Soha N. Ghossaini

Transcranial Contralateral Cochlear Stimulation in Unilateral Deafness

OBJECTIVES: The purpose of this study is to evaluate the effectiveness of Bone Anchored Cochlear Stimulator (BAHA) in transcranial routing of signal by implanting the deaf ear. STUDY DESIGN AND SETTINGS: Eighteen patients with unilateral deafness were included in a multisite study. They had a 1-month pre-implantation trial with a contralateral routing of signal (CROS) hearing aid. Their performance with BAHA was compared with the CROS device using speech reception thresholds, speech recognition performance in noise, and the Abbreviated Profile Hearing Benefit and Single Sided Deafness questionnaires. RESULTS: Patients reported a significant improvement in speech intelligibility in noise and greater benefit from BAHA compared with CROS hearing aids. Patients were satisfied with the device and its impact on their quality of life. No major complications were reported. CONCLUSION AND SIGNIFICANCE: BAHA is effective in unilateral deafness. Auditory stimuli from the deaf side can be transmitted to the good ear, avoiding the limitations inherent in CROS amplification.

Successes and complications of the baha system

Objective: To determine the incidence and type of complications, as well as patient satisfaction, associated with the Baha system. Study Design: Retrospective case review. Setting: The Silverstein Institute, Sarasota, Florida, and the Columbia University Medical Center, New York, New York. Patients: Patients with conductive/mixed hearing loss and single-sided deafness implanted with the Baha system between June 1998 and December 2007. Intervention: Implantation with the Baha system. Main Outcome Measure: Incidence and type of complications associated with Baha implantation and patient satisfaction as measured by a questionnaire administered on site or by telephone. Results: In our series of 218 patients (223 ears), there were no major complications. Of these patients, 4.5% required revision surgery for soft tissue complications and 1.3% needed revision for failure of osseointegration. Eight percent (8%) required local care and resolved within 2 to 3 weeks of treatment. Five percent (5%) required in office procedures. One hundred six (106) patients satisfactorily completed the survey questionnaire. Ninety-two percent (92%) reported using the device regularly and 77% were happy with the device. On average, patients reported using the device 10.1 h/d, 5.6 d/wk. Conclusion: The Baha system is safe and effective in the rehabilitation of patients with conductive or mixed hearing losses and with single-sided deafness. The high success rate, patient satisfaction rate, and predictable auditory outcome place the Baha among the leading choices for auditory rehabilitation.

Localization by unilateral BAHA users

OBJECTIVES: Patients with unilateral hearing loss report difficulty hearing conversation on their impaired side, localizing sound, and understanding of speech in background noise. The bone-anchored cochlear stimulator (BAHA) (Entific, Gothenburg, Sweden) has been shown to improve performance in persons with unilateral severe-profound sensorineural loss (USNHL). The purpose of this study is to evaluate the effectiveness of BAHA in sound localization for USNHL listeners. STUDY DESIGN: Prospective study of 12 USNHL subjects, 9 of whom received implants on the poorer hearing side. A control group of 10 normal hearing subjects were assessed for comparison. Localization with and without BAHA was assessed using an array of 8 speakers at head level separated by 45 degrees. Error analysis matrix was generated to evaluate the confusions, accuracy in response, and laterality judgment. RESULTS: The average accuracy of speaker localization was 16% in the unaided condition, with no improvement with BAHA use. Laterality judgment was poorer than 43% in both aided and nonaided conditions. CONCLUSIONS: Patients with UNSNHL had poor sound localization and laterality judgment abilities that did not improve with BAHA use.

Results of the Bone-Anchored Hearing Aid in Unilateral Hearing Loss†

Objectives The advantages of binaural hearing are well established and universally accepted. However, a tendency remains to withhold the benefits of binaural hearing to adults and children with one normal ear. The purpose of this study is to demonstrate the benefit of the bone‐anchored hearing aid (BAHA) in a group of patients with unilateral conductive or mixed hearing loss.

Osseointegration timing for Baha system loading.

Objectives: The process of osseointegration for creating a biological bond between titanium oxide and bone is time dependent. However, different surgeons have used very varied time frames before loading the implant. The waiting time in dental implant loading ranged from immediate to 6 months. The Baha system (Cochlear Limited, Englewood, CO) traditional waiting period consisted of 3 months for adults and 4 to 6 months for children. The purpose of the study was to evaluate the safety of reducing the waiting time to 6 weeks in adults.

Reconstruction of congenital microtia-atresia: outcomes with the Medpor/bone-anchored hearing aid-approach.

