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Ten years on and I have had a Bone Anchored Implant & Audio Processor fitted

hal baha

This is an Oticon Ponto Pro, which was fitted in October 2012, replacing my Cochlear Divino, which was then over 3 years old

 Introduction
The removal of an acoustic neuroma often leads to deafness on one side, as it did with me.  This reduces one's ability to hear, especially on the deaf side.  That of course is pretty obvious but what is not so obvious is that you lose the ability to tell where sounds are coming from.  In a person with normal binaural (both ears) hearing, the brain processes the sounds arriving at each ear, providing a sense of direction of incoming sounds.  So when someone says "look over here!" you know where they are.

As an added bonus, the brain also provides a subconscious directional filter.  With normal hearing , if you are standing in a crowded room, you can focus your attention on a couple of people talking and hear what they are saying despite the background noise.  Those with single sided deafness lose this ability.  It is irritating but one learns to live with it.  My wife has learned that when I call out "where are you?" not to reply "here", which is of no help but to reply with her location - such as "in the kitchen"!  Cupping a hand around the good ear helps a bit in noisy environments but dinner parties always give rise to a stiff neck from trying to face one's dining companion so that you can hear what they are saying.

When I had my acoustic neuroma removed in 1999, I was offered the opportunity to consider a cross-over hearing aid.  A microphone placed on the deaf side provides a signal through a wire round the back of the head to an earpiece in the good ear.  I decided that this probably was not worth the benefits it may provide.  Since then, wireless cross-over aids have become available but I still suspect that the disadvantages would outweigh the benefits for me.

This website has provided some help to a number of patients and their families, some of whom have kept in touch.  One of those who kept in touch was Trudy, who had her acoustic neuroma removed  in January 2006.  In March 2007 she took the first step in pursuing a Bone Anchored solution to single sided deafness - a Baha.  It took just over a year to go through referral, the implant procedure, recovery and finally fitting the sound processor, which took place in May 2008.  She was, and still is, so thrilled with the outcome, which she shared with me, that I thought it worth investigating.

What is a Baha?
For a professional appreciation visit http://www.cochlear.com/uk/hearing-loss-treatments/bone-conduction-implants-adults but for the purposes of this document I offer this summary.  A bone anchored solution offers those with single sided deafness a means of hearing what is happening on their deaf side by transmitting sounds on the deaf side through the skull to the good ear.  A titanium implant is screwed into the skull behind the deaf ear.  A small box of electronics (the sound processor) is fitted to the implant which transmits sound through the implant into the skull.  The sound is then transmitted through the bone, bypassing the outer and middle ear, right to the inner ear, the cochlea, on the good side.  Incidentally, a bone anchored solution is extremely effective for people with outer or middle ear deafness but that is another story.

Summary Diary of a Baha (Please skip this if you would like to read the whole thing)
Following Trudy's enthusiasm for her Bone Anchored Hearing Aid, I decided to investigate this avenue for me.  An exchange of emails with my original consultant prompted a visit to my GP, who after some research, sent me off to Salisbury District Hospital.  I attended the ENT Clinic, had a hearing test, successfully tried out a hearing aid attached to an Alice band, resting on the bone behind my good ear and saw the consultant who thought that I was suitable candidate, subject to funding.

Five months later I had "day surgery" to fit a titanium screw to my head an inch behind and just above the top of my deaf ear.  Although it is usual to have a general anaesthetic for this procedure in the UK, I opted for a local.  Despite some discomfort it was the right choice for me.  The whole procedure took about an hour and I spent half the afternoon recovering on a day ward.  The bandaging was a bit bigger than I expected but most of it was removed before I went home.  I had been prescribed pain killers but I didn't really need them.  A couple of weeks later I visited the clinic to have all the bandaging removed and to confirm that the healing was progressing satisfactorily.  It was suggested that I should continue to wear a light bandage over the site when I went out.  Four weeks later, another visit to the clinic confirmed that all was well and that I could now shower, swim and generally behave normally - bliss!

I had to wait another five weeks before my appointment for fitting the sound processor, to allow the titanium screw to fully integrate with the bone in my  skull.  On July 7th I was delighted to receive my sound processor but was a bit disappointed that the benefits of wearing it were a bit too subtle.  It worked, as I could still hear when I blocked my good ear but it didn't seem to help the hearing on my deaf side very much.  However, over the next three to four months it did seem to improve a bit, especially when I tried turning the volume up and ignoring the loud background hiss that produced.

