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Bone Conducting Hearing Bone Conducting Hearing Aid SolutionsAid Solutions
Dr Zeeshan AhmadM.S.(ENT,PGY1)
Department of ENT,NMCH,Patna.
27-09-2012
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Hearing impairment is a common occurence.
Most patients have abnormality of cochlear function and can be treated by use of conventional hearing aid.
However, a significant number have conductive cause.
Many of these can also be treated by conventional hearing aid but a proportion do not tolerate mould or insert in ear canal, so alternative means must be considered.
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What is Hearing aid? A hearing aid is a battery-powered, electronic device that makes listening easier for people with a hearing loss. A hearing aid consists of a microphone, an amplifier and a receiver. The microphone picks up sounds in your acoustic environment and turns them into electronic signals. The amplifier selectively amplifies the acoustic electronic signals. The receiver is a very small speaker that changes the electric signals back to sounds and delivers the sound to the ear.
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Consideration in using Hearing aids
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HistoryHistory1551- Bone conduction device consisting
of metal shaft or spear.1670- Sir Samual Moreland, England
invented a large speaking trumpet.
1892- first patent for electric hearing aid in the U.S.
1912- first volume control for a hearing aid.
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History Contd….History Contd….1931- first electric hearing aid eyeglass
patent1937- first wearable vacuum tube HA in
US1953- first all-transistor hearing aid1987- first commercially available
implantable hearing aid system.1997- FDA approved BAHA®
Recently- Oticon implants
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Basic Hearing Aid StructureBasic Hearing Aid Structure
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MECHANISM of BONE MECHANISM of BONE CONDUCTION HEARINGCONDUCTION HEARING
Vibration of bone of skull is coupled to soft tissues of ear canal. More when ear canal is occluded.
Some of sound energy transmitted directly to ossicular chain.
Alternate compression and expansion of cochlear shell by vibratory forces on bone.
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The BAHAThe BAHA®®
BAHA® is the trade namefor bone anchored hearing aid system available From CochlearTM.
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BAHA system is comprised of three BAHA system is comprised of three parts:parts:
Titanium fixture(3)Connecting
abutment(4)Detachable sound
processor(6)
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How does it Work?How does it Work?
The processor receives sound through the abutment and sends it to the functioning cochlea using the skull as a pathway to bypass the outer and middle ears
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CandidatesCandidatesChronic otitis mediaCongenital aural
atresiaMicrotiaCholesteatomaMiddle ear
dysfunction or disease
Acoustic neuromaNeurologic
degenerative diseaseMeniere’s diseaseViral infectionTrauma
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A photograph from NMCH OPDA photograph from NMCH OPD
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PrerequisitesPrerequisitesMixed or conductive hearing loss Bone conduction pure-tone average in the
indicated ear is greater than or equal to 45 dB HL
Monosyllabic word discrimination score ≥ 60%For single sided DeafnessFor bilateral fittings – candidates must have
symmetrical bone conduction pure-tone averages between ears
Age > 5 years
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To anticipate a "high success rate" To anticipate a "high success rate" with BAHAwith BAHA
Patients should have a PTA less than 45 dB, although improvements in hearing should still be expected for a PTA of up to 60 dB.
(Hakansson B, Tjellstrom A, Carlsson P: Percutaneous vs. transcutaneous
transducers for hearing by direct bone conduction. Otolaryngol Head Neck Surg 1990; 102:339-344.)
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Operative TechniqueOperative Technique
A. Posterior-based skin flap is elevatedB. Flap is thinned until all hair follicles are removed from the flap centerC. Soft tissues beneath and adjacent to the flap are excised to create a smooth transition from surrounding tissue to the thin central skin flap
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Operative TechniqueOperative Technique
D. 3- to 4-mm hole is drilled in mastoid or retromastoid cortex. E and F, A countersink creates a recessed surface for implant placement.
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Operative TechniqueOperative Technique
G. The hole is tappedH. Titanium screw is implantedI. Titanium screw is tightened in place
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Operative TechniqueOperative Technique
H/I. The titanium screw is tightened into placeK. The skin flap is replaced
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Operative TechniqueOperative Technique
L/M. Metallic abutment for later attachment of the vibrating external hearing aid is attached to the screwN/O. A healing cap is placed to apply pressure to the skin flap
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Perioperative Complications with the Perioperative Complications with the Bone-Anchored Hearing AidBone-Anchored Hearing Aid
Loss of Skin GraftLoss of Skin Graft
Growth of skin graft over the abutmentGrowth of skin graft over the abutment
Implant extrusionImplant extrusion
InfectionInfection
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The most important factor in The most important factor in obtaining a trouble-free bone-obtaining a trouble-free bone-anchored hearing aid (BAHA) site is:anchored hearing aid (BAHA) site is:
A. Having thin, immobile, hairless skin around the A. Having thin, immobile, hairless skin around the
abutment abutment B. Using a 4-mm fixture flangeB. Using a 4-mm fixture flangeC. Using a longer abutment – The longest C. Using a longer abutment – The longest D. Performing surgery in two stagesD. Performing surgery in two stages
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To Prevent Loss of Skin GraftTo Prevent Loss of Skin GraftHave thin, immobile, hairless skin around
the abutment - This allows for placement of the fixture in a tissue bed that has minimal local tissue reaction to the implant and thereby minimizes chance of skin graft loss, infection or extrusion
Ensure that the skin graft is firmly attached to the underlying periosteum
Ensure that the fixture and skin penetrating abutment are firmly secured
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To prevent growth of skin graft To prevent growth of skin graft over the abutmentover the abutment
Use longest implant possibleObtain adequate removal of surrounding
soft tissueApproximate the surrounding skin edges
to the periosteum
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To prevent implant extrusionTo prevent implant extrusionAllow patients with poor wound healing and
thin bones to have six months of osseointegration
Fix any coagulopathies that the patient may have pre-operatively
Maintain proper hemostasis to prevent hematoma formation
Use a 4-mm fixture if there is bone still present at the bottom after using a 4-mm drill guide
Patients with thin, brittle bone should have a two stage surgery
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To prevent infectionTo prevent infection
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Other complicationsOther complications
Penetration of sigmoid sinus – Insert bone wax or muscle plug
Brain abscess
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OTICON PONTO HEARING AIDOTICON PONTO HEARING AID
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SOPHONO ALPHA 1 SYSTEMSOPHONO ALPHA 1 SYSTEM
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THANK THANK YOUYOU
for patient listeningfor patient listening