The document discusses the history, components, types, needs, candidacy, and surgery of bone anchored hearing aids (BAHA), which transmit sound to the cochlea via bone conduction by bypassing abnormalities of the outer and middle ear through an implanted titanium fixture. It traces the development of BAHA from its origins in the 1950s to current digital processors. BAHA consists of a titanium screw surgically implanted in the skull that protrudes a titanium abutment connecting to an external sound processor.
ECochG is a variant of brainstem audio evoked response (ABR) where the recording electrode is placed as close as practical to the cochlea. We will use the abbreviation ECOG and ECochG interchangeably below. ECOG is preferable to us as it is shorter.
ECOG is intended to diagnose Meniere's disease, and particular, hydrops (swelling of the inner ear). ECOG may also be abnormal in perilymph fistula, and in superior canal dehiscence. The common feature connecting these illnesses is an imbalance in pressure between the endolymphatic and perilymphatic compartment of the inner ear.
ECOG can also be used to show that the cochlea is normal, in persons who are deaf. The cochlear microphonic of ECOG may be normal in auditory neuropathy (Santarelli and Arslan 2002) as well as other disorders in which the cochlea is preserved but the auditory nerve is damaged (Yokoyama, Nishida et al. 1999).
Finally, ECOG's have also been used to as a indicator of the temporary threshold shift that may follow noise injury (Nam et al, 2004).
The use of voice is an integral part of communication; our voice is one of the defining features of our individuality, and it shares a lot of information about you, your voice tells others if you are happy or sad, healthy or unwell, young or old. Our voice can also reveal to others our background, such as the region of the world where we live, and even our social economic status, when a voice produced that perceived by others as unusual or strange and draws attention to the person who is speaking, it is quite likely the person is demonstrating a voice disorder.
So, I am happy to introduce this presentation about Pubertal voice disorders & Puberphonia, I would like this presentation to be useful and add a lot of information on this topic.
ECochG is a variant of brainstem audio evoked response (ABR) where the recording electrode is placed as close as practical to the cochlea. We will use the abbreviation ECOG and ECochG interchangeably below. ECOG is preferable to us as it is shorter.
ECOG is intended to diagnose Meniere's disease, and particular, hydrops (swelling of the inner ear). ECOG may also be abnormal in perilymph fistula, and in superior canal dehiscence. The common feature connecting these illnesses is an imbalance in pressure between the endolymphatic and perilymphatic compartment of the inner ear.
ECOG can also be used to show that the cochlea is normal, in persons who are deaf. The cochlear microphonic of ECOG may be normal in auditory neuropathy (Santarelli and Arslan 2002) as well as other disorders in which the cochlea is preserved but the auditory nerve is damaged (Yokoyama, Nishida et al. 1999).
Finally, ECOG's have also been used to as a indicator of the temporary threshold shift that may follow noise injury (Nam et al, 2004).
The use of voice is an integral part of communication; our voice is one of the defining features of our individuality, and it shares a lot of information about you, your voice tells others if you are happy or sad, healthy or unwell, young or old. Our voice can also reveal to others our background, such as the region of the world where we live, and even our social economic status, when a voice produced that perceived by others as unusual or strange and draws attention to the person who is speaking, it is quite likely the person is demonstrating a voice disorder.
So, I am happy to introduce this presentation about Pubertal voice disorders & Puberphonia, I would like this presentation to be useful and add a lot of information on this topic.
definition of cochlear implant , history of the procedure , purpose of the procedure , indications for cochlear implant , surgical procedure , risk of cochlear implant surgery , post operative care , normal result
Multi-source connectivity as the driver of solar wind variability in the heli...Sérgio Sacani
The ambient solar wind that flls the heliosphere originates from multiple
sources in the solar corona and is highly structured. It is often described
as high-speed, relatively homogeneous, plasma streams from coronal
holes and slow-speed, highly variable, streams whose source regions are
under debate. A key goal of ESA/NASA’s Solar Orbiter mission is to identify
solar wind sources and understand what drives the complexity seen in the
heliosphere. By combining magnetic feld modelling and spectroscopic
techniques with high-resolution observations and measurements, we show
that the solar wind variability detected in situ by Solar Orbiter in March
2022 is driven by spatio-temporal changes in the magnetic connectivity to
multiple sources in the solar atmosphere. The magnetic feld footpoints
connected to the spacecraft moved from the boundaries of a coronal hole
to one active region (12961) and then across to another region (12957). This
is refected in the in situ measurements, which show the transition from fast
to highly Alfvénic then to slow solar wind that is disrupted by the arrival of
a coronal mass ejection. Our results describe solar wind variability at 0.5 au
but are applicable to near-Earth observatories.
Observation of Io’s Resurfacing via Plume Deposition Using Ground-based Adapt...Sérgio Sacani
Since volcanic activity was first discovered on Io from Voyager images in 1979, changes
on Io’s surface have been monitored from both spacecraft and ground-based telescopes.
