BAHA, CI, Which one? Audi has me confused!

Shortened post, because I’ve had to re-type this 4 times because of my computer crashing.

-Severe-profound hearing loss, audiogram attached, slight conductive loss
-Saw CI clinic about possible implantation through Medicare
-Was told speech discrimination was too good for CI but that I was a candidate for BAHA
-Now have appointment on Tuesday the 6th with a specialist about BAHA and possible stapes surgery? (wasn’t clear on that or why I would need it)

As far as I’m aware, a BAHA wouldn’t help me with sensorineural hearing loss, especially at the levels I’m at. I want to go into this appointment firm about what I need and with good information. Can anyone help me? Any help would be appreciated!

Audogram: http://i.imgur.com/ZIFlwu1.jpg

A BAHA simply puts sound waves into your skull. There are only two possible purposes for it - 1. route sound from bad side to a good ear, or 2. route sound to a good inner ear around a middle or outer ear problem.

A CI replaces your inner ear function and stimulates the hearing nerve directly.

That I know- but why would they recommend BAHA if my inner ear is the problem, I.E. SNHL? Should I just go into the appointment insisting on CI?

You should probably ask whoever gave you that advice why they did so. You might be missing something.

Stapes surgery would be for a conductive loss problem, not a SN problem. Perhaps you have mixed loss (i.e. both types are present)?

You should be able to contact whomever gave you confusing advice, and ask for clarification. I know it’s not always easy, but it may be well worth it.

Hopefully others more knowledgeable than I will chime in as well!

I hope so! I’m anxious about this appointment and I’m afraid they’re puttig me through the ringer because I tend to bluff very often and very well even when I don’t understanf the words, heh.

Most HP aids would fit that loss

I am already wearing high power hearing aids, but getting little benefit from them. Speech is just garbled and I can only occasionally catch a good word or two.

I’m just a novice nobody who doesn’t even use hearing aids yet, but … it sure looks like your bone conduction scores are better than your air conduction scores. That might suggest that a BAHA is worth exploring? It can be tried in an audiologists office without surgery; they just sort of clamp it to your head.

Again, why not contact whoever made those recommendations, and ask them (calmly, neutrally) why they did so? Perhaps they had good reasons that they can better explain to you.

That’s a huge conductive loss on top (below) a small SN loss. Therefore it’s mixed but the conductive element is by far the most significant.

The Carhart’s notch at 2Khz is classic Otoscleorsis/stapes fixation.

Nobody suggesting middle-ear reconstruction or a direct shunt from the drum to the stapes footplate?

You’d do well from BC aids like the BAHA due to the good bilateral SN - has nobody considered BC specs to see how you find the improvement?

I’m also surprised that you have maxed-out a pair of properly fitted power aids, I’ve fitted worse losses than that with linear-ish settings/soft moulds and the response is usually quite good in terms of clarity - especially if you can keep the feedback in check.

How you describe your loss and having good word recognition scores doesn’t seem likely. I think I’d see another ENT and not guess during the WR test. That should get you the surgery you really need. We’ve people here who have had the stapes surgery and they had great result. That seems the better solution over BAHA.

I’m pretty sure the lower lines are my sensorineural loss? I’ve never tried bone conduction aids but they didn’t seem to want to spend much time with me in the office. They think this stapes surgery is just going to fix everything and I’ll be hearing but I’m still going to have SNHL?? So I don’t understand what the point of a bone conduction aid or stapes surgery is if I’m still not going to have a working inner ear.

The conductive loss is where the sensorineural loss start. Remove the conductive loss and everything moves up. If the conductive loss were 10 across the board you place the sn loss at the 10 below that instead of the 60 or whatever now. In the example you’d improve 50db – thats huge.

So, I would honestly rather not go through stapes surgery. I’m happy being able to go silent when I want. Would it be weird to ask the doctor to just try a BAHA and see how I do that that? I know there’s a new Super power BAHA out that I think might work well for me, the BAHA 5 Superpower? Would that be a good thing to bring up?

The mind will adopt to the “noise” that comes to your more silent world. You can always buy a noise cancelling headset to get solace. Maybe Um Bongo will correct me but it seems the stapes surgery give you a wholeness that a Baha can only try to give.

I wouldn’t settle for half a loaf.

A member here just had it and others had it in the past. They see it as life changing and not really major surgery. I don’t know your age but the future could add to the sn loss. Why limit that by avoiding the surgery?

Sorry no. The sensorineural part of your loss is quite small, if they can correct even a portion of the conductive element, you’ll get a significant improvement in your hearing. Get the surgery done if they are offering it.

yes, I know that feeling…

Starkid, I was freaked about doing it too. Just had it done, there’s not much to it. Put on the gown, lay down, wheel you in, knock you out…wake up, get dressed, go home. Took about 3 hours total. Anesthesia messed with me for the first two days, nothing bad, just presently groggy. Antibiotics messed with my stomach…learned to love Activia
No pain in the ear at all…just itching now cause it’s healing

All in all…a cake walk

I don’t know all the terms and abbreviations…but what you are describing sounds exactly like me…
My audio is even worse than yours…

When I would get a hearing aid loud enough to work…I could hear…but the hearing aid would get distorted…sounded like a horn through a blown speaker. And, supposedly, I was trying out the newest most powerful hearing aid…I’m sure we were trying to make a hearing aid loud enough to be a bone conduction hearing aid

Bone conduction aids and Cochlear implants were suggested to me first…have no idea why, but I suspect something…anywho, when I told them nope ain’t going there…then all of a sudden I was the perfect candidate for a stapedectomy. Had it in my right ear two weeks ago so I still have a long way to go until it’s healed.

