Comparative BAHA Review

Cochlear BP100/BAHA3, Oticon Ponto Pro,

and Sophono Alpha 1 (S) Soft Band Head Band BAHA Models

Purpose:

The purpose of this review is to provide feedback regarding the functionality of three differently manufactured bone anchored hearing aids (BAHA). This review is geared toward families with infants/toddlers who have been born with a conductive hearing loss and who have been diagnosed with Microtia and or Atresia.

Note: My observations include having myself wear all three soft band head band BAHAs in order to experience hearing what my daughter is hearing as she is incapable of telling me herself due to being only two years of age.

BAHA processors trialed:

Cochlear BP100/Baha3 (loaner unit), received in October 2010 to present

Oticon Ponto Pro BAHA (loaner unit), received in November 2010 to present

Sophono Alpha 1 (S) BAHA (loaner unit), received in January 2011 to present

History of subject:

Name: Alyssa

Sex: Female

Age: 24 months

Location: Colorado, USA

Diagnosis/History: Microtia and Aural Atresia of the right ear with a moderate to severe 65dB/70dB level (unaided) hearing loss . The hearing range for Alyssa’s left (non-Microtic/Atretic) ear is at or near a 10dB/20dB level within normal hearing sensitivity 500-4000 HZ. Loss of hearing is likely a conductive hearing loss with the absence of an ear canal and a functional cochlea. Microtia and Atresia is the result of a congenital deformity presented at Alyssa’s birth. Currently, Alyssa speaks around twenty words between vocal and basic signing combined. Alyssa has no other known associated disorders or syndromes related to Microtia/Atresia and has not shown any changes regarding her current loss of hearing.

Duration for being aided: Since eleven months of age. Originally aided by the Cochlear Intenso BAHA (Bone Anchored Hearing Aid) on a soft band head band in August of 2010. Total months of being aided to present with a BAHA is approximately 13 months.

Review:

BAHA (Bone Anchored Hearing Aid) processors reviewed…

Cochlear BP100/BAHA3

  • (soft band head band) pink colored band and black colored processor, programmed for multi-directional microphone mode use (not set to single mode) and programmed for the right ear. The BP100 model that Alyssa wears is the model where feedback issues have been addressed by the insertion of a clear Gortex rubber material layer located inside of the battery door panel (marketed as the BP100/BAHA3). Weight of the processor containing battery while attached to plastic clip on soft band head band is 1.02oz or approximately 28.9g.

Ociton Ponto Pro

  • (soft band head band) pink colored band and champagne colored processor, programmed for multi-directional microphone mode use (not set to single mode) and programmed for the right ear (model shape made for the right ear). Weight of the processor containing battery while attached to plastic clip on soft band head band is .8oz or approximately 22.7g.

Sophono Alpha 1 (S)

  • (soft band head band) white with pink and white polka dot patch colored band and champagne colored processor, offers single-directional microphone mode only and programmed for the right ear (model shape made for the right ear). Weight of the processor containing battery while attached to magnetic /plastic clip on soft band head band is 1.0oz or approximately 28.3g.

Subject background:

At the age of seven months, Alyssa was babbling and cooing. At the age of eight months, Alyssa stopped babbling and cooing. In fact, she no longer grunted or made any sounds for the matter. At ten months of age, after having Alyssa evaluated by therapists from our state Early Intervention program “Imagine”, it was determined that Alyssa was delayed in her speech and communication skills. At eleven months of age, Alyssa was fitted for a loaner BAHA. As soon as Alyssa’s audiologist turned on the BAHA and said her name behind her Microtic/Atretic right ear, she turned her head quickly and smiled and looked right at the both of us. Prior to wearing a BAHA, Alyssa would rarely raise her head and respond to anyone who spoke to her or tried calling her (regardless of her normal range hearing left ear). Alyssa soon began making sounds again and cooing and babbling after being fitted with a BAHA. Even Alyssa’s therapists from our state Early Intervention program noticed that it appeared as if Alyssa had a light switch turned on and that she had become engaged with her environment. After the age of twelve months, Alyssa began reacting more to her environment by showing facial gestures and looking for sounds when she heard them on occasion.

Observations:

Wearing the soft band head band BAHA

From ten months of age to seventeen months of age, Alyssa did not enjoy wearing the BAHA. She would often tug at it or tear it off and chew on it. It was also observed that the BAHA would leave little red marks on Alyssa’s head. Because of this, I would often move the BAHA around on her head. I believe her skull was still very soft and this may be the reason for the marks as the BAHA fit nicely around her head and not too tightly. As of seventeen months of age, Alyssa began leaving her BAHA on more and tugged at it less often. Also, when removing the BAHA she would sometimes cry as if she would still like to have it on. Alyssa will now leave the BAHA on anywhere from one hour to over four hours during one days time when compared to keeping the BAHA on for only minutes to a max of one hour previously.

