Teamwork is sound success
The Baha programme at Manchester Royal Infirmary was founded in the early 1990s, since which time 249 adult Baha have been implanted.
Since 2002, the programme has gradually been increasing the number of implants and between April 2007 and April 2008, 57 Baha were implanted. The programme has to date concentrated largely on adults, as there is a thriving paediatric programme at the Royal Manchester Children’s Hospital. “This is not a bad thing,” said Kevin Green, ENT surgeon at the Manchester programme. “Children can be inclined to face more problems that adults, so the more experienced the programme the better.”
Funding issues
The programme works with 24 PCTs, mostly in the North West but also regularly with Derby as well as South Staffordshire, Stoke and Yorkshire, at times. Audiologist and Programme Co-ordinator Rachel Andrew said that they have a different relationship with each PCT and that whereas some PCTs pre-approve funding for Baha, others can take up to seven months to come through.
“Baha are a low cost option compared to a lot of treatments and actually little clinical evidence of unilateral (single sided) deafness has been collected to date, which can make it more difficult to secure funding with some PCTs. There is, however, lots of clinical evidence to support Baha for conductive hearing loss and year on year the whole funding situation is getting better as evidence is growing. If there is a successful bid to put Baha up for NICE accreditation, the situation can only continue to improve,” said Rachel.
Lack of awareness
Kevin Green, ENT surgeon at the Manchester programme believes there are a lot of people who would benefit from a Baha, if they were only aware of the procedure, citing deafness in one ear as a widely unrecognised disability. “The vast majority of listening situations in our lives involve background noise, and it is difficult enough for people with no impairment to hear in these instances, let alone someone with unilateral hearing. In reality, we can’t qualify how many people suffer in this way,” he said. Of course, single sided deafness is not the only condition where people can benefit from a Baha; the procedure can also give huge benefit to those with conductive and bilateral hearing impairment.
The Manchester programme is far from alone in believing that an increased Baha awareness is long overdue amongst the general public, but also amongst GPs, ENT surgeons and audiologists. “Patients are referred through GPs, other hospitals, audiologists and ENT departments – many of whom don’t know about Baha,” Rachel explained.
What the papers say
The media, and in particular the tabloids, are not always popular in the way they disseminate news, but when a case study of a Baha patient appeared in the Manchester Evening News recently, there was a definite increase in enquiries. Rachel suggested that, as people are far more health conscious these days, the media certainly has a role to play in raising awareness.
The Manchester programme believes that part of its success is great teamwork, which has become even more important as the number of Baha going through the centre has grown. Every Monday a combined clinic is held by Kevin Green and Rachel Andrew which doesn’t only make operational sense, but is also very popular with the patients.
“Many programmes implant around 10 to 15 Baha a year. We assess over 100 patients each year and deal with more than 30 appointments with people who decide to progress with another procedure,” said Kevin. In order to cope with these numbers, the Manchester team comprises three audiologists, a hearing therapist and a surgeon. As the number of implants grow, so does the experience of the Baha team, which in turn leads to the capability to undertake even more procedures.
Helping the patient to make a decision
Patient choice and assessment are an important part of the programme, and form part of Manchester’s standard - including the opportunity for the patient to trial the Baha using a headband, to give an idea of the extent to which the implant will help an individual. The importance of informing a patient is addressed by giving a visual presentation and a one and half hour assessment, with one week 30 minute post trial follow up appointment, to assess the benefit and help them in the decision making process.
Although not exclusively, many of the programme’s patients are elderly, with the associated problems of advancing years, such as high blood pressure, draining ears or weak hearts. For this reason, 90 percent of Baha procedures are carried out under local anaesthetic, with no sedation. “This opens up the suitability of the procedure to a wider reach of patients,” said Kevin. “The oldest patient I’ve implanted was 86 years old. Local anaesthetic means that after the 20 to 30 minute procedure, a patient can go home, some even drive themselves to the hospital and home again, although isn’t something we would openly promote! It’s a bit like going to the dentist, with the advantage that when I chat to a patient during the procedure, they can talk back.”
Rachel concludes: "There is a User Group at the Manchester Royal, which certainly helps to spread the word about Baha in the community. But there is still a long way to go, particularly in terms of education and research, if all the people out there who could benefit from this simple, but very effective proceedure will reap the rewards."
