BAHA/BAHS surgery

Once an individual is a candidate for an implantable bone conduction sound processor, he/she can have surgery as early as five years of age (mandated by the FDA). Below is information on implantable surgery for a bone conduction sound processor:

Surgical Information for a “traditional” abutment style
(Cochlear Americas and Oticon Medical processors)

Children
Once a child and their parent(s) have decided on the option for having a bone conduction sound processor implanted, a child will typically undergo a 2 stage surgery for the implant.

Stage 1:
After a surgical incision has been made in the skull, slightly above and behind the ear that has hearing loss, a titanium fixture will be inserted into the child’s skull along with a cover screw. A second fixture called a “sleeper” fixture will also be inserted into the skull right beside the first fixture. The reason for inserting an additional fixture is because children can be very rough at play and can easily knock one of the inserted fixtures lose. This way, the “sleeper” fixture remains in the skull as a back up so surgery does not have to be required again. The “sleeper” fixture is typically not removed and remains in the skull.

Stage 2:
At a follow-up appointment, the ENT will then check on the tissue reduction (to make sure swelling has gone down and the incision is healing correctly and is not showing any signs of infection). The ENT will also check to see that osseointegration has occurred (where the fixture becomes firmly anchored to the skull). The ENT will then remove the cover screw and screw the abutment in (the part that screws into the fixture and allows the processor to snap in) and put the healing cap on (which will have a thin dressing inserted beneath it). Following surgery and the healing process, children should be able to be fitted for their sound processor after 6 months or 180 days post op. Note: the healing time for some children may vary. Some children may require a longer period of time to heal if they are diabetic or have a concern regarding clotting or anemia.
Helpful tip: Keep your healing cap (do not discard it) as you can put it on every night when going to bed to help minimize scar tissue/skin overgrowth near the abutment.

Below are some images showing an illustration of what the fixture looks like inserted into the skull, what a fixture looks like with the abutment loaded into it, a healing cap and a sound processor (permission has been granted to post the below images):

: New 9mm Abutment With Inset (fixture is the same as inset) and the abutment here is shown screwed into the fixture (Oticon illustration)

: Oticon Medical 9 mm sized titanium abutment

: Healing cap that snaps into abutment following surgery (image cited from www.entkent.com)

: Oticon Medical Ponto 4

Below are some images showing what to expect post op (permission by support group members and BAHA wearers have been granted to post the following images):

: BAHA on a soft band head band before implantable surgery

: Incision with sleeper fixture

: Incision healing

: Healing cap over abutment before being fitted with sound processor

: Visible abutment and incision healed, ready for fitting of sound processor

Adults
Adults typically undergo only a 1 stage surgical procedure before for being fitted for their bone conduction sound processor.

Stage 1:
After a surgical incision has been made in the skull, slightly above and behind the ear that has hearing loss, a pre-mounted fixture containing the abutment will be inserted into the adult’s skull. After the incision has been irrigated and sutured shut, a healing cap is then placed on top of the surgically implanted abutment with a dressing beneath it. At a follow up appointment about 1 week post op, the ENT will remove the dressing and check on tissue reduction and healing in general looking for any signs of infection. Following surgery and the healing process, adults can expect to be fitted for their sound processor following 3 months or 90 days post op. Note: the healing time for some adults may vary. Some adult’s incisions may heal closer to a two month period and for those who are diabetic or have a concern regarding clotting or anemia may be required to wait until 4 months before being fitted for their sound processor. Helpful tip: Keep your healing cap (do not discard it) as you can put it on every night when going to bed to help minimize scar tissue/skin overgrowth near the abutment.

