‘A whole world opened up to him’: Celebrating a new life of sounds this Autism Awareness Month

Parents of children with autism can have unique challenges in diagnosing and treating their children’s hearing loss. For Autism Awareness Month, blogger Jen B. from Oregon, U.S. has written about her 3-year-old son Xander’s hearing journey, from difficult diagnoses to helping him learn to wear his new sound processor.

You can follow Jen’s blog here on WordPress or here on Facebook.

 


“Xander!” “Xander!” “Xander!?”

But no response did I ever get from my son.

Xander, now 3, plays at school.

Xander, now 3, plays at school.

He will turn on a dime if he hears his favourite theme song start up. He’ll sing along in perfect pitch. And yet, dogs barking right next to him never make him flinch.

My son was born three weeks early with a collapsed lung and rapidly dropping sugars. Very soon he was transferred to a hospital with a Neonatal Intensive Care Unit (NICU). When I first saw him it was obvious that there was a slight deformity of his right ear. I assumed he had lain on it wrong in utero, and that it would work itself out.

The hospital gave Xander a hearing screening, as was standard procedure for all NICU babies. The nurse came in while he was asleep on me and checked his left ear first, because that’s always, even now, the ear he has to have facing out while snuggling.

Everything was fine.

The nurse tried twice to check his right ear and still seemed perplexed, because she couldn’t get the readings she was used to. Ultimately, she marked it as a pass.

It was only later we learned Xander’s hearing wasn’t normal.


My son has Autism Spectrum Disorder. He was diagnosed at only 18 months old. He is now 3 years old and considered non-verbal. He speaks, but not necessarily with what professionals would call, “purpose.”

Autism affects all forms of communication. Where a neurotypical child with a hearing loss might pull at their ear, say they can’t hear, or make some sort of gesture – something — we got nothing. It gradually became clear he needed to have his hearing assessed.

At about 2 years old Xander finally saw an audiologist. Autism can make a child both seek out stimulations (sensory seeking) and feel overwhelmed by them (sensory overload), so diagnosing hearing loss can be a challenge. In a room with all sorts of things making noise and lighting up, Xander wasn’t very cooperative. His tubes were clear, but the audiologist scheduled him for a sedated Auditory Brainstem Response (ABR) hearing screening. All the worst-case scenarios came into my mind during the scan, which felt agonisingly long.

Jen poses with 3-year-old Xander, wearing his Baha 5 Sound Processor on a Softband.

Jen poses with 3-year-old Xander, wearing his Baha 5 Sound Processor on a Softband.

The doctors learned Xander had conductive hearing loss in his right ear, and to learn more he would need a CT scan of his temporal bone. The doctors decided further diagnosis was not urgent and told me things like, “just speak to him on the left side” and, “in cars he probably won’t be able to hear you.”

About six months later Xander need an MRI for another issue, so we decided to have the CT scan done at the same time while he was sedated. We learned he is missing the third stapes, or stirrup – one of the bones of the ear – on his right side, a rare condition.

There is a surgery to implant a prosthetic stapes, but Xander’s major facial nerve runs where the bone should be, making the operation too risky. We decided instead to treat Xander’s hearing loss through bone conduction.


The sensory sensitivity caused by Xander’s autism made it hard for him to wear his first sound processor. The constant vibration against his head, the increase in noise and the strap around his head were difficult for him to tolerate. I would try bribing him, like I do with his glasses. “If you put it on, you can have a candy.” It didn’t help much.

When Xander’s trial was over, he received his Cochlear Baha 5 Sound Processor, and we both loved the way it looked. When I pointed out how cool he looked wearing it on his Softband, he beamed with pride and wore it for several days, for long stretches at a time – even to school!

Believe me when I tell you that I cried when I said, “Xander!” and he looked up at me.

He was able to hear the start of his favourite show in the whole world. He was mesmerized. He had never noticed all the nuances of it before he got his Baha processor. He could understand enunciations. He could hear his electronic toys, the ones that had never interested him before. A whole world opened up to him.

