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British Association of Teachers of the Deaf

Bone ConductingHearing Implants

An abridged versionof the January 2015

BATOD magazinecontaining articles

about BCHIs

From your editorI am delighted that Sue Archbold,

CEO of the Ear Foundation, last year

persuaded me that Bone Conducting

Hearing Implants would be an

excellent topic for a magazine. She

also suggested this abridged version

of the magazine containing only the

BCHI articles which would then reach a much wider

audience.You will see from the articles that there is a

wealth of information about various aspects of these

devices. But there is more than just technical and

practical information – there are excellent pieces from

users – the parent voice and the pupil voice are well

represented amongst these articles. There is also a

thought-provoking article from an adult reflecting on her

experience with a BCHI as a child.

There are various names for Bone Conducting Hearing

Implants and it can become very confusing! The term

BAHA (Bone Anchored Hearing Aid) is often used, but

Baha is a registered trademark belonging to Cochlear.

Other terms include Bone Conduction Hearing

Implants/Devices. We have tried to be careful and

consistent in this magazine, but with many contributions

it is difficult to do so, and some terms have been used

historically and appear in papers referred to.

I hope that you will enjoy this special publication and

that it stimulates you to join BATOD so that you can

receive further full editions of the Association magazine.

You will be reading this because you are not already a

member. Please visit the membership page of our

website to find out about different categories of

member. You don't need to be a Teacher of the Deaf to

join nor do you have to be in the UK!

www.batod.org.uk The Association ► Membership

Magazine Editor

Bone ConductingHearing ImplantsDéjà vu... 1

What is a BCHI? 4

Interviews with Natasha and George 7

Living with my new BAHA 4 9

BCHI and radio aids 11

We Couldn't be Prouder – Sophie’s story 13

Sources of information 16

BCHI – a parent’s perspective 18

Arti’s BCHI Experience 19

Review – Tell it like it is! 20

Testing a bone conducting hearing implant 21

Freddie 22

Bethan 24

Active bone conduction 26

Skin care 27

Need to contact BATODabout other matters?Talk to Executive Officer Paul Simpson

email: [email protected]

answerphone/fax: 0845 6435181

Contents

Cover Photographs: Some of the BCHI users featured in this magazine.

For information on advertising rates see www.batod.org.uk

8 25

B o n e C o n d u c t i n g H e a r i n g I m p l a n t s

© B A T O D M a g a z i n e · J a n u a r y 2 0 1 5 · 1

I feel as if I have been here before – 25 years ago! At that

stage, The Ear Foundation was established to fund the

first cochlear implants for children in the UK, as they

weren’t available on the NHS. At that time many Teachers

of the Deaf were very sceptical about this surgical

development and various comments I received included:

“no child I taught would ever have one..”, “Seen one,

seen them all....”, “it’s just a fashion... like grommets...”

Fast forward 25 years, and what about another form of

hearing technology: bone conducting hearing implants?

Do we realise what potential they have for large groups

of children or are we sceptical about another surgical

intervention? In other countries, such as the

Netherlands, bone conducting hearing implants are

routinely used for those children who need them; what

about in the UK? Do you work with any children with

these implants? Or have you children on your case load

who need one? The excellent BATOD magazine

seemed an ideal way to make up-to-date information

available, so the theme of this edition is bone conducting

hearing implants... and that is the first problem! What do

we call them? They have been called Bone Anchored

Hearing Aids (BAHA) but that is not possible, as the

Cochlear device is called Baha..... other names include

bone conducting hearing systems, and now many

cochlear implant centres have been renamed Auditory

Implant Centres, and the term commonly now used is

Bone Conducting Hearing Implants. However, this also

includes the fitting of soft bands – not implants at all!

Hopefully, other articles in this edition will clarify what

BCHI offer, and what they don’t offer.

Did you know?

l There are about 12,000 wearers of bone conducting

hearing implants in the UK

l They are suitable for those who cannot be aided by

the usual air conduction hearing aids

l Increasing numbers of children are considered – and

can be fitted by around four years of age when the

bones of the skull are mature

l Increasing numbers of young children are receiving

soft bands – from a few weeks old

l Bilateral bone conducting hearing implantation is

available

l A bone conducting hearing implant and an air

conduction hearing aid can be worn – one on each ear

l Bone conducting hearing implants can be used with

FM systems and accessories and remote

microphone.

The history of BCHI is an interesting one, which largely

came from dental expertise. The earliest references to

bone conduction aids are as far back as the 16th

Century with rod devices being used to transmit

vibrations via the teeth. The concept of hearing by bone

conduction was first popularised in the 1930s by Von

Bekesy. He discovered that cochlear hair cell excitation

was the same irrespective of whether the sound wave

pathway was via air or bone conduction. The

development of the carbon microphone and magnetic

receiver in the early 20th century led to the advent of the

bone conduction vibrator. The first modern bone

conduction hearing devices were adapted from existing

body worn air conduction aids where the receiver was

replaced with a vibrating receiver mounted on a tight

fitting headband to hold it onto the mastoid bone.

The challenges faced by

bone conduction aids led

to the idea of directly

coupling the transducer to

the skull. A Swedish

orthopaedic surgeon,

Professor Branemark,

serendipitously discovered

osseointegration. He had

been doing research on

blood flow in the rabbit

using a titanium inspection

chamber inserted into

bone. These chambers

integrated into the bone,

and the principle of

osseointegration (defined as ‘the formation of a direct

interface between an implant and bone, without

intervening soft tissues’) was established. Having

discovered that titanium could integrate into living bone,

the first application was in dental implants and the first

bone anchored hearing device was fitted in 1977 by

Tjellstrom.

A bone conducting hearing implant is effectively a

“middle ear bypass”, consisting of three parts:

l The implant: a tiny titanium screw implanted into the

skull, providing an anchor for the abutment and sound

processor

l An abutment which is attached to the implants

l The sound processor which acts as the middle ear,

converting the sound waves into vibrations, passed

through the implant to the bone, and hence to the

inner ear.

Déjà vu...It is 25 years since the first cochlear implants appeared in the UK to mixed opinion.

Sue Archbold reveals that there are similar mixed feelings about bone conducting

hearing implants

Professor Branemark


2 • © B A T O D M a g a z i n e • J a n u a r y 2 0 1 5

For young children, soft band systems are available, with

the sound processor placed on an elasticated head band

from a few weeks old. The usual referral pathway is

shown above.

The Ear Foundation now collects data from ten centres

implanting both children and adults and this is on our

website, continually updated; the data can be found as

the National Bone Conducting Hearing Implants

Registry at www.earfoundation.org.uk

A major problem for bone conducting hearing implants is

that the group of children who benefit from BCHI are

those whose hearing needs may not be apparent. For

example, those with chronic ear disease, those with

single-sided deafness, those born with genetic and

congenital syndromes which affect the development of

the skull bones and the inner and outer ears. These

children may not have profound hearing losses, but their

deafness may considerably affect their linguistic and

educational progress. For example, we know that

profoundly deaf children are achieving better

educational outcomes than severely deaf children, and

that profoundly and severely deaf children are achieving

better educational outcomes than mild or moderately

deaf children (NatSIP, 2013).

Single-sided deafness or a mild/moderate deafness

impacts on a child’s ability to hear in noisy

surroundings, and to hear the quieter sounds of speech

– which may contain grammatical markers and the

more subtle features of speech. A mild/moderate

hearing loss has been shown to impact on the

development of language and reading skills (Moeller,

Tomblin, Connor, Jerger, 2007) and on their functioning

in class (Most, 2004).

For those with a unilateral loss, language is likely to be

delayed (Bess et al 1998; Leiu, 2004; Lieu et al 2010;

Cone et al, 2010). A unilateral loss also affects the

development of pragmatic skills (Most & Peled, 2007); one

parent, interviewed in our study (Mulla et al, 2013) said:

“Unfortunately what we then still encountered was, wellshe’s got one ear and she’s just not listening. And in factI got hold of her school records and they, its actually onthere and I quote, from them, from memory because I’llnever forget it “class teacher feels (child’s name) usesher deafness as an excuse... we actually had herwithdrawn from school in the September.” (F004)

This is often overlooked, and it is just these children who

are likely to be overlooked in the classroom as their

needs are not obvious, and when prioritising case loads

in times of financial challenge are less likely to be

supported by services. Increasingly, Bone Conducting

Hearing Implants are being considered for those

children with very complex needs.

For those with a conductive loss, the impact on learning

in the classroom may be unrecognised, but there is



growing evidence of the benefit of soft bands and boneconducting implants for these groups (Doshi et al, 2013);Christiansen et al, (2010).

Bone conducting hearing implants require ongoing care,and for teachers there may be some uncertainty abouttheir care: with a percutaneous plug it can beconcerning. As one mother commented:

l “Yeah we’ve had that with the practice nurse (at GP).I couldn’t get a dressing put on it. She wouldn’t touchthe swelling – she was worried about it. Touching it.”(F006)

Cleaning the area requires confidence – which needs tocontinue into independence.

“Yeah Mum and Dad used to clean it every day andI think when I went to Uni I had to keep that up. Yeahand I did go to the nurse – they weren’t as good atcleaning it as my Mum and Dad were. And I think Dadhad to come with me to the nurse as well, to show themhow to clean it... I think at Uni the nurses were a bitreluctant.” (F002)

Ongoing care obviously relies on multi-professionalworking and trust... and even more liaison betweenmedical, audiological and educational services than atpresent. This edition will illustrate some excellentexamples; let us not restrict the options for these groupsof children because of lack of information. There aremany studies showing improved quality of life andlearning outcomes after BCHI gathered by surgicalteams. Thanks to BATOD for this opportunity to providesome information on current practice .... but let’s notforget a look to the future, and recognise the need toexplore the impact of these children in education, togather some real-life long term evidence of the potentialbenefits and the challenges.

Sue Archbold is the Chief Executive Officer of the EarFoundation.

