Interview with Rick A. Friedman MD, Ph.D., House Ear Institute, Los Angeles, California
AO/Beck: Good morning Dr. Friedman. Thanks for spending a little time with me today. Before we get to the BAHA system, would you please tell me where you went to medical school and when did you graduate?
Friedman: Hi Dr. Beck. I went to medical school at UC San Diego and I graduated in 1988 with my M.D.
AO/Beck: And you also have a Ph.D.?
Friedman: Yes. I earned my PhD at UC San Diego too, in Molecular Genetics and I finished that in 1994.
AO/Beck: And where did you go for your residency and fellowship training?
Friedman: I did my residency at UCSD in Otolaryngology and I did a fellowship at the House Ear Clinic in 1995.
AO/Beck: And your current position is?
Friedman: I am an associate of the House Ear Clinic. I'm a surgeon at the House Ear Clinic and I am Chief of the Section on Hereditary Disorders at the House Ear Institute.
AO/Beck: Very good. I know you're pressed for time this morning, but I would like to discuss the Baha System with you. Can you explain a little bit about that?
Friedman: Certainly. The Baha System was originally approved for patients with conductive hearing loss, and specifically for those who were, for one reason or another, not well suited to the use of a conventional hearing aid.
AO/Beck: So the original candidates might have been patients with chronic ears, such as ears that continued to drain, or had ongoing ear disease, and perhaps patients with unusual anatomy, such as congenital atresia?
Friedman: Exactly, those were the patients it was originally designed for. The Baha System offered tremendous benefits for people with chronic otitis media and with ears that were too wet to wear hearing aids. It had (and still has) great application for people with chronic otitis externa or skin allergies to hearing aid material - which is admittedly rare. Other original applications included situations such as unilateral or bilateral aural atresia in children, and in some cases with craniofacial abnormalities. In other words, in situations where we were less likely to be able to surgically reconstruct the ear canal, the Baha System offered a nice alternative. Sometimes, with unusual anatomic presentations, the facial nerve is in a bad location and surgery is simply contraindicated. In many of those situations, the Baha System allows the patient to hear through bone conduction and in those cases, it makes a terrific difference and it's a great alternative.
AO/Beck: How long have you been working with the Baha System?
Friedman: I've been working with the Baha System for about the past four years.
AO/Beck: So you've seen the before and after of the FDA changing their description of cleared applications and potential candidates?
Friedman: Yes, the FDA changed, and actually increased, or opened up their indications to include patients with unilateral profound hearing loss.
AO/Beck: And of course, at the House Ear Clinic, there are many patients in your practice who fit that description, as they are status post-op acoustic neuroma. Can you tell me about your experience with those people?
Friedman: That's exactly right. We have many patients that come here for acoustic neuroma surgery, and typically, after the tumor is removed, they have lost their hearing in the involved ear. The Baha System is a nice option for those patients. I've implanted a few Baha devices and all of the patients are happy with the device. The Baha System gives them information from the deaf side, routed through bone conduction to the good ear, and I would say those people are delighted with the Baha. I have a patient who told me she was lying on the sofa watching TV with her non-functioning ear up while using the Baha, and she hadn't been able to do that for many years - it was a nice quality of life change for her. She can even attend social functions without having to turn her head so her better ear faces the person speaking.
AO/Beck: So the Baha System is a reasonable option for post-op acoustic neuroma patients?
Friedman: Yes, for many of them, the Baha System is reasonable and will offer them a nice option beyond CROS hearing aids, trans-cranial fittings and other more traditional hearing aid options.
AO/Beck: So it seems like the Baha System would be appropriate for patients who've had unilateral hearing loss due to temporal bone fractures, head trauma, and unilateral sudden sensorineural loss?
Friedman: Sure, those people may be candidates depending on the specific situation, and of course it is still FDA cleared for people with conductive hearing loss, such as those we spoke about earlier.
AO/Beck: Can you tell me about any specific patients you've taken care of?
Friedman: Sure. One of my patients is a young lady who had bilateral aural atresia and a unilateral profound loss. She was not a candidate for surgical repair. She was wearing a classic bone conduction aid and was developing pressure sores from her headband, and she mentioned that as a young girl, she didn't like the stigma of the headband! To make a long story short, I offered her the Baha System. It really was (and is) well concealed by her hair and she hears very well with it - she is ecstatic. It has totally changed her life.
AO/Beck: That really is a great story. Frankly, I think it would be very difficult to wear a bone conduction headband - even if the sound was amazing, as she pointed out, the stigma is not trivial! What about contraindications?
Friedman: I would say that patients who had radiation to the bone, and if there's any risk of osteoradionecrosis or devascularization of bone from radiation, it's probably not a good idea to try.
AO/Beck: Because the bone will continue to degenerate?
Friedman: Well the bone has a poor blood supply and won't integrate the titanium screw as well as healthy bone.
AO/Beck: So you wouldn't be able to get the osseointegration, which is really critical for the sound path from the Baha System sound processor to the inner ear.
Friedman: Exactly right.
AO/Beck: Thanks very much for your time today Dr. Friedman. I appreciate your efforts!
Friedman: My pleasure Doug. This really is an interesting treatment and it helps provide people with options and alternatives, and those are good things!