But for a child with autism, that can be really intimidating.

After an accident left him injured, Xander has become even more sensitive to stimulation, and sometimes getting him to wear his sound processor is nearly impossible.

Well, every day is a different day in the world of autism. While trying to take a photo of him wearing his sound processor, I was able to capture a whole video. He let it stay on while cruising around a department store today. I was so excited, and I hope tomorrow he’ll leave it on even longer.

For children with autism like Xander, treating hearing loss might not be a linear journey, but each day brings new opportunities for him to listen to his teacher at school, his toys, and even respond when I call him, “Xander.”

The opinions expressed in this blog are my own views and not those of Cochlear.


If your child is showing signs of hearing loss, use this tool to find a clinic near you.


Want to share your story, hearing tips or Baha advice with The Baha Blog? Let us know! Find us on Twitter at @TheBahaBlog, on Facebook at our page The Baha Blog or via email at bahablog@cochlear.com.

What is MPO? A simple analogy for a complicated audiological term

Learning about the science behind treating hearing loss can be daunting. There are so many terms, concepts and measurements – it’s often hard to understand what each of them really means for your hearing, and how these concepts influence the way you treat your hearing loss.

Here we will try to explain one of those concepts, a sound processor’s maximum power output (MPO),  or maximum output force level (the technical term for bone conduction devices), with a simple analogy: the ceiling of a house. Understanding MPO can give you insight on why your audiologist chooses or recommends a certain sound processor for your individual hearing needs, and this knowledge can empower you to ultimately make a choice that best suits you.

Different people have different levels of hearing loss, measured in an audiogram. Your level of hearing loss will determine your need for amplification. The fitting range is the most common measurement for any given sound processor. Fitting range is a guide to understand the level of hearing loss a device can address. When audiologists determine which sound processor would provide the most benefit to you, they compare your hearing loss to the sound processor’s fitting range. For example, the Cochlear Baha 5 Sound Processor has a fitting range that covers hearing loss to 45 decibels (dB) SNHL.1

All sound processors have limits on how much power they can provide, and this limit is the most important contributor to a device’s fitting range. A device’s power limit is known as the maximum power output, or MPO. In a chart measuring a device’s output (see illustration below), the MPO appears as a line graph showing the maximum power (in dB) it can provide across the hearing (frequency) range – from deeper sounds like the hum of traffic to higher-pitched sounds like a bird’s song. Now imagine the MPO line takes the shape of a house’s ceiling.

MPO-07The height of the ceiling is important: Just as a taller person needs a high ceiling to be comfortable, a person with a high level of hearing loss needs a high MPO level to hear sounds comfortably.

Cochlear and other manufacturers make sound processors with different levels of amplification to “fit” your individual hearing loss, as the person in this illustration “fits” into their house.

However, just as its peak height (the highest level of power provided) is important, the shape of the MPO line – the way it slopes or curves across the chart – is also important. This shows how the sound processor delivers power across a range of the most important lower to higher frequencies. The average MPO is calculated across a number of frequencies, which illustrates the shape of this line.

MPO-03The MPO on some devices delivers significantly more power to middle-range frequencies than the lower or higher frequencies important for speech. For these devices, the MPO chart looks more like a house with a very pointed ceiling and short walls. A tall person may stand comfortably in the centre, but they can’t walk over to the window without bumping their head on the ceiling. In these sound processors, at the lower and higher frequencies important for speech, sounds hit the “ceiling” of the sound processor’s power limits, distorting them.

MPO-01Ideally, a device with a high average MPO allows you to clearly hear sounds across the frequency range – in the same way that a house with a gently sloped ceiling allows you to move around freely inside, all the way to peer out each window without bumping your head.

As most people have hearing loss across a wide range of frequencies, a peaked MPO means the sound processor may not amplify sound along the whole frequency range where they need it. The person wearing this sound processor actually hears sounds less clearly across these important frequencies.

