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.

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.

 

 

 

 

In the News: Congratulations to 2018 Anders Tjellström, Graeme Clark scholarship winners

Eight students were awarded the 2018 Graeme Clark and Anders Tjellström scholarships.

Last week, Cochlear Limted announced the winners of the 2018 Anders Tjellström and Graeme Clark scholarships. Congratulations to the winners!

The three 2018 Anders Tjellström Scholarship winners are:

  • Monica Pasqualino (Johns Hopkins Bloomberg School of Public Health) from Oceanside, New York
  • Elise Schiller (Trinity College) from St. Louis, Missouri
  • Carol Rynar (Canisius College) from Buffalo, New York

“Just as my Baha System opened a new world for me, I have become inspired to help others confidently navigate their life without anxiety, and to work to minimise the barriers that prevent them from engaging fully with their world because of hearing loss,” said Rynar, a Baha System recipient and an Anders Tjellström Scholarship winner. “This scholarship will help me extend this miracle of sound from me to the students I serve as a teacher.”

The five 2018 Graeme Clark Scholarships winners are:

  • Elaine Wright (Princeton University) from Tucson, Arizona
  • Tania Karas (Oxford University) from Palos Park, Illinois
  • Keenan Murphy (Manhattan College) from Bronx, New York
  • Hunter Orthmann (University of Iowa) from Iowa City, Iowa
  • Natalia Adriance (Notre Dame) from Napa, California

About the Scholarships
The scholarships, named after two pioneers of the hearing implant industry, recognize Cochlear™ Nucleus® Implant and Baha® System recipients in the United States and Canada who uphold the Cochlear ideals of leadership and humanity, and demonstrate high academic achievement. The Anders Tjellström Scholarship is named after Anders Tjellström, the research physician in the department of otolaryngology at the Sahlgrenska University Hospital in Sweden who collaborated with Per-Ingvar Brånemark, a pioneer in his field, to treat the first patient with a Baha device. The Graeme Clark Scholarship is named after Professor Graeme Clark, the inventor and pioneer of the multichannel cochlear implant.

Read more about the scholarships and apply here.

Read more about the 2018 winners here.

What You Need to Know: 10 FAQs on the Bone Conduction Procedure

Have you tried the Baha® 5 sound processor on a Baha Softband and decided to move on with a bone conduction implant? Has your child been scheduled for the implant procedure and you need to know how to prepare?

Jennifer Brown, Clinical Product Manager at Cochlear and audiologist, answers the ten most frequently asked questions about the bone conduction procedure.

Jennifer has more than six years of clinical experience in the United States with both pediatric and adult cochlear implant recipients, and she has worked for Cochlear in a variety of roles for the past four years.

(Picture: an audiologist fits a Baha Softband on a toddler’s head. A Baha 5 sound processor is attached to the Softband)

FAQ

1. How do I prepare for the implant procedure?

The good news is that no special preparations are needed before the procedure. The procedure is fast and minimally invasive. Your physician will give you all the details to plan for a successful procedure.

2. Will the procedure be painful?

The procedure is performed under anesthesia. The type of anaesthesia – local or general – is determined by a number of factors, like age, or pre-existing conditions. Ultimately, which anesthesia is right for you is determined by you and your surgeon. Post-operatively, you may experience swelling or skin sensitivity at the implant site. Should it be necessary, your doctor can prescribe pain reliever. Always discuss the procedure and any concerns you may have with your surgeon.

3. Will I be able to go home from the hospital the same day?

In the vast  majority of cases, patients go home the same day. While rare, sometimes in the case of small children or individuals with multiple involvements, the physician may take a precaution and keep the patient over night, but this seldom happens.

4. Can I shower after the procedure?

Usually, patients are allowed to shower the day after procedure. Avoid rubbing the area when drying as this may knock off the healing cap. Cover the cap area by holding a dry towel over it. Here’s what Dr. Pete Weber said in an earlier post.

“The site will still get wet. Since the incision is now very small for Baha Connect surgery, getting the site wet is usually not an issue. Full shower when cap and packing off. The best shampoos to use are the hypoallergenic ones, such as baby shampoos. I also let my Baha Attract patients shower the next day after removing the dressing. Again telling them to pat dry the area and not rub.”