Four months after getting my sound processor I had a follow up check-up with both my audiologist and the ENT surgical team.  My audiologist responded to my comments about the noise level by suggesting that it should go back to the manufacturers in case there was a fault with it.  I agreed with some reluctance.  The surgical team were pleased with the way the abutment was being looked after and suggested a further check-up at the end of March 2010.

I picked up the sound processor just less than two weeks later and was amazed to note that it was working completely differently.  There was virtually no background hiss and it seemed to be three or four times more powerful.  I had my Eureka moment at last!  My irritation at having what was clearly a faulty processor right from the start was mitigated by my enthusiasm for the working device.  I am now completely convinced this is the right solution for me and will enthusiastically support others to achieve similar benefits.

Blow-by-blow Diary of a Baha
Referral
Following Trudy's enthusiasm for her Baha, I contacted Anne Davis, the consultant who removed my acoustic neuroma to ask if she thought it was a suitable solution for me.  She kindly responded positively, suggesting I go through my GP.  So I went to see my GP on 8 September 2008 to seek a referral.  She concurred but had to do some research to find out who in our region specialised in Baha's.  About six weeks later I was offered an appointment at the Salisbury District Hospital ENT Clinic on 28 November.

At the clinic I was given a hearing test by a delightfully cheerful nurse, both to confirm my single sided deafness (!) and to establish how good my hearing was on my good side.  She said that my hearing was excellent and that the smallest of the Baha's would be suitable.  She then fitted an Alice Band over my head, which held a sound processor similar to the one used in a Baha but connected to a pad, resting on the bone behind my deaf ear.  At first I couldn't see the point but when she asked me to put my finger in my good ear, oh wow!  A finger in my good ear normally produces near silence but I now could still hear, if not perfectly, certainly well enough to carry on a conversation.  She encouraged me to go off for half an hour and see how I got on with it.  My wife and I had a walk around the hospital and stopped off for a coffee and a Danish at the restaurant.  My wife sat on my deaf side and we were able to carry on a normal conversation, which would have been impossible without the Alice Band aid.  We returned to the clinic and I returned the Alice Band and enthused.  We then had to wait for a little while to see the Consultant, Mr Brockbank, who agreed that fitting a Baha was a suitable course of action and that he would take the necessary steps, subject to funding.  I live in East Dorset, my GP's  surgery is in Hampshire and Salisbury District Hospital is in Wiltshire - an administrative nightmare!  He explained the procedure, which I will describe in detail later and suggested that I might have to wait 4-6 months for the next step, which would be surgery.

I phoned the hospital about 6 weeks later to enquire on progress and was informed that funding had been approved and that I was on the waiting list.  On 31 March I was offered surgery on 20 April, just seven and a half months after my first enquiry.

Anaesthesia - local or general?
Internet research reveals that fitting the implant can be done under either a local or a general anaesthetic.  My preference, to the horror of friends and family alike, will always be to have a local rather than a general.  I don't like the feeling of going under when given a general anaesthetic and the recovery process takes a day or two, instead of an hour or so.  Driving is prohibited for forty eight hours too.  Under a local, the team have to respect your body and there is a fair chance, if you are inquisitive like me, that you will have a better understanding of what has been done to you.

I asked my consultant, Mr Brockbank, during my initial consultation if he would be prepared to do mine under a local but he declined, although he did mention that my surgery might be carried out by his colleague.  When my appointment letter arrived it confirmed that my surgeon would be his Consultant colleague, Miss Melanie Collins.  My acceptance of the date for surgery included a letter to her, asking if she would be prepared to perform the procedure under a local rather than a general.  To my delight, two weeks later her secretary telephoned to confirm her willingness to do it under a local.  Notwithstanding that agreement both my anaesthetist and Consultant tried to get me to change my mind on the day.  My anaesthetist said that if it was him, he would choose a general and my Consultant said that while she was happy to do it under a local, she normally only did so when there was a reason why the patient couldn't have a general.  Having established that they were both prepared to do what I preferred, I stuck to my guns.  I was warned that I would probably suffer some discomfort - actually they said it would hurt a bit.  They were right!