A chart shows the shape of the MPO of Cochlear sound processors (yellow) vs. competitor (orange). Circles on the chart show what sounds are represented at certain frequencies.

A chart compares the power in a device with a high average MPO (yellow) with a device with a peaked MPO (orange). Circles on the chart show what sounds are represented at certain frequencies.

Two devices may have a similar fitting range but can differ widely in average MPO. Ideally you should experience clear sounds, even moving across lower and higher frequencies, without hitting the “ceiling” distorting the sounds you hear. This is what a high average MPO delivers.

To find out whether you could benefit from a more powerful device, or to learn more about your treatment options, use this tool to find a clinic near you.

MPO is compared between Cochlear sound processors (yellow) and a competitor's (orange). The graph shows what sounds are represented at different frequencies.

The power is compared between  a device with a high average MPO (yellow) and a device with a peaked MPO (orange).


1 Flynn M. (2015) Smart and Small – innovative technologies behind the Cochlear Baha 5 Sound Processor. Cochlear Bone Anchored Solutions AB, 629761.

 

 

When losing something leads to something ‘wonderful’: Dwight’s experience upgrading to the Baha 5 Sound Processor

When losing something leads to something ‘wonderful’: Dwight’s experience upgrading to the Baha 5 Sound Processor

This blog was adapted from its original article on Hear and Now, a Cochlear Americas recipient blog. Read it here.


Dwight J. of Colorado streams a phone call directly into his Baha 5 Sound Processor.

Dwight J. of Colorado streams a phone call directly into his Baha 5 Sound Processor.

Sometimes losing something important to you turns out to be surprisingly “wonderful.” Just take it from Dwight J. in Colorado, U.S.

After a day of hiking, Dwight noticed he could not hear as well as he was used to. He reached up and discovered his BP100 Sound Processor was gone. He looked everywhere for it, but he realised he must have lost it while out on the hike.

Dwight acted quickly and called Cochlear to get a replacement. To his surprise, the representative told him Cochlear no longer offered the BP100. They introduced Dwight to the Baha 5 Sound Processor, and he knew he wanted an upgrade.

“It’s wonderful,” Dwight said after upgrading.

He said he especially likes being able to connect to his sound processor with Bluetooth, stream phone calls and stream radio directly to his sound processor while out on a walk.

Dwight also said he carries his Cochlear Wireless Mini Microphone with him wherever he goes. “I put it on whoever I’m talking to, if I’m in a loud situation, so that I’m able to hear them,” he said.

When it comes to continuing his journey as a part of the Baha family, Dwight seems thrilled.

“Cochlear culture oozes with a four-letter word: care,” he said. “They care about people.”

Dwight is a member of his local chapter of Cochlear Community, a Cochlear Americas program that connects Cochlear recipients in the U.S.


Want to share your story, hearing tips or Baha advice with The Baha Blog? Let us know! Find us on Twitter at @TheBahaBlog, on Facebook at our page The Baha Blog or via email at bahablog@cochlear.com.

 

World Down Syndrome Day and hearing loss: Celebrating children like Chloe

The following is a re-post of a guest blog from 2014 about Chloe, who was born with Down syndrome and lived with hearing loss until she was implanted with the Baha System at 10 years old in 2010. Chloe was 14 when her mother Jane wrote this guest blog to share with us the affect Chloe’s Baha implant had on her life. Join us in marking World Down Syndrome Day today (21 March) and celebrating children like Chloe.


It’s been a while since you last heard about Chloe. She is now 14, in year nine at senior school and even more of a little madam than when we last met four years ago.

Unfortunately Chloe’s health hasn’t been very good the past two years. She has had some major operations which have left her bed bound for weeks, and in and out of hospitals. Chloe has shown incredible strength and determination, both because that’s the type of girl she is and because she was able to communicate effectively with hospital staff and myself.

