Interview with Connie R Bilaterally Implanted BAHA Patient
AO/Beck: Hi Connie. Thanks for meeting with me today.
Connie R: Hi Dr. Beck. Thanks for inviting me.
AO/Beck: Connie, without getting too personal, I wonder if you'd be willing to tell the readers a little about your education and profession?
Connie R: Sure. I am a librarian and I earned my master's degree in Library and Information Services. Through the years I have worked in a few different library environments, and I enjoy it very much.
AO/Beck: Thanks Connie. Can you tell me about your hearing loss please?
Connie R: Yes. I'm 58 years old. I was born with Treacher Collins syndrome and with bilateral atresia, meaning my inner ears were fine, but the ear canals were not open at birth, so sound couldn't get to my inner ear. This is one instance of what is generally referred to as conductive hearing loss. I first wore a hearing aid when I was 6 years old, around 1951 or so. That was a bone conduction hearing aid worn on my body, a large boxy sound processor which contained the microphone. It had a wire that went to the oscillator, which was pressed against my skull by a stainless steel spring-loaded headband. That system conducted sound through my skull bones on one side to both cochlea. Because of the logistics and physical size of the body-worn hearing aid, I could wear only one sound processor and one oscillator.
AO/Beck: Can you recall how that worked for you?
Connie R: Yes. At the time, it was pretty good actually. It didn't distort sound, and I was able to hear clearly. Of course, wearing all of that equipment was not comfortable, but it did work. What I didn't hear, I supplemented as best as I could by lipreading. Subtle tones I didn't hear at all and didn't realize what I was missing. As I mentioned, Dr. Beck, my hearing loss was purely conductive and so I just needed sounds to be louder. That first hearing aid and the several body aids I wore through the next twenty-odd years served their purpose. Eventually I was fitted with a behind-the-ear hearing aid which was modified for bone conduction. I wore modified BTE bone conduction aids for many years. I still wore the headband and had the oscillator pressing against my skull on one side while the hearing aid/microphone itself was now behind my ear on the opposite side, positioned by the headband. Many people with traditional bone conduction hearing aids continue to use that system. Not only is it uncomfortable, I have been told that it's somewhat embarrassing for males, due to the high visibility of the headband. However, until the Baha System, that was the only way for people with conductive hearing loss to use bone conduction hearing aids, and most people could wear only one bone conduction hearing aid due to the fact that you cannot place an oscillator too close to the microphone, because of feedback. Not to mention how uncomfortable two oscillators and two hearing aids on one headband would be! For years I had wistfully wondered if there would ever be a way for me to have bilateral hearing...and the first time I read about the Baha System, I thought, "hey, you could easily have TWO of these!"
AO/Beck: Just to clarify, conductive hearing loss is the type of hearing loss that results from a mechanical blockage of sound, such as absent or narrow ear canals, impacted ear wax, or a foreign object in the ear, or a broken ear drum to name a few. In those cases, the inner ear generally is fine, but sound needs to be very loud to reach the inner ear. In situations which are not surgically treatable, traditional air conduction hearing aids can sometimes be used. However, for more significant conductive hearing loss, another way to stimulate the inner ear is to use bone conduction hearing, which is what the Baha System provides. One important point is that the Baha has another whole group of patients who can benefit from this technology, and those are people with Single Sided Deafness. We'll talk more about that with other interviewees but for now, I'd like to stay focused on your situation and your conductive hearing loss.
Connie R: OK, sure. The Baha System sound processor allows me to hear almost at normal loudness levels. In fact, I am hearing you quite comfortably over the telephone with my Baha. Actually, I am wearing two sound processors, as I have for the last two years.
AO/Beck: Connie, can you tell me the degree of your hearing loss?
Connie R: I am not sure of the numbers. I know the audiologist told me it's moderate-to-severe. When I take off the sound processor to shower or swim, I cannot hear much...unless it's very loud and very close to me, like a loud door slamming right behind me.
AO/Beck: What do you have to do everyday to keep the skin around the implant clean and healthy?
Connie R: Before I talk about that, let me take a step back. The Baha System is bone anchored, so there is a little screw placed into the bone behind my ears, on both sides, which comes through the skin to the external piece. That's called the abutment, and that's what the Baha external sound processor snaps on to. When the sound processor is snapped onto the screw, the screw vibrates with the sound processor, and the sound is transferred to my inner ears using bone conduction hearing.