References Bess FH, Murphy JD, Parker RA (1998). Children withminimal sensori-neural hearing loss: prevalence, educationalperformance and functional status. Ear & Hearing.19,339-354

Christiansen L, Richter G, Dornhoffer J (2010). Update onbone-anchored hearing aids in paediatric patients withprofound sensorineural hearing loss. Archives ofOtolaryngology Head & Neck Surgery. 136: 175-7

Cone BK, Wake M, Tobin S, Poulakis Z, Rickards FW (2010).Slight, mild sensori-neural hearing loss in children:audiometric, clinical and risk factor profiles.Ear & Hearing. 31, 2, 202-212

Doshi J, Banga R, Child A, Lawrence R, Reid A, Proops D,McDermott AL (2013). Quality of Life Outcomes after bone-anchored hearing devices surgery in children withsingle-sided sensorineural deafness. Otology andNeurotology. 13, 34-1, 100-103

Lieu J (2004). Speech language and EducationalConsequences of Unilateral hearing loss in children. Archivesof Otolaryngology Head & Neck Surgery 130: 524-30

Lieu JEC, Tye-Murray N, Karzon RK, Piccirillo JS (2010).Unilateral hearing loss is associated with worse speech andlanguage scores in children. Pediatrics. May 10

NATSIP (2013) Outcomes Benchmarking Report

Moeller MP, Tomblin B, Connor CM, Jerger S (2007). Currentstate of knowledge, language and literacy of children withhearing impairment. Ear & Hearing. 28, 740-753

Most T (2004). The effects of degree and type of hearing losson children’s performance in class. Deafness and EducationInternational 6: 154-166

Most T & Peled M (2007). Perception of SuprasegmentalFeatures of Speech by Children With Cochlear Implants andChildren With Hearing Aids. Journal of Deaf Studies andDeaf Education. Vol 12. Issue 3. 350-361

Mulla I, Wright N, Archbold S (2013). Views and Experiencesof families on Bone-Anchored Hearing Aid Use with Children:A study by interview. Deafness and Education International.15, 2, 70-90

BATOD represents you at various meetings andwe may be asked for demographic information.If you provide these details and keep them up-to-date it will help us to help you. Log into theBATOD website and then ► My Details

www.batod.org.uk



A bone conducting hearing instrument (BCHI) is a

hearing aid system that allows sound to be conducted

through the temporal bone directly to the cochlea (inner

ear). This is known as bone conduction as it carries the

sound through the bone in the skull. Sound vibrations

are delivered to the skull by a processor which

stimulates the cochlea. This process bypasses the usual

air conduction pathway of the ear canal and middle ear.

Who is suitable for BCHI?

BCHI devices are suitable for children with permanent or

longstanding conductive hearing loss, single sided

deafness or mixed (conductive with sensorineural

component) hearing loss. This could be congenital (from

birth) or acquired. Suitable candidates can have either

no previous experience with hearing aids or have

already trialled a conventional air conduction hearing aid.

Conductive hearing loss

Many children with a permanent or longstanding

conductive hearing loss could benefit from a BCHI.

The hearing loss can either be unilateral (in one ear) or

bilateral (in both ears).

Conductive hearing losses could be caused by

l middle ear disease

l perforation (hole) of the ear drum

l collapsed or very narrow ear canals

l atresia/microtia – a malformation of the ear canal or

outer ear

l long standing glue ear

l otosclerosis – fusing of bones in the middle ear

l ongoing or chronic ear infections

l syndromes – such as Down syndrome and

Treacher Collins.

As the BCHI sends sound directly through to the cochlea

via bone conduction, the conductive element of the

hearing loss is bypassed. Studies suggest that patients

with an average air-bone gap of 30 dB or more will

experience advantages with a BCHI compared to air

conduction hearing aids. This is because less

amplification is required as the cochlea is stimulated

directly, as opposed to an air conduction aid where more

gain is required to get sound through the part of the ear

that has the conductive hearing problem.

Single sided deafness (SSD)

Children with SSD and satisfactory hearing in their

better ear could benefit from a trial with a BCHI.

What is a BCHI? Laura Marl and Maureen O’Hare give an overview of Bone

Conducting Hearing Instruments

Fig 1. Diagram illustrating sound transmission with a BCHI

Fig 2. Audiogram illustrating a left sided conductive hearing loss

Fig 3. Illustration ofcontralateral routingof signal via boneconduction



The BCHI picks up sound from the deaf side and sends

it via bone conduction to the better ear’s cochlea. This

gives the child the perception of hearing sound from the

deaf side which could possibly help with sound

localisation and improve the signal to noise ratio.

This can be a suitable option for children who have a

congenital or acquired SSD.

Mixed hearing loss

Many children with a mixed hearing loss, in either one or

both ears may be suitable candidates for a BCHI. Bone

conduction thresholds up to 55 dB can be considered.

Children with an air-bone gap of 30 dB or more are

suitable candidates. Children with a greater air-bone gap

will perceive significantly increased benefit.

How the BCHI is worn

There are two different ways that BCHIs can be worn:

on a softband or on a surgically implanted

abutment/magnet.

Softbands

It is possible to fit a child with a BCHI on a softband from

a very young age. Early access to sound amplification is

vital for a child’s development, speech and language

skills and educational progress. If a child has a bilateral

hearing loss, then consideration should be given to a

bilateral BCHI fitting. The softband can be substituted

with an Alice band for older children.

The softband is used to hold the BCHI transducer

against the skin at the back of the ear over the mastoid

bone. It is important that the softband has sufficient

tension to hold the BCHI in place; otherwise the sound

quality will be poor and the device may give feedback.

Softbands are available in a range of sizes and are

adjustable to enable adequate tension. Different designs

and colours are available. It is recognised that bone

conduction sound transmission via a softband is not as

Fig 4. Audiogram illustrating right sided SSD

Fig 5. Illustration of a left sided mixed hearing loss

Fig 6. Examples of softbands from different manufacturers



effective as through an implant as the amplified sound

has to travel across the skin tissue. If the child

demonstrates good outcomes with the softband then an

implanted BCHI can be considered.

Implanted option

The BCHI can be worn without a softband as a

permanent solution. This involves a surgical procedure

to implant a titanium screw into the skull. Surgery can

only be performed when a child has sufficient skull

thickness to allow the implant to be inserted and

retained. For the majority of children, surgery can be

considered from the age of four to five years upwards.

However, for some children with additional medical

conditions/syndromes, the skull thickness may not be

suitable until they are significantly older. If the device is

implanted before the child has appropriate skull

thickness, there is an increased probability that the

implant will fall out.

Before anyone is considered for a surgically implanted

BCHI, it is essential they have a full audiological

assessment and a trial of the BCHI on a softband. If they

are deemed suitable candidates and the trial is

successful, both the child and parents will need to be

counselled about the surgery and expected outcomes.

There are two ways of retaining the BCHI processor:

1. Abutment (transcutaneous)

Once the titanium screw is implanted into the mastoid

bone, an abutment can be attached which then

protrudes a little way

through the skin over

the mastoid bone.

The bone conduction

processor then clips on

and off the abutment

with a snap coupling.

Comparing the BCHI

worn on the softband

to when worn on the

abutment, there tends

to be an average of

10-15 dB improvement

in sound conducted.

As the abutment protrudes through the skin, hygiene is

very important. The site must be carefully monitored and

cleaned every day to ensure it does not become

infected. Children must have easy access to their BCHI

service for treatment if required.

2. Magnet (percutaneous)

It is possible for a BCHI to be worn attached to a

magnet so there is no abutment protruding through the

skin. There are two different methods to attach the

magnet to the bone of the skull.

a. The first process is the same as the transcutaneous

option, but instead of an abutment a magnet is inserted

under the skin which attaches to the titanium screw

implant. A second magnet is then attached to the sound

processor which connects with the internal

percutaneous magnet, holding the processor in place

and allowing sound vibrations to be transmitted through

the skull to the cochlea.

This process of sound transmission is not as effective

as the transcutaneous abutment. Therefore, the magnet

is currently only a suitable option for children with

satisfactory bone conduction thresholds in at least one

ear (i.e. not mixed losses). Currently this option is only

available to children 8 years old or above.

b. The second method does not use a titanium screw in

the skull but a floating mass transducer (FMT) that is

housed within the bone of the skull and screwed into

place. The FMT is attached to a coil magnet which sits

under the skin. The outer processor is held in place

externally by a second magnet. This system delivers

sound by bone conduction to the cochlear via vibrations

from the FMT.

This is a suitable option for children with bone

conduction thresholds of up to 45 dBHL. A recent

approval has been given for this type of BCHI to be

used in children over the age of 5.

The percutaneous magnet is a fairly new development

in the BCHI field, so may not be widely available in all

implant centres.

Parents and professionals working with the child can

Fig 9. Illustration of percutaneous BCHI using an FMT

Fig 8. Illustration of percutaneous BCHI

Fig 7. Transcutaneous abutment

Continued at base of opposite page ►



test the device by

performing

listening tests

using a test rod.

The BCHI is

turned on and

held firmly against

the mastoid. The

ear canals are

then occluded,

which simulates a

temporary

conductive

hearing loss. The listening check can reassure parents

and teachers that the device is functioning correctly.

Further information regarding BCHI can be found on the

Ear Foundation website (www.earfoundation.org.uk),

the National Deaf Children’s Society website

(www.ndcs.org.uk) or by contacting your local Audiology

Service who can refer children for assessment at a

BCHI implant centre.

Laura Marl and Maureen O’Hare are both Audiologistsworking at Alder Hey Children’s Hospital in Liverpooland are part of the BCHI team.

Pictures courtesy of Cochlear, Oticon and Bruckhoff.Fig 10. Illustration of test rod

My name is Natasha and I am in Year

10 at High school.

I like craft and drawing. I study

Geography, Art, Textiles and Drama at

school (as well as all the other mandatory

subjects). I really enjoy Art! I love it so

much!

I have two sisters and three pets –

Poppie and Titch (dogs) and I walk them

every night! I also have a cat called

Jessie.

I do get extra help in school; it helps me

reach my full potential!

