Hearing Device Options - Surgical and Implantable Devices

Cochlear Implant

Cochlear Implant Department

The Hearing Device Center is committed to providing clinical services to those children and adults with specific needs regarding cochlear implantation and amplification. Individuals are seen for extensive comprehensive evaluations to determine both audiological and surgical candidacy and receive extensive information regarding device options. Our facility offers a selection for implantation of all FDA approved manufacturer’s devices including Cochlear Corporation, Advanced Bionics and MedEl.

How Does Hearing Work?

Hearing Animations: In order for the normal process of hearing to take place, all of the intricate components of the outer, middle and inner ear must function normally. If one of the components is damaged, malformed or missing- a hearing loss may be present.

The ear is made up of three parts:

Outer Ear: The visible part of the ear, the pinna or auricle, collects sound from the environment and funnels it into the middle ear

Middle Ear: Comprised of the eardrum (tympanic membrane) connected to three tiny bones that move together to send sound vibrations to the inner ear.

Inner Ear: Comprised of two main parts: the cochlea, which contains the intricate hair cells (sensory cells); and the vestibular system, which controls your balance. The hair cells are responsible for sending impulses to the auditory nerve fibers, then on to the brain for interpretation into sounds.

View the animation below to learn more about how we hear with normal hearing and with a cochlear implant.

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Cochlear Implant Evaluation Process

All patients will be seen for a candidacy evaluation by the cochlear implant audiologist and the implant surgeon. Pediatric candidates will also be evaluated by the speech-language pathologist. General hearing and health history, hearing device use, and educational placement/therapy services will be some of the topics reviewed during the evaluation appointments. A separate appointment will be made for a CT Scan to assess your inner ear. Audiologic unaided and aided testing will be performed to assess hearing ability and benefit as well as an assessment of word recognition ability with amplification devices. Additional evaluations may be recommended. These may include, but are not limited to: Psychological Evaluation, Physical Therapy/Occupational Therapy Evaluation, and Vision Assessment.

Once a patient is determined to be a cochlear implant candidate, the following will be reviewed:

  • How the Implant works
  • Expectations for device use
  • Choice of implant devices for use and how they function
  • Surgery process/Date/Ear for implantation selection
  • Cochlear implant programming follow-up
  • Educational placement
  • Rehabilitative service
  • Other evaluations needed to complete candidacy work-up
  • All short and long term costs involved in the surgical, audiological, and rehabilitation processes, as well as maintenance of implant equipment

What is involved with implant surgery?

Cochlear Implant surgery is performed under general anesthesia. The patient is placed on their back with their head turned away from the side of surgery. A small amount of hair is shaved, and an outline is traced around the receiver/stimulator area on the side of the head where the implant will be placed. The placement of the receiver/stimulator won't interfere with the BTE.

Cochlear Implant Surgery

Indications for Surgery

Severe to Profound Sensorineural Hearing Loss is an indication that you may need surgery.

Anesthesia

This procedure requires a General Anesthetic.

Surgical Time

The length of this procedure is 1 hour for unilateral implantation, or 1 3/4 hours for bilateral implantation.

Hospital Admission

Patients less than 1 years of age require an over night admission to the hospital. Patients between 1 and 65 years of age may have their procedure on an out patient basis.

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CI Programming & Follow-up

Patients return for initial programming of their device approximately three to four weeks following surgery. The audiologist that is working with you in the clinic will fit the external equipment to make sure that all components are appropriate. The speech processor is then connected to a computer for programming. The audiologist, with the help of the cochlear implant recipient, sets the “softest” sound and a “comfortably loud” sound for specific contacts point for the internal cochlear implant. Expectation levels for how the device will sound are discussed prior to programming. Once programming has been completed and a useable program has been downloaded to the processor, the external equipment function is reviewed with the recipient. You can expect approximately 7 follow up visits in the first year to allow for proper adaptation to the new sound stimulus. After the first year, ongoing, follow-up visits will be scheduled every 6-12 months in order to help fine-tune the program settings, assist the recipient with specific needs, and measure productivity and maximization of device function and use.

