ENT - Bone Anchored Hearing Solutions (BAHS)

What is Bone Achored Hearing Aid (BAHA)?

A Bone Anchored Hearing Aid is a type of hearing aid that vibrates the bone of the skull which sends sound to the organ of hearing (cochlea). The hearing aid is usually used over the bone behind the ear. It can be worn on a headband or attached to an implant which fits into the skull bone after a small operation.

What are the benefits of a BAHA?

These hearing aids send sound through the bone, compared to normal hearing aids which sit in the ear canal and send sound through the air. The benefit of a BAHA is that nothing is required in the ear canal which can reduce the risk of infections. For people with particular types of hearing impairment where the sound waves cannot get to the organ of hearing, a BAHA is able to bypass the obstruction to get sound to the organ of hearing. The sound processor is discrete. It can connect to your phone via Bluetooth.

What is the first step?

If you are eligible and would like to consider a BAHA then speak with your Doctor or Audiologist. You will be referred to a Specialist Audiologist who will meet to discuss the options and check you are eligible. If you may benefit from a BAHA you will be provided with a loan device to try at home. If this trial is successful you may be offered to have a permanent implant placed behind your ear which the hearing processor can be attached to.

BAHS Surgery

Generally, the operation is performed under local anaesthetic as a daycase procedure for adults. The experience is similar to going to the dentist. In children, depending on parental wishes, and the age and maturity of the child, the operation may be offered under local anaesthetic but the option of general anaesthetic is available based on the clinical need in all patients (adults and children).

The surgery involves shaving some hair from a small area behind the ear and the injection of a local anaesthetic using a needle.
After making a small cut into the skin, a small amount of bone is removed with a drill. This causes some vibrations. A titanium implant is then inserted into the hole.

Implant (fixture and abutment)

After the operation you will return to the Day Surgery ward for a short period of time to recover. You may experience some mild pain. Normally paracetamol should be sufficient. You should make sure you have paracetamol (if you can take this) at home before the operation. The pain should settle within a few days.

A silver-coated dressing is applied and is held in place by a soft healing cap which keeps the dressing on. This allows good healing of the wound and protects the implant. The dressing will usually stay in place for 7-10 days until the post-surgical review by the ENT surgeon in an outpatient clinic. It is essential that the dressing is kept dry and the healing cap is not removed during this period.

What are the risks of the Surgery?

A small cut is made behind the ear so that the implant can be placed. Once this heals there will be a scar. In some cases the wound takes longer to heal and can break down. After the operation the site will be sore and require paracetamol for a couple of days. Rarely patients can develop long term pain around the site of the implant. If this happens the doctor can discuss options to help treat this. If these treatments don’t work then the implant can be removed. There may be a small amount of bleeding from the wound after the operation, this is normal. If there is a continuous flow of blood then attend your local emergency department.

The site can become infected leading to redness, increased pain and smelly discharge from the wound. If this happens see your GP for a course of antibiotics and call the BAHS Team (numbers below).

As the skin heals around the implant it can start to grow over it. If this happens call the BAHS Team and your doctor will assess if a short procedure is required to remove the excess skin.

In most cases the implant will heal into the skull bone. Occasionally this will fail and the implant will fall out. If this happens don’t worry, keep the site dry until you see your doctor. Call the BAHS Team so they can arrange an appointment to see you and discuss if you want to go ahead with another operation to place another implant.

After BAHA Surgery

After the healing cap over the implant is removed the skin around the implant might be sore. You can now wash your hair and get the site wet. Wait at least one month after surgery before colouring your hair. Tell your hairdresser about your BAHA implant.

A small area of skin around the implant may feel numb temporarily and usually settles within 2-3 months. It is also advisable to avoid any contact sport which could result in trauma to the implant for the initial 6 weeks post surgery.

Cleaning

Keeping the area of skin around the abutment clean is paramount for long-term success of the implant and use of the sound processor. Once the dressing and the healing cap are removed we will advise you to commence cleaning the skin site on a daily basis. Use a non-alcoholic wetwipe to clean the abutment and the skin. Gently wipe the skin around the base of the abutment. We will explain the process to you in detail including what to use for cleaning.

Fitting

Around 4 weeks after the surgery you will be reviewed by one of our specialist audiologists. In adults, provided there is satisfactory healing of the skin site, you will be fitted with the sound processor and further advice regarding cleansing of the area around the abutment will also be given. In children, we may delay the fitting until we are happy with the stability of the implant.

The sound processor will be programmed appropriately for your needs. The Audiologist will then monitor your progress periodically.

FAQs

When can I return to work after surgery?

You will be able to return to work the next day if your surgery was performed under local anaesthetic. Most people who have surgery under general anaesthetic may need an extra day to recover fully from the effects of anaesthetic.

What do I do if the healing cap and the dressing come off?

If the healing cap comes off, you can try to put it back on yourself. If not then contact the BAHS Team on the numbers below.

When can I wet the area and wash my hair?

Aim to keep the dressing dry until it is removed a week after your operation. Avoid washing your hair for at least 3 days after the operation to prevent the wound getting wet.

Do children need any special care?

Initially parents or guardians will need to do the cleansing around the abutment, but once a child is taught how to clean it, they may take responsibility for their daily cleaning.

How to contact The NCA BAHS Team

1st Contact – Clare Mackie (ENT Secretary)
Tel: 07977 343 401
email: Clare.Mackie@nca.nhs.uk

2nd Contact – Julie Coutts (ENT Secretary)
Tel: 0161 778 3671
Email: Julie.Coutts@nca.nhs.uk
Implant Audiologist – Tracy Lawless Tel: 0161 778 3033