Basically my BCHI is a bone anchored

hearing aid that snaps on to a titanium

abutment; I feel that it really helps me and

that I wouldn't be able to manage without

it! I do use a radio aid – it helps me hear

better in lessons and really makes a

difference!

The best three ways someone could help

me in class are:

1 Look at me when speaking

2 Make sure they speak clearly and have

a clear lip pattern so I can lip read them

3 Speak directly and use the radio aid.

In the future, I would like to be a teacher!

I have wanted to be a teacher since I was

little! I also would like to work at Disney

World Orlando!

Interviews with Natashaand GeorgeElizabeth Reed-Beadle introduces two young BCHI users

►What is a BCHI? – continued from bottom of previous page

Continued on next page ►



George is in the final year of his A level studies

in a mainstream High school

I am in my last year of A level study, I have two

Oticon Ponto Power Bone anchored hearing aids.

I have been asked to write about the use of my

radio aid in school.

I use the radio aid every day! It has become an

essential part of studies during A levels.

I find the radio aid especially useful during Physics

and Chemistry when we have an experiment to do,

as the teachers may wander when explaining the

practical and giving instructions. Particularly if it's

an assessed practical, it is vital to ensure I hear all

instructions, and the radio aid is perfect for this.

The radio aid is always useful. However, when a

teacher is talking to other students it can transmit

what they are saying to the receiver and can be a

distraction at times. Fortunately, the transmitter

has a mute button which can prevent this from

happening.

The radio aid has made a massive difference to

my school life; before, when my teachers used to

wander around I never used to be able to hear

them clearly all the time, and this has helped me to

ensure I can hear my teachers clearly all the time.

My teachers are all very happy to wear the FM and

all of them see it as a new

toy that's fun to wear and

think it's a marvel that such

a thing exists to help people

who are hard of hearing.

I would highly recommend

the FM system to anybody

who feels like they are not

getting the full extent of

their education, as it’s vital

to ensure you hear and take

in everything your teachers

are telling you.

Elizabeth Reed-Beadle isan Educational Audiologistat Virtual School SensorySupport, Norfolk.

Have you the skills and inclination to come forward to be afellow Foundation Trustee to support and help shape its work in

improving the education of the deaf children and young people?

Our current focus is Acoustics Find out more www.batodfoundation.org.ukContact us [email protected]



When I was 11 years old, I had a perforated eardrum

due to an infection I got from swimming. I was finally

referred to an ENT consultant and 45 years later I am

still under their care. When I was 18, I had a radical

mastoidectomy as I had an inflammation of the mastoid

bone. This left me with a mild hearing loss and

consequently I started to speak with a louder voice

than before as I couldn’t monitor my voice properly.

Over the years I have suffered from many ear

infections and my hearing thresholds have dropped

because of this, and about twelve years ago, they

dropped to a moderate level (50/60 dB loss) and my

voice got even louder. To compensate for this, I would

always make sure people were on my right-hand side,

and I’d sit at the front of any group, use my good ear

for the phone, have the TV and car radio on loud and

ask people to repeat things.

Years ago, one of my students had a BAHA and the rep

from the original BAHA company came to talk to my

colleagues and me about them as part of our

professional development in audiology. It set me

thinking, so I asked my ENT consultant to refer me to

Hope hospital in Salford where they performed this

procedure. After assessment by audiology and another

ENT consultant, I had to trial a post-aural digital hearing

aid. I loved it but had a constant wet ear so I tried a soft

band BAHA and that seemed better. After listening to

what was involved in acquiring a BAHA I decided to go

ahead and a date for my day surgery was set!

A bone anchored hearing aid is one of many different

hearing aids prescribed on the National Health Service,

alongside digital hearing aids and cochlear implants.

Even though it is a hearing aid, the funding for this type

of aid comes out of a different budget from other types

of aids and your local PCT and doctor have to agree to

it. About two years ago, I

attended a BAHA day for

professionals at the Ear

Foundation and it was

here that I learnt about this

funding. I had never known

anything about this as my

operation and fitting had

gone ahead with no

problems at all.

Traditionally a titanium

plug is surgically implanted

into the mastoid bone, an

abutment is connected to the plug and a sound

processor is connected to the abutment. Titanium is

used for the plug because the body osseointegrates the

titanium and it conducts like bone – this is called the

Branemark Principle. The procedure took about an hour

under local anaesthetic and I chatted to the surgeon as

he was working. It was like root canal work at the

dentist, as you can hear and feel everything but it

doesn’t hurt. Honestly!

I now have a titanium abutment in my skull just behind

my left ear, up to the right and not in the way of my

glasses. After three months, when the metal had

embedded into the bone, I returned to get my BAHA

which clipped into the abutment. The whole process

from request to actually wearing the BAHA took about

12 months.

It took me a while to get used to clipping the BAHA in

without getting my hair caught in it. It is dark in colour to

match my hair so it is almost invisible. Initially I had the

volume on low but as my brain got used to bilateral

sound, it was reset to a higher level. I hadn’t realised

how my brain used to cross over sound, and what noise

I had been missing. I was given a soft brush to brush off

any dead skin that collects around the abutment, a box

to keep it in and a transparent tube for others to test the

aid by clipping the aid to it and placing it on their

mastoid bone. The NHS will replace it once if I lose it,

have repaired it when required and I’m now on my third

upgrade which is a digital

one. The previous two were

analogue ones.

I was fitted with a standard

BAHA last summer but I had

so many problems with

feedback it really drove me

crazy!! It went bananas

when I sat in my kitchen and

the washing machine was

spinning and when there

was any high pitched sound,

it whistled very loudly due to

feedback which others could

hear. I talked to my specialist

Audiologist at Salford about

these issues and he tried to

reset it. I talked to my ENT

consultant, Mr Rothera

about this and he had told

Living with my new BAHA 4Mary Fortune shares her experiences of obtaining and wearing her new

state of the art BAHA


1 0 • © B A T O D M a g a z i n e • J a n u a r y 2 0 1 5

Cochlear about these problems of feedback. As I was a

ToD and had an abutment that would support another

device from another company, he agreed that I could

trial another bone anchored hearing aid with feedback

management. This all meant that the audiology

department would have to commission a new company

which would take time. In the meantime Cochlear had

been developing a new BAHA with feedback

management so I was one of the first to try the new

BAHA 4 in the North West in Spring of this year! Many

thanks to manager Pat Clough and my specialist

audiologists Glen Robinson and Gemma Jones at

Salford Royal.

It has many new features: the main one being the Dual

Track Feedback Manager, a special program to deal

with wind noise when out walking (I have three to toggle

through: the first for all-round sound, the second for

direct sound in front such as when listening to the radio

in the car and the third program for walking) and being

able to receive phone calls via Bluetooth. To use this

feature you need a Cochlear Wireless phone clip which

has to be connected via Bluetooth to your BAHA and

you can buy this as one of the many accessories

available. I have one which is great once I had learnt

how to use it correctly!

On the plus side, it has enabled me to regulate the

volume of my voice and people have said I do speak

more quietly than before. I can now hear whispers on

my left-hand side and people talking in the back of the

car more clearly. It is great to hear music and sound in

stereo, especially at the cinema and theatre and to

answer my phone in the car via Bluetooth. I feel I can

be a positive role model for my students and I

completely understand how easy it is to forget your

hearing aid in the morning when you are in a hurry!

On the down side, the hearing aid can flick off when

taking a top off or when holding an umbrella too close to

the head and the abutment isn’t fully flush with my skull

so I can feel it when I lie on my left-hand side in bed. In

fact when I was trying to use a cordless Radio system

with my BAHA, there was too much interference due to

the scarring around it so I had a slightly longer

abutment screwed in. It also means I can wear a hat

without taking off my BAHA now.

At the Ear Foundation training day I was also

introduced to a new way of fitting a bone anchored

hearing aid using a magnetic implant by a company

called Sophono. All I know is that is means that there is

no abutment sticking out of your head. Just recently one

of my FE students has had this procedure but as he

hasn’t got his bone anchored hearing aid yet, I can’t

compare it to my BAHA. Would I want this type of bone

anchored hearing aid if I had the choice now? I’m not

sure but I wouldn’t be without my new BAHA 4!

Mary Fortune is a ToD in Stockport. She is also an NEC member.

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© B A T O D M a g a z i n e · J a n u a r y 2 0 1 5 · 1 1

Elizabeth explains: As the years have passed the

technology available to enable children to experience

sound has become more and more sophisticated. My

first encounter with a child and a bone anchored hearing

instrument was over twenty years ago. It was a simple

instrument which clipped to a titanium abutment

implanted into the child's mastoid bone. The aid was

either on or off; it was a no frills instrument but it allowed

this child with atresia to experience sound. Now, in

2014, the technology has moved on and today a

Teacher of the Deaf may find him or herself working with

a young child with a bone anchored hearing instrument

attached to a soft headband before they are old enough

to have the surgery to implant the abutment.

I work in a large rural county; we are quite a large team

of peripatetic and resource based staff and as such

each member of the team needs to be knowledgable

about types of hearing instruments worn by the children

in the county and especially those on their caseload.

Once qualified as a Teacher of the Deaf, CPD is very

important in order to keep informed about current

hearing technology.

Exactly what does a Teacher of the Deaf need to know

about bone conducting hearing instruments and where

does that information come from?

Colleagues in my team cited the following as being

important information to know about children on their

caseload with a bone conducting hearing instrument

(BCHI);

A Aetiology and how that may affect the

child's functioning. For example is the

issue purely a middle ear condition or is

there a cosmetic element to the

condition eg; microtia and atresia

(malformation of the pinna and ear

canal)?

B Unaided and aided hearing thresholds.

It is important to provide INSET to

mainstream staff about what an

individual child can and cannot hear

with the BCHI. They may be reluctant to

wear it and if mainstream staff

understand what benefit it gives they

may be more encouraging in getting the

child to wear the BCHI.

C Type of BCHI and how it is worn; hard

or soft band and whether surgery is

impending is important information

needed to ensure consistency of approach by

mainstream staff on the wearing of the device(s).

D How the BCHI works and how to troubleshoot;

confidence in handling the device and in training

mainstream staff in its use and care.