The audiologist will help in determining whether the implant recipient is an appropriate candidate for aural (re)habilitation/speech and language therapy. We have a therapist on staff who can provide these services. New implant users (children and adults) often find that one-on-one therapy initiated shortly after they obtain their device is very beneficial! The therapist can assist in establishing realistic goals and expectations, help the individual to maximize their listening potential, assist with IEP goal selection, and provide home program exercises. Even families of children who are already receiving therapy services at school find that adjunct services in the private sector are quite beneficial. Especially because these services are provided here, at the Cochlear Implant Center, allowing for excellent communication and continuity of care between all of the implant team members.

Cochlear BAHA - Bone Anchored Hearing Device

What is the Baha® System?

The Baha System utilizes your body’s natural ability to conduct sound.

Bone, like air, can conduct sound vibrations. For people with hearing loss, this provides another pathway to perceive sound. Typical hearing aids rely on air conduction and a functioning middle ear.

In cases where the middle ear function is blocked, damaged or occluded, the Baha system may be a better option as it bypasses the outer and middle ear altogether. Instead, sound is sent around the damaged or problematic area, naturally stimulating the cochlea through bone conduction.

Once the cochlea receives these sound vibrations, the organ ‘hears’ in the same manner as through air conduction; the sound is converted into neural signals and is transferred to the brain, allowing a Baha recipient to perceive sound.

How does Natural Hearing Work?

We receive sound in two ways, by air conduction via the ear canal, eardrum, and ossicles, and by bone conduction. Bone conduction transmits sound directly though the bones in the jaw and skull, bypassing the outer and middle ear.

In most cases, those with a hearing loss will be fitted with traditional air conduction devices. Typically, these hearing aids are placed inside the ear canal or behind the ear. However, some people are unable to benefit adequately from this type of device.

The Baha system, which is based on bone conduction, utilizes a titanium implant, which is placed in the skull bone behind the ear. An abutment connects the sound processor with the implant in the bone. This creates direct (percutaneous) bone conduction. In contrast, traditional bone conduction hearing aids connect indirectly to the bone through unbroken skin (transcutaneous) and work by exerting pressure against the skull.

Direct bone conduction, provided by the Baha implant, may give improved access to sound when compared to traditional bone conduction hearing aids because sound is not weakened or distorted by passing through the skin, muscle and fat covering the skull.

What Conditions can the Baha® System Treat?

For thousands of people worldwide, the Baha system is the treatment of choice. The Baha system is recommended for three different types of hearing loss within specific audiological indications:

  • Conductive hearing loss
  • Mixed hearing loss
  • Single sided deafness (SSD)

Cochlear™ Baha®

The first system based on direct bone conduction
One reason the Baha system works so well is due to its simple design. The Baha system combines a sound processor with an abutment and a small titanium implant. The implant is placed behind the non-functioning ear. Surgery is minor, and Baha recipients report a wide range of advantages over other hearing devices.
After a period of approximately three months (six months for children) the implant will have osseointegrated with the bone. The sound processor may now be attached to the abutment, enabling the recipient to hear with the Baha®system fully in place for the first time.

There are three Baha sound processor models: the new Cochlear™ Baha® BP100, the Intenso and Cordelle II.

Cochlear™ Baha® BP100

The Baha BP100 is a programmable sound processor built exclusively for bone conduction. The BP100 now has both automatic noise reduction and directional microphones to help improve your ability to understand speech in background noise, such as a restaurant.

Clarity in Sound:

Experience a whole new sound with the Baha BP100. In a recent clinical study, patients showed better hearing in noise, using a Baha BP100. the Average improvement was equivalent to about 25% better performance than with their Divino listening with both ears.

Design:

Active individuals place high demands on their hearing solutions. Large selection of colors; Smart LED indicators; 3 easy-to-use buttons; easy access to music and telephones using BP100 accessories, and new pediatric-friendly solutions.

Simplicity in Use:

No matter where you are, the Baha BP100 automatically selects the optimum combination of sound processing settings. You can enjoy clear, comfortable sound quality without lifting a finger.

