(BAHA = Bone Anchored Hearing Aid)
This paper contains 10 helpful tips that may help you get the most out of your BAHA, both on a soft band head band and as an implantable device.
Try using the following two descriptions for a BAHA when speaking with your ENT, audiologist and/or insurance companies: “bone-anchored auditory device” or “bone-anchored auditory implant.” Try not to use generic names or descriptions such as “hearing aid” as labels like this are what often cause discrepancies with insurance companies when it comes to coverage.
Note: The acronym “BAHA” not only has the description of “hearing aid” in it, but it also contains the description of “bone anchored” and for some wearers, the processor is not implanted (bone anchored), and is worn on a soft band head band instead.
Note: The above (2) suggested descriptions were suggested directly by Cochlear Americas.
Note: Although the acronym “BAHA” is used throughout the industry, only Cochlear has a registered trademark on it. Recently, the acronym “BAHA” has become a “branded product” for Cochlear. Other manufacturers may refer to their “BAHA” as a bone anchored sound processor or even a BCHA, which is known as a bone conduction hearing aid.
Try using these four codes when inquiring about your insurance coverage:
L8690 (for the processor and for surgical supplies, for a child or an adult for an implant)
L8691 (for the processor only…as when worn on a soft band head band)
L8692 (for an audio integrated device without integration for a soft banded BAHA)
L8699 (for a “prosthetic implant (NOS) = meaning Not Otherwise Specified)
Note: Know what your insurance coverage is (deductible vs out of pocket pay percentages). However, it is suggested to allow your audiology office of choice to manage calls with your insurance company as these offices are typically experienced in making these calls and are aware of the above listed codes. They can often be very helpful with appeals and providing the correct codes to begin with.
Where to best position your “bone-anchored auditory device” when being worn on a soft band head band:
For the soft band head band wearer:
The concept of a bone-anchored auditory device was meant to be worn directly behind the ear or darn near to it. However, the technology behind bone conduction still allows the patient to hear through the vibration (oscillation) of sound anywhere on the skull no matter where the processor is placed. Though, I have been told by a few adult bone-anchored auditory device wearers that they did experience the best sound quality when the processor was placed on the occipital bone directly behind the ear. Regardless, a patient can still hear when wearing a bone-anchored auditory device around the area of the ear such as on the forehead and in front of the ear. Below are two examples when a bone-anchored auditory device may be worn in places other than directly behind the ear:
(Unilateral Microtia/Atresia) Young children during the infancy years may tend to show indentation marks from the processor being worn behind their ear and on their head. This is only because an infant’s skull is still fairly soft. The indentation marks do not hurt the child. It can be helpful to move the processor around at different points on the child’s head to help alleviate the indentation marks.
(Bilateral Microtia/Atresia) Young children who have Atresia in both ears may tend to wear two bone-anchored auditory devices. However, if one of the processors is damaged or is being repaired, they have no choice but to wear only one. Often times, the one processor can be worn in the middle of the forehead with even distance between the two ears so sound quality is evened out. Again, a child or adult can still hear through a processor that is not worn directly behind the ear.
Where to best position your bone-anchored auditory implant when planning for surgery:
The best position for a bone-anchored auditory implant will be determined by your ENT/surgeon. The reason for this, is because the processor has to be placed on the flattest or most level area of bone behind the ear. If you wear eye glasses, is helps to bring them into your pre-op appointment so that your surgeon of choice can help determine how he/she can best accommodate you regarding where the best position would be for your processor. Sometimes, following a surgery a patient may think their new bone-anchored auditory implant is much higher than they had expected. Again, the surgeon will determine where the best area for placement is for the implant based on the flattest area on your skull. Soon, you’ll adjust to where your implant is as you get use to wearing your new processor.
Note: If planning to have ear reconstructive surgery (later down the road), it is best to tell your ENT that you are planning to do so prior to having bone-anchored auditory implant surgery. It may also be suggested that your ear reconstructive surgeon speak directly with your ENT who will be performing your implantable surgery so that it is clearly discussed where the best possible position would be for the implant (for future surgery sake). If there is no clear communication between both, it is possible that the implant can be placed in the way of where the new ear would best be attached. Often times, scar tissue can get in the way of damaging the area where a skin graft and fascia would be taken from for part of the newly reconstructed ear. Just make sure everyone is on the same page for the best planning so that you can have the best results.
Adjusting to a bone-anchored auditory device (implantable or on a soft band head band):
No matter how old a patient is and no matter how long a patient has lived life unaided, there will always be an “adjustment” phase when trying to hear through a bone-anchored auditory device at first.
The below three examples describe how patients may have to take time to adjust to wearing a processor when first wearing one.