E What FM receiver fits the BCHI; at the moment one

size does not fit all and this can be an issue for

Sensory Support teams, not only financially but

practically too having to assimilate knowledge of

various receivers.

F The time to have "hands on" practice with the BCHI,

including troubleshooting, battery fitting, listening,

and FM fitting.

Where does all this information come from?

1 The local hospital audiologists may be willing to train

individuals when the child is at clinic. They may be

willing to provide an annual update to a team

meeting.

2 It is always worth asking the company which provides

the model of BCHI used in your area if they will come

and provide some training. This may be more of an

overview rather than a "hands on" session but if you

don't ask you don't get!

3 Company websites are useful, as are independent

charity websites and a list can be found in this

magazine of sources of information. (See page 22)

BCHI and radio aidsTwo bite bars and a bag of chips – Elizabeth Reed-Beadle and

Imran Mulla talk about working with children with a bone

conducting instrument in 2014

Team of Teachers of the Deaf in training on BCHIs



4 The BATOD magazine and regional and national

training days.

Are there any essential pieces of equipment to have

in your ToD toolkit when you have a child with a BCHI on

your caseload?

The following may be useful:

l batteries

l a bite bar for testing if the BCHI is working, although it

is possible to test this without one

l hearing aid wipes, as it is good practice to use them

to handle the BCHI initially.

Do schools need to take extra care? A care plan is

always a good idea and essential if the child has an

abutment.

This is not an exhaustive list and if the practice in your

area does something different, please tell BATOD about

it so we can share information.

Does all this happen in the reality of the busy schedules

Teachers of the Deaf run? In my team yes it does. We

believe it is vital for Teachers of the Deaf to keep

themselves up to date especially in today's world where

technology does not stand still for long!

BCHI and FM

There are currently two types of BCHI in use in the UK –

from Oticon, the Ponto family and from Cochlear, the

BAHA family. These BCHIs can be FM enabled but take

different receivers.

The Oticon BCHIs use a special receiver with three

straight pins and the Cochlear devices use a Europin

Direct Audio Input (DAI) which enables an MLX type of

receiver to be plugged in directly. It's an issue for

sensory teams as the BAHA receiver can only be used

with the Oticon instrument and usually has to be bought

separately. The Oticon family instruments have to be

programmed for FM but once the audiology clinic has

done its job the FM fitting can be done in school the

usual way.

The mainstream teacher of a Reception aged child

recently fitted with a Ponto Pro power on a softband

reports that the use of a radio aid has been beneficial to

the child, she commented:

“It is obvious that he can hear whoever is speaking and

wearing the transmitter because his responses are

faster. We use the radio aid when the children are on the

carpet listening and the child is much more responsive

to my voice. The transmitter is worn by whichever adult

is working with child and all the adults have noticed a

difference in the child’s responses to questions and

eagerness to communicate. Remembering to mute the

transmitter is difficult for us all but we will get used to

doing that.”

This was the school’s first experience of a child with a

BCHI and a radio aid. The child uses a Phonak Inspiro

transmitter and a BAHA FM receiver.

BCHI and remote microphone technology

Imran gives further information: Both Cochlear and

Oticon Medical devices have improved receiver

connectivity options in their latest device models. The

BAHA 4, Cochlear’ s most recent bone conduction

device, still has the Europin Direct Audio Input (DAI)

which allows for RM/FM receivers to be fitted in directly.

Other accessories that can be fitted into the BAHA 4 DAI

include the audio adapter (3.5mm jack which can be

used in place of headphones) and the Cochlear BAHA

telecoil. The BAHA 4 also has a range of proprietary

wireless accessories that connect directly to the device,

including Mini Microphone, Phone Clip, Remote Control

and TV Streamer. The Mini Microphone wirelessly

transmits the speaker’s voice directly, improving signal

to noise ratios at distances of approximately seven

metres, without the need for a receiver device as this is

built into the BAHA 4. However, this does not replace the

need for an FM system in the classroom. For more

information on the BAHA 4 connectivity options see the

following webpage: www.cochlear.com ►Cochlear

Products ►Baha® Bone Conduction Implants

►Baha 4 Sound Processor ►Wireless accessories

The Oticon Medical Ponto Plus and Plus Power are the

most recent bone conducting devices from Oticon

Medical and both have wireless connectivity with the

Ponto Streamer. The Ponto Streamer has multiple

connectivity functions allowing direct connectivity with

Bluetooth enabled devices like mobile phones, mp3

players, tablets and laptops. It also has a built-in Europin

DAI socket where an RM/FM receiver can be plugged in

allowing for wireless streaming of the RM/FM signal to

one or both Ponto Plus devices. Other connectivity

options with the Ponto Streamer include proprietary

connection with the Oticon Connect Line system of

accessories including the Connect Line microphone and

TV streamer. The Connect Line Microphone can be

used at distances of approximately 15 metres and

transmits the signal wirelessly through the Ponto

Streamer to the Ponto Plus processor. For more

information on Oticon wireless connectivity options

please see the following webpage:

www.oticonmedical.com►Our Products

►Wireless►Ponto Streamer – wireless opportunities

Below are some useful websites when searching for the

compatibility of various RM/FM receivers with different

hearing devices: www.comfortaudio.com►professionals

►Support and service►Compatibility Guide

(on the bottom left hand corner select type then the

option to select brand, series and model comes up).

www.phonakpro.com/uk►support►compatibility

►FM Configurator

(select brand from the drop list, and the option to select

product line and hearing instrument comes up).

Elizabeth Reed-Beadle is an Educational Audiologistat Virtual School Sensory Support, Norfolk.Imran Mulla is Consultant Research Audiologist at The Ear Foundation.



Hi, my name is Fiona. I am 30 years old and married to

Colin. We have two beautiful children, Sophie and

Caleb. We live in Lisburn, Northern Ireland. I would love

to share Sophie’s journey so far with you.

On 7th December 2010, at 8.31pm we were blessed with

a beautiful daughter, Sophie Faith Ross. I remember so

clearly the moment the midwife said "It's a girl". The

picture on my husband Colin's face was priceless. He

had secretly wanted a 'daddy's girl'. We had so much

love already for this little bundle. As I lay thinking about

how proud I was of myself for surviving labour I heard

the words "she has a wee folded ear". Colin tells me that

I replied "Aw just like mine" (I have a quirky fold at the

top of one of my ears). Then I saw a slightly worried look

from Colin. He brought Sophie over to me so I could

have a look for myself. At first glance I wasn't concerned

as they did literally look like they were folded over and

just need unfolded. The midwife tried to reassure us and

suggested that it might be a case of her having some

kind of procedure to correct them. I was so delighted to

have my baby in my arms that I didn't dwell on her ears.

No one else seemed that worried so I wasn't.

Back down on the ward we sat in awe of Sophie. She

was simply gorgeous. Neither of us really mentioned her

ears. We both then started to look more closely at them

and fiddled with them. Suddenly things seemed

worse...there was no hole/canal. What was there for her

ear didn't seem much and it didn't look like they could be

unfolded to me. My mind went into overdrive. Could she

hear me? Did I cause this? Why had her ear not

formed? Was she deaf? To be honest even though my

head was spinning with unanswered questions I still

wasn't overly concerned. The joy of holding Sophie

outweighed everything.

The next day we carried out all the usual routines that

come with a newborn – feeding, bathing, changing

nappies, settling and all the while I wondered whether

she could hear my voice. This seemed to be the most

pressing question on my mind. Later in the afternoon a

paediatrician came round to see us. He was quite a

quiet man who barely introduced himself. He examined

Sophie very carefully as we sat in silence. Then came

the words I didn't want to hear..."So does deafness run

in your family?". His words broke my heart and as I

looked over at Colin I could see in his eyes that his heart

was broken too. The doctor left to get us some

information and returned with a printed out sheet. He

explained that he thought she had a condition called

microtia and that we would be seeing an ENT doctor the

next day. I sobbed for Sophie. Why her? We were

moved to a private room for privacy. Visitors came and

went and this was a distraction from the reality of the

situation but deep within I was devastated.

It's probably a good time to give you some info on

microtia as, like me back then, you might never have

heard of it. Microtia literally translated from the Greek

means ‘little ear’. It is the medical word to describe a

small or absent ear. Most children with microtia will have

some degree of hearing loss on the affected side. This is

because the middle ear, which contains the eardrum

and tiny ear bones, is affected as well as the outer ear.

In some children the ear canal is blocked or absent, so

sound waves cannot pass through the ear in the normal

way. Generally, although the outer and middle ear are

affected, the inner ear is healthy so some options for

restoring hearing are available. Children with bilaterial

microtia will usually need some form of hearing aid at a

young age to enable them to develop speech. This is

We Couldn't be Prouder – Sophie’s storyFiona Ross describes her daughter Sophie’s life with microtia and her journey from

birth to age four, happily living with bilateral implants

My first cuddles with Sophie

I couldn't stop staring at this wee beauty



often a ‘bone conduction hearing aid’ that transmits

sound waves to the inner ear through the bones of the

skull. In very young children, these hearing aids are

usually on a headband, but as a child grows older a

‘bone anchored hearing aid’ might be suggested.

Our appointment with the ENT doctor the next day was

extremely informative and reassuring. He took time to

explain exactly what microtia was and answered all of

the questions we had. He gave us a general plan as to

what would happen next and referred us on to the

surgeon he described as the best consultant for the job.

Things seemed to be a bit clearer and we were able to

enjoy our daughter with a bit more hope.

At around a month old we met with our consultant and

Sophie had her hearing tested. It was decided that she

would be fitted with a bone conduction aid which would

be on a headband. We were so excited that she would

finally be able to hear! Alongside this, other

professionals became involved. Sophie was referred to

speech and language therapy and a Teacher of the Deaf

was assigned to us. In March 2011 she was fitted with

her hearing aid. This was another moment that I

remember so well. As the hearing aid was turned on and

I spoke – she cried. I also cried! After a few minutes she

got used to being able to hear and was enjoying

listening to everyone! Another milestone in her little life.