Here, we present the highest spatial resolution images of Io ever obtained from a groundbased telescope. These images, acquired by the SHARK-VIS instrument on the Large
Binocular Telescope, show evidence of a major resurfacing event on Io’s trailing hemisphere. When compared to the most recent spacecraft images, the SHARK-VIS images
show that a plume deposit from a powerful eruption at Pillan Patera has covered part
of the long-lived Pele plume deposit. Although this type of resurfacing event may be common on Io, few have been detected due to the rarity of spacecraft visits and the previously low spatial resolution available from Earth-based telescopes. The SHARK-VIS instrument ushers in a new era of high resolution imaging of Io’s surface using adaptive
optics at visible wavelengths.
Cancer cell metabolism: special Reference to Lactate PathwayAADYARAJPANDEY1
Normal Cell Metabolism:
Cellular respiration describes the series of steps that cells use to break down sugar and other chemicals to get the energy we need to function.
Energy is stored in the bonds of glucose and when glucose is broken down, much of that energy is released.
Cell utilize energy in the form of ATP.
The first step of respiration is called glycolysis. In a series of steps, glycolysis breaks glucose into two smaller molecules - a chemical called pyruvate. A small amount of ATP is formed during this process.
Most healthy cells continue the breakdown in a second process, called the Kreb's cycle. The Kreb's cycle allows cells to “burn” the pyruvates made in glycolysis to get more ATP.
The last step in the breakdown of glucose is called oxidative phosphorylation (Ox-Phos).
It takes place in specialized cell structures called mitochondria. This process produces a large amount of ATP. Importantly, cells need oxygen to complete oxidative phosphorylation.
If a cell completes only glycolysis, only 2 molecules of ATP are made per glucose. However, if the cell completes the entire respiration process (glycolysis - Kreb's - oxidative phosphorylation), about 36 molecules of ATP are created, giving it much more energy to use.
IN CANCER CELL:
Unlike healthy cells that "burn" the entire molecule of sugar to capture a large amount of energy as ATP, cancer cells are wasteful.
Cancer cells only partially break down sugar molecules. They overuse the first step of respiration, glycolysis. They frequently do not complete the second step, oxidative phosphorylation.
This results in only 2 molecules of ATP per each glucose molecule instead of the 36 or so ATPs healthy cells gain. As a result, cancer cells need to use a lot more sugar molecules to get enough energy to survive.
Unlike healthy cells that "burn" the entire molecule of sugar to capture a large amount of energy as ATP, cancer cells are wasteful.
Cancer cells only partially break down sugar molecules. They overuse the first step of respiration, glycolysis. They frequently do not complete the second step, oxidative phosphorylation.
This results in only 2 molecules of ATP per each glucose molecule instead of the 36 or so ATPs healthy cells gain. As a result, cancer cells need to use a lot more sugar molecules to get enough energy to survive.
introduction to WARBERG PHENOMENA:
WARBURG EFFECT Usually, cancer cells are highly glycolytic (glucose addiction) and take up more glucose than do normal cells from outside.
Otto Heinrich Warburg (; 8 October 1883 – 1 August 1970) In 1931 was awarded the Nobel Prize in Physiology for his "discovery of the nature and mode of action of the respiratory enzyme.
WARNBURG EFFECT : cancer cells under aerobic (well-oxygenated) conditions to metabolize glucose to lactate (aerobic glycolysis) is known as the Warburg effect. Warburg made the observation that tumor slices consume glucose and secrete lactate at a higher rate than normal tissues.
THE IMPORTANCE OF MARTIAN ATMOSPHERE SAMPLE RETURN.Sérgio Sacani
The return of a sample of near-surface atmosphere from Mars would facilitate answers to several first-order science questions surrounding the formation and evolution of the planet. One of the important aspects of terrestrial planet formation in general is the role that primary atmospheres played in influencing the chemistry and structure of the planets and their antecedents. Studies of the martian atmosphere can be used to investigate the role of a primary atmosphere in its history. Atmosphere samples would also inform our understanding of the near-surface chemistry of the planet, and ultimately the prospects for life. High-precision isotopic analyses of constituent gases are needed to address these questions, requiring that the analyses are made on returned samples rather than in situ.
The increased availability of biomedical data, particularly in the public domain, offers the opportunity to better understand human health and to develop effective therapeutics for a wide range of unmet medical needs. However, data scientists remain stymied by the fact that data remain hard to find and to productively reuse because data and their metadata i) are wholly inaccessible, ii) are in non-standard or incompatible representations, iii) do not conform to community standards, and iv) have unclear or highly restricted terms and conditions that preclude legitimate reuse. These limitations require a rethink on data can be made machine and AI-ready - the key motivation behind the FAIR Guiding Principles. Concurrently, while recent efforts have explored the use of deep learning to fuse disparate data into predictive models for a wide range of biomedical applications, these models often fail even when the correct answer is already known, and fail to explain individual predictions in terms that data scientists can appreciate. These limitations suggest that new methods to produce practical artificial intelligence are still needed.
In this talk, I will discuss our work in (1) building an integrative knowledge infrastructure to prepare FAIR and "AI-ready" data and services along with (2) neurosymbolic AI methods to improve the quality of predictions and to generate plausible explanations. Attention is given to standards, platforms, and methods to wrangle knowledge into simple, but effective semantic and latent representations, and to make these available into standards-compliant and discoverable interfaces that can be used in model building, validation, and explanation. Our work, and those of others in the field, creates a baseline for building trustworthy and easy to deploy AI models in biomedicine.