Soft Band Head Band

I noticed that Alyssa seemed to favor both the Oticon Medical and Sophono soft band head bands over the Cochlear soft band head band and kept these BAHAs on for longer periods of time. When looking closely at the three soft bands I noticed that both the Otcion Medical and Sophono soft bands were softer or smoother in texture and a bit wider. The Cochlear soft band is a bit rough around the edges, stiffer, and thinner. Also, the Oticon Medical clip (where the processor attaches/clips into) on the soft band head band is a bit thinner and lighter and is concave on the side that rests against the skull. The Sophono clip also lies very flat against the skull whereas the Cochlear clip is thicker and a bit bulkier and does not lie quite as flat to the skull. I originally favored the adjustable buckle soft bands that both Oticon Medical and Sophono have, but over time I have gotten use to all three including the Velcro adjustable band from Cochlear. I applaud how nice and snug the Cochlear processor snaps on to the soft band clip. Alyssa can take both the Oticon Medical and Sophono processors off very easily. In fact, I was disappointed at how easily the Oticon Medical processor can be removed from the soft band clip. Sometimes a slight bump to the processor would knock if off of the head band. Since then, Oticon Medical has launched a new soft band head band that I have also used with Ally’s Ponto Pro processor. The new band fits nice and snug and no longer comes of easily. Oticon’s new soft band head band became available in July of 2011. The new Oticon Medical band looks almost identical, except that the connection is reinforced on the underside with a cross structure to keep the “abutment” from compressing and thus losing the connection resistance. The Sophono processor stays on well and does not come off due to a slight bump. However, it can be easily removed when Alyssa pulls on it. Cochlear has also redesigned a new soft band head band that should launch during Fall of 2011. Cochlear’s newly designed soft band head band has a thinner styled clip for the abutment to attach to and the soft band is now wider and made of a softer textured material.

* Note: Taking into account that Alyssa has worn these BAHAs between infancy and toddler ages, I have observed how she has gotten use to them and tends to leave them on for longer periods of time without pulling on them so much. As infants and toddlers tend to roll over, lay down more often, reach for objects, and put them in their mouth, it is more likely that an older aged child or adult would be able to wear the BAHAs with much more ease.

Functionality

The Cochlear processor can be turned off and on manually at the touch of a button where as both the Oticon Medical and Sophono processors have to have the battery inserted in order to turn the processor on and remove the battery in order to turn the processors off. The battery door on the Oticon Medical is a little difficult to open. The sophono battery door opens easily. The Cochlear battery door (back panel) is easier to remove than to put back on, but without the included magnetic wand to help remove the battery, it becomes very difficult to get the battery out. Originally, I favored the idea of indicator lights on the Cochlear processor (amber LED for right ear fitting and blue LED indicating that the processor is off). However, some times the lights would flash or not turn off. Even when trying to replace the battery, the “amber” indicator light would not turn off preventing me from shutting the processor fully down in order to change the battery. This made me worry that it was not working properly or that I would cause a change to the programming. Quickly, I realized how simple it was to use both the Oticon Medical and Sophono processors because I did not have to worry about any indicator lights (although they can be disabled) or touching the wrong buttons in the wrong sequence. I found it easy to adjust the volume on all three processors, but favored the rotary dials on the Oticon and Sophono processors over the button switches on the Cochlear processor.

Sound Quality

As Alyssa’s mother, I have listened through and worn all three processors myself on my head with the soft band head band. I have also listened to the Cochlear and Oticon Medical processors with their tester pieces. When listening to all three processors, they each offered excellent sound quality. Although I am not hearing impaired, but was able to hear what Alyssa is most-likely hearing, I thought the technology was ever so slightly tinny…as if one were speaking through a tin can. However, at the same time I thought the Oticon Medical sounded very very clear with the Sophono and Cochlear following close behind. The difference was very slight. All three processors sounded fantastic and I was amazed at how well and clean and crisp I could hear sounds in the environment. Both the Cochlear and Oticon processors were set to the multi-directional microphone modes where as the Sophono processor was set to the single mode microphone (only offers single mode). When listening through both the Cochlear and Oticon Medical processors I could hear sound all around. I observed this as well with Alyssa when she would have her BAHA on. When I would present a sound for Alyssa I would witness her looking for it and she would try to look for it. Without wearing any of the BAHAs, she is non-responsive often times or simply can not find where the sound is coming from. The sound quality of the Sophono processor is very clear, although when moving away from a sound the sound would become less evident due to the single mode directional microphone.