Fast forward 2.5 years to September 2013. Sophie is

nearly three and has worn her hearing aid religiously

every day. She has reached various milestones in these

three years including being discharged from speech

therapy. We couldn't be prouder. We have had regular

reviews with our consultant who monitors her progress

and plans ways forward. One of these will be her getting

an implant for her hearing aid. This is commonly done

around the age of four when the skull is thick enough.

We now had the opportunity to trial bilateral hearing aids

to see if they brought any improvement to directional

sound. Again we were very excited as this was another

development in improving Sophie's hearing. She

received her second hearing aid at the end of

September.

Coming into 2014 we saw a huge improvement in her

hearing. She started to show some directional

responses to sound and now relies heavily on both

hearing aids to hear. If one turns off or falls off she would

describe it as 'not being able to hear properly'. She is

now approaching the age for implant...eek! Our

consultant is keen to go ahead but wants to implant one

side only. This is what he knows best. Bilateral implants

have never been done before in Northern Ireland. As

Sophie's mum my views were different. I see daily how

she relies on both of her aids. I have seen the

improvements two aids have made. It was my job with

the support of others to convince him to implant

bilaterally and in one operation.

As parents we want what's best for our children. Sophie

is too small to make decisions so it is up to us to make

the best decisions for her. If I had a pound for every time

I doubted our decision I would be very rich. Maybe the

consultant is right? Is one implant enough? Are we

rushing into this? Should we wait for further

developments in technology? The list of questions is

Sophie being fitted with her BAHA softband

Sophie enjoying some toast after her operation



endless. Deep down I knew it was the right decision as

I know my little girl best.

To be honest it didn't take as much convincing as we

thought. We put forward our thoughts and feelings and

the next thing we were signing on the dotted line. Sophie

was finally on the waiting list for bilateral implants. She

would be the first child in Northern Ireland to receive

them. We finally got the phone call to say Sophie’s

operation would be on the 3rd September. I experienced

a mixture of emotion all at once. Excitement, nerves,

relief and the doubt crept in again too! We explained to

Sophie that she would be getting diamonds (much

prettier than screws) which she would be able to click

her hearing aids onto. She was as excited as we were

especially at the prospect of not having to wear a

headband anymore.

On the day of surgery Sophie was an absolute star! She

was so brave. Everything went smoothly and to plan.

Her skull was a little thinner than expected so we have

to wait a bit longer before we can 'go live'. Her

'diamonds' have to be cleaned every day to prevent

infection and this will be a lifelong routine. We are very

much looking forward to getting her new hearing aids

hooked up at the end of November!

When I look back on the past four years I can't be

anything but proud of what we have achieved as a

family with the support of our wider family, friends and

professionals such as Patrice, who was Sophie’s speech

therapist, and Fionnuala, Sophie’s Teacher of the Deaf.

Fionnuala continues to support Sophie and us as a

family. She visits us at home and spends time assessing

Sophie and offering invaluable advice. Sophie’s

favourite times with her are when she brings the toys!

She also visits Sophie in nursery to make sure that her

additional needs are accommodated. Sophie has

reached so many milestones with ease and is happily

settled in nursery. In years to come when bilateral

implants are the norm in Northern Ireland, I will be

delighted to tell her she was the first ever!

Fiona Ross is Sophie’s Mum.

Our beautiful Sophie loving life!

Searching for a QToD?Job vacancies can be advertised on the

BATOD website at a cost of £250.00If you have to re-advertise the same post,

the cost is reduced to £150.00

Teaching Section – Situations Vacantwww.batod.org.uk

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As with other hearing technologies, developments in

bone conducting hearing implants are taking place fast,

and it is important to keep up to date, to provide

accurate information for parents, young people and

families. Useful information can be obtained from:

► The Ear Foundation website:

www.earfoundation.org.uk provides information,

downloadable information leaflets, user stories, a user

forum, and shop for accessories if you look in the Bone

Conducting Hearing Implants section of the Hearing

Technologies section. In the download section you will

also be able to find an edition of ENT News which has

several interesting articles on the surgical and scientific

aspects of bone conducting hearing implants. The site

also has a booklet for parents and children about getting

a bone-anchored hearing processor, and the research

section has reports from research studies into bone

conducting hearing implants. The site also provides a

shop where Cochlear and Oticon Medical spares can be

obtained.

► At ndcs.org.uk you will

find their booklet on

information for

parents and

families on

bone anchored

hearing aids,

and their

Quality

Standards

booklet on bone

anchored

hearing aids.

► Cochlear.com provides information on Baha® bone

conducting hearing implants and their Baha® users app

► Oticonmedical.com provides information on their

Ponto system

► Sophono website for those interested in Sophono

devices https://sophono.com/

Sources of informationThere is a wealth of information available on the subject of BCHIs and Sue Archbold

gathers together a useful collection of resources



► Medel.com for information about their

Bonebridge system, an active middle ear implant,

and for user stories

► Down’s website for those interested in

Down’s syndrome http://www.downs-syndrome.org.uk/

► Goldenhar website, for those interested in Goldenhar

syndrome http://www.goldenhar.org.uk/

► Bana UK, for those with acoustic neuroma

http://www.bana-uk.com

► nhs.uk for the latest commissioning guidelines for

BCHI and the latest criteria and recommended practice.

Tablet ♦ smartphone ♦ PC ♦ laptopNo matter how you access it, the BATOD

website provides members with a wealth ofinformation, advice and materials to support

professionals working in deaf education

EXPLORE!!

news ♦ events ♦ resources ♦ jobsExplore the fantastic resource that is

www.batod.org.uk



Reuben lost complete hearing in his right ear when he

was two years old, after suffering from Pneumococcal

Meningitis.

Shortly after starting school Reuben started to wear a

wireless cross hearing aid, which helped him to pick up

more sound on his right side; however, it was far from

ideal. One of the biggest issues was that he now had a

mould in his good hearing ear, blocking sound from the

ear that he had grown to rely on. Whilst his audiologist

was able to make adjustments to bring his hearing up on

this side it sometimes felt like “robbing Peter to pay Paul”.

The size of the aids also meant battery life was

extremely short and we recently found out that Reuben

had not always felt comfortable in alerting his teacher.

This meant he wasn’t keeping up in class and was also

getting told off for not paying attention. Reuben also

suffered from regular ear infections in his hearing ear

and at times like this he was like a child with next to no

hearing - he relied on copying others and lip reading but

this was exhausting for him.

It was incredibly frustrating for him and for us; with the

best will in the world, trying to make people aware of his

need for good positioning of him and the teacher in the

class room, as well as his inability to localise sound, was

not always easy. I found myself constantly trying to

convey to the adults with whom Reuben interacted, the

need for him to see their faces when they spoke to him,

to clearly articulate their words and to not keep moving

about, but, be it teachers, after-school club or lunch-time

staff I often felt like I was unable to really explain how

hard it was for him. When hearing and listening continue

to be difficult for an eight-year old boy the option to just

switch off and not make the effort was by far the easiest.

A year ago, following a consultation at Birmingham

Children’s Hospital, Reuben began the assessment

process as a candidate for a BCHI and started to wear an

Oticon Pronto Pro on a softband. We knew that a boy

wearing a softband would be likely to draw some

unwanted attention and so agreed with his year group

teachers that I would come into school and explain it to

his year 3 peers. This was incredibly useful and

something I would recommend in a similar situation.

When he started to wear the softband it was accepted as

quite normal and the children were interested in how it

helped him.

It was obvious straight away that the BCHI far better

suited Reuben. He gained hearing on the side of his

non-hearing ear but not at the detriment of the hearing he

did still have on the other side. We also saw signs of him

getting a better perspective of where sound was coming

from and the ability to cope better when there was

increased background noise. He did however find the

band got uncomfortable and it became a habit for him to

take it off at afternoon playtime and not put it back on until

the next day. This amounted to more than five hours a

day where he was at a distinct disadvantage to his peers.

In the last couple of months, Reuben did begin to become

far more conscious of the softband and so it was with

great relief that he had the two stage operation to have

the abutment put into his skull. This brought with it the

benefit of further increased hearing, no pressure on the

head from the BCHI and of course no soft band.

It is still early days (the BCHI has been worn on the

abutment since early November 2014) but so far the

results, especially the level of hearing gained, have

been phenomenal – I would go as far as saying life-

changing! He wears his BAHD all day, every day and is

learning to understand and give names to the new

noises that he hears on a daily basis. It is only now that

he is hearing this full spectrum of sound that I can see

just how much he has missed out on in the past. For a

child with single sided deafness the consequences of

not having full hearing are more subtle and so often

overlooked but when we don’t hear, and can’t

distinguish the everyday sounds in our environment

(sounds that pass a person with normal hearing by) our

ability to interact and form a connection with our

environment is far harder. For a nine-year old boy this

interaction and connection are vital in helping him reach

his full potential both now and in the future.

Louise Savage is Reuben’s mum.

BCHI – a parent’sperspectiveLouise Savage explains how her son's implant is helping him achieve his potential



This year marks 20 years since I was fitted with my first

bone conducting hearing implant (BCHI). As I was only a

little five year old girl at the time, it was up to my parents

to make the biggest decision of my life. Luckily for me, it

was the best decision they’ve ever made.

Why I have a BCHI

I was born with Treacher Collins Syndrome (TCS), a

genetic condition affecting the growth and development

of bones in the face and ears. There is a wide spectrum

of severity and I am fortunate to have a very mild case.

My parents suspected very early on that I had a hearing

loss as my speech was delayed and I wasn’t reacting to

normal everyday sounds. I was finally diagnosed with a

moderate bilateral conductive hearing loss when I was

two years old. Shortly after, I was fitted with ‘behind-the-

ear’ hearing aids.

Although these hearing aids were good, they were not

very suitable for me. I suffered from frequent ear

infections and wax build up. My parents also struggled

to keep the hearing aids in my ears. At one point, they

even had to resort to using double-

sided sticky tape to help the hearing

aids stay in!