Bio
Dr. Michel Dumontier is the Distinguished Professor of Data Science at Maastricht University, founder and executive director of the Institute of Data Science, and co-founder of the FAIR (Findable, Accessible, Interoperable and Reusable) data principles. His research explores socio-technological approaches for responsible discovery science, which includes collaborative multi-modal knowledge graphs, privacy-preserving distributed data mining, and AI methods for drug discovery and personalized medicine. His work is supported through the Dutch National Research Agenda, the Netherlands Organisation for Scientific Research, Horizon Europe, the European Open Science Cloud, the US National Institutes of Health, and a Marie-Curie Innovative Training Network. He is the editor-in-chief for the journal Data Science and is internationally recognized for his contributions in bioinformatics, biomedical informatics, and semantic technologies including ontologies and linked data.
Nutraceutical market, scope and growth: Herbal drug technologyLokesh Patil
As consumer awareness of health and wellness rises, the nutraceutical market—which includes goods like functional meals, drinks, and dietary supplements that provide health advantages beyond basic nutrition—is growing significantly. As healthcare expenses rise, the population ages, and people want natural and preventative health solutions more and more, this industry is increasing quickly. Further driving market expansion are product formulation innovations and the use of cutting-edge technology for customized nutrition. With its worldwide reach, the nutraceutical industry is expected to keep growing and provide significant chances for research and investment in a number of categories, including vitamins, minerals, probiotics, and herbal supplements.
Introduction:
RNA interference (RNAi) or Post-Transcriptional Gene Silencing (PTGS) is an important biological process for modulating eukaryotic gene expression.
It is highly conserved process of posttranscriptional gene silencing by which double stranded RNA (dsRNA) causes sequence-specific degradation of mRNA sequences.
dsRNA-induced gene silencing (RNAi) is reported in a wide range of eukaryotes ranging from worms, insects, mammals and plants.
This process mediates resistance to both endogenous parasitic and exogenous pathogenic nucleic acids, and regulates the expression of protein-coding genes.
What are small ncRNAs?
micro RNA (miRNA)
short interfering RNA (siRNA)
Properties of small non-coding RNA:
Involved in silencing mRNA transcripts.
Called “small” because they are usually only about 21-24 nucleotides long.
Synthesized by first cutting up longer precursor sequences (like the 61nt one that Lee discovered).
Silence an mRNA by base pairing with some sequence on the mRNA.
Discovery of siRNA?
The first small RNA:
In 1993 Rosalind Lee (Victor Ambros lab) was studying a non- coding gene in C. elegans, lin-4, that was involved in silencing of another gene, lin-14, at the appropriate time in the
development of the worm C. elegans.
Two small transcripts of lin-4 (22nt and 61nt) were found to be complementary to a sequence in the 3' UTR of lin-14.
Because lin-4 encoded no protein, she deduced that it must be these transcripts that are causing the silencing by RNA-RNA interactions.
Types of RNAi ( non coding RNA)
MiRNA
Length (23-25 nt)
Trans acting
Binds with target MRNA in mismatch
Translation inhibition
Si RNA
Length 21 nt.
Cis acting
Bind with target Mrna in perfect complementary sequence
Piwi-RNA
Length ; 25 to 36 nt.
Expressed in Germ Cells
Regulates trnasposomes activity
MECHANISM OF RNAI:
First the double-stranded RNA teams up with a protein complex named Dicer, which cuts the long RNA into short pieces.
Then another protein complex called RISC (RNA-induced silencing complex) discards one of the two RNA strands.
The RISC-docked, single-stranded RNA then pairs with the homologous mRNA and destroys it.
THE RISC COMPLEX:
RISC is large(>500kD) RNA multi- protein Binding complex which triggers MRNA degradation in response to MRNA
Unwinding of double stranded Si RNA by ATP independent Helicase
Active component of RISC is Ago proteins( ENDONUCLEASE) which cleave target MRNA.
DICER: endonuclease (RNase Family III)
Argonaute: Central Component of the RNA-Induced Silencing Complex (RISC)
One strand of the dsRNA produced by Dicer is retained in the RISC complex in association with Argonaute
ARGONAUTE PROTEIN :
1.PAZ(PIWI/Argonaute/ Zwille)- Recognition of target MRNA
2.PIWI (p-element induced wimpy Testis)- breaks Phosphodiester bond of mRNA.)RNAse H activity.
MiRNA:
The Double-stranded RNAs are naturally produced in eukaryotic cells during development, and they have a key role in regulating gene expression .
3. INTRODUCTIO
N
• Mostly the individual with hearing impairment are fitted with hearing aids with the help of
custom ear mould
• Few hearing not possible
Reasons :
1)Stenosis of the EAM
2) Frequent CSOM
3) Mastoidectomy resulting wider EAM
4) Anotia
4. • Requirement of rehabilitation with new technology than conventional hearing aid
• BAHA – bypasses the pathologies at outer and middle ear
• BAHA is the type of hearing aid technology which is attached to an implanted titanium
abutment through which sound is transmitted to cochlea via bone conduction similar, as
tuning fork, bypassing EAM and middle cavity.
5.