This is all thanks to her Baha sound processor. Chloe’s language skills and attention skills have flourished over the last four years; her vocabulary has grown, she is learning new words each day and she is definitely more attentive to those talking to her (apart from when she chooses not to!). This meant the hospital staff was able talk her through what was going to happen and she could indicate her pain levels and talk to the doctors.

I dread to think how she would have coped six or seven years ago, when her hearing levels were so low, and she hardly had any language. The world would have been a very lonely and scary place for her.

Chloe still loves drama and attends a very good secondary school that specialises in drama so she can devote more time to her passion. She is still my drama queen and a budding actress, dancer and musician. Obviously she is becoming a young lady and her life is changing. Developing language and communication skills has played a big part in this and will continue to do so.

My one aim for my daughter has been to become as independent as her disability would allow her. The Baha [System] has contributed to the success of this aim. She can order her food in restaurants. She can shop at the supermarket. She is also very good at being a typical teenage and slamming doors on me!

So am I pleased with the Baha [System]? Yes, my only regret is that I didn’t push for it sooner. I would recommend it for any parent or young person who needs it. Read the literature, speak to the professionals and if you feel it right go for it! It opens many doors and not once have we looked back.”

Jane lives in Birmingham, UK. In 2013 she won the Birmingham Parent of the Year Award for her tireless work with a special needs support group, as well as caring for her own two children who both have special needs.


Want to share your story, hearing tips or Baha advice with The Baha Blog? Let us know! Find us on Twitter at @TheBahaBlog, on Facebook at our page The Baha Blog or via email at bahablog@cochlear.com.

Creative solutions: Baha SoundArc replaces patient’s outdated, uncomfortable steel headband

First released only months ago, the new Baha SoundArc is already beginning to improve hearing experience for some Baha users. For one 82-year-old user in Belgium, the SoundArc proved to be an innovative solution to the daily discomfort of an outdated steel headband.

The patient, John (not his real name), was not able to receive a Baha implant, so he instead wore his Baha Cordelle II on a steel headband. The headband became uncomfortable, painful and even created pressure wounds on his head, so he rarely wore his sound processor and instead lived with his hearing loss most of the time. His audiologist even worked together with an orthopaedic technician to modify the headband and adapt it, but still the discomfort was too much for him.

When John upgraded his sound processor to a Baha 5 SuperPower in 2017, he was already able to hear a great improvement in speech understanding. Still, he had this uncomfortable headband that kept him from wearing his sound processor much of the time and improving his day-to-day hearing experience.

A patient wears a Baha 5 SuperPower sound processor on a SoundArc.

A patient wears a Baha 5 SuperPower sound processor on a SoundArc.

The turning point came in November of 2017, when the audiologist was able to offer John the new SoundArc and attach to it his Baha 5 SuperPower. Easier on the skin and the eyes, he said it was both profoundly more comfortable and much more attractive than his old steel headband.

The audiologist, very happy with the new solution, said, “This is a textbook example of how a Baha sound processor fitting should be!” John hopes to get adjusted to wearing his Baha 5 SuperPower for longer periods of time now that he has a creative and comfortable solution.


Want to share your story, hearing tips or Baha advice with The Baha Blog? Let us know! Find us on Twitter at @TheBahaBlog, on Facebook at our page The Baha Blog or via email at bahablog@cochlear.com.

Happy World Hearing Day 2018 from The Baha Blog!

Today, 3 March, is World Hearing Day. Everyone deserves to hear what the world has to offer. Help your loved ones hear the difference today at hearingmatters.info and share the video!

Join the conversation on social media with hashtags #HearTheFuture, #WHD and #HearingMatters.

