BAHA (bone-anchored hearing aid)

 

A BAHA (bone-anchored hearing aid) is a device that works by coupling of the sound processor to the underlying bone through 1) a small connector across the skin, and 2) an implant that directly bonds with the underlying bone – an osseointegrated implant (bone grows into the screw into the bone of the skull over time).

 

The system consists of three components: the titanium fixture, the abutment, and the external sound processor. Minor surgery is required to place the Baha behind your non-functioning ear.

 

Risks of surgery

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• There is always a low risk of infection and/or bleeding with any operation, as well as risk from anesthesia.

• There is a small chance of device extrusion, skin infection and/or breakdown requiring antibiotics and/or revision procedures.

• Additional rare risks include spinal fluid leak, an undesired outcome with implant performance, and/or device failure with the need for further procedures.

 

Day of surgery

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• The operation is performed as an outpatient (same-day) procedure under local or general anesthesia.

• Do not eat or drink after midnight the day prior to surgery (no coffee or breakfast the day of surgery).

• Your primary care physician and/or anesthesiologist will review your medication instructions with you and instruct you on what to avoid the morning of surgery.

 

Post-operative care

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• The pressure head dressing must stay on for 24 hours.

• For CONNECT surgery (with an abutment): Once the outer bandage is removed the inner bandage must stay connected to the post until you return to the clinic for your first post-operative visit, typically 1 week after surgery. You may wash your hair during this time over the sink with a cup over the bandage.

• For ATTRACT surgery (with magnet only): No further dressing is required after the outer dressing is removed.

• Keep the incision dry for another 48 hours then you may wash hair as normal and allow soap and water to wash over the site.

• The operation does not typically cause much post-operative pain, but you will be given pain medication after the procedure. We will not refill pain medication.

• Most people take about one week off from work or normal activities- you may return to work sooner if desired.

 

Additional post-operative information

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• If you wear glasses, you may want to remove an arm as to be able to use your glasses with the head dressing in place and not put pressure over the incision.

• It is normal to hear funny noises in the ear (buzzing, ringing, popping) and feel pressure or occasional sharp/shooting pains while the area heals.

• Call the office for any swelling, and/or redness of the incision site, fever, or other concerns.
  Minor swelling is normal.

 

Activation

 

You will schedule an activation appointment roughly 2-3 months after the surgery, to be determined by your surgeon and audiologist.

 

Cochlear Implant

 

A cochlear implant is a small electronic device that is surgically implanted and has given the gift of hearing to thousands of children and adults. Cochlear implants are not hearing aids, nor do they restore hearing. The implant converts sound energy into an electrical signal that gets transmitted to the cochlear nerve (nerve of hearing), and then to the brain.

 

The implant consists of an external device worn on the ear or body that contains a microphone to pick up sound in the environment, and the surgically implanted internal receiver/stimulator that converts the sound information to electrical
pulses that send this information to the brain through the electrode placed in the cochlea (organ of hearing).

 

Our cochlear implant team is dedicated to providing patients with the best hearing health care and services.

 

Pre-operative Planning Protocol/Checklist

 

The following checklist is a general guideline for the pre-cochlear implant process. These steps must be completed for you to receive a cochlear implant. ​

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• Insurance authorization- this will be completed by our office and can take up to 3-6 weeks. Authorization must be completed PRIOR to scheduling your surgery.

• Hearing Aid Fitting/Trial- The patient must have undergone at least a 4-6 month period of hearing aid use before having the cochlear implant evaluation.

• Cochlear Implant Evaluation- performed by specific cochlear implant audiologist
  Baker ENT Audiology (989) 684-4400
  Central Michigan University Audiology (989) 774-3904
  Northwoods ENT Audiology (231) 348-5900

• MRI or CT scan- to be determined based on your history by the surgeon

• Vaccinations- you must have vaccinations (Pneumovax, Prevnar; Hib [children only]) to prevent against meningitis- you must have one prior to the day of the operation and may get the other after the surgery. We will give you a prescription to take to your primary care provider or health department to have these given.

• Medical Clearance- If deemed necessary, a medical clearance from your primary care physician must be provided to us within 30 days of the date of the operation.