6. Scheme of BAHA
Bone conduction stimulation explained via different theories as:
OSSEO TYMPANIC MODE
• Cannot reach inner ear due to obstruction at the level of outer or middle ear structures
• Thus other two modes of bone conduction are important for BAHA
7. • Herzog and Krainz (1926)
• With the alternating force cochlear capsule gets expansion and
compression.
• Bulging of cochlear capsule at the level of round window takes place as
its more compliant and cochlear fluid is not compressible.
• Variation in the shape of basilar membrane leads to the hair cells
excitation.
COMPRESSION MODE
8. OSSICULAR LAG OR INERTIAL MODE
• Loosely coupled ossicles
• Different timing in vibration of the temporal bone and ossicles (Barany,1938)
• Ossicular movements get lagged.
• BC sensitivity at mastoid placement is maximum (lateral placement vibrates the
skull in the direction of ossicular movement)
• Minimum for forehead placement (frontal placement vibrates the skull
perpendicular to their movement)
9. HISTORY
OF
BAHA
1) Per Ingvar Branemark,1952
• Discovered the formation of osteocytes around the titanium screws
kept uninterrupted in bone
• Stable anchor with no connective-tissue in between.
• Connection of living bone with implant at level of titanium is known as
Osseo integration.
• Helped invention of percutaneous titanium implants came into
existence.
2) Per Ingvar Branemark, 1965
• Osseo integration was successfully applied in craniofacial and
dental reconstructive surgery.
3) Tjellstrom et al, 1974
• Osseo integrated titanium implant at the level of mastoid
• Direct bone conduction
10. 1977
BAHA was used with osseointegration
1980 (Hough and Xomed- Treace)
Transcutaneous approach was introduced for BAHA.
1987
Transcutaneous BAHA got commercially available
1996
Introduced as rehabilitative measure for CONDUCTIVE AND MIXED
HEARING LOSS.
1997
Food and Drug Administration (FDA), US cleared BAHA for clinical
usage.
HISTORY
OF
BAHA
11. 1999
• FDA approved it for use by children ≥5 years of age
2000
• FDA approved bilateral BAHA fitting.
• Baha Compact for clinical usage
• Smaller to Classic by 33%
• Present automatic Gain Control & Output compression
• Shielded well from telephone signals
• Less powerful
2002
• FDA approved BAHA for unilateral deafness.
• Baha Softband came into existence for peadiatrics (<5yrs).
HISTORY
OF
BAHA
12. 2004
• BAHA Divino in clinical usage
• Digital sound processing system
• Directional microphone
• Automatic Gain control output compression.
2005
• Entific Medical Systems was purchased by Cochlear Limited
Renamed BAHA as BONE ANCHORED IMPLANT
• Elimination of its connection with hearing aids
• Highlight as a Surgical Implant
• Late of 2005, Medicare re-categorized BAHA as PROSTHESIS.
HISTORY
OF
BAHA
13. 2008
• Commercial availability of Divino, Intenso and Cordelle
• Cordelle used for Severe Hearing Loss.
• Presence of induction telecoil receiver
Intenso
• More powerful BAHA
• Clarity in listening environments with minimum acoustic feedback.
2009
• Cochlear BAHA
• Latest BAHA processor
• First programmable BAHA as BP100 with compatibility to Bluetooth and
iPod.
• Oticon brought Ponto pro for both adults and children
HISTORY
OF
BAHA
14. Latest BAHA 210 Abutment has concave profile preventing skin from overgrowth.
HISTORY
OF
BAHA
2010
• BAHA 210 had concave shaped abutment preventing skin from overgrowth
15. BAHA manufacturing
companies
Different models available
CochlearTM Cochlear™ Baha® BP100
Baha Intenso™
Baha® Cordelle II
BAHA 3
BAHA 4 Attract
Baha 5 Attract
Oticon Medical Oticon Ponto
Ponto Pro
Ponto Power Pro
Ponto Plus
Sophono Sophono Alpha 1 (S)
Sophono Alpha 2 with magnetic
processor
Medel Medel Bonebridge
Different companies and models of BAHA
17. a) Titanium Fixture (Osseointegration)
1. Surgically a small titanium implant is fitted in the mastoid
2. Osseointegration.
3. Strength of osseointegration determines the long-term success of Baha
rehabilitation.
4. Corrosion-resistant oxide layer by Titanium on the surface of the implant
enhance osseointegration.
1Sound
Processor
2Titanium
Abutment
3Snap-Lock
Coupling
4Titanium
Fixture
5Temporal Bone
6Skin
18. b) Titanium Abutment
• Percutaneous titanium abutment is attached to the fixture
• Processor is connected to the protruding part of the abutment.
• Secure retention of Baha sound processor by Osseo integrated
implant and abutment system
• Vibrations are transmitted from the sound processor via the bone conduction to
the cochlea.
Previously, a magnetically driven osseointegrated device was in use, but was
withdrawn due to technical difficulties with the transcutaneous device (Xomed’s
Audiant Bone conductor).
1Sound
Processor
2Titanium
Abutment
3Snap-Lock
Coupling
4Titanium
Fixture
5Temporal Bone
6Skin
19. c) Snap-Lock Coupling
• Clasp in the implanted abutment and sound processo
• Can be disconnected if it creates impact on tissues around or the
impant.