Practical and Comfortable Solution

Children born with, or later aquiring middle or outer ear problems, or single sided deafness (SSD)TM, can still benefit from bilateral hearing. Hearing is a vital part of a child’s learning process and it's of great importance to start stimulation for speech and language development as early as possible. For mixed, conductive hearing loss or SSD, bone conduction is a natural alternative.

Children’s skulls are thinner and their bone is softer than an adult’s. The FDA has only cleared implant placement in children age 5 and up, who have stronger and thicker skull bones. However, younger children can be fitted with a Baha sound processor with an external attachment. Until recently, only uncomfortable metal steel spring headbands were available as an option for children to use Baha while awaiting surgery. These proved difficult to wear for some children due to discomfort and difficulties keeping the headband in place. Now with the Baha® Softband, a more practical and comfortable solution is available.

Frequently Asked Questions

What is the Baha® Softband?*

The Softband is an elastic band with a plastic snap connector sewn into the band. The Baha sound processor can be easily attached to the plastic connector. The band is adjusted to the size of the baby’s head and secured with Velcro®. The sound processor is held against the skin behind the ear, or at another bony location of the skull, through the pressure from the band. The sound travels through the bone to the functioning inner ears. The band can be turned so that the connector is not always in the same position, which will help to avoid skin discomfort.

What is the minimum age for Baha surgery?

The minimum age for implantation in the U.S. is 5 years old per FDA guidelines.

What if your child is too young for surgery?

The Softband is an elastic band with a plastic snap connector disk sewn into the band. The Baha sound processor can be easily attached to the plastic connector and the band can be worn by kids of any age, including a newborn baby. The Softband is often used as a temporary solution until the child is old enough for surgery.

Do children with Baha need special care?

Children using Baha can be taught to clean the abutment just as they are taught to clean their teeth. You will know when they are ready to take responsibility for their own daily routine. In the US, children aged five years and older are cleared by the FDA for implantation, but younger children can use a Baha with a Softband. Children with Baha should be treated just like any other child. They need to practice good hygiene in the Baha implant area and to be supervised by responsible adults who also ensure that the Baha care and maintenance instructions are followed.

*The Softband works in the same way as a conventional bone conduction hearing aid, with the signal being weakened as it passes through the skin (attenuation).

Cautions: If it is used during the fixture healing process, the sound processor must not be placed on top of the abutment or implant as this might jeopardize osseointegration. The Softband contains natural rubber latex that may cause allergic reactions.

Why do People Choose Baha®?

One of the benefits of choosing Baha is that you can ask your hearing care professional for a Baha demonstration, so you can hear the difference yourself. Many people are surprised by the amount of hearing improvement that the Baha delivers.

These are some of the top reasons why people make the decision to go with Baha.

  • Direct Bone Conduction allows the recipient to hear sounds more clearly and naturally.
  • Potential recipients can easily test the Baha so that they can experience the benefits before they have surgery.
  • The Baha is comfortable to wear; recipients say that they forget that they have it on.
  • The Baha is in use by thousands of individuals around the world. The outcomes are predictable and well documented.
  • The Baha procedure is reversible and does not damage or harm residual hearing. Additionally, the Baha system does not preclude any benefits from future hearing technological advances because it doesn’t compromise middle or inner ear or compromise hearing nerve sensitivity.

Can I try a Baha sound processor before making up my mind?

You most certainly can! It can be connected to a test band, test rod or the Softband, which allows you to try the sound processor in different environments such as at home, at work etc.

Can I wear a Baha all the time?

You can wear it for all normal activities, but you should take off the sound processor before going to sleep, taking showers, swimming or other water. You may need to wear special protection for contact sports.

When can I go back to work after surgery?

You should be able to go home after a short time in the hospital. Most people prefer to take an extra day off work before resuming their normal activities. However, in most cases you may return to work on the advice of your surgeon.

Is a Baha compatible with mobile phones?

Yes, all Baha sound processors can be used with GSM or other mobile phones. But you should never hold the phone against the sound processor itself, because this could cause feedback problems. A telecoil unit can be used with any Baha to help improve the sound quality of an ordinary phone that is fitted with a loop or a coil.