Happy World Hearing Day 2018! #HearTheFuture

Happy World Hearing Day 2018! #HearTheFuture

Hear the Future this World Hearing Day: The history and future of hearing through bone conduction

Dr. Anders Tjellström

Dr. Anders Tjellström

March 3 is World Hearing Day, observed globally and designated by the World Health Organisation. To mark the occasion, The Baha Blog has asked Dr. Anders Tjellström, the pioneering bone conduction surgeon, to reflect on the history of bone conduction and what developments the future could bring to the treatment.


By Anders Tjellström, M.D., Ph.D., D.Sc.hc

It is an old saying that to be able to look into the future you must know the past.

Hearing loss is the most common disability in the industrialised world. The World Health Organisation has estimated that more than 5% of the world population have hearing impairment, and that 1.1 billion teenagers and young adults are at risk of developing hearing loss due to high noise exposure. Around 50% of people between ages 12 and 35 are exposed to excessive noise due to different types of audio devices. How do we handle this situation? The key word is “prevention.”

However, when a patient has already developed hearing loss from noise exposure, hearing devices are often the only solution. In severe cases a surgical procedure placing a cochlear implant in the inner ear might be indicated. Even if sensorineural hearing loss is the most common cause of poor hearing, there is another group of patients who have severe conductive hearing loss. Some patients with congenital malformation and chronic ear disease could be helped with surgery, but for many this is not an option. Some of these individuals cannot use a conventional air conduction hearing aid where the amplified sound is presented through a mould in the external ear canal opening. For these patients, a bone conduction device could be of great benefit.

Direct bone conduction is based on the concept of osseointegration – the process by which bone bonds directly to the surface of an implant – a term introduced by professor Per-Ingvar Brånemark in Sweden. Bone conduction treatment for hearing loss starts with an implant made of titanium placed in the bone behind the ear, onto which a transducer could be attached. The sound goes directly to the inner ear bypassing any defect in the external ear canal and the middle ear. This is called direct bone conduction, and the treatment is indicated in patients with mixed or conductive hearing loss, or single-sided sensorineural deafness (SSD).

In 1977, the first patients were treated with bone conduction at Sahlgrenska University Hospital in Gothenburg, Sweden. This is now a routine operation all over the world, and it has been estimated that about 150,000 to 200,000 hearing impaired people have since been treated with bone conduction.

The hearing instrument and the surgical technique have of course been refined over the years. Engineers have applied modern technology to the early prototype of the 1970s, and today the sound processor is a highly sophisticated device.

Hearing technology has come a long way since the ’70s. The most recent Cochlear Baha 5 Sound Processor is the smallest bone conductor available and comes filled with many programming options that could be controlled wirelessly with the Baha 5 Smart App. It can be adjusted to fit a variety of listening situations with options like audio streaming and Bluetooth connectivity. The Cochlear Wireless Phone Clip allows hands-free use of your phone. Directional microphones make it possible to hold a conversation even in noisy places. Many of the wireless needs we encounter in everyday situations are already available in the Baha portfolio.

The Baha Attract System from Cochlear, where the sound processor is kept in place with a magnet without skin penetration, is already used by many patients. The SoundArc is also a recent addition to the Baha family. No surgery is needed as the high quality and power of the Baha 5 sound processors can overcome most of the soft tissue sound attenuation.

Cochlear is already making strides into the future with hearing technology, but where is bone conduction hearing headed? More and more of the electronic components of the sound processor have already been miniaturised and, looking to the future, could be placed in the implantable part. This means that eventually, the need of skin penetrating coupling might even become obsolete for direct bone conduction.

As bone conduction treatment evolves, more and more people will have access to helpful hearing solutions in the future. It is of course impossible to predict the future of bone conduction, but advances in the last 40 years can give us a clue to how advanced hearing technology could become just 40 years from now.


Anders Tjellström is an ENT-surgeon who performed the first surgery for direct bone conduction hearing in 1977 in Gothenburg, Sweden. He has published and presented bone conduction research at scientific conferences and surgical workshops in more than 50 countries. Tjellström remains active in the field of direct bone conduction as Professor Emeritus at the University of Gothenburg.