Multi-directional microphone mode vs single-directional microphone mode

I wore all three processors out to restaurants and to loud places such as malls and public restrooms and I was amazed at what I could hear through them. For example, when dining out at restaurants and wearing the Oticon Medical and Cochlear processors set to the multi-directional microphone mode, I thought I was hearing peoples thoughts. I heard every single sound from dishes clanking to utensils tinging and everyone’s conversations including the air condition and drink sippers. When wearing the Sophono (on its single-directional microphone mode), I soon realized how much of the background noise was filtered out from the noisy environment. To briefly explain, the multi-directional mode microphones can help you or your child hear surround sounds (or in stereo) because of the three positioned microphones on the processor, one that is located behind their ear, one directly beside the ear, and one in front of the ear. This greatly helps with improving and achieving sound localization. By switching to the single-directional microphone mode, the processors allow you to filter out the background noise from a head of you and from behind you to where your sound is now focused right beside your ear. This single-directional mode works wonders when having conversations at noisy tables. Honestly, when I had the Oticon Medical and Cochlear processors on in public restaurants and at malls, I heard everyone’s conversations from the tables around me and walking past me, but had difficulty hearing my husband talking to me directly in front of me or just beside me. When hearing through the single-directional mode, I maybe heard some conversation from one table behind me or others near me, but I was able to hear every single word my husband said without having to strain. So, I now understand how important it is to know how to operate the processor and be able to understand how the different microphone mode settings can help within the environment. Many of the processors on the market are termed “smart” because over time, they learn to adjust automatically in loud environments to quieter settings and visa versa. For an infant or say a young child under the age of four, these wonderful options will most-likely go unused and unnoticed. I was relieved to be able to experience and understand what a difference it makes to be able to hear through different settings in different environments. I also realize how loud sounds can really “hurt” someone who is wearing a BAHA or hearing aid in general. For example, a public restroom is very uncomfortable with the loud flushing toilets. They were especially loud while wearing the BAHAs. I find them loud to begin with without wearing an assisted hearing device. I also wore Alyssa’s BAHAs around the house listening to water running in the faucet near and far and listening to my husband talk or the TV as I walked in and out of rooms. Overall, I am very impressed with the sound quality of each processor we trialed.

Safety Lines

All three processors have safety lines. I have tried a safety line with each processor and at Alyssa’s age, the safety line actually caught her attention most of the time and lured her in to where she would grab for it. I often found Alyssa pulling on the safety lines and then taking the entire head band off along with the processors. Although the safety lines give a sense of “security” knowing that they are still connecting the processor to the band, the safety lines did not work very well for us. This is why I was so happy that Oticon Medical launched their new soft band head band. I feel just as safe with a processor that snaps snugly into the abutment clip on the band when compared to being attached to the safety line. Of course, if a child is in school playing, it would be nice to have the safety line on so the processor does not get lost.

Maintaining a BAHA

During the period of time that Alyssa has worn her BAHA(s), she has managed to get them wet and get some food in them. Most of the time, I do not allow Ally to wear any of the three BAHAs during meal time out of fear that she would get food in them. However, during 11 months to almost 18 months of age, Ally was teething and when she did pull her processors off, they went directly into her mouth. All three processors had their chance of getting wet with her saliva. Both the Oticon Medical and the Sophono processors were wet to the point of saliva penetrating the battery door. The Cochlear did not seem to allow the moisture in as easy as the Oticon and Sophono. I am guessing this may be because of the Gortex rubber flap that lines the battery door on the Cochlear processor. Regardless, each time I did remove the battery and carefully inspect the processors and put them in our “hearing aid saver” container. Each time the processors dried thoroughly and functioned properly. A couple of times, Alyssa’s saliva hardened and I could see the “white” residue in the microphone holes. I just waited until it was hard and then very carefully flicked out the pieces with a toothpick without damaging the microphone. Since Alyssa is in the stage of touching everything while she eats, I just choose to not have her BAHAs on her during meal time. We have also tried the “Ear Gear” slip cover for the Cochlear BP100/BAHA3 processor once and when I tried it on, the cover seemed to cause some feedback to the microphone. I had purchased the “Ear Gear” slip cover to try and protect the processors from moisture. I only have a cover for the Cochlear BP100/BAHA3 model as each processor is shaped differently and each cover fits a specific model. Overall, each of the three processors have been very easy to maintain. We have not yet had to send a processor back due to experiencing any problems with functional issues.

What Can and Can’t Our Children Really Hear?