Infants/Toddlers: Some children may adjust to wearing a bone-anchored auditory device on a soft band head band easier than others. For example, younger children may tend to pull the processor off or throw it. The processor may also come off easily due to a child laying down often or rolling around more because they are not yet walking or upright. It takes time for a child to feel comfortable with wearing a band on their head in addition to hearing extra sounds that they are not use to. It just takes some getting use to. Try not to become frustrated. It is completely typical for a child to begin wearing a processor anywhere from only a couple of minutes at a time to maybe 20 minutes overall per day. As a child gets use to wearing the processor, eventually they will leave it on for longer periods of time, realizing that the processor is helping them to hear better.
Tips: Try allowing infant/toddler aged children the chance to wear their processor when they are more in an upright position. Such as: in a stroller while at the zoo or in a grocery cart at the grocery store. They may be inclined to leave the processor on more when there are other distractions taking the focus off of the processor. For example, wearing their processor when working with a therapist if one is needed or when playing a game. If the soft band head band seems to slip down or is annoying your child, you can try to make your own band. Also, by making your own soft band head band can help make it fun for your child. You could use different fabrics, colors, ribbons and bows that can color coordinate with outfits and such. Try and make the processor fun to wear. Some parents even sing to their child when putting the processor on at first to make it a fun or pleasant accessory.
Children: Some children may adjust easier to wearing their processor more than others. Some may not want to wear their processor as often because of hearing extra noises from their environment that they are just not yet use to hearing. Also, some sounds may be loud for them and this can cause head aches or sometimes acting out. Sometimes, children can come home from school a bit fatigued because they are not yet use to hearing so much in their environment. Again, it just takes some time to get use to. In time, patients realize how nice it is to be able to hear everything.
Note: Depending on how long a child has gone unaided, it may take longer to get use to wearing a processor. For years, a child may have already adjusted to hearing through one ear (such as with unilateral hearing loss) and this can take some time to adjust to when suddenly additional sound is presented.
Note: FDA regulation mandates that the earliest age a child can be implanted with an implantable hearing device is 5 years of age. It is possible to have surgery sooner, but this is not what the FDA approves of and medical professionals are aware of this.
Note: If a patient believes his/her processor is too “strong” in sound or too loud, first try adjusting the volume. The mode you have your volume set to may just be a little too loud. Second, some processors can be a little stronger than expected, aside from trying to change your volume setting. Sometimes, a simple software upgrade can be made to the processor changing some of its settings, making it more comfortable or adjustable for the user. Software upgrades can be made in the field by your audiologist or simply by contacting customer service and sending your processor back to the manufacturer you purchased it from.
Adults: Some adults may adjust easier to wearing their processors more than others. Hearing additional sounds can be something to get use to. Especially, if a patient is use to being unaided for years. The brain is a very smart organ and in time it learns how to rewire itself helping the body adjust as best as possible into its environment. Learning how to make adjustments to a processor can also help make wearing a processor more comfortable. There is no “average” time line that shows when most adults adapt to or get use to wearing a bone-anchored auditory implant. It could be anywhere from a couple of weeks to several months. Again, in time, patients soon realize how nice it is to be able to hear everything.
Note: Depending on how long an adult has gone unaided, it may take longer to get use to wearing a processor. For years, an adult may have already adjusted to hearing through one ear (unilateral hearing loss) and this can take some time to adjust to when additional sound is presented.
Keeping a safety line on a soft band head band bone-anchored auditory device and implant:
Every processor offers a safety line that can be attached to the processor and something else such as clothing or a shirt collar to help keep the processor from falling off in the event that it should come lose or be bumped off. Safety lines work great for some wearers and for others, it just gets in the way. This option is a wonderful option that can help prevent a processor from being lost. It is a helpful option to those who choose to wear a safety line, but is not mandatory. A couple of suggestions for when to wear a safety line is when you are doing extracurricular activities such as: sports, horse back riding, riding rides at a carnival, working out, etc… Sometimes, the safety line can bring more attention to a patient who is wearing a processor or may be distracting to infants/toddlers making them want to pull at it. Again, a safety line is only a helpful option to help keep your processor from falling off. If a safety line breaks, you can order more from the manufacture who markets your processor or you can go to a craft store and make your own with craft floss or fishing line. Just make sure you know how to tie the line tightly so the knot does not come undone.