5. If I choose an abutment or a magnet system, how long after surgery until I can wear the sound processor?

Different countries have different regulations.

  • If you choose the abutment system – Baha Connect: depending on where you live it can be anywhere from two weeks to three months before receiving the sound processor.
  • If you choose the magnet system – Baha Attract: depending on where you live it can be anywhere from two weeks to five weeks before receiving the sound processor.

Your doctor will examine the implant site before fitting the sound processor.

6. Are post-operative skin infections common and how are they treated?

As discussed in question 2, there could be swelling or sensitivity at the implant site after the procedure. Post-operative skin infections might occur, although the probability is low. Most skin-related issues happen in the abutment system, because it is skin protruding. In most cases, issues are mild, and can be resolved medically after consultation with your physician. Usually, the skin issues do not affect your ability to wear the sound processor. In the rare incident of persistent skin issues, it may be beneficial to transition to the magnet system.

7. How do I know if an abutment system or a magnet system is appropriate for me?

Both of the Cochlear Baha systems are indicated for individuals with hearing loss in one ear (single-sided deafness, or SSD), or for individuals with conductive/mixed hearing loss.  Whether to choose a Baha Connect or a Baha Attract depends upon a variety of factors, including the degree of hearing loss.

The magnetic system – Baha Attract – is a transcutaneous, or an under-the-skin implant system.  It is comprised of the internal fixture, with a magnet attached to it.  Individuals with the hearing losses noted above are candidates for this system, but it is important to remember that because the sound must pass through the skin, it may be necessary to use a more powerful sound processor, like the Baha 5 Power or the Baha 5 SuperPower.

The abutment system – Baha Connect – is a percutaneous, or through-the-skin implant system.  It too, uses the internal fixture but has an abutment attached to it.  It is appropriate for individuals with SSD or conductive/mixed hearing loss, but unlike the Baha Attract system, there is no skin attenuation of the sound.   This is a great option for individuals needing more power.

In some instances, it may be possible or necessary to transition from one system to another.  For instance, if a recipient chooses the Baha Attract system, and notices a change in his/her hearing, it is possible to remove the magnet and attach an abutment to eliminate dampening of the sound through the skin and to offer more direct bone conduction. Conversely, if a recipient needs to transition to a completely under-the-skin system because of lifestyle or soft tissue concerns, the abutment can be removed and the magnet can be attached.  In both instances, the recipient can likely continue to use the same sound processor.  Cochlear is the only manufacturer that allows for this flexibility based on the patient’s needs.

8. Why do I have to wait so long before I get fitted with a sound processor?

Bone bonds well to titanium, which is what the internal fixture is comprised of. To allow for osseointegration, it is recommended that appropriate healing time be allotted. In an abutment system, the surrounding skin also needs time to adhere to the abutment, to minimize skin issues. In a magnet system, it is important to wait the allotted time to give a chance for the swelling to reduce so that the patient can wear the weakest external magnet possible and still have adequate retention.

9. Will my child need a new implant as she or he grows?

No, an implant is designed for life. There are no pediatric-specific implants, abutments, or magnets. In the event that the child’s hearing changes, non-surgical options – such as a more powerful sound processor – should be tried first. Only in the event of a transition would a procedure be required, but keep in mind the same internal implant is used.

10. Will the Baha® System affect my child’s choices in sports or other activities?

A bone conduction implant is designed to allow your child a world of sound in every activity. While hearing loss is the most important factor to consider when choosing an abutment or a magnet system, lifestyle plays an important role. Some sports may be more conducive to having an under-the-skin magnet system.  It is important to choose a manufacturer that offers your child choices in hearing solutions – whether an abutment, or a magnet.

Remember, communication is key. Always discuss your options and thoughts with your audiologist and surgeon. Your hearing professional will be able to provide timely, accurate, and documented information.

Second Decade of Baha Technology

1987 – 1997:  more innovation, new countries and the first five thousand patients

Thirty years ago, bone conduction technology was emerging as the treatment of choice for people suffering from conductive hearing loss. Thanks to the excellent results observed from the fitting of the first patients starting in 1977, the development of the bone conduction implant system continued to grow. The interest and awareness of the intervention spread across Europe throughout the 1980’s, with increasing numbers of clinical reports revealing positive outcomes in implant recipients. In the UK, the Netherlands and Sweden in particular, the treatment became more common and part of a choice of options available to people with hearing loss.