How many people have received a Baha to date?

Many thousands of people have been treated so far – some of whom have been wearing Baha sound processors since they were introduced in 1977. Over the last 10 years, Baha has become a treatment of choice for thousands of hearing impaired people worldwide, and the numbers of Baha users are increasing rapidly.

Indications for Surgery

Conductive hearing loss with no other surgical option, Sensorineural hearing loss with intolerance of hearing devices, unilateral deafness.

Anesthesia

Bone anchored hearing aid placement is generally performed under a general anesthetic. In some cases where the patient has a concurrent medical condition and they cannot safely withstand general anesthetic, a local anesthetic can be used.

Surgical Time

The length of this procedure is 30 minutes.

Hospital Admission

Patients are not required to register in the admissions area of the hospital.

About the Procedure

A titanium post is inserted in the bone of the skull behind and above the ear. After a 2 month healing phase, a sound processor is attached to the post allowing transmission of hearing directly to the inner ear, bypassing the eardrum and middle ear structures.

Auditory Brainstem Implant

An auditory brainstem implant (ABI) provides a sensation of hearing to deaf people by directly stimulating the brainstem. The ABI bypasses the cochlear nerves, so it may be an option for individuals with nonfunctioning or absent cochlear nerves.

The device is used most commonly in people with neurofibromatosis type II (NF-2), a disease causes tumors to form on the balance and hearing nerves, which usually results in deafness.

How Does it Work?

In people with NF-2, the ABI usually is placed at the same time the nerve tumors are removed, so it's completed within one surgery. The device comprises a tiny microphone positioned by the ear, a decoding chip and an array of electrodes implanted on the brainstem. The ABI connects directly to the brainstem, bypassing the damaged cochlea and cochlear nerves. The microphone picks up sounds from the environment and digitally transmits them to a decoding chip placed under the skin. The chip stimulates the brainstem electrodes, allowing the patient to hear a variety of sounds.

The placement of the ABI is just the first step in restoring some hearing. After surgery, the patient returns for multiple sessions with an audiologist to test and adjust the sound processor, and to learn and interpret new sounds. This process can take significant time, because the sound cues from an ABI are different from normal hearing.

The device doesn't give the full range of hearing, but it provides increased environmental noise awareness. Most patients are able to hear noises like a telephone ringing or horn honking, but the degree of hearing usefulness can vary greatly. Some people get good word recognition, while others get more general sound cues. In combination with lipreading, the cues help improve communication with others.

Indications for Surgery

Diseases that damage the inner ear and the auditory nerve connecting the inner ear to the brain (such as Neurofibromatosis Type II in which bilateral acoustic neuromas are present) require a novel solution to provide hearing. In this procedure and with this device, the hearing pathway is stimulated electrically at its connection to the brain.

Anesthesia

The Auditory Brainstem Implant procedure requires a General Anesthetic.

Surgical Time

The length of this procedure is 1 hour.

Hospital Admission

Patients are required to register in the admissions area of the hospital.

About the Procedure

The device (very similar to a cochlear implant) is placed under the skin behind and above the ear. An electrode is placed through the inner ear and connected to the auditory nucleus on the portion of the brainstem where the hearing nerve connects from the inner ear. This procedure is usually done in conjunction with a translabyrinthine approach for acoustic tumor removal and the closure is accomplished in the same fashion. The device is turned on 1 month after placement and tuned individually for each patient.

Vibrant Soundbridge

The VIBRANT SOUNDBRIDGE® is the first FDA approved implantable middle ear hearing device to treat sensorineural hearing loss (the most common form of hearing loss). A proven, safe and effective treatment that leaves the ear canal completely open, the Soundbridge features a 94% improvement in patient satisfaction1, with thousands of patients worldwide.

The intent of this section is to help you understand how the Vibrant® Soundbridge® may help you or a family member.

The Vibrant Soundbridge is indicated for use in adults, 18 years of age or older. The Soundbridge is intended to treat moderate to severe sensorineural hearing loss for patients who cannot achieve success or adequate benefit from hearing aids or cannot medically tolerate hearing aids. Prior to receiving the device, it is recommended that an individual have experience with appropriately fit hearing aids.