Maintaining and cleaning a bone-anchored auditory device:
Maintaining a processor is very important. Take care of it as you would your own hearing. After all, a processor is helping you hear better so you can get on with your life. It is important to follow the maintenance instructions from the manufacturer. If moisture manages to get into the processor (such as saliva from young children chewing on the processor or if it happens to fall into a drink), it can often be dried out with a hearing aid dryer kit. There are many dryer kits available, one of them is manufactured by Westone. For more details on the Westone Dryer Kit or how to order a dryer kit you can visit www.westone.com or simply search on line for hearing aid dryer kits. You can also ask your audiologist about ordering one too. Please remember, processors are not water proof, they are not even water resistant. Never put your processor in the microwave to try and dry it and always remove the battery when using a dryer kit.
If you believe you are experiencing more feedback than usual with your processor, ask your audiologist to take a look at it. Also, if an infant/toddler is wearing a processor and happens to get food smeared in it, try to let the food dry and then attempt to clean it with a moist cloth. If it appears that food has hardened in the microphone(s) or speaker of the processor, very carefully try to flick the food out with a tooth pick. Again, carefully so you do not harm the microphones and speaker. This may not be suggested in the manufacturer’s maintenance manual for the processor, but does get the job done. It is suggested to contact the customer service department or clinical support hotline of the manufacturer in which you purchased your processor from and seek guidance from them directly on what to do. There is also a protective cover that wearers of bone-anchored auditory devices can purchase. This protective cover is similar to a slip cover for the processor and can help to protect it from some moisture, such as food and saliva from young children or misty weather and dirt. For more information on this protective cover, please contact Ear Gear at www.gearforears.com.
If you have an implantable device, it is also very important to maintain good hygiene and keep your abutment clean. Follow the instructions that your surgeon provides you with following surgery. If you need additional help, please contact the customer service department or the clinical support hotline of the manufacturer in which you purchased your processor from.
Protect your bone-anchored auditory device. When not wearing your processor, carry it or store it in its protective case. Try to also keep it away from extreme hot and cold temperatures. Also, try to keep functioning batteries in your processor to ensure that it is working properly at all times.
Know how to adjust your settings so you can get the most out of your bone-anchored auditory device:
Processors today can offer helpful features and options such as mute or pause buttons (in the event of loud sounds), ergonomic shapes that fit comfortably behind the ear, and easy to use touch button switches. Some even offer Blue Tooth compatibility for your car and cell phone, I-pod connections and TV compatibility when pairing with or looking into an FM System. Most of the newer processors that are offered today are termed “smart” because they can have adjustments and software upgrades made to them that can help you hear better. Ask your audiologist to help you learn how to operate your bone-anchored auditory device so that it works the best for you. One suggestion is to learn how to switch in-between microphone modes. For example, an individual wearing a processor in a loud restaurant may want to switch to the single mode directional microphone so that he/she can hear the conversation better at the dinner table instead of hearing everyone and everything else in the background of the entire room. Another example would be to switch to the multi-directional mode microphone setting when playing sports for better sound localization. Some processors also learn to automatically adjust to louder environments by toning down in volume, etc.
When purchasing a bone-anchored auditory device or implantable auditory processor (or any hearing aid for the matter), the manufacturer that you make your purchase from will offer insurance coverage. Often times, there is an original two year factory warranty on the processor. Some (not all) bone-anchored auditory device manufacturers offer one complimentary replacement if the processor is lost or destroyed beyond repair with in the original two year warranty itself. However, each manufacturer has guidelines that are very specific to the product warranty and it is best that you are made aware of this information when purchasing your processor at first. In addition to the original two year warranty, you may also purchase extended insurance coverage for your processor through the original manufacturer (OEM). Extended coverage may also be offered through a third party company called ESCO “Ear Service Corporation.” Details on ESCO insurance coverage can be found at www.earserv.com. Another option for extended insurance coverage may be through your home owners insurance plan just as you would for have jewelry and such. However, each home owner’s policy is different and it is very important to know the details of the coverage plan as home owner’s plans may be worded very carefully where the processor is only covered if lost or stolen, but not damaged. It is best to speak with a representative from your insurance company for the most accurate information and best suggestions.
Note: It is suggested by most ENTs to purchase extended insurance coverage for a processor in the event that the processor casing should crack or internal components are compromised. This can happen if the processor is dropped or “other.” Processors are built pretty tough, but they are not built to withstand every single challenge life throws its way.
Note: In the event that your processor is damaged or destroyed and needs repair, please contact the customer service department for the manufacturer in which you purchased your bone-anchored auditory device from and seek guidance. It is possible that it can be returned (RMA’d) back to the manufacturer (OEM), repaired, and simply returned back to you within an acceptable amount of time depending on the situation. Often times, a loaner processor (of same or similar style) can be sent to you while your processor is being repaired.