1Sound
Processor
2Titanium
Abutment
3Snap-Lock
Coupling
4Titanium
Fixture
5Temporal Bone
6Skin
21. e) Accessories
i) Audio adapter (present for Divino/Classic300/Classic BAHAs in CochlearTM).
Via this one can connect music system, MP3, MP4, etc directly to the sound output.
22. ii) Telecoil (present in BP100 BAHA for CochlearTM)
Helps in better perception while using telephone or in case of presence of
induction loop.
23. iii) FM receiver (present in CochlearTM).
In presence of FM system enclosed such as classrooms, FM receivers in Baha
can play a vital role to avoid noise.
24. iv) Baha Softband (present in CochlearTM).
• Elastic band for infants and young children
• Baha sound processor to inact without surgeries for implantation.
25. v) Baha Safety line (present in CochlearTM)
• Ties the processor of the implant to the collar of upper wear
• Safe from damage or lost.
26. vii) Test Rod and Test Band (present in CochlearTM).
• Pre-operative equipment
• Judge out which side the implants to be placed
• Helps to demonstrate the individual regarding sound processor,
coupling and abutment.
27. viii) App controllable
• Present in Oticon Streamer Pro 1.3 A (Open)
• Allows access to sound from loop systems for hearing aids that don’t have the T programme
• An Oticon radio aid receiver can be connected so that it can pick up sound from a radio aid
transmitter
28. ix) Cochlear wireless accessories
• Present in Lets Baha 4
• 7 metre range (stated in the manufacturer's specification)
• Also include an app. (Apple and Android)
WIRELESS REMOTE
WIRELESS PHONE CLIP
WIRELESS MINI MIC
29. Types of BAHA
Two different BAHA uses different vibration reluctance transducer to excite the skull bone directly
1) Percutaneous BAHA
2) Transcutaneous BAHA
VIDEO
30. 1) Percutaneous BAHA
Percutaneous BAHA include a transducer to vibrate the mastoid bone in an external unit with
a direct physical link through the skin to the anchor screw (Tjellstrom and Granstrom, 1995).
A titanium screw is surgically anchored in the mastoid and protrudes through the skin.
Attached to this exposed screw is a removable bayonet connector and a vibratory
transducer.
This approach requires good hygiene but provides efficient vibrational transmission.
1-Mastoid bone,
2- soft tissue,
3-titanium fixture,
4-titanium abutment,
5- bayonet coupling,
6- percutaneous transducer.
31. 1) Transcutaneous BAHA (Hough et al., Hough and McGee, 1995)
Transcutaneous BAHA uses an external magnetic field to cause a magnet anchored
to the mastoid under the skin to vibrate.
This is surgically attached to the mastoid bone via a screw.
The bone-anchored magnet is stimulated electromagnetically.
Because of the coil-to-magnet distances dictated by the skin thickness, these
devices provide lower efficiency and poorer frequency response.
As a consequence, these devices are currently not marketed.
1. Mastoid bone.
2. Soft tissue,
3. Titanium anchored magnet,
4. Transducer.
32. Study by Hakansson et al 1984
• Comparison of electroacoustic performance of the BAHA classic 300 and transcutaneous bone
conduction implant in cadaver
• Vibration response given were measured at ipsilateral and contralateral cochlear promontories
by doppler vibrometer
Hakansson et al
1984
33. • Transcutaneous bone conduction implant gives 5 dB higher maximum output level
and has a slightly lower distortion than the classic-300 at the ipsilateral
promontorium at speech frequencies.
• At the contralateral promontorium, the maximum output level was considerably
lower for the BCI than for the classic-300 except in the 1-2 khz range, where it was
similar.
34. Based on level of processor:
TWO types
A. Body Level Device
B. Ear Level Device
35. B. The Body worn Device by Cochlear Americas (Englewood, CO)
Cordelle BAHA
• Powerful bone anchored device
• 10-15 dB more output at higher frequencies
• 5-7 dB more output at lower frequencies.
• Also the resonance frequency was kept at lower frequency so as to incorporate the
individual with moderately severe sensory-neural hearing loss whose residual hearing
would be at low frequency.
36. • Classic 300 BAHA by Entific Medical Systems
• Basic ear level device
• Consists of : 1) Volume control
• 2) Gain control and continuous tone control for low frequencies
• 3) N and L position switch for two different high frequency response
• 4) E switch for connecting electrical input directly (internal mic gets off)
37. The Baha Divino by Cochlear Americas (Englewood, CO)
• Includes digital technology
• Directional Mic with 2 programs for speech in noise and quiet
situations
• Adjustable AGCo that avoided distortion for improvised sound quality
in adverse loud situations.
Divino can be connected to external systems such as TV, mobile phones, IR
systems with the help of electrical input.
38. Cochlear Baha BP100 (Currently Used)
by Cochlear Americas (Englewood, CO)
Features :
1) Dual Layer Protection
• Limit the risk of processor breakdown.
• A tight seal protects the transducer from moisture entering from the snap coupling.
• Re-engineered with transducer suspensions and mechanical stops in the snap coupling
• The changes prevent excessive movement in any direction,
39. 2) Transducer stability –
• At the core of the Baha sound processor, the transducer creates the
vibrations that transfer the sound through the skull bone to the inner ear.