Surgery
Our elder son and his family visited us for a week over Easter, two weeks before surgery.  The legacy of that visit was a shocking sore throat, cold and cough, bad enough for me to visit my GP a week before surgery, asking her to help me avoid having to put it off.  She checked me out and decided that it wasn't on my chest, that it was a virus but that she would give me a precautionary course of antibiotics.  That didn't help or hinder the progress of the virus but made me feel that I had done what I could to avoid a delay.  I even rang the hospital on the Friday before the proposed Monday surgery to tell them how I was but we agreed to hope for the best!

The procedure is done as "day case", in and out in a day.  I assumed that as I was going in at 8:00 am I would be home by lunchtime - wishful thinking!.  The staff in the Day Surgery Unit were superb, very friendly and on the ball.  However, as I had opted for a local, I was the last of three operations to be done in the morning session, so had to wait until 11:00 for my procedure.  I was visited by my Consultant, her Registrar and the Anaesthetist soon after my induction, when we had the conversation reported above about anaesthesia and I was also told that there would be at least a 3 hour recovery stay afterwards before going home.

Just before 11:00, I was asked to remove my clothes above my waist and put on a short gown and was walked to the operating theatre.  I was surprised at how many people there were in theatre, at least eight!  I climbed onto the operating table and lay down with my head in a pillow with a hemispherical bite taken out of it.  Everyone was dressed in scrubs and masks so it was quite difficult to know who was who!  There was a bit of a delay, waiting for a scrub nurse but then I was covered from head to toe in green drapes, cutting me off from proceedings, except for a small gap through which I could see a distant wall.  A canula was inserted in my left wrist, through which I was given antibiotics before any work began.  The procedure took from 11:30 until 12:30 during which time someone occasionally crouched down to look under the drapes to ask if I was OK.

I had to lie on the pillow with my body flat but with my head turned to the right, causing my right ear to be in the pillow, reducing what I could hear.  However, my Consultant provided me with an audible running commentary most of the time.  The first step was shaving an area of my head, perhaps two inches wide by six inches long with an electric shaver.  The second step was the local anaesthetic.  She told me it may hurt - it did.  She asked me to let her know if I felt significant pain later and she would give me some more.  There were times during the next hour when I came close to saying "excuse me but that hurts!" but it never lasted long enough to make a fuss.  I was worried about coughing but I managed the hour without doing so.  I was also worried about being able to keep still for so long.  I wriggled just once  - an unconscious act - and was told "you wriggled!".  I apologised and made sure it didn't happen again.

After the local anaesthetic had done its job the procedure began in earnest.  Here I have to mix my understanding of the procedures undertaken with the sensations I remember, so this account may not be strictly accurate.  I have checked out as much as I can with both my Consultant and her Registrar and hope that it is not too far from reality.

The first step was to create a thin flap of skin, like a small door with the hinge on the left hand side (the side closest to my ear).  It was just under 1" square, using a machine  called a dermatome (see the first video link under Links below).  It whirred and felt cold.  The rear of the skin flap is cleaned of hair follicles to prevent the re-growth of hair at the site of the implant.  Then the removal of tissue from the area revealed by pulling back the skin flap was undertaken.  The first few cuts hurt a bit, probably undercutting at the edges of the skin flap.  The removal of the rest of the tissue took quite a while.  I could hear my Consultant talking to her Registrar as he assisted with checking the bleeding (confirmed with him at my two week visit to the ENT Clinic).  A large contact pad placed on my stomach may have facilitated this.

Then came the drilling.  There was no pain and it didn't take very long but it did sound very loud indeed.  The drill was used intermittently, obviously very carefully!

I had asked my Consultant to show me the implant before it was screwed in.  So it was at this point that she came round to my right side, bent down and showed me the implant held in forceps.  It was quite small and without my glasses it was difficult to focus on it but at least she tried.  I then heard it being screwed in, in one go; it took a few seconds.  My head moved when the screw went tight and my Consultant commented that my head moved, which was good because it meant it was in tight!  It did not seem to take very long to stitch the skin flap into place, clean up and apply dressings.  The drapes were removed and I had to lift my head to allow a bandage to be wrapped around it.  I then had to wriggle onto a trolley and was wheeled back to the ward.

A cup of tea and some toast were offered, accepted and consumed with relish.  I hadn't eaten since the previous evening, just in case I had to have a general.  My Consultant visited during the recovery period and pronounced herself happy with the procedure.  She commented that I had bled a bit, because the surgery was close to the site of the original surgery to remove the acoustic neuroma.  She warned that I could expect some continued bleeding for a day or two.  I asked when I could return to the gym and was surprised and disappointed to learn that this should await the removal of the dressing in two weeks time.  I was not to undertake exercise that made me hot and sweaty or raised my blood pressure, any of which might hinder recovery or encourage bleeding.  I was given some pain killers, although I wasn't in any pain, perhaps to prepare me for the wearing off of the local anaesthetic.