Ideal surgery for congenital microtia-atresia would offer excellent cosmetic and hearing rehabilitation, with minimal morbidity. Classic approaches require multiple procedures, including rib cartilage harvest and aural atresia repair. Our facial plastic and otologic team approach incorporates a high-density porous polyethylene (Medpor, Porex Surgical, Newnan, GA) auricular framework, followed by single-stage bone-anchored hearing aid (BAHA) implantation. We evaluated the efficacy, safety, and morbidity of this 2-stage dual system approach. A prospective database of microtia patients was used to identify patients undergoing combined Medpor/BAHA auricular reconstruction and hearing rehabilitation between 2003 and 2006. The first stage involves placement of a Medpor framework beneath a temporoparietal fascia flap, followed by a second-stage procedure for lobule transposition and BAHA implantation. Twenty-five patients (28 ears) were evaluated. Aesthetic quality of the implants was excellent, with a high degree of framework detail visible, and a postauricular crease created in all patients. All patients were satisfied with the cosmetic result. There were no major Medpor complications such as infection, extrusion, loss of implant, or flap necrosis, and a 10.7% incidence of minor complications requiring operative revision. BAHA significantly improved hearing in all patients, with a complication rate of 31.8%, mainly skin overgrowth and cellulitis. The Medpor/BAHA dual plastic-otologic approach to microtia-atresia has produced excellent cosmetic results and hearing outcomes, which compare favorably to traditional microtia-atresia repair. This is a 2-stage aesthetic and functional protocol with an acceptably low rate of complications, which safely and efficiently achieves both aesthetic and functional goals.

Local steroid injections in the management of skin growth over the abutment in Baha patients

Bone-anchored cochlear stimulator (Baha system; Cochlear Bone Anchored Solutions, AB Mölnlycke, Göteborg, Sweden) has offered safe and successful rehabilitation for patients with various types of hearing loss. Major complications are rare, but the percutaneous nature of the Baha system predisposes the surgical site for soft tissue complications after surgery. Skin overgrowth around the abutment is one example and has been reported in a few series, with a frequency of five to 23 percent. Patients presenting with skin overgrowth over the abutment are usually treated conservatively with topical and oral antibiotics in addition to local hygiene. Some patients, however, fail conservative management and revision soft tissue surgery becomes necessary. The extent of surgical management ranges from local excision of skin overgrowth in an office-based setting to revision soft tissue surgery in the operating room. Skin graft from a donor site or use of longer abutments is sometimes necessary. Biopsies of tissue surrounding the area of skin penetration by the titanium implant and abutment were examined by Holgers et al, who demonstrated an increase in the number of immune cells. In addition, specimens with associated clinical skin irritation demonstrated an increase in the level of B lymphocytes. Holgers et al concluded that “there is an immunological compensation for the mechanical loss in barrier function at these implants and that antibody-mediated response is present at clinical signs of irritation.” On the basis of this study, it was postulated by the authors of the present article that perhaps local steroid injections in patients with skin overgrowth around and over the abutment have a role in the treatment and prevention of further inflammation and, thus, soft tissue complications. Triamcinolone acetonide injectable suspension USP (Kenalog-40 Injection; Bristol-Myers Squibb Co, Princeton, NJ), which has been used in treatment of keloid or scar tissue formation for

Localization and speech perception by unilateral BAHA users

Abstract Objectives: Patients with unilateral hearing loss report difficulty hearing conversation on their impaired side, inability to localize sound, and diminished understanding of speech in background noise. The Bone-Anchored Cochlear Stimulator, or BAHA, has been shown to be useful for persons with unilateral complete sensorineural hearing loss in improving speech perception in noise using the Hearing-in-Noise Test (HINT). The purpose of the present study is to evaluate the effectiveness of BAHA in sound localization and speech tasks in noise for unilateral sensorineurally impaired listeners. Methods: Prospective study of 20 unilaterally hearing impaired subjects with sensorineural loss. All subjects were implanted with a BAHA on the poorer hearing side. All subjects underwent audiometric evaluation under headphones preoperatively to classify loss and degree. Soundfield measurements were conducted in a calibrated audiometric suite: HINT sentences and localization testing, with and without a CROS hearing aid or BAHA. Localization measurement was performed using a specialized array of 7 calibrated speakers at head level separated by 15 degrees. An error analysis matrix was generated to evaluate the confusions and degrees of separation of errors. Results: Results to date indicated that accuracy of identification of speaker localization was poorer than 50% for 100% of the sample in both unaided and aided conditions. Errors were severe, ie, more than 30 degrees of arc. In contrast, the improvement in speech perception, as obtained in the previous study, was observed. Conclusions: Use of the CROS or BAHA did not result in improved performance on the localization task for this sample.