Questions: Don’t be afraid to ask your audiologist, ENT or bone-anchored auditory device manufacturer customer service/clinical support hotline questions…
Some common questions to ask and suggestions are the following:
Ask to trial a bone-anchored auditory device on a soft band head band. This is particularly helpful prior to making the decision on implantable surgery.
If possible, ask to try at least a couple of trial or loaner processors. Especially, a couple of different models and/or manufactured styles. Some processors are better suited for some patients over others depending on personal hearing loss differences and needs. Also, some processors offer helpful features and options that may be of benefit to one user over another user. It is up to the patient to determine which processor is the best choice for him/her along with the guidance and suggestion given by the audiologist and/or ENT.
If you are suddenly experiencing additional feedback with your processor, ask your audiologist about making some adjustments or making a simple software upgrade to your processor. It is possible that some adjustments need to be made to further accommodate your hearing.
When planning for implantable surgery, inquire where the incision will be made and how big the incision will be. Ask to see a picture of what your scar may look like. Every patient heals differently, so some scars may heal better than others and may also look better over time.
When planning for implantable surgery, ask how to help prevent excess scar tissue. There is often an abutment cap that the surgeon will place over the abutment as your incision heals, preventing the build up of excess scar tissue. Also, inquire about removing excess scar tissue around the abutment area and ask how often this has to be done. Some patients experience this, but not all. Scar tissue removal may be required once to twice per year depending on the individual.
Ask your ENT, surgeon or audiologist about clinical feedback from patients who have worn the model or style of processor you are interested in. This type of information may help you make a better decision when purchasing one. Product user reviews can help provide you with more details that can help you when looking for a processor that is best for you.
If you are experiencing pains or tingling/numbness near the area where your abutment is or where your incision is, speak with your ENT or surgeon who implanted your processor. It is possible to make things feel better. Some pains could be caused by ingrown hairs in the scar tissue or around the incision. Sometimes, there may be numbness near the implanted abutment. Ask you surgeon what can be done to help the numbness go away or feel better. Scar tissue can also cause “zinging” or sharp stabbing pains too. This is often because of the scar tissue shrinking or feeling tight as it has healed. It is possible that your ENT can help provide some options for massage around the area or provide topical creams that can help break up some of the scar tissue. You may also inquire about getting a longer abutment (9mm instead of 6mm).
Ask about dry skin and itching (psoriasis) that may occur around the abutment and near the incision. Not all patients experience this, but some do. Your ENT may be able to suggest some topical creams or ointments that may help. You can also visit with your dermatologist and inquire about prescription creams such as Clobetasol .05% (steroidal cream) to help prevent dry skin and inflammation. Some bone-anchored auditory device wearers use other creams and oils such as: Vanicream (for Eczema) or tea tree oil. Find what works best for you. Sometimes, it may just be your shampoo causing scalp irritation around the abutment. It may also help to switch to a longer abutment (for example from a 6mm to a 9mm sized abutment).
Inquire about loss of hair, balding or hair that may not grow back next to and around the incision. Again, not all patients experience this, but sometimes there may be a small patch area where hair does not grow back from the surgery.
Ask about compatibility with processors and different manufacturers. Some processors are considered compatible and will fit other manufactured abutments. However, as of 2009, Cochlear released a new style of abutment for their newer series of BP100 processor models. Anyone with a Cochlear abutment after 2009 most-likely can not wear an Oticon Medical processor. The Sophono is completely different as the processor is held to a magnetic plate through magnetic coupling.
Ask about the material that your abutment and screw are made of. For example, the screws and abutments for both Cochlear and Oticon Medical processors are typically made of titanium. Although it is suggested to remove your processor while going through security at airports and such…this is only because of the battery inside of the processor which may cause the alarm to sound when passing through security. You do not have to worry about the titanium triggering alarms. Each manufacturer typically offers a “helpful travel info” card that provides a brief explanation about your processor that can help airport security and (others) understand that your processor is just a hearing device. Most wearers do not experience problems with security with their bone-anchored auditory devices.
If choosing a Sophono Alpha series processor, ask if it is safe to have an MRI in the event that you may need one because of the magnetic plate that will be implanted. For one reason or another, if you require multiple MRIs due to health conditions and such, you need to know if it is safe to choose the Sophono system. Sophono has mentioned that although the Sophono is currently contraindicated for MRI, that initial studies show there is no loosening of the internal implanted magnet. Also, it has been found that Sophono’s devices only had a small decrease in magnetic strength and does not interfere with a patient wearing the processor following an MRI. Sophono is in the process of conducting a full MRI compatibility study which should be completed soon. The screws that are used to secure the magnetic plate are similar to the screws used in facial surgeries.