I took a photo of myself using my mobile phone and was distressed to note the size of the bandage.  However, it was removed after an hour and a half, for an hour, before being being bandaged again, a little more lightly, in preparation for my return home.  My wife took a photo using my mobile phone, while the bandage was removed, showing the immediate dressing, held in place by a white plastic disc.

big bandage bandage removed
taken upon my return to the ward after surgery, using my mobile phone bandage removed for a while; note the "this side" arrow and red gauze spiral

I was provided with pain killers, materials for replacing the bandage and outer dressing and was allowed to return home soon after 3pm.  I was informed that an appointment would be sent to me for about two weeks time, to have the dressing completely removed.  I took some pain killers that night as a precaution and had a good night's sleep but did not require any further medication at all.

Recovery
The following morning I removed the bandage with a view to renewing the dressing.  The wound had bled through the dressing during the night.  Unfortunately, the dressing had stuck to the spiral of gauze which directly covered the wound, held in place by the plastic disc.  This spiral of gauze was quite a bit bigger than the disc and as I removed the dressing, about 9 inches of gauze unwound - panic, panic!  My wife did her best to put it back in place but we decided to phone the hospital to seek advice.  The specialist Baha team didn't come in until midday so I had to be patient until then. Sister decided I should come in.  As I hadn't had a general, I could drive myself - one up to me!  Sister took off the dressing and cut off the 9 inches of loose gauze and decided it was probably OK, as the gauze under the disc appeared to be intact.  My consultant came in to look and confirmed that it was satisfactory.  She encouraged me to keep the outer bandage in place, although I had been told by a nurse the previous day that it would be OK to take it off during the day while at home.  Sister bandaged me up again and gave me some more dressing materials, this time with a non-stick plastic film on one side.

Upon reflection, if the dressing that was put on just before I left hospital on the day of surgery had been the non-stick type, the gauze would probably not have stuck to the dressing and unwound. The spiral of gauze can be seen in the photo taken in the hospital - the red circle outside the disc, which is clearly missing from the photo below taken three days after surgery.  This self portrait was an interesting photographic challenge.  My Canon 50D digital SLR, 100mm macro lens, electronic ETTL flash-gun, tripod, computer and remote view were all bought to bear!

3 days after surgery close-up
three days after surgery, you can just see the faint outline of the ten year old scar; it touches the bottom left hand corner of the dressing. detail; notice the dip in the scalp caused by removing tissue under the "flap"

I changed the dressing every morning, as the wound continued to bleed a little for the next few days. Thereafter I only wore the bandage when going out and at night. By the end of the week, I was only wearing it at night and for the last few days before the next visit to the clinic, I did without a bandage completely, just wearing a hat for protection when I went out. Throughout this period there was no pain at the site of the surgery, although my scalp above the wound had some numb patches and was occasionally a little sore. Washing my hair was an interesting challenge. My wife did the honours while I held a very small clear plastic bowl firmly against my head, to prevent wetting the wound. Once I stopped wearing the bandage, I could at least comb my hair normally - with the bandage on and my hair combed up and away from the dressing, I had looked like a very old Pat Cash.

ENT Clinic
Fifteen days after surgery, on Tuesday 5 May, I went to the ENT Clinic at Salisbury District Hospital to have the dressing completely removed and checked out.  The stitches didn't need taking out as they were dissolvable.  We had a long wait - 45 minutes - perhaps they had a problem earlier in the day - but we were entertained by a large screen TV, complete with subtitles. Unfortunately we were called just as they were going to auction the three first edition Bond books and I never did find out how much they made.  (I used to have a first edition Bond, but lent it to someone, who never returned it).

Staff nurse Amanda was very solicitous, removing the plastic disc and the dressing with great care.  She showed me the remnants and also helped me to see the site with the aid of a couple of mirrors.  She cleaned the wound, giving my wife guidance on how to do it for me, making her practise putting the disc back and taking it off again.  She said the wound looked good and went to inform my Consultant that I was available to be viewed.  The Registrar passed by the room and popped in for a chat.  I asked about the dermatome and his part in the operation.  Soon afterwards, my Consultant arrived and expressed her satisfaction; everything looked fine, just as it should at this stage.  We were instructed to clean the site and apply antibiotic/cortisone cream twice a day for a week, then once a day for a week, then every other day.  I was to keep the plastic disc in place as protection.  I could go back to the gym, gently but she didn't want me to swim until after my next visit, in four weeks time.

