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

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  1. Default 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

  2. Default

    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.
    Left masked bone:
    250 30
    500 45
    1000 35
    2000 55
    4000 50

    Freq Right Left
    250 15 105
    500 15 105
    1000 5 110
    2000 0 100
    3000 5 105
    4000 10 105
    6000 10 >110
    8000 15 >110

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    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?

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    Quote Originally Posted by StarKidJupiter View Post
    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!
    Left masked bone:
    250 30
    500 45
    1000 35
    2000 55
    4000 50

    Freq Right Left
    250 15 105
    500 15 105
    1000 5 110
    2000 0 100
    3000 5 105
    4000 10 105
    6000 10 >110
    8000 15 >110

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    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.

  6. #6

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    Most HP aids would fit that loss

  7. #7
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    Default

    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.
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    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.
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  9. #9

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    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.
    Last edited by daisymae; 09-06-2016 at 01:59 PM.
    Freq: Right Left
    250 40 60
    500 50 65
    1000 50 60
    2000 45 45
    4000 65 70
    8000 9070

    Right: SRT=50 dB, WRS 92% at 70 dB
    Left: SRT=60 dB, WRS 80% at 80 dB

    Had stapedotomy on left ear in May, 2015. Prior to that had a severe/profound loss across all frequencies in my left ear.

    Widex220

  10. #10

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    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.
    Last edited by Squerly; 09-06-2016 at 04:01 PM.
    Freq - 250 -- 500 - 750 - 1k -- 1.5 --- 2k -- 3k --- 4k --- 6k -- 8k
    --R --- 105 - 105 - 105 - 120 - 120 - 120 - 105 - 105 - 120 - 105
    --L ---- 75 --- 95 --- 90 -- 90 -- 85 --- 80 - 105 - 100 - 100 -- 95

    SRT R 100 L95
    WD R 0% L 84%

    unmasked bone
    Freq - 500 - 1K - 2K - 4K
    ---R -- 40 - 55 - 75 - 75
    ---L -- 35 - 50 - 75 - 75

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