Getting the BCHI

Thankfully one day an ENT consultant

at my local hospital mentioned that I

might be suitable for a bone conducting

hearing implant. Unlike today, softband

trials didn’t exist, so my parents had to

go by the word of doctors. Once they

were convinced, we were soon on our

way to Birmingham Children’s Hospital

for my assessment. However, like many

other people, there was another battle

to secure the funding for my implant

and new hearing aid.

But, after a long few months, I was

sitting in Birmingham Children’s

Hospital waiting to have the operation

that would change my life forever. I

don’t remember much about the

operation, just waking up afterwards

with the biggest bandage on my head

and receiving the cutest teddy bear as

my get well present.

Three months later, I was finally fitted

with my BCHI. On the day of my fitting,

I went shopping with family and it was

clear my parents had made the best decision. After a

few months, my parents noticed that my speech had

improved; I was more confident and doing better at

school.

Growing up with my BCHI

After my operation, I remember going back to school

and showing everyone my new hearing aid and telling all

my friends how it helped me to hear better. My

classmates were all fascinated by it and I got to be the

‘cool kid’ for a while. As I was the first BCHI user many

people had encountered, my Teacher of the Deaf (ToD)

was always on hand to explain to my teachers and

support staff what this new hearing aid was, how it

worked and what to do if any problems occurred.

I can still remember the first time my ToD showed me

my first radio aid. It was this strange looking box with

wires longer than I was. I wasn’t very keen on it, but my

ToD said it would help me hear the teacher better at

school. Needless to say, she was right; I was able to

hear the teacher perfectly whilst cutting out the noisy

Arti’s BCHI ExperienceArti Patel explains why she regards her BCHI as her prized possession



classroom. Thankfully, technology has moved on miles

from then and today’s FM systems are much smaller

and wireless too – allowing both teacher and student to

move around the classroom as they need.

As with any hearing aid, there are advantages and

disadvantages. My journey with my BCHI has been a bit

of a rollercoaster, but it’s definitely all worth it. I seem to

have very sensitive skin and I am prone to flare-ups

around the abutment. However, these are only minor

issues and I can still wear my hearing aid and carry on

with my day. Growing up, my parents cleaned the area

daily which takes as long as it does to clean your teeth.

However, today I am able to maintain it myself (much to

the relief of my parents)!

During secondary school and university, I had no

hesitation telling the world about my BCHI. On the few

occasions that other students saw my BCHI, they were

never sure what it was and I was always pleased to see

the look on their faces as I explained that it’s a hearing

aid and not some hi-tech music gadget.

Life today with my BCHI

As my hearing aid is very discreet and hidden

underneath my huge hair, many people are unaware of

my hearing loss. I’ve been very fortunate that my

friends, family and employers have understood my

hearing loss and taken a keen interest in my hearing aid.

There has been a huge development in bone conducting

hearing technology over the last few years and I can’t

wait to see what comes next. Although I’ve been offered

a second BCHI, I’m comfortable at the moment with just

one. Sometimes, I also wear a second BCHI on a

headband at times during large meetings and it’s been

great to actually hear something behind me!

My BCHI is my most prized possession (even more than

my mobile) and I’m pleased to be in a position where

I can share my experience and raise awareness of the

brilliant piece of technology. The BCHI gives me the

confidence I need, knowing that it’s going to help me

hear with clarity and I’m not missing out on anything. It is

with huge thanks to my parents and elder sister, along

with the support of many health and education

professionals, that I’ve been able to come this far.

Arti Patel is a Membership Assistant at The NationalDeaf Children's Society, a volunteer with The EarFoundation and Trustee of the Treacher Collins FamilySupport Group, working to increase awareness of BCHIs.

Tell it like it is!Author Cochlear implanted children’s support

group

Publisher www.gemini-print.co.uk

Reviewer Corinda M. Carnelley, Teacher of theDeaf, London Borough of Croydon

However empathetic one is, however many counselling

courses one has attended, ultimately there are not

many ToDs who know what it is like to have a deaf

child, or an implanted child. Yes, we know the theory

behind the practice; yes, we know about targets, Ling

sounds, and mapping, but we don’t actually know what

it is like to live on a daily basis with a small person who

cannot hear or who relies on highly expensive

technology to access sound.

Parents, by their very nature, tend to want to compare

their children with others, and even those who are not

comparing overtly are probably doing so covertly. This

book is an amazing window into the world of other

parents, implanted children, successes, and challenges.

The book itself is A4 format and each page is one family’s

story. What makes it stand out from other similar

publications is that it is written by parents, for parents. It

has a couple of very clear explanatory pages at the

beginning about what is a cochlear implant, sound

processors, and why parents should consider

implantation. However, one of its greatest strengths is

the most extraordinary indexes – you can search for

stories by cause of deafness, by implant scenario, by

method of communication, educational placement,

grandparent stories, teenager

stories, and more. The book itself

is not long – 80 pages, but it is

very easy to find what you are

looking for.

So, however much as

professionals we tell parents

that comparisons are invidious,

that all children are different

and all circumstances are different – parents do actually

want to be able to look and say, “This happened for this

child so it may happen for mine.”

I loaned the book to a mother whose child was about to

be bi-laterally implanted. When I asked her about it a

couple of weeks later she said, “It was amazing” and “It

became my bible and my homework all rolled into one.”

Perhaps, most telling, when I asked her if I might have it

back to put in the Service library she said, “I thought you

said if I liked it I could keep it.” Target achieved.

The CICS Group (Cochlear Implanted Children's

Support Group) is a completely voluntary charity run by

parents who have children who use cochlear implants.

The Group offers contact, information and support and

events for families whose children already have cochlear

implants and for those who are considering an implant

for their deaf child

For further information or to order copies contactTricia Kemp at [email protected]. Single copies are available free (although a donation tocover p & p would be appreciated). Otherwise thebooklets are available in boxes of 36 for which there is a delivery charge.

Reviews



For both ToDs and parents, it is important to carry out

daily listening checks on hearing instruments, especially

for young children, to ensure that they are performing to

their optimum.

Connevans, in conjunction with the Ewing Foundation

Technicians, developed a special listener for both the

Cochlear Baha and Oticon Medical Ponto sound

processors so that you can carry out these daily

listening checks easily.

The Baha/Ponto Listener consists of a

stainless steel stem that is mounted with

a transducer into an acrylic base. The

vibrations from the BCHI processor are

transmitted via the stem to the

transducer and turned into an electrical

signal. The signal is then amplified

using either a Crescendo portable

amplifier or the FM Accessories

Tester and listened to with a pair of

headphones. ToDs who themselves

wear hearing instruments can use a

neckloop or direct input cable to listen instead.

This allows you to check each day that the sound is

consistent. The listener is suitable for use with

bone anchored processors by both Cochlear and

Oticon Medical.

It is important to mount the sound

processor correctly onto the stem or

you risk damaging the processor.

Please follow the instructions

supplied with the listener in order to

mount the sound processor correctly.

You can also listen to a Baha sound

processor using a shaped piece of

plastic called a bite bar supplied by

Cochlear, which is gripped between

your teeth with the sound processor

mounted on the end. The vibrations

from the processor are

conducted along your

jaw bone to the

cochlear and heard

as sound. Personally, I

found it uncomfortable

to use and not very hygienic.

BCHI processors can be used with Radio Aids with

either ear level receivers or body worn receivers.

The Baha/Ponto Listener is particularly useful for

checking that the Radio Aid is working correctly and that

the audio level into the sound processor is giving an FM

Advantage to the user.

The listener can be used in the following way in order to

set up or check a Radio Aid system:

1 Connect the Sound Processor to the Baha/Ponto

Listener and adjust the volume so that it is

comfortable.

2 Ask a colleague to talk to you at arm’s length distance

from the sound processor and make a mental note of

the volume level.

3 Connect the Radio Aid system and turn it on. Your

colleague should then take the transmitter and walk to

the other side of the room whilst talking normally into

the microphone at 150mm from the mouth.

4 If you can, adjust the volume level of the receiver so

that your colleague’s voice is louder by approximately

10 dB than just through the Sound Processor alone.

This will subjectively give you the FM Advantage that

is required. If the volume cannot be adjusted you will

at least be able to check that volume level through the

radio aid is achieving an FM Advantage. This process

is the same for all makes of radio aid, including the

new Roger systems from Phonak.

The Baha/Ponto Listener is also useful for making sure

that the Audio Adaptors that are available for connecting

the processors to audio devices such as MP3 players,

radios, TVs, computers etc.

are working correctly.

In conclusion, any Teacher of

the Deaf who has a BCHI user

on their caseload should have

one of these handy devices in

their arsenal.

John Popplestone is a directorof Connevans Limited.

Testing a bone conductinghearing implantJohn Popplestone stresses the importance of regular testing and shows how a

Baha/Ponto Listener can be used to test Cochlear and Oticon Medical instruments

Cochlearprocessors fitinside the mount

Oticon Medicalprocessors fitover the mount



History

Freddie was referred to the Paediatric Hearing Implant

Centre at St Thomas’ Hospital, London and was seen

for an initial assessment in November 2009.

Freddie was born at full-term by emergency caesarean

section at Farnham Hospital. He was referred to Great

Ormond Street Children’s Hospital following his birth due

to suspected CHARGE syndrome. The clinical genetics

team at GOS confirmed the diagnosis of CHARGE in

February 2009.

Freddie failed the newborn hearing screen and was

referred to local audiology; he was 4-6 months old.

Initially his hearing loss was suspected to have a

conductive element possibly due to middle ear effusion

and therefore grommets were fitted in June 2009. He

then had ABR testing in August 2009 by local audiology,

which was reported as highly indicative of a bilateral

severe-to-profound sensori-neural hearing impairment.

Freddie was subsequently fitted with high powered

hearing aids but did not make any progress. He was

then referred for cochlear implant assessment.

Audiological Information

Freddie was assessed by the Hearing Implant Team for

suitability for cochlear implantation. Initially it was difficult

to get audiometric behavioural responses for air

conduction or bone-conduction stimuli. Therefore whilst

under general anaesthetic for scanning, objective tests

were performed. ABR testing showed that Freddie did

have a profound sensorineural hearing loss in the left

ear but in the right ear his bone conduction thresholds

were within normal limits. Therefore following objective

testing it was found that he had good cochlear function

with a severe conductive overlay. The CT scan revealed

bilateral oval window atresia and absent stapes bones

with MRI scanning revealing a hypoplastic nerve on the

left side.

