Bone Anchored Implant Program
Program Policies
Bone Anchored Hearing Aids
Candidacy Requirements
Surgery and Fitting
Special Considerations for BAHA Users
More Information

Program Policies:

Device Policy:

Manitoba Health provides one (1) bone anchored implant + one (1) sound processor to recipients who pass candidacy criteria for surgery.

Financial Policy:

There are no up-front costs to patients who proceed with bone anchored implant surgery as Manitoba Health covers the surgical procedure, internal implant and the first external sound processor.

All patients are responsible for the upgrade costs of their sound processor when it requires replacement ($5,000).

Patients who are not surgical candidates but wish to use the hearing aid with a head band are responsible for all costs associated with the purchase and upkeep of their sound processor.

Referral Policy:

All bone anchored implant referrals MUST be sent directly to the Department of Otolaryngology – Head & Neck Surgery:

Attention: Dr. Les Garber     
Referral Fax Number: 204-787-1727 

All referrals MUST include the following to be seen by the surgeon:

  • Completed referral form.
  • Recent audiogram (within 6 months) including air/bone thresholds, unaided speech testing and tympanometry.
  • Relevant case history.

All candidates who meet medical criteria for a bone anchored implant will be referred directly to Audiology for a 2-week bone anchored hearing aid trial.  


Bone Anchored Hearing Aids:

A bone-anchored hearing aid is a type of hearing aid based on bone conduction. It is primarily suited to people who have conductive hearing losses, unilateral hearing loss and people with mixed hearing losses who cannot otherwise wear conventional hearing aids. “Anchoring” the hearing aid to the skull involves osseointegration, or the functional merging of living bone with a load bearing implant.  Osseointegration allows for an efficient and consistent delivery of amplified sound to the cochlea (inner ear).  

There are generally two different patient groups who may benefit from a bone anchored hearing implant:

  • Patients with chronic middle ear disease that is resistant to further medical or surgical intervention or patients with congenital malformation of the outer and/or middle ear (ex. atresia and microtia)
  • Patients with profound, unilateral sensorineural hearing loss with normal hearing in the unaffected ear (also known as single sided deafness)

A patient needs to commit to the required time and training to become an effective bone anchored hearing aid user.

Results vary from person to person, but most successful candidates find that bone anchored hearing aids affect the following:

  • Improved ability to recognize common environmental sounds
  • Improved ability to hear speech without reliance on visual cues
  • Improved speech reading ability
  • The ability to detect soft sounds
  • The ability to locate where sounds are coming from

Candidacy Requirements:

To be considered a candidate for a bone anchored hearing implant, patients must present with the following:

  • Be at least five years of age or older
  • Bone conduction thresholds of 55 dBHL or better
  • An audiometric configuration that supports a conductive or mixed hearing loss with an air-bone gap of at least 25 dBHL – or an audiometric configuration that supports “single sided deafness”
  • Display subjective and objective benefit from a bone anchored hearing aid

Surgery and Fitting:

Bone anchored hearing implants are usually performed as a day surgery under local anesthetic with sedation.  Normal activity can be resumed within a few days.

Implantation
The surgeon prepares a small area behind the ear for a single incision. A titanium implant with an abutment will be inserted in the centre of this area. The implant is 4 mm long and is drilled directly into the skull. The abutment can vary in length based on soft tissue thickness, but is generally around 6 mm in length.  When surgery is complete, the top of the abutment is slightly elevated above the skin.  Generally, regular Tylenol or Tylenol #3 (with codeine) is all that is needed for pain control. 
 
Healing
After surgery, a dressing which should be changed regularly is required. The stitches are usually removed within 10–14 days. Some numbness in the area around the abutment can occur. Most likely this condition is temporary. Once the dressing is removed it is important to keep the abutment area clean using a supplied cleaning brush. To avoid the small chance of infection, good hygiene is critical to maintaining the implant site and external sound processor. Users who are unable to clean the skin themselves need help from family members or caregivers.  Infection is treated with topical and/or oral antibiotics and in rare cases, require a revision surgery to reduce soft tissue.

Osseointegration
The healing time also includes the process of osseointegration, where the skull bone fuses with the titanium implant to ensure consistent delivery of sound to the cochlear.  Typically, osseointegration takes 6-8 weeks post-surgery. 

Fitting
The external sound processor will be fitted at the adult ear, nose and throat clinic at Health Sciences Centre.  The initial fitting appointment will include fine tuning of the external sound processor to suit the patient’s needs.  The patient will also receive information on how to operate and maintain their sound processor.  Finally, counseling is provided to ensure each patient maintains realistic expectations on how much real-world benefit they can expect from their bone anchored hearing aid system. A subjective questionnaire will be provided to help each patient assess subjective benefit with their new processor. 

Follow-Up
Each patient will return two weeks following their initial fitting to further fine tune the sound processor based on real-world experiences.  An additional two week follow up will be scheduled to confirm the device settings and perform an objective benefit assessment in a sound booth.  An annual follow up is scheduled to monitor progress, however patients are encouraged to contact the ear, nose and throat clinic for additional follow-up appointments as needed. 


Special Considerations for Bone Anchored Hearing Aid Users:

MRI: The external processor must be removed prior to undergoing an MRI.  The abutment and internal implant may stay in place.

Infection: The titanium implant of the Baha is screwed from outside into the bone. Because of this procedure, there is some risk of infection. With proper healing and normal precautions, this is not an issue for the great majority of recipients.

Daily Maintenance: Daily care is required. This consists of using a very soft toothbrush-like tool to clean around the post and skin area to keep it clean and assist in avoiding infection.

Damage from Water: The sound processor is not waterproof! Never wear it in heavy rain, in the bath or shower.

Feedback: A brief acoustic squeal or whistle can emanate from the sound processor when physically manipulated or when placed close to a reflective surface.  Due to the nature of amplification via bone conduction, this may be a recurrent and consistent phenomenon while wearing a bone anchored hearing aid.

Financial Commitment: Manitoba Health will cover the cost of the initial surgery, implant and external sound processor for successful candidates.  However, patients will be responsible for the cost of replacing the external sound processor as needed and may want to investigate third party reimbursement from their private insurance.  Similar to a high-end hearing aid, the approximate cost of a new bone anchored sound processor is $5,000 CAD.


For more information on the bone anchored hearing aid fitting process, please contact the coordinator of the surgical hearing implant program at Health Sciences Centre:

Justyn Pisa, Au.D.
Phone:  204-787-5039
Department of Otolaryngology
Health Sciences Centre
Winnipeg, Manitoba R3A 1R9

Contacts:

Dr. Les Garber
Otology & Neurotology                         
Phone: 204-787-3349
Health Sciences Centre
Winnipeg, Manitoba R3A 1R9

Justyn Pisa, Au.D.
Surgical Hearing Implant Program
Phone:  204-787-5039
Health Sciences Centre
Winnipeg, Manitoba R3A 1R9


 Resources:

Bone Anchored Implant Referral Policy 

Bone Anchored Implant Referral Form

Bone Anchored Implant Post-Surgical Care

Sound Processor Replacement Policy


External links:

Cochlear BAHA Processor

Oticon Medical Ponto Pro Processor

Canadian Hard of Hearing Association

Society for Manitobans with Disabilities

Manitoba Health Services