I asked her what difference it made to the team to perform the operation with a local, instead of a general.  She admitted that they have to take greater care with what they say and do, as the patient is awake, that there can be more bleeding and that there is a greater tendency for the patient's head to rotate (face the front).  I remembered she had me to ask to twist my head to the right a couple of times during the operation.  She commented that British patients generally have more general rather than local anaesthetics for many operations than in several other countries.  I commented on the fact that there was no pain from the wound but that my head had both numb and uncomfortable patches above the wound.  This was quite normal, a result of the surgery cutting nerves crossing the scalp and would improve over time, I was told.  We laughed about the sensation of insects crawling through one's hair - fortunately it only lasts for a few seconds at a time.

We left with a bag of goodies; cream, some sachets of sterilised water, some plastic gloves and an appointment to return in four weeks.

Ongoing Recovery
The following morning I took some photos of the wound.  This was an interesting challenge.  I couldn't see the site in a mirror, it is too far behind my ear.  I had to use a tripod, digital SLR (Canon EOS 50D), a flashgun and "live view" on my computer.  With the camera connected to the computer I can view the image seen through the lens on the computer screen.  By manipulating my position and the tripod, I can see the site of the surgery from a variety of angles and with the aid of  macro lens, record the images for posterity.  I know they look a bit gruesome but I should reiterate that it looks far worse than it felt - there was no pain!

15 days on profile after 15 days
fifteen days after surgery the abutment almost in profile

After taking the photos, I tried a little experiment.  I had noticed that I could hear my finger move over the plastic disc very well indeed.  I had read up on the way a Baha works, including both the electronics and the mechanics.  I borrowed my wife's iPod and tried placing the shell of one earpiece in contact with the plastic disc.  I could hear the iPod through my good ear, without the earpiece in place in that ear, because it was turned up quite loud.   However, when I put a finger in that ear, I could hear nothing until the earpiece was in contact with the disc and then I could hear the iPod quite clearly.  In retrospect, of course, it should have worked but at the time I was thrilled!

 

titanium abutment

This is a photo of an implant and abutment, similar to mine.  The self tapping screw section is 4mm deep and 3.75 mm in diameter.  The abutment projects above the skin by 5.5mm.  My thanks to Cochlear Europe Ltd for the photo.  The material is titanium.

 

3 weeks on protective disc
three weeks after surgery, the abutment is clean but you can still see the antibiotic/cortisone cream plastic disc providing modest protection

 

4 weeks on abutment is very small
four weeks after surgery and the flap scar is healing well, but the hole for the abutment has a way to go the abutment is really quite small at 5.5mm high, it hardly protrudes above the scalp, as it is in a "dip"

 

5 weeks on 6 weeks on
five weeks on and it is looking good - must get a haircut! six weeks, ready for inspection at the clinic later today


Six Week Check-up
Forty three days after surgery, on Tuesday 2 June, I went to the ENT Clinic for a check-up.  Having rushed to be on time, I had a wait of 20 minutes to see Sister Angela Allen.  She was bright and cheerful and did not take long to pronounce that all was well.  After closely inspecting the site of the surgery she showed me the abutment using a CCTV camera and monitor and I shared with her the close-up photos I had taken that morning (see above!)  She then organised my next appointment, the really important one, for fitting the sound processor by the Audiology Team.  The date offered and eagerly accepted was 7 July, an agonising five weeks away.  After a brief wait for my Consultant, Miss Melanie Collins, to be available, she confirmed Sister Allen's assessment and told me that I was a model patient.  This was to underline that my recovery was going "to plan" and was therefore a suitable subject for this diary, rather than any credit to me personally!

I was told I could do everything normally now, including washing my hair properly, getting the abutment and surrounding area wet and I could swim too.  I was also told that I could stop wearing the plastic button on the abutment during the day, although it remained a sensible precaution to wear it at night.  I was also asked to make an appointment to see Miss Collins for a final check-up in four months time.  I was reminded to go back to the clinic if I had any problems with the site of the surgery rather than going to my GP.

I returned home, went to the gym and after a one hour fitness session went for a proper swim for the first time in six weeks, followed by a decent shower, including a proper unprotected hair wash - bliss!  All I have to do now is be patient for another five weeks; that is going to be a challenge!