So the titanium abutment actually does come out of the skin. For this reason it is important to keep the area around the abutment clean and healthy. Entific provides a very soft brush which is similar to a toothbrush, and I use this in the shower when washing my hair to gently scrub around both abutments. I also use a Q-Tip once a week or so to gently go around and under each abutment to clean out any debris (skin flakes, dried skin cells, etc.). Ordinary soap and water works just fine for this. During the post-operative period, the surgeon provides instructions for detailed cleaning, which involves using hydrogen peroxide and antibiotic ointment, but once the initial healing process is complete, the day-to-day maintenance is quite simple and becomes just another part of one's daily hygiene. It is important to keep up with this, though, in order to prevent any problems from developing. I use a mirror to check my abutments and also ask a friend to take a look periodically, too.
AO/Beck: Sounds like you've done a lot of homework. You have a very good understanding and appreciation of how this technology works.
Connie R: Thanks. I really worked hard to learn all of this! In addition to reading about the Baha, I spoke to lots of other people who were using one or two sound processors and pretty soon I decided now's the time. The Baha System is becoming more prevalent and more patients with different conditions have been able to utilize this unique technology.
AO/Beck: What was it that made you decide to get two? Certainly many audiologists and otolaryngologists would tell you that using one Baha should really stimulate both ears anyway!
Connie R: Yes, many people told me that, but I knew from the very beginning that I wanted two. It was the right decision for me because for the first time ever, I think I have nearly true bilateral hearing. With just one Baha the sound is clearer than I ever had with my traditional bone conduction aid. However, with two, there is a noticeable improvement. When I wear the two units together, sound is richer and has more dimensions to it. I can hear more tones now; tones that I had missed before. Listening to music is a whole new experience for me! I didn't realize what I was missing. Now I can tell where sounds are coming from. I went 50 years without knowing where sounds were coming from, but now I can hear this, and it's made my life much easier! I can also hear the difference between using one BAHA versus two, and it is pretty significant. When I wear only one Baha, the non-amplified side is missing something and the quality of the sound is not as full as it is with two. For someone with bilateral conductive loss, I would recommend two Bahas. I do want to reiterate that even one Baha is a significant improvement over a traditional bone conduction aid. With the Baha System, the sound quality is remarkably clear and pure. There is the comfort factor, too; when I am wearing my sound processors I do not even feel them in place on my head. I have a groove in my skull from the years of wearing a headband. Aside from the comfort factor, while using a traditional bone conduction aid, subtle tones and sounds are lost.
AO/Beck: So if you were wearing both sound processors, and we were out walking on the street and someone called your name, would you be able to tell where the sound was coming from?
Connie R: Absolutely. Things like that happen all the time. In the old days, I had to look all around to figure out where the sound was coming from and it was very embarrassing. Now I can tell easily and for me, that's really a remarkable change. It is actually a safety issue, too, being able to hear from which direction sounds are coming.
AO/Beck: What about noisy situations?
Connie R: I do very well with the two Bahas in noise. In the past, I always had to turn down the volume control on my traditional bone conduction hearing aid, and even with that, if it was noisy, I just couldn't separate out the various sounds because everything was pouring into one microphone on one side. With the two Bahas, I can get by in a crowded and noisy situation and I can hear and make sense of what people speaking to me are saying. I didn't anticipate doing well in noise - it was an unexpected benefit! I find that I also do well with situations where I am walking alongside a person; I no longer need to keep looking at them to see what they're saying, nor do I have to make sure that they're on the side with the microphone. With two Bahas, that's no longer an issue.
AO/Beck: Were your implants done as an out-patient procedure, or did you spend the night at the hospital?
Connie R: I was an outpatient. I went in and out of the OR in about 90 minutes. They used local anesthetic, and some other IV medicines, and then after another hour or two I was on the way home. Most adults undergo the procedure with local anesthetic, but for children general anesthesia is usually the norm. The recovery process was surprisingly quick, and I was back at work a week after the surgery.
AO/Beck: And if you had to do it again, would you?
Connie R: Yes. Absolutely. I wish I had done it sooner! I have talked a lot about the value of bilateral Bahas, but basically, what this is about is bilateral hearing. In my situation, I have bilateral loss and was thrilled at the opportunity to finally have bilateral hearing due to the compact size of the sound processor and the fact that each is a self-contained unit. I snap a sound processor on each side of my head and away I go. In other situations someone may not need two Bahas if they're experiencing hearing loss on only one side, and a single Baha could be the answer for their problem. Of course that varies and they should speak with their audiologist and their ear surgeon to see what's best for them.
AO/Beck: Thanks so much for your time Connie. It's been a pleasure.
Connie R: Thank you too. I am happy to be able to share my experience with the Baha System.
For more information about the BAHA system, click here.