• Transducer is very precise component with the air gap inside the vibrator
measuring 50 – 70 micrometers.
• Transducer is sensitive to excessive force that could result in its collapse.
40. Other features
1) Compatibility – FM systems, Direct Audio Input for phones, and
other audio sources.
2) Wind noise protection
41. Ponto and Ponto Pro by Oticon Medical
Features
a) Automatic Adaptive Multiband Directionality
• In noisy restaurants or other crowded areas, the directionality
system helps to hear people speaking in front of more clearly.
• Moving across the environment, Ponto shift itself to the best setting
automatically.
b) Tri-State Noise Reduction
• Helps suppressing the noise by identifying if the signal consists of
speech alone, only noise or both in mixture.
42. 3) Wind Noise Reduction
• Better listening in outdoor situations.
4) Learning Volume Control
• Presence of memory device
• Remembers the volume control setting used consistently for period of
time
• Automatic changes as per the similar situation given.
43. BONEBRIDGE - by Medel, Innsbruck, Austria
• A new era in bone conduction stimulation
• Semi-implantable hearing system
• Implant is positioned completely under the skin.
• Implant receives the signals from an external audio processor, which is worn
comfortably under the hair.
The system consists of an external and an internal component.
44. EXTERNAL
Audio processor
• Fully digital signal processor.
• Held in position on the head by magnetic attraction
• Can be worn discretely and comfortably under the hair
• Consists of the battery and the microphones
INTERNAL
Implant
• Positioned completely under the intact skin
• Has magnet that holds the audio processor in place above the
implant.
45. Merits of BONEBRIDGE
Undamaged cosmetically tempting skin.
Avoids skin complications.
Less visible as it’s totally below skin, thus audio processor can be kept below the hair.
Ear canal is not closed like conventional hearing aids.
Gentle and brief surgical procedure (0.5-1 hr) with only external units replaceable.
Audio processor is replaceable, so one can exchange it with the advancement of technology.
Can be activated within 2-4 weeks of post-surgery by audio processor fitting.
User friendly audio processor with battery to be replaed once in 5-7 days.
46. Different companies and models of BAHA
CochlearTM
Australia
MODELS Technology Direct audio input
BAHA Intenso
• Advanced digital
technology
• Less feedback Present
BAHA Cordelle
• Body worn device
• Powerful BAHA
• 10-15dB more output for
higher frequencies
• Less feedback and
distortion
BAHA 3 /
BAHA BP100
Advanced
digital signal processing
47. CochlearTM
Australia
MODELS
BAHA BP110
power
first high
power sound
processor
with
advanced
automatic
signal
processing for
greater loss
individual
more
than 50%
improved
speech
understandin
g in noise
(Snik et al,
2002)
Automated
directionality
automatic
noise
reduction
BAHA 4
Attract
advanced
signal
processing
technology by
using a smart
classifier that
scans your
listening
environment
magnetic
connection
2.4GHz
wireless
technology
comfortable
and easy to
use hearing
system
BAHA 5
Attract
advanced
hearing
technologies
smallest
sound
processor
48. OTICON MEDICAL
MODELS
Ponto
automatical
ly adjust to
the
situation
and the
environme
nt and
provide the
superior so
und quality
Tri-state
Noise
Reducti
on
Wind Noise
Reduction
3-4 mm
titanium
implant
Ponto Plus
a new powerful
transducer, the
innovative Inium
feedback shield
and the latest
Bluetooth 2.4
GHz wireless
technolog
Less
whistling
and fewer
artificial
sounds
first new Inium Sense highly Pending FDA
49. MODELS
Sophono Alpha 1 Abutment-free,
magnetically coupled
bone anchored hearing
aid
Automatic noise
reduction and feedback
suppression
Available with direct
audio input for use with
FM receiver, telecoil
and other external
accessories
8 channels
16 frequency bands
4 programs
Customizable program
switching and low
battery warning tones
Sophono Alpha 2 Abutment-free hearing
with no sacrifice in
performance
smallest implant on the
market (2.6 mm high)
8 channels
16 frequency bands
4 programs
WDRC
Sophono
50. MODELS
Medel Bonebridge • Semi-implantable
hearing system
• Implant is positioned
completely under the
skin.
• Fully digital signal
processor.
• Held in position on
the head by magnetic
attraction
Remote Control
(changing programs,
adjust volume)
Medel
51. Indication for Baha and Selection Criteria
FDA criteria
• Oticon, Sophono, Medel follows FDA criteria,
• However cochear has slight modifications from that of FDA criteria
52. AUDIOLOGICAL EVALUATION
Conductive hearing loss
FDA OTICON COCHLEAR MEDEL SOPHON
O
All conductive hearing
loss present till up to
45 dB HL.
Upto
55 dBHL
with Ponto
Pro
Candidates with an air-bone gap of
more than 30 dB will have significant
improvement with Baha System,
than conventional hearing aids.
(Snik et al, 2005; Hol et al, 2005;
McDermott et al, 2002).
Same as
FDA
Same as
FDA
• For bilateral implantation, average bone conduction should be ≥ 45 dBHL
• Symmetrical between the ears i.e the difference can be 10 dB at 0.5 KHz, 1 KHz, 2 KHz and 3
KHz between the ears.