Today, there are a couple of different techniques for making the incision in the skull to place the abutment:
1. In-line incision – a simple and clean incision that helps minimize scaring and hair loss.
2. MIPs Procedure (Oticon Medical only) – a simple hole punch method

Below are some images showing what to expect post op (permission by support group members and BAHA wearers have been granted to post the following images):

: Following implantable BAHA surgery (for Cochlear BP100/BAHA3)

: Healing cap with dressing after bandages have been removed (Cochlear BP100/BAHA3)

: Visible abutment with incision still healing (Cochlear BP100/BAHA3)

: Healed incision with visible abutment (for Cochlear BP100/BAHA3)

: Cochlear BP100/BAHA3 processor on abutment with eyeglasses

: Cochlear Baha 5 on abutment

: Following implantable BAHA surgery (Oticon Ponto Pro)

: Healing cap with dressing after bandages have been removed (Oticon Ponto Pro)

: Incision healing with healing cap removed (Oticon Ponto Pro)

: Incision healing with visible abutment (Oticon Ponto Pro)

: Oticon Ponto Pro sound processor fitted on abutment

Surgical Information for a “magnetically coupled” abutment style
(Cochlear Americas and Medtronic/Sophono processors)

Children
Once a child and their parent(s) have decided on the option for having a bone conduction sound processor implanted, a child will typically undergo a 1 stage surgery for the implant.

Stage 1:
Only 1 stage is required for children regarding magnetic plate implantable surgery for Cochlear Americas and Medtronic/Sophono sound processors. After an incision is made in the skull, a magnetic plate is implanted and sutured shut. The magnetic plate is hermetically sealed beneath the scalp. So, none of the magnetic plate protrudes from the skull (such as the titanium screw w/abutment for traditional implants). Osseointegration is not necessary and a sleeper implant is not needed. Since the incision is the only thing that needs to heal and does not require a healing cap, the healing time for a Cochlear Americas “Attract” or Medtronic/Sophono “Alpha” sound processor to be fitted is approximately 3 to 4 weeks.

Adults
The same 1 stage surgical procedure is also used on adults.

Stage 1:
After an incision is made in the skull, a magnetic plate is implanted and sutured shut. The magnetic plate is hermetically sealed beneath the scalp. So, none of the magnetic plate protrudes from the skull (such as the titanium screw w/abutment for traditional implants). Osseointegration is not necessary. Since the incision is the only thing that needs to heal and does not require a healing cap, the healing time for a Cochlear Americas “Attract” or Medtronic/Sophono “Alpha” sound processor to be fitted is approximately 3 to 4 weeks (same healing time for children).

Below are some images showing what the magnetic implantable plate looks like, the magnetic base plate, and the sound processor itself (permission has been granted by Cochlear Americas and Medtronic/Sophono to post the below images):

: Cochlear Baha 5 Attract System

: Cochlear Baha 5 Attract magnetically coupled sound processor

: Medtronic/Sophono internal magnetic plate that is sutured in beneath the scalp

: Medtronic/Sophono external magnetic base plate (this is removable)

: Medtronic/Sophono Alpha 1 (M) sound processor

Below are some images showing what to expect post op (Medtronic/Sophono has granted permission to post the following images):

: Incision where magnetically coupled plate has been sutured beneath scalp (Sophono Alpha 1 (M))

: Healed incision site with external base plate magnetically coupled to plate beneath scalp (Sophono Alpha 1 (M))

: Sophono Alpha 1 (M) sound processor attached to magnetic base plate (base plate is removable)

Additional helpful information for implantable sound processor surgery

Procedure time: takes approximately 20 minutes and you can be home with in three to four hours following surgery (out patient surgery)

Follow up appointments: following surgery, the first follow up appointment may be anywhere from two days to 1 week post op when the bandages will be taken off. The second follow up appointment may be made another week to two weeks out where the healing cap will be removed by the ENT and cleaned and then put back on. Another follow up appointment may then be set for 2 weeks out with instruction to remove the abutment twice daily for cleaning with ointment. Another follow up appointment for 1 or 2 weeks out will be set with instruction to continue wearing the healing cap everyday while removing it daily for cleaning. For a number of weeks, an individual who just had an implant will be required to wear the healing cap and continue to remove it daily or even twice daily for cleaning with peroxide and ointment care. Eventually, the healing cap can be removed with daily care until three months has passed (for traditional abutment implants) before being fitted with your new sound processor. * This is just an approximation to help provide you with an example of what to expect during the healing process. Every patient heals differently and every surgeon will offer different suggestions. Always follow the guidance of your ENT or medical doctor when it comes to post operative care. Always follow the cleaning directions and care instructions that your surgeon has explained to you following your surgery.