As Freddie had good right sided cochlear function he

was not a cochlear implant candidate. It was decided by

the team and family that surgical BAHA would be

appropriate management in his case. Due to Freddie’s

age, he was 2 years 3 months old at this stage, he was

fitted with a Bone Anchored Hearing Aid (BAHA) on a

softband until his skull was thick enough to have a

surgical BAHA.

Functional Listening

Freddie was an excellent softband BAHA user wearing

the aid practically all waking hours. Freddie could detect

all the Ling sounds /a/, /e/, /oo/, /m/, /sh/ and /s/ with his

BAHA, indicating that he had good access to all the

frequencies in the speech spectrum. Mum reported that

his listening steadily improved and that he was making

more and more vocalisations.

Freddie was seen in the Specialist Clinic in December

2011 when he was four years old and it was decided

that the surgical BAHA could now take place and he was

listed for surgery.

FreddieMarsha Jenkins introduces Freddie, who has CHARGE syndrome, and describes

how he came to be a very successful user of a BAHA



Surgery and Outcomes

Freddie had two stage BAHA surgery, with stage one in

May 2012 and stage two in December 2012. The BAHA

processor was fitted and activated in April 2013. Freddie

is an excellent user wearing his processor every day at

home and at school. Freddie conditions beautifully for

play audiometry and gives excellent aided responses

across the speech frequencies. At his last review

appointment in September 2014 he managed to perform

automated speech perception testing. Freddie tackled

the Toy Discrimination Test. This test measures the

loudness level at which a child can identify familiar

words with 71% accuracy. Freddie was seated in front of

a touch screen computer where ten toys were pictured.

He was asked to “Point to the X”. Instructions were

presented at varying loudness levels depending on the

accuracy of Freddie’s response. Freddie did very well in

his very first attempt, identifying the toys with 71%

accuracy at 45 dBHL. This was fantastic work.

Freddie has been a delight to work with over the last

four years; the team looks forward to working with him in

the future and monitoring his continued progress. Well

done Freddie!

Marsha Jenkins is Principal Clinical Scientist (Audiology)at St Thomas' Hearing Implant Centre (Paediatric).

Our FreddieFreddie was born on the 7th November 2007. He was

born with a facial palsy and had trouble feeding;

because of this he was taken straight to the special care

baby unit. He was a 9 pound 6 ounce baby, and he

looked huge compared to all the premature babies.

Once admitted to special care, he was given a hearing

test, which showed he was deaf, but the diagnosis and

the extent of his hearing loss took a while to find.

Along with other problems, including a mild case of

CHARGE Syndrome, we had to spend a lot of time at

various hospitals. Eventually Freddie was diagnosed

with middle ear hearing loss, which meant he had a

small amount of hearing in his right ear, so would be

eligible for a BAHA, not a cochlear implant as we first

thought.

Because of his hearing loss, Freddie has quite bad

balance, so has had a number of falls and has cut his

head open quite a few times, so we have had quite a

few trips to A & E.

He was using a BAHA on a band to begin with which

meant he was getting some sound; then in May 2012 he

had the first part of his implant which involved an

operation to place a metal plate into his skull. I think

when Freddie was put to sleep it was more traumatic for

us than him – bless him, he was brilliant. Freddie woke

up after the operation with a large bandage round his

head and was very unhappy, trying to pull it off, but

eventually calmed down. His head took a couple of

weeks to heal including regular checks with the doctors.

By December 2012 Freddie was due for the second part

of his operation, which involved an abutment being

attached on the outside of his head where the metal

plate was put in his skull. The abutment is just like the

popper on a coat or jacket that the hearing aid is

inserted into. By April 2013 it was time to switch it on;

this meant the hearing aid he wore on a band would

now be popped on to the abutment on his head, which

gave much better hearing. It was very emotional when

he had his hearing aid switched on as the first thing he

did was mimic the sound of the door opening, and he

had a big smile on his face.

It took some time getting used to the BAHA but

eventually he got used to it and wears it all day at

school. He is coming on leaps and bounds at school,

and has just had a fantastic report

at parents’ evening. He also signs

and it is lovely to watch Freddie

and his little brother George

signing to each other and playing

nicely. Sometimes it's a bit of a

struggle at home with mummy and

daddy, as like any child he can

sometimes be quite naughty, but

we are getting there.

Freddie's speech is coming along

really well also, and he is doing so

well in all areas of his life. He also

has regular eye checks, a growth

hormone injection every night and

checks with urology and genetics.

We're very proud of our Freddie,

he is a real little character and

"charms" everyone he meets with

his big brown eyes. He is turning

out to be a strong and happy boy.

Anna Bridel is Freddie’s mum.



I was born with microtia to my right ear which literally

means ‘small ear’ and meant that I was born with an

under developed right ear. In my case I was born with

grade 3 which meant I literally just had a peanut-sized

fold of skin/tissue instead of an ear. Due to being born

with microtia I had no hearing at all in my right ear, as I

had no external ear, so there was nowhere for me to

physically be able to hear sounds. However, my left ear

was completely normal and thankfully had no hearing

issues.

Things were definitely hard for me at school even before

I had realised this for myself, such as when I was in

infant school I thought everything was completely

normal and I didn't think I was different in the slightest.

However I did struggle, as I found out some

years later from my parents; for example I

struggled a lot with knowing where sounds

were coming from. I used to always have to

be sitting near to my class teacher when on

the carpet and had one to one support from

a classroom assistant.

It was only as I got older, towards the age

of eight, that I began to realise that I wasn't

the same as everyone else but different,

although still being young I didn't

understand why I was different from

everyone else. I began being bullied which

then affected my self-esteem and

confidence and I felt like it was a bad thing

being different. The bullying made me very

self-conscious including about my hair and

I tried to make my ear as unnoticeable as I

could and kept it covered with my hair

(except in PE). The bullies made me feel

embarrassed to be who I am and to ask for

any help with my hearing, so I did often fall

behind in class as I was too scared to ask

the teacher to repeat things.

I decided in 2006 I wanted to have my ear

reconstructed using my rib cartilage, so that

when I went up to secondary school, the

older kids wouldn't notice my ear or not as

much as they would have done at that time.

This was done in two stages, the first being

in 2006 and the second being in 2007 –

both of them were done at Great Ormond

Street Hospital in London by my surgeon

and consultant Neil Bulstrode. The results

were a lot better than I ever expected them

to be and my surgeon went above and beyond any

images I had in my mind, I hadn't expected it to look as

realistic as it did.

However I did still get bullied in secondary school and

worse than I had in juniors.

It wasn't until I left school and started college that I

began to feel confident and happy about my ear (even

though I was happy with my ear once reconstructed) but

this was like a different form of happy and I felt like I

could put everything behind me and move on into the

future and I wanted my ear to be a part of that, as it still

was a part of me. I started researching and looking into

microtia more, as I was very determined to find

BethanBethan describes her life with microtia which led to her being bullied at school and

the difficulties she encountered in trying to get fitted with a BCHI



someone, anyone else out there, who had a little ear like

mine. Luckily I did find out more information so that I

fully understood what microtia was and why my ear was

different. I also came across a support group on

Facebook called Microtia Mingle UK which was and still

is a HUGE help and it helped me to be connected with

other people and their families of all different ages who

had microtia. I found out about Bone Conducting

Hearing Implants through one of the meet ups arranged

by this group, where I met two girls similar in age to me

who were wearing them and explained to me and my

parents what they were and how they worked.

The day after that Mingle my dad rang my consultant

and surgeon Neil Bulstrode at GOSH to ask him about

Bone Conducting Hearing Implants and whether this

was something that could be suitable for me. He

agreed to speak to me and my dad at my next

appointment, which wasn't too far away and arranged

for me to go and see someone within the audiology

department to trial a Bone Conducting Hearing Implant

on a headband and I knew within seconds of it being

activated that I both wanted and needed to have one,

as it made such a huge improvement before it was

even in place properly, and was honestly the most life-

changing moment of my life.

Unfortunately we were told that due to my age (I was

16) I was unable to have the surgery done at GOSH.

However they were happy to refer me to the Royal

National Throat, Nose, Ear Hospital, also in London

and not that far away from GOSH. However,

unfortunately we had a long hard battle of getting the

Bone Conducting Hearing Implant due to the hospital

losing my information and not having a record of me

and then ending up with the same appointment multiple

times. We then had problems with my left ear as they

noticed that there was a loss in that ear too and so that

had to be resolved first and I had a regular hearing aid

fitted in January 2013. I eventually had my bone

conducting implant fitted in January this year and

although I had a few setbacks at the beginning with

regular infections, things are looking up and, fingers

crossed, are all going well. I honestly love having my

bone conducting implant and I wouldn't be without it

now, and I really don't know how I was without it for all

those years before.

My blog has now been up for 3 years. I'm completelybully free and growing in confidence and happiness withevery day and opportunity given to me with raisingawareness such as I recently gave a speech about myjourney with Microtia at the launch party of Microtia UK,a UK based charity for Microtia where I spoke to over400 people including medical professionals such asprofessors, surgeons, doctors and researchers as wellas those with Microtia and their friends, family andgeneral supporters.

http://www.microtiamingle.co.uk/

Deafness & Education International

Did you know that as a member ofBATOD, you are entitled to free online access to Deafness &Education International?

Volume 13 (2011), 4 issues a year

Editors: Linda Watson (University ofBirmingham, UK) & P Margaret Brown(University of Melbourne, Australia)

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Editors: Linda Watson(University of Birmingham, UK) & P Margaret Brown(University of Melbourne, Australia)

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The world’s first, and only, active bone conduction implant,the Bonebridge, is now available to help transform the livesof children over five years old.