With use of phonetically balanced CVC words, SIS to be ≥ 60%.
53. Mixed hearing loss
• (E.g. cochlear otosclerosis, genetic causes, noise trauma, ototoxicity, presbycusis)
• BAHA directly stimulate the cochlea, it bypasses the conductive component and gives
additional amplification to compensate for the sensorineural element.
FDA OTICON COCHLEAR MEDEL SOPHON
O
Average BC
threshold up to 45
dB HL.
Same as
FDA
Candidates with an air-bone gap of
more than 30-35 dB plus
sensorineural component up to
mild-to moderate level to be fitted
with BAHA.
(De Wolf 2011).
Same as
FDA
Same as
FDA
SIS of ≥ 60%.(Hankansson et al 1990)
54. FDA
(approved on
September of 2002)
OTICON COCHLEAR MEDEL SOPHONO
Unilateral deafness, PTA of AC (0.5 KHz, 1 KHz, 2 KHz and 3 KHz) of normal ear to be ≤ 20-25 dB HL.
Individual who are candidate of CROS but doesn’t want to go for it (Snik et al, 2004).
Single sided Deafness
55. OTOLOGICAL INDICATIONS
Skin allergies
Allergies in the outer ear and/or the ear canal aggravated by the placement of
an ear mold can be compensated with the usage of BAHA device as it
maintains open ear canal. (Evans et al, 2007)
Congenital malformations
For most candidates with congenital ear malformations, surgical intervention
or a bone-conduction (BC) hearing aid is often prescribed because an AC
hearing aid is simply not an option.
Congenital malformations can be atresia of M.E or outer ear/ innate
deformities with agenesis, microtia, anotia etc. (Evans et al, 2007)
56. • Draining ears
Individual with hearing impairment having CSOM where earmould couldn’t be used
as it enhances the infections.
With a Baha System, the ear canal remains open at all times, thus allowing the ear
to dry (Snik et al, 2005; Sheehan and McDermott. 2010).
• Ear canal stenosis
Individuals with stenosis of the ear canal are not suitable for a surgical intervention,
and the use of conventional hearing aids can also be difficult due to the presence of
an ear mold. With a Baha System, the ear canal is bypassed.
• Previous ear surgery
Candidates who have had previous surgeries using, for example, a canal wall down
procedure, may find it difficult to wear an ear mold without feedback problems. The
Baha System is a good solution because an ear mold is not required.
57. • Radical cavity
Patient who have undergone mastoidectomy with wider EAM resulting in
often acoustic feedback.
• Syndromic hearing losses
Treacher Collin Syndrome (Oliveria et al 2013)
Goldenhar Syndrome (Marres et al, 1995; Hol et al, 2010;)
Downs Syndrome (Sheehan et al, 2006)
• Unilateral total deafness caused congenital/acquired, e.g. post-
neurinoma surgery where hearing couldn’t be preserved;
neurodegenerative disease; ototoxicity etc
58. Contraindications:
• BC threshold of ≥ 60 dB HL in an average at 0.5 KHz, 1 KHz, 2 KHz and 3 KHz
• Clients with mental retardation
• Less cooperative clients such as small children (lower age limit for Baha use at
US is 5 yrs.), drug addicts, mentally ill patient etc.
• Patients vulnerable to increased risk of infection.
• Patients having allergic reaction to the implant.
• Rejection of the device due to subjective factors like cosmetic appeal.
59. • Poor hygiene.
• In case of less bone volume and density for successful Baha abutment fixation.
• Obliteration of the cochlea, auditory nerve, auditory cortex. This can be revealed by CT
scan, MRI etc. MRI is a better technique for finding ossified cochlea, nerve hypoplasia
and CNS anomalies.
• Also need to assess family dynamics and their expectations on the device plus psycho
social aspects.
60. Surgery for BAHA
• Less difficult one
• However precise care
• Inclusion of multi-disciplinary team with at least otologist and audiologist.
• Different stages of surgeries includes as:
61. TYPES OF SURGERY
One-Stage Surgery
Selection criteria
• Good bone quality
and
• thickness > 3 mm
Two-Stage Surgery
Selection criteria
• Compromised or soft bone
• Bone thickness < 3 mm
• In conjunction with other surgery
• (e.g. Acoustic Neuroma removal)
62. Step I: Placement of BAHA.
50 – 70 mm from the ear canal
One-Stage Surgery
72. Surgical follow-up (5-7 days)
Remove the dressing and
assess the wound site. If
healed, no further dressing
is required. If not healed, place
a new dressing
10-14 days
Remove sutures after
if incision is sufficiently healed
73. Fitting the sound processor
4 weeks after surgery
• Check and clean skin.
• Fit the selected Sound
Processor Magnet and
sound processor.
• Orient the patient
regarding the handling
of sound Processor.
Follow up (once or twice a year)
• Audiological assessment after
fitting sound processor.
• Examination of skin and tissue.
74. Surgical follow-up
• Remove sutures, if healed (1 week)
• Osseointegration period (3–6 months)
Two-Stage Surgery
First stage
Place implant and cover screw
75. Second stage
Remove the cover screw and place the implant magnet.