Abutment sizes: abutments are available in 6mm, 9mm, 12mm, 14mm sizes, and angled styles. The longer the abutment, the more it protrudes from the head area, helping prevent the risk of infection and offering more comfort.

Skin irritation: from time to time, the skin around your incision may become infected or inflamed. There are a couple of things that may be suggested that could help reduce or eliminate the skin irritation: 1. see if your surgeon can prescribe Clobetasol .05%, a steroidal cream/cortizone cream. Some have found that an over the counter cream such as VaniCream or teatree oil also work. 2. if your skin continues to become irritated or if you begin to experience scar tissue (skin) overgrowth preventing the abutment from staying on or fitting correctly, it may be suggested to begin wearing your healing cap every night you go to bed. This will help prevent excess skin overgrowth. You may want to inquire about wearing a longer sized abutment.

Cleaning maintenance: your ENT will show you how to take care of the skin around the abutment and how to clean your abutment. You must clean your abutment and skin area with warm soapy water, daily, with a tooth brush. You will also be instructed on how to clean inside of your abutment, weekly, so that any dead skin debris is properly removed to keep the area clean. * If cleaning is too abrasive and causing skin irritation, contact your ENT for suggestions on how to alleviate the irritation.

The following link offers lots of helpful information:
http://www.entkent.com/baha.php

Technology is always advancing with implantable surgery

Abutment Extension by Oticon Medical

The abutment family for Ponto by Oticon Medical

When having a BAHA/BAHS implanted, be sure to ask your ENT what the latest surgical technique is. Technology is constantly advancing for the better that is even more minimally invasive and quicker recovery time. Some even require little to no anesthesia during the quick outpatient procedure. Surgery for implanting an abutment device has gone from a linear incision in the skull to a tiny whole punch method. Also, today management of the abutment site and good hygiene are also easier than ever before. Different sized abutment styles can be offered to help bypass any scar tissue/skin overgrowth near and in and around the abutment that may prevent one from snapping their hearing device on with ease. Also, there are many helpful abutment styles such as the Abutment Extension offered by Oticon Medical.

MIPS
Also, regarding the advancement in surgical technique…there is now an even easier method to implanting an abutment that helps remove the need for suturing, which reduces scarring, and improves the overall cosmetic outcome and enables faster healing post op. When undergoing bone anchored hearing surgery, many users are concerned about the cosmetic outcome, and any scarring or hair loss the procedure may cause. Minimally Invasive Ponto Surgery (or MIPS) has been designed to create a circular incision that fits perfectly with the Ponto abutment. This is similar to a hole punch method. Ask your ENT about the MIPS surgical techniqe. Here is a helpful article on this surgical technique pioneered by Oticon Medical: http://www.oticonmedical.com/Medical/OurProducts/Implants%20and%20Surgery/tissue-preservation-with-the-ponto-implant-system.aspx#.VvXzVvkrJ3I

Some Moral Support

Hi, I have been fortunate to have been fitted with a BAHA and very much enjoy the benefits it has provided me. The decision to have an abutment permanently attached involved serious consideration due to the fact that physical activity is such a big part of my life. How would this affect wearing a helmet? Would there be any activities that I would not be able to partake in? To be quite honest some precautions must be taken, but I have been able to enjoy my sports fully. These precautions include removing the processor during certain activities and wearing the tether clip during others. Snowboarding, skateboarding, and kiteboarding are as big a part of me as my BAHA. The wind and cold are two factors the BAHA does not like so I remove the processor, also it usually is not worn with my helmet. If you are active in any way, I would recommend wearing the tether clip when you can, I even clip mine to a necklace when at the beach. I love my BAHA!

Kenny Wong, BAHA wearer and support group member

* See our “Life Stories” tab under our “Hearing Loss” section of this website…

The following is an article by a Baha user named Michael Brown who was born with unilateral Microtia/Atresia and wears a prosthetic ear living in Canada:
http://www.albertahealthservices.ca/4063.asp

BAHA Videos

Hearing Loss Videos
This is a news clip that shows how a BAHA can help localization of sound issues in a woman who experienced single side deafness as the result of an accident.

BAHA Implant surgeries
This video clip discusses BAHA implantable surgery where canalplasty or Atresia repair was not an option for this little boy.