I can hear in that ear now…and that was the ear that was totally dead…nada, zippo, nothing
Even if I end up having to use a hearing aid for that ear…I can use just about anything now

Point is, my advice is find a good, really good, ENT surgeon that does a lot of these things.
Bone conduction, cochlear implants are not that easy to reverse if you decide you don’t like it.
You’re pretty much stuck with it.
Stapedectomy you can do over, and over…and as you get older you might need the extra help from an implant
…but I would not start out with one if there’s an easier fix

Most of your loss is conductive.

It sounds like what was suggested to you by your provider (right?) was stapes surgery or BAHA, either of which would address with that.

Stapes surgery, if it works would actually correct it (to greater or lesser extent) and restore hearing.

When you see the specialist, please don’t bluff. Ask for a thorough explanation of what’s going on and why they are recommending this, that, or the other thing. Please ask them to explain your audiogram so you understand what it says.

You have a very small sensorineural loss at most frequencies. That’s shown by the lines connecting the [ and ] bracket signs on your audiogram. If that loss were all you had to deal with you probably wouldn’t even notice it. The bracket signs show a big dip in sensorineural hearing at 2K – that’s the Carhart’s Notch Um Bongo mentioned. All I know about that is that when I had stapes surgery my hearing at 2K improved much more than the original audiogram had predicted. So I wouldn’t worry about that right now.

As I understand it a cochlear implant is only for people with profound sensorineural loss. That’s not you. I would forget about CI.

Your problem is that you have a large conductive loss. A BAHA addresses conductive loss, but I wouldn’t jump to the conclusion that you need that. A BAHA is usually used for patients who have lost all of their hearing in one ear but have good hearing in the other ear. Stapes surgery is also a solution for conductive loss. Um Bongo says the Carhart’s notch (that big dip at 2,000 Hz shown in the upper part of your audiogram) is an indicator for otosclerosis, which would be fixed by stapes surgery.

When we hear a sound, the sound waves enter the ear canal and vibrate the eardrum. As the eardrum vibrates, it strikes a tiny bone in the middle ear, which sets two more tiny bones vibrating. The last of those bones is the stapes bone. The stapes vibrates against the cochlea, which contains many sensory cells designed to respond to specific frequencies. Those cells send signals to the auditory nerve, which sends the information to the brain. The brain then interprets what we’ve heard.

If something goes wrong with the eardrum or the three bones in the middle ear, that causes a “conductive” loss. It’s a mechanical problem, basically. For instance, if there’s a big hole in the eardrum, the eardrum can’t vibrate to set the whole hearing process in motion. If the middle ear is full of pus from a bad ear infection, that can dampen the eardurm’s vibrations and interfere with the vibration of the bones. In otosclerosis, extra bone gets deposited which fuses the bones in the middle ear together and it can fuse the stapes bone to the cochlea. That prevents the bones from vibrating as they should. I hope the specialist you’re going to see will explain exactly what the problem in your ears is.

“Sensorineural” hearing loss is a problem in the cochlea or the auditory nerve. Usually it’s a problem in the cohclea, and in older people it’s often simply a case of the sensory cells dying off. In older people, it’s the cells that perceive high frequencies (high-pitched sounds such as birds, squeaky things, and unfortunately many consonants) that tend to die.

When they do an audiology test, one part of the test sends sounds through the air. Those sounds have to go the whole distance – to the ear drum, then the bones of the middle ear, then the cochlea, then the nerve. The results are called “air conduction.” Then they strap a device tightly to your skull and test again. The device sends sounds directly to the bone near your cochlea. It bypasses the eardrum and the middle ear. Those results measure “bone conduction.”

If someone has good bone conduction results but poor air conduction results, they’re said to have a conductive loss. That describes your situation. It indicates there’s something going wrong before the sound ever reaches the cochlea or the nerve.

I had otosclerosis in my left ear in addition to moderate/severe sensorineural loss in both ears. I became almost deaf in my left ear. Two years ago I had stapes surgery (stapedotomy) in that ear. The surgery replaced part of the stapes bone with a piece of titanium and restored the ability of the bone to send vibrations to the cochlea. The results were wonderful. I still need hearing aids because of my sensorineural loss, but now my hearing is about equal in each ear, and my loss is in the range that is easily corrected with hearing aids. It’s an outpatient surgery which takes about an hour. Medicare covers it.

Another member of this forum had stapes surgery recently. His name is Squerly. If the specialist recommends stapes surgery, you could look at his posts to learn more.

Good luck at your appointment!

Edit: I had the surgery last year, not two years ago.

Daisy, can’t thank you enough for that post!

My doctor gave me the down and dirty cliffs notes version, you just filled in all the blanks he didn’t have time for…

Thank you again!

(one more thing I just ran into…medicare covers 80%…I got plan F which covers the rest…cost me nothing)
I was also told that medicare will only cover one ear for an implant…not both ears.

LOL, Squerly, you’re welcome! Thanks for sharing your experiences. There aren’t many of us here!