Surgical follow-up (5-7 days)
Remove the dressing and
assess the wound site. If
healed, no further dressing
is required. If not healed, place
a new dressing
10-14 days
Remove sutures after
if incision is sufficiently healed
76. Follow up
Fitting the sound processor
4 weeks after surgery
• Check and clean skin.
• Fit the selected Sound
Processor Magnet and
sound processor.
• Orient the patient
regarding the handling
of sound Processor.
Follow up (once or twice a year)
• Audiological assessment after
fitting sound processor.
• Examination of skin and tissue.
77. Surgical complications of BAHA
• Implant continues to rotate when seated.
• Inaccurate location of the implant
• Inappropriate handling of the implant
• Exposure of Dura Mater or Perforation of the Sigmoid Sinus
• Subdural Hematoma
• Inability to create a thin, hairless, immobile flap due to thin skull
tissue. (Wazen et al, 2008)
78. Post-surgery complications
Less post-surgery complications such as local inflammation/infections due to
Osseo integration failure has been reported.
The skin reactions after surgery has been classified by Holgers into:
0 - No irritation
1 - Slight redness
2 - Red and moist, no granulation tissue
3 - Red and moist with granulation tissue
4 -Revision of skin penetration necessary (Kraai et al 2011)
Serious post-surgery complication is the loss of osseointegrated fixture at
temporal bone level which can be due to trauma (mostly in children), poor
hygiene etc.
79. Overgrowth of the soft tissue and drooping due to gravity may obstruct in
fixing BAHA transducer with the abutment
Percutaneous implants may get affected up to 10% due to the Osseo
integration loss, bone disease, trauma, infection, or radiation.
Clients affected by intracerebral abscess & by metastatic carcinoma post
BAHA implant have been reported earlier which are rare in nature.
However, as they are fatal, client should undergo CT/MRI.
Post Baha pain is a rare condition.
80. Most of these complications can be treated with
antibiotics and also steroid, however, 1 to 2% needs
surgical intervention such as correction of the
placement, removal of the BAHA fixture. (Falcone et
al, 2008)
81. Conclusion
• Appropriate candidacy criteria maintained and surgery done, BAHA can be
effective.
• Better than conventional BC hearing aids.
• Bilateral BAHA is an option for bilateral hearing loss for binaural sound processing.
• BAHA can be used unilaterally in one sided deafness as transcranial CROS that
reduces HSE in an effective manner.
• However lack of competition at commercial level and high cost are the major
disadvantage of this hearing implant device.
82. References
• Jack Katz. Handbook of cliniacl audiology(5th ed.)
• Gelfand, S. (2001). Essentials of hearing, NY: Thieme medical publishers, Inc.
• Silman, S. & Silverman, C. (1997). Auditory diagnosis: principles and
applications, NY: Academic press.
• E. J. Forton and P. H. Van de Heyning. Bone Anchored Hearing Aids (BAHA). B-
ENT, 2007, 3, Suppl. 6, 45-50
• A Tjellström, B Håkansson (1995) The bone-anchored hearing aid. Design
principles, indications, and long-term clinical results. Otolaryngologic Clinics, 28,
53-72.
• Holgers KM, Tjellström A, Bjursten LM, Erlandsson BE. Soft tissue reactions
around percutaneous implants: a clinical study of soft tissue conditions around
skin-penetrating titanium implants for bone-anchored hearing aids. Am J
Otol. 1988 Jan;9(1):56-9.
• David W. Proops. The Birmingham bone anchored hearing aid programme:
surgical methods and complications. The Journal of Laryngology &
Otology (1996), 110 : pp 7-12
• Tjellström A, Granström G. Long-term follow-up with the bone-anchored hearing
aid: a review of the first 100 patients between 1977 and 1985. Ear Nose Throat
J. 1994 Feb;73(2):112-4.
83. • Hagar,A. (2007).Bone Anchored Hearing Aid. International Journal of Health
Science, 2, 265-276.
• Berger,K.W. (1976).Early Bone Conduction Hearing Aid Devices. Arch Otolaryngol,
5, 315-318.
• Tjellstorm,A., & Hakkansson,B.(1995). The Bone anchored hearing aid.Design
principles, indications and longterm clinical results. Otolaryngol Clinic, 28, 53-72.
• Surgery for the Bone Anchored Hearing Aid. David W Proops,
• Van der Pouw CT, Johansson CB, Mylanus EA, Albrektsson T, Cremers CW.
Removal of titanium implants from the temporal bone: histologic findings. Am J
Otol. 1998 Jan; 19(1):46-51.
• Mylanus EA, Johansson CB, Cremers CW.Craniofacial titanium implants and chronic
pain: histologic findings. Otol Neurotol. 2002 Nov;23(6):920-5.
• Hadjihannas E, McDermott AL, Warfield AT, Proops DW, Reid AP. Occult
bronchogenic carcinoma presenting as metastasis to the site of a bone anchored
hearing aid. J Laryngol Otol. 2003 May; 117(5):396-8.
• Mylanus EA, Johansson CB, Cremers CW. Craniofacial titanium implants and
chronic pain: histologic findings. Otol Neurotol. 2002 Nov;23(6):920-5.
• www.baha-professionals.org.uk
• www.cochler.com
• www.medel.com