Information provided on this website is for informational purposes only and is not a substitute for professional medical advice. Only your healthcare provider can diagnose your healthcare problems and prescribe treatment. Please select topics from the menu on your left to read more about hearing loss and treatment options.

ARE YOU A SOUNDBRIDGE CANDIDATE?

The questions below may be helpful in determining whether you are a candidate for the MED-EL Vibrant Soundbridge®. Successful Soundbridge users typically answer "yes" to the questions listed. If you respond with a "yes" to most of the statements you may want to discuss the Soundbridge as a potential treatment option with your hearing healthcare provider.

Keep in mind that only an Audiologist or Otologist can determine whether your hearing loss is appropriate for this device. If you would like to find an Audiologist or Otologist in your area that is experienced with the Vibrant Soundbridge, please click on Locate a Soundbridge Center.

 Do you desire clearer, more natural sounding hearing?
 Are you looking for better hearing in adverse listening environments such as background noise?
 Do you have trouble with whistling or feedback?
 Do you find it difficult to wear hearing aids because they are uncomfortable?
 Do you experience difficulty with your own voice quality due to occlusion?
 Do you experience multiple hearing aid repairs due to wax and debris build-up?
 Do you have a medical condition that makes the use of a hearing aid difficult?

THE SOUNDBRIDGE ALTERNATIVE

The Vibrant Soundbridge® is not a hearing aid; it is a new category of implantable middle ear prosthetics. The Soundbridge is an implant that directly vibrates the small bones in the middle ear. It has been approved by the FDA as a safe and effective treatment option for adults with moderate to severe sensorineural hearing loss who have been unsuccessful with or are medically unable to wear hearing aids. Prior to receiving the device, it is recommended that an individual have experience with appropriately fit hearing aids.

Extensive clinical studies conducted in the United States and Europe have documented that patients implanted with the Vibrant Soundbridge reported the following:

  • Based upon subjective responses, when comparing the Vibrant Soundbridge to their own hearing aids, a majority (86% or 42/49) of patients reported significantly improved sound clarity and overall sound quality.
  • The Vibrant Soundbridge significantly improved patients' perceived benefit in many listening situations, such as: familiar talkers, ease of communication, reverberation, reduced cues, background noise, aversiveness of sound, and distortion of sound.
  • The Vibrant Soundbridge significantly reduced acoustic feedback when compared to the patients' own hearing aids.
  • Patients reported that the Vibrant Soundbridge provided better overall fit and comfort compared to their own hearing aids, and reduced maintenance issues due to cerumen and moisture accumulation.
  • For most patients, the Vibrant Soundbridge did not significantly affect residual hearing.
  • The Vibrant Soundbridge provided equal or increased functional gain when compared to the patients' own hearing aid.

THE SOUNDBRIDGE ALTERNATIVE - How Does It Work?

The Vibrant Soundbridge consists of two components, one internally implanted and the other externally worn that work together enhancing the normal middle ear hearing function. The external component is the Audio Processor™. It is 100% digital and is programmed by an Audiologist to fit the user's specific hearing loss. The implanted receiver contains the Floating Mass Transducer™(FMTTM).

  • The Audio Processor picks up sound from the environment and transmits that sound across the skin to the implanted receiver.
  • The implanted receiver converts the signal and transmits it to the FMT.
  • The FMT is a tiny transducer that directly vibrates the ossicles by mimicking the natural motion of the ossicular chain, sending an enhanced signal to the fluid-filled inner ear (cochlea).
  • That ossicular motion creates movement in the fluid of the cochlea, stimulating the hair cells. The hair cells provide stimuli to the auditory nerve, which are then interpreted by the brain as sound.

THE SOUNDBRIDGE ALTERNATIVE - What To Expect?

Fitting Process

Candidacy evaluations include a series of hearing tests to determine if your hearing loss is appropriate, followed by a medical exam to determine your surgical candidacy. The implant surgery itself is a 2-hour outpatient procedure, performed under general anesthesia. The internal receiver is placed under the skin behind the ear, and the FMT is attached to one of the bones of the middle ear. About 8 weeks after surgery, after the external audio processor is digitally programmed by an audiologist to best fit your hearing loss, the Soundbridge is activated.