Bonebridge is the first bone conduction implant system touse transcutaneous, intact-skin technology. This means thatthe implant is positioned completely under the surface of theskin, so that the protective role of the skin is fully preserved.This is especially importantfor children because itmeans the risk of externalinfection is significantlyminimised.

As active implants directlystimulate the cochlear, asopposed to passive systems which require an externaltransducer to transfer the energy through the patient’s skinfirst, audiological outcomes are improved. Additionally activeimplants require reduced skin pressure to retain theprocessor as the transducer is internal. This means thatchildren with a Bonebridge will wear their processors longeras they’re more comfortable to wear, and naturally this willimprove their hearing experience and development.

Hearing through the bones of the skullThe award-winning technology allows children and adultswith conductive hearing loss or single-sided deafness tohear again by actively transmitting sound through the bonesof the skull.

Like all MED-EL hearing implant systems, Bonebridge hastwo components: internally, the active implant and externallythe audio processor. The active implant converts the signalsfrom the audio processor into mechanical vibrations. Theseare transferred to the bones of the skull, which conduct thesound waves to the inner ear.

NEW – Introducing the SAMBAThe Bonebridge system includes the SAMBA* audioprocessor which allows users to connect to smart phones,FM receivers and other assistive listening deviceswirelessly. Thisstate of the artaudio processoris compact, verylightweight (7g inc. magnet),and easily hiddenunder hair.

Intelligent sound adapter The SAMBA distinguishes between different hearingsituations and automatically adjusts to the most appropriatesetting so users can hear speech and music in both noisyand quiet environments. The audio processor also has theability to learn and recognise manual adjustments that theuser regularly makes regularly, for example, if the useralways re-adjusts the volume in a quiet environment, theSAMBA recognises and stores this information.

Adaptive directional microphones – background noiseis a thing of the pastThe adaptive directional microphone automatically identifiesand minimises noise interference.

This feature is particularly helpful in situations where thereis loud background noise, such as in a classroom or theplayground.

Speech tracking – razor sharp speech from alldirectionsThis special feature automatically recognises the directionfrom which speech is coming and adjusts the directionalityof the microphone. In a classroom this means that a pupilbenefits from the optimum focus on speech; this works inthe same way for adults when driving.

Individual adaptable programmes The user can select one of five programs, each with its ownindividual settings, for particular situations (e.g. for noisyenvironments or for TV & music). This makes the SAMBAquick and easy to use.

Wireless connectivityThe SAMBA can be connected to external devices viaBluetooth or telecoil. This enables th signal from a FMsystem, assistive listening device, mobile phone, or MP3player to be transmitted wirelessly and with no loss of soundquality. These wireless connectivity functions are availablewith the Siemens miniTEKTM.

Backwards compatibility for added reassuranceOne factor that is especially important for children is thatMED-EL implant users can always benefit fromtechnological innovation in the future. MED-EL externalaudio processors are always backwards compatible withimplants meaning everyone can access the very latestprocessor technology at the time of their upgrade.

Sarah Humphreys, UK & Eire Vibrant Business UnitManager comments: “MED-EL strives to be at the forefrontof scientific innovation and offer patients with hearing lossa range of solutions that allow them to overcome hearingloss as a barrier to communication. The connectivity of ourlatest audio processor is a huge step forward in allowingpatients to communicate in the digital age, with moderndevices such as mobile phones connecting seamlessly tothe implant.”

The innovative Bonebridge implant system is now beingused worldwide with a high level of patient satisfaction,comfort and reliability with the system. For more informationabout this award winning technology and the full range ofMED-EL hearing implant solutions, visit: www.medel.com.

* The SAMBA audio processor is pending regulatory approval

Active bone conductionMED-EL introduce Bonebridge, active bone conduction with intuitive audio

processing, which is now approved for children



The first bone anchored hearing aid was implanted at

Birmingham Children’s Hospital in 1988. Since then we

have implanted many children and have one of the

largest programmes in the United Kingdom. A bone

anchored hearing aid may be implanted for a variety

reasons but the wound care and aftercare are

essentially the same for any child with these devices.

There are currently two manufacturers who provide

bone anchored hearing aids: Cochlear and Oticon.

The advice for each device is the same too!

The surgery itself is usually done in two stages for

children. The first stage is when the implant is placed in

the skull of the child. The second stage is performed

about three months later when the abutment is placed

on the implant. The reason why there is a time delay is

to allow time for the bone in the skull to grow around the

implant. This is called osseointegration. Both stages are

mostly performed as a day case.

After the abutment is placed, I will see the child a week

after surgery to remove the dressings. On that same day

we try and fit the sound processor.

After the dressing is removed there are a number of

things that a parent/carer needs to do to ensure that the

skin around the abutment is cared for.

Cleaning the abutment

I advise that the abutment is cleaned on a daily basis.

This is to remove any debris from around the abutment,

rather like cleaning your teeth every day! I advise the

parent/carer that they can clean the abutment in a

variety of ways; with a soft toothbrush, with some cotton

buds or with a non-alcohol wipe. It’s the child’s and

parent/carer’s choice, but the message is the abutment

needs to be cleaned. Older children can wash the area

themselves in the shower or bath. I advise that the child

then asks somebody to take a look at the abutment

every couple of days just to check that the skin around

the abutment is OK. If debris is left around the abutment,

it can lead to a local skin infection which may be painful

and is also a nuisance.

Washing hair

From experience over the years, parents/carers have

informed me that simple baby shampoo is the best as it

doesn’t seem to irritate the skin around the abutment.

I advise that they can use a cool hairdryer around the

abutment to rid the area of any moisture. It is essential

that hair does not wrap itself around the abutment as it

can cause a local skin infection.

Skin infections

From time to time a child may get a skin infection around

the abutment. I advise that if the child has a skin

infection, the parent/carer should apply some antiseptic

cream to the area as soon as they can. I give them a

tube of cream and let the GP know what cream they

should use if there is a problem. If you notice that the

skin around the abutment is red, swollen, sore or

discharging, please inform the parent/carer as soon as

possible.

Swimming

Swimming is fine for a child with a bone anchored

hearing aid. Clearly the child needs to remove the sound

processor before entering the water. I would advise that

the abutment is rinsed when the child comes out of the

pool as swimming pool water can be quite dirty!! Rinsing

can be done with some plain tap water.

Accidents at school

Any accidents relating to the abutment should be

reported to the parent/carer. Unfortunately accidents do

happen! If the abutment is loose it can cause a local skin

infection. A loose abutment can also make the sound

processor whistle. The parent/carer should then contact

the nurse or their surgeon at their hospital and we can

give the necessary advice.

Pain

Pain from the abutment site is unusual. It can be treated

with simple analgesia. Any pain experienced by the child

should be reported to the parent/carer.

Advice for school

If at any time you would like to attend an appointment

at the ENT clinic with the child, we would be more than

happy to see you. Clearly you would need to get

permission from the parent/carer and the child

first. I know many Teachers of the Deaf who have

attended find the experience very useful for their

own learning.

Radio aids

Some of the children will benefit from radio aids in the

classroom setting. This is something that you may need

to assess when the child has been fitted with the

sound processor.

Useful websites

NDCS – National Deaf Children’s Society –

www.ndcs.org.uk

Ear Foundation – www.earfoundation.org.uk

Cochlear – www.cochlear.com

Oticon – www.oticonmedical.com

Jo Williams is an Advanced Nurse Practitioner ENT –Birmingham Children’s Hospital –[email protected]

Skin careJo Williams talks about the importance of wound care and after care following bone

anchored hearing aid surgery

Officers of Nations and Regions

BATOD contacts and Magazine Distribution

Northern Ireland [email protected]: Revolving postSecretary: Valerie McCreedyTreasurer: Antonette Burns

Scotland [email protected]: Catherine FinestoneSecretary: Jean McAllisterTreasurer: Elaine Harris

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East [email protected]: Jo SayersSecretary: Trina RankinTreasurer: Joanne Hughes

Articles, information and contributions for theAssociation Magazine should be sent to:

BATOD National Executive Officer: Paul SimpsonTel/fax: 0845 6435181 Email: [email protected] should Association information and general queries.

Advertisements for the Association Magazine should be sent to:Elizabeth Reed-Beadle, BATOD Advertising Manager142 New Road, Hethersett, NR9 3HGTel: 01603 812111 Email: [email protected]

Full guidelines for submissions and abstracts of paperspublished in the Journal ‘Deafness & EducationInternational’ are to be found atwww.maney.co.uk/instructions_for_authors/deiEnquiries related to the Journal to: Dr Linda Watson, email: [email protected]

Manuscripts should be submitted online atwww.editorialmanager.com/dei

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North [email protected]: Sue DennySecretary: Trish CopeTreasurer: Sandy Goler

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South West [email protected]: Post vacantSecretary: Hazel SutherlandTreasurer: Post vacant

DISCLAIMERThe Editors and the Association do not necessarily

endorse items or the contents of advertisementspublished in the Magazine and cannot accept

responsibility for any inaccuracies.Please note that items from this Magazine

may not be reproduced without the consent ofBATOD and the source must be acknowledged.

Photocopying items may breach copyright.

BATOD Magazine distribution by: The Creative Adult Project,

The John Townsend Trust, Victoria Road, Margate, Kent CT9 1NB

Association Magazine: ISSN 1366-0799

Published by: The British Association of Teachers of the Deaf,

21 Keating Close, Rochester, Kent ME1 1EQ

Printed by: Berforts Information Press Ltd

Southfield Road, Eynsham, Oxford OX29 4JB

Magazine Project Manager: Rosi Hearnshaw

BATOD membershipBATOD activities are funded from your membership fee and some advertising income. Colleagues who share your Magazine and Journal also benefit from BATOD negotiations withgovernment and other influential bodies ‒ but they are not contributing! Persuade your colleagues to join BATOD and you will receive 10% of their membership fee as an‘introduction fee’.

Full details of membership plus membership form are available at www.batod.org.uk ►The Association ►BATOD Membership

ToDs in training will be entitled to a £20 reduction in annual membership fee when the CourseTutor countersigns the membership application form for those paying by Direct Debit (applies for up to 2 years; payable at the end of the year).

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