9 weeks on DP Challenge entry
nine weeks on, only two weeks to go before the sound processor fitting on 7 July!   entered for a photo competition (DPC) at nine weeks  - they didn't like it!

 

July 7th - Baha Day!
I think it is important to note at this point that the next four months were a disappointment.  This was because my sound processor was not working properly during this time, although it was another four months before I found out.  The problem is no-one can tell you how it should sound nor can they tell what you are hearing.  Now that I have experienced how it should behave, it is quite clear to me that my disappointment was entirely due to the poor performance of a faulty device.  I have left my diary intact but you should bear in mind that the following part of the story, up to the Four Month Follow Appointment, is far from typical.  I am now thrilled to bits and would encourage anyone with a similar condition, single sided deafness, to pursue this potentially life changing option.

It was now 10 months since I went to my GP to enquire about a bone anchored hearing solution to my single sided deafness and 11 weeks and a day since I had the surgery to fit the abutment.  It was inevitable with this passage of time that one builds up this day in one's mind into some sort of watershed.  I tried very hard to moderate my expectations but to little avail.  In the last few days leading up to the 7th, I began to worry that it might prove not to be suitable for me.  I wondered if I might regret the consumption of NHS resources on my behalf and the protracted and occasionally uncomfortable journey I had made.

We arrived at the ENT clinic in good time and were called on time.  My audiologist, Tina Parsons, welcomed us to her office and as we went in, there was my Divino Sound Processor (the newest and smallest Baha from Cochlear Europe), in an egg sized black box, on the desk, awaiting my arrival!  Tina was cheerful, pleasant and businesslike.  She inspected the abutment and cleaned it with a cotton bud.  I was then lectured about keeping the abutment and sound processor clean and was warned that the latter was extremely fragile and so needed to be handled with care.  I was given a little package which included a clip on a fine nylon cord (to act as a safety line attached to my clothes if there was a risk of it being knocked off) and half a dozen batteries.  I was also given a box of 60 batteries and a brush, like a toothbrush only much softer, for cleaning the abutment.  The batteries should each last about a week, I was told.  (Hmm, maybe I remembered that wrong, because they last between 2 and 3 weeks.)  I should be able to get replacement batteries on the NHS from my local hospital, when necessary.  I was shown the sound processor and had the controls explained; on/off/volume and the switch for omni-directional sound (quiet environment) or forward facing sounds (noisy environment).

She explained how to fit the sound processor into the abutment, at an angle, with a rocking movement and I practised on a trial abutment fitted to a plastic plate.  Then it was time to try it out for real. . . . .

I sat opposite Tina and clicked it into place, turning it on and increasing the volume to half way.  I felt a bit odd, sort of spaced out, almost dizzy but unaware of any effect on my hearing.  I had expected some sort of Eureka moment and it didn't happen.

She asked me if I could hear her.  I'm afraid I thought that was a silly question (sorry Tina - maybe I didn't understand the question because I should have said no - if it had been working properly I would have been aware of her voice through the sound processor even with my good ear unblocked); of course I could hear her - I would have been perfectly able to do so without any "assistance"!  However, I tried listening with my hand over my good ear and I could still hear her, just as I had been able to with the Alice band, so it appeared to be working OK.  Thinking back, this is the moment when we all should have realised something was wrong.

I was given some documentation, including a booklet of instructions in English, French, German and Dutch, information about accessories like a lead for connecting up to an MP3 player (120!) and a battery issuing record book.  Disappointingly, there was no rod.  This is an attachment given to some Baha users so that they can share the experience with friends and family.  You fit the rod to the Baha, get the friend to put his fingers in his ears and then place the rod against the bone behind an ear and they can then hear just how it sounds for us Baha users!  I was given a card to offer up at airports if I dinged the security sensors, although that is extremely unlikely.  The sound processor has to be removed and the titanium  abutment is so small that it is unlikely to be detected.  An appointment was made for a follow up visit in 3 months on the same day as my follow up appointment with the consultant, Melanie Collins.

Having an electronics background, I had researched the history and development of bone anchored hearing aids and had a fairly good understanding of how they work and the electronics and mechanics involved.  I asked about what adjustments could be made and was surprised to be told: "there weren't any; that my model, the Divino, was not really digital; it would be too big if it was".  I decided it would be diplomatic not to disagree; maybe I had not phrased the question in the right way.