When I had learned that my daughter had Atresia and was missing her ear canal, I began wondering how much she could hear in her right ear. At a moderate to severe hearing loss of 65dB/70dB, it was explained to me that Alyssa can hear as if someone is speaking to her underwater. I didn’t think that was so bad until I came a cross a bone conduction simulation video on line where you can see for yourself what it is like to hear at a moderate to severe hearing loss. I was shocked! What I heard was hardly anything at all. The following links are just a couple of examples to help us hear how someone hears with a conductive loss:



Speech Banana

(*) Another great tool that can help us understand what our children are hearing (based on different pitches within their environment) is the “speech banana.” The sounds that we use to produce speech in conversation have frequencies and decibels. The most typical frequency and decibel for each speech sound has been graphed on an audiogram to provide information about what sounds can be heard at specific degrees of hearing loss. A child that can hear the sounds of speech will have a much easier time imitating, understanding and learning spoken language.

When all the sounds necessary for speech were initially graphed and a line was drawn around them, the shape looked like a banana. The term “speech banana” was coined. This area is the target hearing area for children with hearing loss. If they are able to hear sounds within the speech banana when they are aided with hearing aids, there is a better chance they will understand that sound and be able to reproduce it in their speech.

The audiogram below contains drawings depicting typical sounds and where they fall on the audiogram. Jet planes, for instance, are loud, high decibel, high frequency, sounds while wind rustling leaves is a much lower decibel sound. A child may be able to hear certain low frequency sounds such as [m] but not hear higher frequency sounds such as [s] and [sh] even with the use of hearing aids. Missing those sounds may change their understanding of what is being said. (*)

For example, knowing that my daughter’s conductive hearing loss is moderate to severe (65dB/7db), I realize that she can hear dogs barking, phones ringing and lawnmower sounds, but may not be able to hear the (f),(S), and (th) sounds when certain words are presented to her during conversation as these pitches are typically recognized within a normal 20dB range of hearing.

Speech banana audiogram (click to enlarge image)

Degree of hearing loss ranges

0-25dB Normal Hearing Limits, 26-40dB Mild Hearing Loss, 41-55dB Moderate Hearing Loss

56-70dB Moderately Severe Hearing Loss, 71-90dB Severe Hearing Loss, and >91dB is Profound Hearing Loss

- Attached Speech Banana image sourced from American Academy of Audiology at audiology.org

Does a BAHA Help Benefit a Hearing Loss?

Many parents often wonder if their child can really benefit from wearing a BAHA. They also wonder if a BAHA really works. Although every child is different and may react differently to a BAHA, I will tell you what I have observed with my daughter, Alyssa, when wearing her BAHAs. As mentioned previously in this review, Alyssa had stopped babbling and cooing. She wouldn’t even lift her head or look for me. On the first day when Alyssa received her BAHA, there were tears of joy from both our audiologist and myself. To see Alyssa turn her head and look and smile when her name was quietly spoken behind her Microtic/Atretic ear was such a site to see and such an experience to observe. Later that evening at home, she was all smiles. Although she tried to pull the BAHA off and reach for it to see what it was, she had become a different baby in just one appointment. That was the day she became reacquainted with her environment. Alyssa had become engaged and began showing excitement looking for sounds when before she often wouldn’t lift her head when spoken to (despite having normal hearing in her left ear). Regardless of what others may experience, I saw a difference and that is all I needed as Alyssa’s mom and to realize that I had found an option that could help her.

Some parents will believe their child does not require a BAHA and can hear just fine without one. That is perfectly fine. Just know your options and know that a BAHA is an option that can help your child hear better when considered. It is also important to realize that our brain is very smart and learns how to adjust. As a child develops and grows older, the brain learns how to compensate for the hearing loss helping that child function within their environment as best as possible. As a result, many children and adults with Micotia and Atresia have learned how to get by in life just fine if they have a single sided hearing loss. Bilateral hearing loss is another story. I honestly believe the earlier a child can wear a BAHA will help them to hear better in general. Sure, you can always try a BAHA, at any age, but sometimes this may make it a little more difficult to adjust to because you have already been hearing your environment a certain way for years. Again, a BAHA is a wonderful option that should be presented to patients with a conductive hearing loss so that they are given this option.

I do schedule quarterly hearing aid evaluations for Alyssa in order to keep an eye on her hearing loss and to monitor any ear infections. In most of Alyssa’s evaluations, we also check to see how well she is hearing while being aided with her BAHA. Below are two of Alyssa’s evaluation reports that show how she is benefiting from wearing a BAHA. The following two evaluation reports will show you how Alyssa’s moderate to severe hearing loss measures within a normal dB range when being aided with a BAHA. The two processors tested on Alyssa in her hearing evaluations are the Cochlear BP100/BAHA3 and the Oticon Medical Ponto Pro. The Sophono Alpha 1 (S) has not yet been tested.

