every day, with usage around 6,000 hours per year. The sound processor does contain moving parts (particularly the transducer which converts the sound signal into vibrations in the metal) and it will eventually wear out. The manufacturers of the sound processor estimate its working life expectancy to be around three to five years, depending on usage. You have two main options to budget for this

  1. Pay as you go – servicing, repairs and replacement as required
  2. Three year maintenance & replacement plancovers all repairs and servicing, with provision of replacement sound processor at 3 years. If your existing processor is still in working order, you can keep it as a spare. Cost approximately £3,500 spread over 3 years, equates to around £22 per week or £3 per day.

For full details of the maintenance replacement package, see Cochlear Corporation and Oticon Medical documentation.

New alternative to BAHA – Sophono Alpha 1 magnetic hearing system

The Sophono Alpha 1 implant is a new alternative to the conventional bone anchored hearing aid. It is fitted under intact skin. The sound processor is held in place by magnets. With no skin-penetrating abutment, problems with hygiene, pain and infection are largely eliminated. The magnetic coupling is not quite as powerful as the direct drive bone anchored system. As with all hearing implants, a careful pre-operative evaluation is needed.

NHS Availability of BAHA

Bone Anchored Hearing Aids are available on the NHS, but restricted to a variable degree around the UK. In 2010, in Kent and Medway District, BAHA became part of a List of Low Priority Procedures and Other Procedures with Restrictions. A check list of criteria is applied before funding can be considered.

Recommended further information

References to published medical papers on BAHA

  1. 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 Jul;120(7):537-42. Epub 2006 May 4. PMID: 16672090
  2. 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. PMID: 9015447
  3. Lustig LR, Arts HA, Brackmann DE, Francis HF, Molony T, Megerian CA, Moore GF, Moore KM, Morrow T, Potsic W, Rubenstein JT, Srireddy S, Syms CA 3rd, Takahashi G, Vernick D, Wackym PA, Niparko JK. Hearing rehabilitation using the BAHA bone-anchored hearing aid: results in 40 patients. Otol Neurotol. 2001 May;22(3):328-34. PMID: 11347635
  4. Dutt SN, McDermott AL, Jelbert A, Reid AP, Proops DW. The Glasgow benefit inventory in the evaluation of patient satisfaction with the bone-anchored hearing aid: quality of life issues. J Laryngol Otol Suppl. 2002 Jun;(28):7-14. PMID: 12138792
  5. Arunachalam PS, Kilby D, Meikle D, Davison T, Johnson IJ. Bone-anchored hearing aid quality of life assessed by Glasgow Benefit Inventory. Laryngoscope. 2001 Jul;111(7):1260-3. PMID: 11568551
  6. Arunachalan PS, Kilby D, Meikle D, Davison T, Johnson IJ. Bone-anchored hearing aid: quality of life assess by glasgow benefit inventory Clin Otolaryngol Allied Sci. 2000 Dec;25(6):570-6. PMID: 11123173 [PubMed – as supplied by publisher]
  7. Hol MK, Spath MA, Krabbe PF, van der Pouw CT, Snik AF, Cremers CW, Mylanus EA. The bone-anchored hearing aid: quality-of-life assessment. Arch Otolaryngol Head Neck Surg. 2004 Apr;130(4):394-9. PMID: 15096420
  8. Powell RH, Burrell SP, Cooper HR, Proops DW. The Birmingham bone anchored hearing aid programme: paediatric experience and results. J Laryngol Otol Suppl. 1996;21:21-9. PMID: 9015445
  9. McLarnon CM, Davison T, Johnson IJ. Bone-anchored hearing aid: comparison of benefit by patient subgroups. Laryngoscope. 2004 May;114(5):942-4. PMID: 15126761
  10. Dutt SN, McDermott AL, Burrell SP, Cooper HR, Reid AP, Proops DW. Patient satisfaction with bilateral bone-anchored hearing aids: the Birmingham experience. J Laryngol Otol Suppl. 2002 Jun;(28):37-46. PMID: 12138790
  11. Wazen JJ, Caruso M, Tjellstrom A. Long-term results with the titanium bone-anchored hearing aid: the U.S. experience. Am J Otol. 1998 Nov;19(6):737-41. PMID: 9831146
  12. Mylanus EA, Snik AF, Cremers CW. Patients’ opinions of bone-anchored vs conventional hearing aids. Arch Otolaryngol Head Neck Surg. 1995 Apr;121(4):421-5. PMID: 7702816
  13. McDermott AL, Dutt SN, Reid AP, Proops DW. An intra-individual comparison of the previous conventional hearing aid with the bone-anchored hearing aid: The Nijmegen group questionnaire. J Laryngol Otol Suppl. 2002 Jun;(28):15-9. PMID: 12138786
  14. Hol MK, Bosman AJ, Snik AF, Mylanus EA, Cremers CW. Bone-anchored hearing aids in unilateral inner ear deafness: an evaluation of audiometric and patient outcome measurements. Otol Neurotol. 2005 Sep;26(5):999-1006. Erratum in: Otol Neurotol. 2006 Jan;27(1):130. PMID: 16151349
  15. Kunst SJ, Hol MK, Snik AF, Mylanus EA, Cremers CW. Rehabilitation of patients with conductive hearing loss and moderate mental retardation by means of a bone-anchored hearing aid. Otol Neurotol. 2006 Aug;27(5):653-8. PMID: 16788427 [PubMed – in process]
  16. Proops DW. The Birmingham bone anchored hearing aid programme: surgical methods and complications. J Laryngol Otol Suppl. 1996;21:7-12. PMID: 9015443
  17. Cooper HR, Burrell SP, Powell RH, Proops DW, Bickerton JA. The Birmingham bone anchored hearing aid programme: referrals, selection, rehabilitation, philosophy and adult results. J Laryngol Otol Suppl. 1996;21:13-20. PMID: 9015444
  18. McDermott AL, Dutt SN, Tziambazis E, Reid AP, Proops DW. Disability, handicap and benefit analysis with the bone-anchored hearing aid: the Glasgow hearing aid benefit and difference profiles. J Laryngol Otol Suppl. 2002 Jun;(28):29-36. PMID: 12138789
  19. Lekakis GK, Najuko A, Gluckman PG. Wound related complications following full thickness skin graft versus split thickness skin graft on patients with bone anchored hearing aids. Clin Otolaryngol. 2005 Aug;30(4):324-7. PMID: 16209673