We left the hospital, with me still feeling al little bit peculiar and went into nearby Salisbury for a coffee.  In retrospect this was a mistake.  It was busy and noisy in the street and my wife was clearly disappointed, as was I, when I was unable to hear her as she walked beside me on my deaf side.  The same thing happened in the coffee shop, which was full of "musak" and noisy people.

We went home and I confirmed my belief in the tweaking facilities on the Divino, contained in the instruction manual!  A close look at the bottom of the Divino reveals two controls - they are tiny and are marked "L" and "AGCO".  Both of mine appeared to be set to maximum.  The manual suggests that they are for the audiologist to adjust, not the patient!  A few days later I took the protection cap off the connector which sits just below the two position switch on the sound processor; it reveals a tiny 4 pin connector.  I shall have to find out what it is for!  Getting the cap back on again was a challenge.  It is less than 2mm in diameter and has a keyway. . . .   I dropped the cap onto the carpet and had a fine time finding it again. . . . but I did succeed eventually and vowed not to take it off again.

The absence of a Eureka moment weighed heavily on my soul for the next few days and when people asked me about my new facility I had to admit that I was disappointed.  The first evening I felt tearful.

If you are reading this because you are contemplating a Baha, please don't be put off.  The problem is not the Baha.  I have since discovered that my reaction is not uncommon.  In fact it is really irritating that no-one warned me that it would take some considerable time to adapt to the new facility.  I have been single sidedly deaf for 10 years and during that time have adopted a whole range of contrivances, both conscious and unconscious, to minimise the effects and it is going to take quite some time to unlearn them because they are no longer necessary!

After a few weeks I did have a mini Eureka moment recently when I realised I couldn't hear my wife, who was sitting on my left (deaf) side, because I wasn't wearing my sound processor.

There is no doubt that my ability to exploit the benefits of the sound processor are improving every day.  It isn't a great deal of help in noisy environments but practice and experience with the right settings will provide some benefits even in these challenging circumstances.

My thanks to Trudy and Lyn who have both been very helpful and supportive, especially since July 7th.

Here are some photos of my sound processor, on its own and "in place" and some "before and after" surgery portraits.

Four Month Follow Up Appointment
After some appointment timing changes,  I attended follow up appointments at Salisbury Hospital for both ENT and Audiology on 10th November.  We attended Audiology first and met Tina again, who had someone else sitting in to learn about what she was doing.  Tina was bright and cheerful, as before, and I was very pleased to be able to tell her that during the last four weeks I had noticed a significant improvement in the benefits of having my Baha.  It all came down to the setting of the volume control.

You would have expected someone with my electronic background to have got there a bit quicker but actually it might have been a hindrance.  If I turned the volume control up to full, there was a very significant amount of hiss generated by the sound processor.  I associated this with the way an amplifier works.  It was natural for me to turn the volume down until the hiss was only just noticeable.  However, at this volume setting, the sounds generated by the sound processor and conducted to my good ear through the skull were not really much louder than the sounds reaching my good ear travelling through the air, so any improvement was very subtle.

I don't know why but eventually I tried putting the volume up to nearly full and found that it made a big difference to my perception of its performance, as long as I could put up with the hiss.

Tina was pleased that I had found the Baha beneficial but, after hearing about the hiss, wondered if it was working properly.  She asked me to take it off and using a small post attached to the sound processor, she listened to it herself.  A hearing person can block both ears and hold the post against the bone behind one ear and hear what it is like for a Baha patient.  She felt it was making more noise than she would expect and further suggested that it should be sent back to the manufacturer for a check-up.  I was a bit sceptical and not at all pleased at the idea of doing without it for two to three weeks, a clear indication that I found it worthwhile!  However, common sense prevailed and I let Tina "confiscate" it!

She promised to phone when it was back so that I could collect it.  I asked for and was given a post so that I could demonstrate to family and friends what it sounds like to have a Baha.  Apart from picking up the repaired Baha, it was agreed that I would return for a further check-up in a year.

We were intercepted on our way back to reception to go to our appointment in ENT.  I had hoped to see my consultant Miss Melanie Collins but she was not conducting the Clinic that afternoon.  However, the doctor we did see was very pleasant and spent some time with us.  He inspected the abutment and surrounding area closely, pressing quite hard around the abutment with a tool, which was quite uncomfortable but pronounced himself very satisfied with its condition.  He commented that it was one of the cleanest and best looked after he had seen!  Well, that was nice, five gold stars for my wife who cleans it up once a week, removing the build up a skin each time.  It gets washed daily because I shower and wash my hair, with special attention to the abutment area, every weekday after an hour in the gym and a short cooling swim.