If you believe that you are no longer hearing as well with your processor, take it into your audiologist and see if he/she can make some adjustments to it or upgrade the software (SW) of the processor. Also, it is possible that the case of the processor is cracked or something other is not working correctly because of one or more components malfunctioning. It could simply be that the battery is no longer being held in tight enough because the battery door is loose.
If you are interested in finding out how much your hearing has improved by wearing a bone-anchored auditory device on a soft band head band or an implant, inquire about having a hearing evaluation conducted. A hearing evaluation can help show you how well you hear while wearing your processor and how well you hear without wearing your processor. It is amazing at how much a patient can benefit from wearing a bone-anchored hearing device.
Inquire about additional accessories: Some are different colored soft band head bands, stickers to make your processor look pretty or cool, extension products that can help you hear better such as FM Systems and compatibility with blue tooth technology for use with car and cell phones, etc… Even additional cables and adapters for travel and plug-in for TVs and computers/DVD players that will allow you to hear through your processor or FM System. Also, the technology behind induction coils “Telecoil Looping” is very exciting for the future regarding hearing aids. Hopefully, no matter where you go and travel, you will be able to hear in buildings, trains, conference rooms, malls, etc…through telecoil technology.
Images of bone-anchored auditory devices (on a soft band head band/same as implantable):
Note: Cochlear Americas will be launching a new soft band head band in the Fall of 2011.
Note: As of July 15th, 2011, Cochlear launched the new BAHA 3 Power BP110 processor.
Note: As of August of 2011, Oticon Medical launched their new soft band head band for the Ponto Pro.
Soft band head band bone-anchored auditory device images:
Images of abutments for bone-anchored auditory implantable processors:
Note: Some abutment styles can be angled or straight and some may be longer or shorter (in projection from the skull) depending on an appropriate size for the patient.
Permission was obtained from Oticon Medical to include the above images, www.oticonmedical.com
Image 1 shows an angled abutment.
Image 2 shows a 9mm straight abutment.
Image 3 shows a derma (skin) layer of how deep the abutment is implanted into the skull for it to have a (9mm) high projection where the processor attaches. There are also 4mm and 6mm long abutments.
The below images are of the Sophono Alpha 1 series magnetically coupled processor:
Permission was obtained from Sophono to include the above images, www.sophono.com
Image 1 shows the magnetic plate (implant) which is 1.54” long x 1.25cm wide in size.
Image 2 shows the external base plate. The external base plate varies in magnetic strength and can be determined by the patient’s needs.
Image 3 shows the processor attached to the external plate. The external base is held to the patient’s head through magnetic coupling from the under lying magnetic plate beneath the skull’s surface.
Note: Cochlear Americas launched a newer abutment style during 2009 for their BP100/BAHA3 and BAHA 3 Power (BP110) series of product. The newer abutment style is a little narrower than the older abutment style. The older abutment style was compatible with Oticon Medical processors. The newer abutment style now only fits Cochlear processor products. As mentioned by Cochlear, the development of the newly shaped abutment has been in the works for several years before Oticon Medical spun off its bone anchored sound processor product division. The reason for the new design is to help reduce soft tissue complications around the implant site. The continuous curve of the new abutment helps to reduce skin overgrowth and increases skin adhesion at the implant site. Oticon Medical bone anchored sound processors will not able to attach to the new abutment style securely. Still pending images from Cochlear of the two different abutment styles, www.Cochlear.com
Degree of hearing loss ranges
0-25dB Normal Hearing Limits
26-40dB Mild Hearing Loss
41-55dB Moderate Hearing Loss
56-70dB Moderately Severe Hearing Loss
71-90dB Severe Hearing Loss
>91dB is Profound Hearing Loss
- Bone conduction processors can help individuals who have Aural Atresia, mixed hearing loss or Sensorineural Hearing Loss (SNHL) depending on the degree of hearing loss and implications causing the hearing loss. An audiologist, ENT or bone-anchored auditory device manufacturer can help suggest a model that is best suited for your hearing loss needs.
- A bone-anchored auditory device or bone-anchored auditory implant should always be presented as a helpful option to the patient. The decision or choice to wear a processor should always be left up to the patient or to the parents regarding what “they” believe is best for their child.
- New models of bone conduction sound processors can come available every three to five years.
I really hope many of you can benefit from these helpful tips and I hope that as medical professionals, these tips help you advocate better for your patients, help individuals become better self advocates for themselves, and help parents become better parent advocates for their children.
“Know your options so you can make the best decisions.” – Melissa Tumblin
Founder of the Microtia and Atresia Support Group on Facebook and www.EarCommunity.org
* This document was created and released in September of 2011.