New indications for Baha
Ian Johnson, ENT surgeon at Freeman Hospital, Newcastle, talks about major new indications for Baha and how patients are being turned away by professionals due to an under awareness of the procedure.
Ian Johnson goes on to report on a study carried out using Baha soft band for the management of glue ear with paediatric patients from Freeman Hospital.
Between 9 to 10,000 people each year suffer from Single Sided Sensorineural Deafness and are turned away from GP surgeries and ENT hospital departments because of a lack of awareness of how a Baha could help them. Even many neurosurgery departments, who are coming across patients with head trauma, skull fractures, skull based tumours or acoustic neuromas are unaware of the procedure. They don’t even carry out audiograms. Baha doesn’t only restore hearing but can help (in about 50% of cases) to give people the ability to localise sound again.
Meniere’s disease is a disorder of the inner ear which causes episodes of vertigo, tinnitus, a feeling of pressure in the ear and fluctuating hearing loss. For patients with this disease, a conventional hearing aid is of little use, as the levels set one day can change just a few days later. So a Baha is an ideal solution for this type of fluctuating hearing loss; Baha has often not yet even been considered in this group of patients.
Another new indication, which is more child oriented, is in the field of craniofacial work, where hearing restoration simply doesn’t appear on the radar. Included in this field is also Treacher Collins syndrome, a rare genetic disorder characterised by craniofacial deformities and Apert syndrome, a genetic defect which falls under the broad classification of craniofacial/limb anomalies. Many children with these indications, and also Down’s syndrome children, have conductive hearing loss and middle ear infusions and Baha is extremely effective in improving the functional hearing of these children.
Quality of Life
The management of glue ear in some paediatric groups can be challenging, as we found in a recent study we conducted with Baha softband to evaluate the quality of life benefit in school age children with fluctuant conductive hearing loss. This is largely because the questions ideally need to be asked of the individual involved.
However, we did reach a satisfactory outcome through sending the questionnaires to parents and Teachers of the Deaf who went to visit children using the softband in school. All the children had disability in hearing or educational difficulties as perceived by parental reports. Parents didn’t want grommets inserted either because of previous failure or just didn’t want surgical intervention for their child. The soft band with device was worn for a minimum of three months by the children, then questionnaires were sent to parents and teachers.
The results were very positive, with six out of 10 teachers noticing an improvement in the child’s hearing. We achieved our aim of proving that soft band with Baha was beneficial to this group of children, particularly in learning situations. The study also shows that randomised trials are needed in this field if we are to assess the widespread benefit of this application.
The results for Baha soft band are universally good for children between the ages of 8 to 10, after which they become more self conscious. Teachers are not keen to have the responsibility of intervening to help a child with hearing devices, but with a soft band the simple on/off switch and ‘hair band’ they feel that no harm can be done.
Still, soft band is under utilised. For instance, I met a GP who didn’t want his daughter to have grommets, but had never heard of soft band.
Bi-lateral Baha
So far as bi-lateral Baha is concerned, they can give a 15 – 16% additional benefit and should be available for everyone who is bi-laterally deaf, particularly children, otherwise you are in effect making them single sided deaf.
Ten to 20 years ago, patients with Single Sided Deafness were being told there was nothing new to help them. Now we have Baha and softband which can help, not just with Singled Sided Deafness but also conductive and mixed hearing loss.
We are hoping to conduct further research into Baha outcome in terms of speech and noise. In the meantime we need to continue with effort to raise awareness of this fabulous procedure, which offers such an easy restoration of hearing, particularly for sudden hearing loss, but also such a positive outcome and significant improvement in quality of life for other with hearing impairment.