The Quality of Sound You Can Expect

The charts below compare Vibrant Soundbridge patient satisfaction to their satisfaction with the hearing aid they used to wear.*

*Sources:
1) Luetje C, et al. Phase III Clinical Trial results with the Vibrant Soundbridge Implantable Middle Ear Hearing Device.Prospective Controlled Multicenter Study. Otolaryngology-Head & Neck Surgery 2002; 126; 2:97-107.
2) Data from the original IDE study, sponsored by Symphonix.

Greater Satisfaction with Sound Clarity & Quality


Significant Improvement in Multiple Listening Situations

Improved Fit, Comfort & Maintenance

THE SOUNDBRIDGE ALTERNATIVE - Frequently Asked Questions

Does health insurance reimburse the Vibrant Soundbridge?

If you have private insurance, there is a good chance that your insurance may cover the Soundbridge implant procedure. Since February 2002 many of the patients who have submitted the Soundbridge procedure for payment have been successful. Currently, Medicare coverage is not available.

How many people have received the Vibrant Soundbridge?

Thousands of people have been implanted with the Vibrant Soundbridge.

What's the difference between the Vibrant Soundbridge and a cochlear implant?

Cochlear implants are for those who suffer from severe to profound hearing loss. They are implanted directly in the inner ear, or cochlea, where they electronically stimulate the nerves through a series of electrodes. In contrast, the Vibrant Soundbridge is for hearing-impaired people with moderate to severe hearing loss. It provides an enhanced signal to the inner ear by directly vibrating the middle ear bones.

What is occlusion and why is it a problem?

Occlusion is the sensation of hearing distorted, muffled sounds experienced when an object blocks the ear canal. It is a common complaint among hearing aid users, who often find that the presence of the hearing aid, or hearing aid ear mold, in their ear canal distorts not only outside sounds but also the sound of their own voice.

What is the size of the Vibrant Soundbridge?

The Vibrant Soundbridge is made up of two components. The externally worn portion (Audio Processor™) is about one inch in diameter. The tiny FMT ™, part of the implant and the component that is attached to the bone (incus) in the middle ear, is approximately the size of a grain of rice.

Can the Vibrant Soundbridge be customized to different levels of hearing loss, and can it be upgraded when new technologies are developed?

The Vibrant Soundbridge is fully programmable using software that enables audiologists to customize the device depending on patients’ individual hearing needs. The Vibrant Soundbridge is designed to accommodate technology advances via the Audio Processor. As a result, patients will be able to take advantage of new signal processing circuits and enhanced programming options as they become available without further surgery.

How often will I need to change the battery?

The battery life depends on usage and device settings. A typical patient who uses their Vibrant Soundbridge 12-16 hours a day may need to change the battery about once a week.

How long does the implant procedure take?

The procedure to implant the Vibrant Soundbridge is done on an outpatient basis and it takes approximately one and a half to two hours.

Is the device safe?

Extensive clinical studies conducted in the Unites States and Europe have confirmed that the Vibrant Soundbridge is a safe and effective treatment option for adults with moderate to severe sensorineural hearing loss who are seeking an alternative to acoustic hearing aids. Implant patients are exposed to the normal risks of middle ear surgery and general anesthesia.

What does direct drive mean?

Direct drive hearing technology directly stimulates the bones in the middle ear. The Vibrant Soundbridge is a direct drive device which mechanically vibrates the bones in the middle ear without surgically altering the structures of the middle ear.

How is the Vibrant Soundbridge® different from a hearing aid?

Hearing aids, which are worn in the ear canal, amplify sound acoustically in order to increase the movement of the eardrum and indirectly vibrate the middle ear bones. In contrast, the Vibrant Soundbridge is an implantable prosthetic that provides an enhanced signal to the inner ear by directly vibrating the middle ear bones, while leaving the ear canal open and the eardrum undisturbed.

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