 

Cochlear Implant Surgery

 

Risks of surgery:

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• Most often the hearing remaining in the operative ear will be gone after the surgery, leaving the ear completely deaf until the implant is activated.

• There is always a low risk of infection and/or bleeding with any operation, as well as risk from anesthesia.

• Additional rare risks include spinal fluid leak, temporary or permanent facial weakness, dizziness or imbalance, taste change.

• There is also a risk of undesired outcomes with implant performance, and/or device failure with the need for further procedures.

 

Day of surgery

​

• Most often the operation is performed as an outpatient (same-day) procedure under general anesthesia.

• Do not eat or drink after midnight the day prior to surgery (no coffee or breakfast the day of surgery).

• Your primary care physician and/or anesthesiologist will review your medication instructions with you and instruct you on what to avoid the morning of surgery.

 

Post-operative care

​

• The head dressing must stay on for 24 hours and the incision be kept dry for at least 48 hours. You may wash your hair during this time over the sink with a cup over the ear and incision. Hair dye after 3 weeks.

• The operation does not typically cause much post-operative pain, but you will be given pain medication after the procedure. We will only refill pain medication for post-operative pain for up to two weeks after the procedure, then you must discuss it with your primary care physician.

• No nose blowing or heavy lifting over 5 pounds for 2 weeks.

• Most people take about one week off from work or normal activities- you may return to work sooner if desired. We will approve up to two weeks of leave.

 

Additional post-operative information

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• If you wear glasses, you may want to remove an arm as to be able to use your glasses with the head dressing in place and not put pressure over the incision.

• It is normal to hear funny noises in the ear (buzzing, ringing, popping) and feel pressure or occasional sharp/shooting pains while the area heals.

• Children with ear tubes in place will have ear drainage- this is normal. Use a cotton ball as needed and keep water out of the ear.

• Call the office for any swelling, and/or redness of the incision site, fever, or other concerns.

 

Activation

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You will schedule an activation appointment roughly 3-4 weeks after the surgery.

 

Craniotomy Surgery

 

Risks of surgery

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• There is always a low risk of infection (wound infection, meningitis) and/or bleeding with any craniotomy, as well as risk from anesthesia.

• Additional rare risks include death, stroke, temporary or permanent facial weakness/numbness/vision change, dizziness or imbalance, permanent hearing loss.

 

Day of surgery

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• Most often you should expect a hospital stay of 3-7 days on average.

• Some people require a lumbar drain for spinal fluid drainage- your surgeon will discuss this with you if necessary.

• Do not eat or drink after midnight the day prior to surgery (no coffee or breakfast the day of surgery).

• Your primary care physician and/or anesthesiologist will review your medication instructions with you and instruct you on what to avoid the morning of surgery.

 

Post-operative care

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• A head dressing will be in place from 3-5 days.

• You may wash your hair 5 days after the surgery- over the sink with a cup over the ear and incision. Keep the incision dry one week.

• You will be given pain medication after the procedure. We will only refill pain medication for post-operative pain for up to two weeks after the procedure, then you must discuss it with your primary care physician.

• You may not drive while on pain medication. You are safe to drive when you are off this medication and able to look into your blind spots and all mirrors without getting dizzy.

• No nose blowing, heavy lifting over 5 pounds, heavy exercise, or bending over with head down for 6 weeks. This includes activities such as pulling weeds, etc, or anything that requires exertion. This will increase the pressure in your head and increase your risk for a spinal fluid leak.

• Most people take about 6 weeks off from work or normal activities- you may return to work sooner if desired.

• You can expect to feel very tired for a least 6 weeks; this is a part of normal recovery.

 

Additional post-operative information

 

• If you wear glasses, you may want to remove an arm as to be able to use your glasses with the head dressing in place and not put pressure over the incision.

• It is normal to hear funny noises in the ear (buzzing, ringing, popping) and feel pressure or occasional sharp/shooting pains while the area heals.

• Call the office for any swelling, and/or redness of the incision site, fever, mental status changes, or other concerns.