The world’s first bone conduction sound processor, the HC-100, which became commercially available in 1985, was followed up by an improved version in 1988 – the HC-200. Within a few years another new processor was launched, the Classic 300, followed closely by the Baha 360 model. Both new processors took considerable steps toward increasing the ease of use of the system.

The Classic 300 Sound Processor was launched in 1993

The Baha 360 sound processor, launched in 1995, was a smaller version of the Classic 300 (pictured). It was the industry’s first miniaturised sound processor and took a big step toward offering a more discreet design that would help users feel more confident when wearing the device. Patients who were fitted with a bone conduction hearing system in the 1990’s reported increased comfort as compared to conventional hearing aids. ¹

A very important milestone was reached in 1996, when the FDA approved the use of the Baha System in the USA. The result of opening such a big, new market was simply amazing – by 1997, five thousand people were hearing better with the help the Baha System!

The year of 1997 was also marked by another crucial event – the launch of the Baha Cordelle. It was the world’s first super power device, designed for people with more severe hearing loss, and was suitable for people with up to 65 dB SNHL. This meant that people who had struggled to hear, despite attempts with hearing aids, would now have access to power levels high enough to compensate for their hearing loss. The Baha Cordelle was also equipped with the first generation of snap coupling that improved the connection between sound processor and implant.

The Baha Cordelle (right), launched in 1995, is the predecessor of the Baha 5 SuperPower Sound Processor (left), launched in 2016.

In the next article, read about the third decade of bone conduction hearing.

 

Sources:

  1. “Baha – A Third Option for Otosclerosis”. Nobel Biocare International Updates 2/96. Volume 5, No.2, 1996, pp. 3

World Health Day: Depression Tops List of Most Widespread Diseases

The latest estimates reveal that more than 300 million people worldwide suffer from depression, a figure that has increased by 18 percent from 2005 to 2015. Hearing loss is closely tied to depression, studies confirm.

(Source: pixbay.com)

Today is the World Health Day, the high point in World Health Organization ‘s (WHO) year-long campaign “Depression: Let’s Talk”. Depression is a silent and hidden condition, that can affect anyone. The subtle signs of the disease can easily pass unnoticed, leading to low levels of recognition and access to treatment. In many cases, once the disorder is acknowledged, stigma can be so damaging that sufferers refuse to seek help. WHO warns that untreated depression results in a global economic loss of a trillion US dollars every year, and prompts international governments to allocate more funds to mental health.

Depression is a mental condition characterised by persistent sadness, critically reduced capacity to carry out daily activities, and a feeling of emptiness.

Hearing loss is connected to depression

Unsurprisingly, many studies have confirmed the link between hearing loss and depression. The percentage of depressed adults, particularly women, increases with the decline in hearing, from 5% in those without hearing problems to a staggering 11% in those with hearing impairment, according to a 2014 study published in JAMA Otolaryngology – Head and Neck Surgery.

In many of our previous blog posts, the recipients of a bone conduction hearing implant mention social isolation as one of the tolls hearing loss took on them. Mona Andersson, the world’s first recipient of a bone conduction implant, recalls her mental discomfort as her hearing capacity declined in her teen years.

“I felt embarrassed and I would choose to hide myself”, says Mona in an interview with Cochlear Bone Anchored Solutions.

Like depression, hearing loss is a silent condition that affects more than 360 million people worldwide – over 5% of the world’s population, warns WHO. Depression, social exclusion, and lower chances of employment are possible effects of disabling hearing loss.

Take the signs of hearing loss seriously

The US National Institute on Deafness and Other Communication Disorders recommends people who answer “yes” to more than two of the questions listed below to visit an audiologist.

  • Do you have a problem hearing over the telephone?
  • Do you have trouble following the conversation when two or more people are talking at the same time?
  • Do people complain that you turn the volume of the radio or television up too high?
  • Do you have to strain to understand conversation?
  • Do you have trouble hearing in a noisy background?
  • Do you find yourself asking people to repeat themselves?
  • Do many people you talk to seem to mumble or not speak clearly?
  • Do you misunderstand what others are saying and respond inappropriately?
  • Do you have trouble understanding the speech of women and children?
  • Do people get annoyed because you misunderstand what they say?