X represents Alyssa’s left ear that hears at or near a 20dB normal range of hearing. A represents Alyssa’s right (Microtic/Atretic) ear while being aided measuring her within a normal 20dB range of hearing. O is her original 65dB/70dB hearing loss for her right ear.

Note: In both aided hearing evaluations, new batteries were used in the BAHA processors tested. Also, middle ear pressure and eardrum mobility was within normal limits during testing (no present infection/blockage).

Additional Note: Cochlear launched its newly designed BAHA 3 Power (BP110) processor on July 15, 2011. It has a thinner, flatter package that is more powerful focusing on sound clarity. Although the BP110 is a bone conduction technology processor, it is also designed to meet the needs for individuals with substantial mixed hearing loss with sensory-neural loss.

Additional Note for Oticon Medical Processor: One additional feature that I found to be nice on the Oticon Medical is the one touch mute/pause button. If possible, when knowing that you will be exposed to a loud sudden noise, the Ponto series offers a nice mute option that you can just press/depress with your finger. It has a nice tactile feel as you can feel it pulse against your finger to let you know that the processor has been muted or reactivated. There are also a series of tones/beeps that the user can hear when the battery is running low. When the battery was depleted once, I noticed when I tried to power the processor back on there were a series of four different tones that sounded.

Statement to the bone anchored hearing aid device manufacturers mentioned in this review: This review was not intended to criticize individual technology or pit any of the above mentioned BAHA models and its developers against one another. Plenty of clinical feedback has already been provided and gathered during clinical trials. I purposely decided not to rank which processor I believe to be the best on the market as each individual user is different and requires different needs from these processors. The purpose for this review was to provide feedback on an infant/toddler aged child wearing three differently manufactured BAHA models for comparison. Also, to observe how well a child adjusts to wearing a BAHA. In addition, observing how well a child with a hearing loss in the moderate to severe dB range can improve to within normal range of hearing when being aided by a BAHA. Most importantly, it was my primary focus to help educate families with small children about the BAHA and help update them on the how important it is to know about your child’s hearing loss and how it may affect them.

In Summary:

A child or adult can benefit from the use of wearing a BAHA. The option for a BAHA should always be presented to a patient having a conductive hearing loss. Although the choice to aid a child should be presented, the decision should be left up to the parents. All BAHAs on the market today offer excellent technology for aiding in hearing loss and are amazingly clear in sound. It is important to try a few different manufactured BAHAs or at least a few models before purchasing a BAHA. Sometimes, one BAHA model may be much easier to use, sound better, or offer advanced options that are better suited for an individual’s lifestyle when compared to another BAHA model. If a BAHA is going to become part of your life and act as an ear(s) for hearing, then make sure it is fits comfortably and you understand how to get the most out of it so you can get on with your life as care free as possible. Aside from infants and young children, it is important to understand the programming features and how to get the most out of your BAHA as an adult in your environment. Ask your audiologist to help you learn how to operate your BAHA and how to help it learn to be as smart as it can for automatic changes when responding to your environment. Most of all, please educate yourself as much as possible about the loss of hearing in general.

About the reviewer:

My name is Melissa Tumblin. I am a mother of two biological daughters who are some of the happiest little girls on earth. I am married to my best friend, Brent, who I met in college. Only Alyssa was born having Microtia and Atresia. There is no genetic evidence of Microtia or Atresia on either side of the parental blood line as far back as researched in my family. I am a Colorado, USA Native. I hold a Bachelors Degree in Biology and Psychology (emphasizing on pre-med) from the University of Colorado at Boulder. Currently, I am the Founder of the Microtia and Atresia Support Group on Facebook, Board of Director Member for the Hands & Voices Organization, and Parent Advocacy Board and Council member for Children’s Hospital Colorado for the Bill Danienl’s Center for Children’s Hearing. For the past three and one half years, I have had the priviIege of staying at home with my daughters. On a part time basis, I am a marketing consultant. I have over 10 years of medical/surgical device marketing and sales experience working closely with surgeons and peri-Operative staff. My most important job is being the best mommy and parent advocate that I can for my daughters.

Know your options so you can make the best decisions.” – Melissa Tumblin

Thank you!

Melissa

Link to the Microtia and Atresia Support Group on Facebook

https://www.facebook.com/pages/Microtia-and-Atresia-Support-Group/118851728152174?sk=wall

*  This document was created and released in September 2011.