 

How to Care for Your Child’s Ear Tubes

 

Ear tubes help protect your child from ear infections, the build-up of middle ear fluid behind the eardrum, and the hearing problems that go along with these issues. Most tubes last 6-18 months, allowing most children to outgrow their ear problems as the head and eustachian tubes grow in size. Most tubes fall out by themselves. The chance of the tube falling inside is very rare.

 

Tubes that do not come out after two years need to be removed by your doctor to prevent further complications such as the increased risk of permanent perforation, chronic ear drainage, and infection, or development of skin ingrowth (cholesteatoma). After two years the likelihood that the tube will fall out on its own without surgical removal is very low.

 

The hearing may be checked prior to ear tube placement to establish a baseline and SHOULD ALWAYS be performed after the procedure to determine the hearing has returned to normal.

 

Ear Tubes and Water Precautions

 

Some children with ear tubes may wish to wear earplugs when swimming or with water exposure based on patient comfort. The earplugs may keep water out of the ear canal and out of the ear tube. However, water does not usually go through the tube during swimming and therefore earplugs are not necessary for most
children.

 

If the water is clean (chlorinated- pool or shower/bathtub) there is no danger if there is a small amount that enters the ear. There may be an increased risk of infection with dirty water such as that from a lake or ocean. Although most children with tubes do not require earplugs be worn, they may be preferred in the following
situations:

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• Pain or discomfort when water enters the ear canal

• Drainage or discharge – current or frequent bouts

• Swimming is more than 6 feet of water or diving (increased pressure may push more water through
  the tube)

• Swimming in lakes/oceans or non-chlorinated pools

• If dunking head in soapy water in the tub

 

A variety of soft, fitted earplugs are available, if needed, as are special neoprene headbands to cover the ears. NEVER use items from the home to place into the ear as it may become trapped and require surgical removal. Once the tube falls out and the eardrum has healed, no further use of earplugs is necessary.

 

Ear Tubes and Ear Infections

 

Your child may still get an ear infection (acute otitis media) even with a tube in place. If an infection occurs, you will typically notice a drainage in the ear canal or a foul odor.

If this occurs:

 

1. Do not worry: the drainage indicates the tube is working to drain the infection from the middle ear space. Most children do not have pain or fever with an infection when the tube is in place and working. There is no danger to hearing.

 

2. Ear drainage can be clear, cloudy, or even bloody. Brown drainage is typically wax.

 

3. The BEST TREATMENT for an ear infection with a tube in place is EAR DROPS ALONE (ofloxacin, Ciprodex or Otovel), and NOT an oral antibiotic. This should be given for up to 10 days
(inappropriate use longer than 10 days can cause a yeast infection). Pump the flap in front of the ear canal (tragus) a few times after placing the drops, which will help the medication enter the tube. ORAL ANTIBIOTICS may be necessary if your child is very ill or the infection persists despite drop use.

 

4. Ear drainage may build up or dry at the opening of the ear canal and should be removed to prevent skin irritation. It may be removed with a cotton-tipped applicator with peroxide or warm water.

 

5. Water should be kept out of the ear while an infection is present but blocking the ear canal with a cotton ball with the outside covered in Vaseline or ointment to serve as a barrier. Do not swim with an ear infection.

 

Possible Complications of Ear Tubes

 

Complications of ear tubes are usually minor. Some children develop a white patch on the eardrum called sclerosis, or scarring. It DOES NOT affect your child’s hearing or future change of developing ear infections. Some children develop a small depression or retraction pocket in the eardrum at the tube site after it falls out. Again, this does not affect the hearing and rarely requires further treatment. About 1-2 out of every 100 children will develop a small hole (perforation) of the eardrum after the tube falls out. The hole will often close on its own over time, and if not, may require a patch placed in the operating room. More serious complications such as skin in-growth, hearing loss, or damaging surrounding structures are very rare.

 

Ear Tube Follow-Up and Aftercare

 

Routine follow-up with your doctor every 6-10 months is important to make sure the tubes are in place and to check for any possible problems. All children need to follow up with the ear doctor no matter how well they are doing. Children may feel well even when there is a problem developing with the tube. Once the tube falls out, there should be another follow up to ensure the eardrum has fully healed and there is no fluid buildup once again.