The world’s first recipient of a bone conduction implant celebrates 40 years of hearing

News from Cochlear Bone Anchored Solutions

Mona Andersson had suffered from hearing loss for more than 30 years before she could hear again. In 1977, thanks to a medical innovation developed in Gothenburg, her hearing capacity was dramatically improved. Today, forty years later, 150, 000 people have regained their hearing with a bone conduction implant.

img_3561(Photo: Anders Tjellström and Mona Andersson)

Hearing loss is a major public health issue and its impact is set to increase. More than 360 million people live with disabling hearing loss and this figure is set to increase significantly. According to the World Health Organization (WHO) there will be 1.2 billion people living with disabling hearing loss in 2050. Every year on March 3, WHO celebrates the World Hearing Day, an advocacy event that calls for international action to address hearing loss. This year’s event campaign “Make a sound investment” reveals that unaddressed hearing loss costs the global economy a staggering $750 billion annually.

In Sweden alone, about 1.4 million people suffer from hearing impairment, of which 700, 000 need to use hearing aids, according to Hörselskadades Riksförbund, the National Association for Hearing Impairment in Sweden.

Forty years ago, an innovation from Gothenburg created a new industry that was set to restore hearing in many people affected by hearing impairment. Gothenburg resident Mona Andersson was one of those people.

The innovation is based on the concept of osseointegration, a process discovered and coined by Professor Per-Ingvar Brånemark, when in Gothenburg in the 1960s, he serendipitously discovered that titanium completely fused with bone. The discovery of osseointegration led to the development of the bone conduction hearing implant, pioneered by Anders Tjellström, surgeon and Senior Lecturer at Gothenburg University and member of Brånemark’s research team, in collaboration with Bo Håkansson, Professor at Chalmers Institute.

Already in early childhood, Mona was suffering from bilateral chronic ear infections, caused by scarlet fever. Her natural capacity to hear had dropped dramatically and it was not long before she had serious problems with her hearing. At the age of 15, Mona received her first hearing aid, which improved her hearing slightly, at the cost of constant headaches and embarrassment. When she started working at a plastic factory, she realised that exposure to warm temperatures affected her hearing even more.

She reached a turning point in 1965 when she became a mother.

“I struggled to communicate with my daughter in the first years of her life. I had nothing to lose when I accepted Dr. Tjellström’s proposal to receive a bone conduction implant”, says Mona.

In 1977, Mona underwent the world’s first bone conduction implant surgery, performed by Dr Anders Tjellström at Sahlgrenska University Hospital. The implant was specifically designed for patients affected by conductive hearing loss, like Mona. Today its application has increased to treat other types of hearing loss.

“For the first time since childhood I could hear birds singing”, she told Dr. Tjellström when she received her implant. Sounds like the buzz of a fly or ice cubes clinking in a glass, suddenly became new experiences for her.

Forty years after the surgery, Mona celebrates not only functional hearing, but hearing capacity that has gone beyond what most “normal hearing” people can experience. The latest technology, developed in Gothenburg by Cochlear Bone Anchored Solutions, allows the recipients of a bone conduction implant to stream sound from their phones directly to their ears.

“Bone conduction technology has come a long way. Today, Mona is using a sound processor that has the capacity to adapt to different noise environments, something we had never imagined possible all those years ago”, explains Dr. Tjellström.

More than 150, 000 people worldwide benefit from Gothenburg invention

The bone conduction implant system was approved in Sweden ten years after Mona received her implant. In 1993, the Gothenburg-based Nobel Pharma, whose bone conduction business later became Entific, started commercializing the product. In 2005, international hearing implant manufacturer Cochlear Ltd bought Entific and named it Cochlear Bone Anchored Solutions, based in Mölnlycke. Today, more than 150, 000 people hear thanks to a bone conduction implant.

“We created the world’s smallest sound processor that is also the first ever to connect wirelessly to electronic devices, allowing users to stream sound directly to the ear. Gothenburg is a unique centre of innovation, where we can benefit from all the expertise, technology, and research of the region, helping us to constantly evolve our industry”, says Rom Mendel, President Acoustics & Managing Director at Cochlear Bone Anchored Solutions.

Most hearing specialists agree that bone conduction hearing systems are an effective solution for patients with conductive hearing loss, mixed hearing loss or single-sided deafness.