He asked us to return for a further check-up in another four months and an appointment was made for 30 March 2010.

Tina phoned to tell us my Baha was back ready for collection ten days later (ahead of the promised schedule), on a Friday afternoon, so we collected it the following Monday morning.  When I collected it I asked her if they had found anything wrong with it - fearful that it had been returned NFF (no fault found.)  She showed me the list of problems they had found.  It was pretty dramatic, including a partially collapsed transducer.  I wondered out loud whether or not I had been looking after it properly but Tina seemed unconcerned.  Anyway, we hurried away to the car park, so that I could try it out.

Oh dear, it didn't work.  When it was confiscated it had a new battery in it but that was nearly a couple weeks ago so maybe the battery was flat.  I took the sound processor off and checked it only to find it had been returned without a battery!!!  And I hadn't had the presence of mind to bring a spare one.

After some having some coffee and doing some shopping in Salisbury we returned home.  I fitted a new battery and my repaired sound processor worked fine.  In fact, I had my Eureka moment.  There was very little background hiss, even with the volume turned up full and the power of the sound it generated was three or four times greater than it had been right from the start.  It was a completely different experience.  The sounds coming from my deaf side via the sound processor were much louder than those coming through the air from that side.  If I listened to the radio, facing it squarely, the sound coming from my good ear and through the sound processor were both at the same level; if I blocked my good ear there was practically no difference in the sound.  This suggests that the frequency response was much improved too.  I could hear my clothes rustling as I moved.  If I used the telephone, held to my good ear, I could hear my own voice from the sound processor as well as the side tone from the telephone, most importantly synchronised in time. Previously the sound processor sound had been delayed, causing an echo!  I really cannot express how thrilled I was to hear so much better.  There is still a bit of a problem with intelligibility, especially in noisy environments but there is now no question in my mind, this is the solution for me.  It is truly amazing and thrilling.  I will now do all I can to support others in their quest for improvement in their hearing where a Bone Anchored Solution is suitable.  Feel free to email me if you think I can be of any help to you.

Second Four Month Follow Up (nearly twelve months after surgery)
An appointment with both Audiology and ENT had been arranged for 30 March.  We arrived on time and were seen by Tina straight away.  She asked for an update and examined the site, pronouncing her satisfaction with the way it was being looked after.  I commented that although I was disappointed that the performance in noisy environments wasn't better, I was nevertheless pleased with the overall benefits provided by my sound processor.  In relatively quiet situations like in the car and sitting on the settee at home, there is no doubt that it makes conversations with people on my left "normal".

We discussed the possibility of a digital aid - the BP100 from Cochlear, perhaps, but it seems they are still too expensive for the funding authority.  Hopefully I will eventually get the opportunity to see if Cochlear's claim of a 25% improvement in intelligibility stands up to examination.

We didn't have long to wait before we were called into ENT where I was seen by Mr Corlett, "staff surgeon", the same chap as I saw on my previous visit.  He inspected the site of the surgery and again pronounced satisfaction with the way it was being looked after.  He found some small spots which he said was normal and squeezed them away - yuk - and suggested that  I should do the same whenever they appeared.  He suggested that there was no need for another visit to ENT and that I could now simply have follow-ups with Audiology on a yearly basis, unless any problems arise.

Links
http://www.cochlear.com/uk/hear-now-through-bone-conduction  This is the manufacturer's site and gives lots of useful information.  Up until recently they have been the only manufacturer but there is a another one which has now entered the marketplace, Oticon Medical .
 
http://www.baha-users-support.com  This is an independent patient run website, offering stories and advice for anyone either with or contemplating having a Baha.  They suggest that "BUSK is the only membership charity working to offer friendly support and information to those who use implanted bone conduction systems, and those considering having it fitted".  I am expecting to assist with website management!

https://en.wikipedia.org/wiki/Bone-anchored_hearing_aid This link provides some of the history of the development of the Baha, and some additional material.

http://entsurgery.net/Single-stage-Baha.html  This link takes you to a British video of a Baha operation with text mark-ups, which I found useful in explaining what would be and had been done to me.  It includes film of a dermatome being used.  Not for the squeamish!

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