 

When to Call the Ear Doctor

 

1. Your child’s regular doctor can no longer see the tube in the ear
 

2. You are concerned your child has hearing loss, continued ear infections, or pain/discomfort
 

3. Ear drainage continues for more than 7 days or occurs frequently
 

4. Excessive wax build-up in the ear

 

Stapes Surgery

 

Risks of surgery

 

• Taste change is common after this operation and typically improves over weeks to months. Rarely this can be permanent.

• There is always a low risk of infection and/or bleeding with any operation, as well as risk from anesthesia.

• Additional rare risks include temporary or permanent facial weakness, dizziness or imbalance, permanent hearing loss (~1%).

 

Day of surgery

​

• Most often the operation is performed as an outpatient (same-day) procedure under sedation or general anesthesia.

• Do not eat or drink after midnight the day prior to surgery (no coffee or breakfast the day of surgery).

• Your primary care physician and/or anesthesiologist will review your medication instructions with you and instruct you on what to avoid the morning of surgery.

 

Post-operative care

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• The band-aid and any additional dressing placed (over or around the ear) may be removed after 24 hours.

• You will have packing in the ear that must stay in place until your return visit. Use a cotton ball as needed if there is ear drainage. This is normal and should lessen with time.

• The operation does not typically cause much post-operative pain, but you will be given pain medication after the procedure. We will only refill pain medication for post-operative pain for up to two weeks after the procedure, then you must discuss it with your primary care physician.

• No nose blowing or heavy lifting over 5 pounds for 2 weeks.

• You must keep the ear dry after surgery for 6 weeks (or until cleared by your surgeon)- use a cotton ball with ointment coating the outside when showering.

• Most people take about one week off from work or normal activities- you may return to work sooner if desired.

 

Additional post-operative information

 

• It is normal to hear funny noises in the ear (buzzing, ringing, popping) and feel pressure while the area heals.

• The packing in the ear will take up to six weeks to dissolve, and the final hearing result is not expected until after this time.

• Call the office for any swelling, and/or redness of the incision site, fever, or other concerns.

 

Tympanoplasty, Mastoidectomy Surgery

 

Risks of surgery

 

• Taste change is common after this operation and typically improves over weeks to months. Rarely this can be permanent.

• There is always a low risk of infection and/or bleeding with any operation, as well as risk from anesthesia.

• Additional rare risks include temporary or permanent facial weakness, dizziness or imbalance, permanent hearing loss.

 

Day of surgery

 

Most often the operation is performed as an outpatient (same-day) procedure under general anesthesia.
 

Do not eat or drink after midnight the day prior to surgery (no coffee or breakfast the day of surgery).
 

Your primary care physician and/or anesthesiologist will review your medication instructions with you and instruct you on what to avoid the morning of surgery.

 

Post-operative care

​

• The head dressing/band-aid must stay on for 24 hours and the incision be kept dry for at least 48 hours. You may wash your hair during this time over the sink with a cup over the ear and incision.

• You will have packing in the ear that must stay in place until your return visit. Use a cotton ball as needed if there is ear drainage.

• The operation does not typically cause much post-operative pain, but you will be given pain medication after the procedure. We will only refill pain medication for post-operative pain for up to two weeks after the procedure, then you must discuss it with your primary care physician.

• No nose blowing or heavy lifting over 5 pounds for 2 weeks.

• You must keep the ear dry after surgery for 6 weeks (or until cleared by your surgeon)- use a cotton ball with ointment coating the outside when showering.

• Most people take about one week off from work or normal activities- you may return to work sooner if desired.

 

Additional post-operative information

 

• If you wear glasses, you may want to remove an arm as to be able to use your glasses with the head dressing in place and not put pressure over the incision.

• It is normal to hear funny noises in the ear (buzzing, ringing, popping) and feel pressure or occasional sharp/shooting pains while the area heals.

• The packing in the ear will take up to six weeks to dissolve, and the final hearing result is not expected until after this time.

• Call the office for any swelling, and/or redness of the incision site, fever, or other concerns.

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