Implantable Prosthesis of Osseous Conduction (BAHA): Case Report

Summary

Introduction: The implantable prosthesis of osseous conduction (BAHA) is deemed to be an excellent option in the auditory rehabilitation of patients with conductive and mixed hearing loss, unilaterally or bilaterally, and unilateral sensorineural hearing loss. It has been a good advantage over the conservative bone conduction apparatus and those of individual sound-amplifier apparatus (ISAA), when their usage becomes unfeasible because of chronic otitis externa, which has a hard clinic control.

Objective: To introduce the first BAHA case performed in Brazil, as duly authorized by ANVISA (National Agency for Sanitary Surveillance), to rehabilitate the mixed hearing loss with occurrences of chronic otitis externa.

Method: 50-year-old female patient with right-ear moderate and left-ear severe hearing loss, bilateral tinnitus derived from otosclerosis, was submitted to 04 surgeries of stapedotomy and unable to use ISAA as a result of otorrhea and bilateral otalgia. The medical and audiological evaluation indicated the benefit of using BAHA. Having surgery been performed and BAHA implemented, the patient showed a significant improvement in audiometric thresholds, speech perception and distinction, as well as she declared to be extremely satisfied with the esthetic factor.

Final commentaries: BAHA surgical process is safe, simple and swift, thus providing excellent audiological results and a higher degree of satisfaction to patients.

Resumo

Introdução: A Prótese Implantável de Condução Óssea (BAHA) consiste em uma excelente opção na reabilitação auditiva de pacientes com perda auditiva condutiva e mista uni ou bilateral, e sensorioneural unilateral. Tem sido uma alternativa vantajosa sobre os aparelhos de condução óssea convencionais e os aparelhos de amplificação sonora individuais (AASI) quando o uso dos mesmos fica impossibilitado pela presença de otite externa crônica de difícil controle clínico.

Objetivo: Apresentar o primeiro caso de BAHA realizado no Brasil, após a autorização da ANVISA, para a reabilitação da perda auditiva mista com episódios de otite externa crônica.

Método: Paciente do sexo feminino, 50 anos, com perda auditiva de grau moderado à direita e severo à esquerda, zumbido bilateral, decorrente de otosclerose, submetida a quatro cirurgias de estapedotomia e com impossibilidade de uso de AASI devido a otorreia e otalgia bilateral. A avaliação médica e audiológica indicaram o benefício do BAHA. Realizada a cirurgia e implantação do sistema BAHA, a paciente apresentou melhora significativa nos limiares audiométricos, na percepção e discriminação da fala, além de relatar extrema satisfação relacionada ao fator estético.

Comentários Finais: O processo cirúrgico do BAHA é seguro, simples e rápido, proporcionando excelentes resultados audiológicos e alto grau de satisfação por parte dos pacientes.

Keywords

prosthesis and implants - hearing loss - otitis externa

Palavras-chave

próteses e omplantes - perda auditiva - otite externa

• Bibliographical References

• 1 Branemark P, Breine U, Lindstrom J , et al. Intra-osseous anchorage of dental prostheses: I experimental studies. Scand J Plast Reconstr Surg 1969; 3: 81-100
• 2 Tjellstrom A, Lindstrom J, Hallen O , et al. Ten years of experience with the Swedish Bone Anchored Hearing System. Ann Otol Rhinoll Laryngol Suppl 1991; 99: 1-16
• 3 Audiological Manual Baha. Cochlear Américas.
• 4 Hakansson B, Tjellstrom A, Rosenhall U. Hearing thresholds with direct bone conduction versus conventional bone conduction. Scand Audiol 1984; 13 (1) 3-13 . Audiological Manual.
• 5 Lawrence RL, Alexander A, Derald E , et al. Hearing Rehabilitation Using the BAHA Bone anchored Hearing Aid: Results in 40 patientes. Otology e Neurotology 2001; 22: 328-334
• 6 Van Der Pouw CTM, Mylanus EAM, Cremers CWRJ. Percutaneus implant in the temporal bone for securing a bone conductor. Surgical methods and results. Ann Otol Rhinol Laryngol 1999; 108: 532-537
• 7 Snik AF, Mylanus EA, Cremers CW. The bone-anchored hearing aid: a solution for previously unresolved otologic problems. Otolaryngol Clin North Am 2001; 34 (2) 365-72
• 8 Snik AF, Mylanus EA, Cremers CW. Bone Anchored Hearing Aids in patients with sensorioneural hearing loss and persistrent otitis externa. Cion Otolaryngol 1995; 20 (1) 31-5
• 9 Hakansson B, Liden G, Tjellstrom A, Ringdahl A, Jacobsson M, Carlsson P, Erlandson BE. Ten years of experience with the Swedish bone-anchored hearing system. Ann Otol Rhinol Laryngol Suppl 1990; 151: 1-16
• 10 Bance M, Abel SM, Papsin BC, Wade P, Vendramini J. A comparison of the audiometric performance of bone anchored hearing aids and air conduction hearing aids. Otol Neurotol 2002; 23 (6) 912-9
• 11 Mylanus EAM, Van Der Pouw CTM, Snik AFM, Cremers CWRJ. An Intra-individual comparison of the BAHA and air-conduction hearing aids. Arch Otolaryngol Head Neck Surg 1998; 124: 271-276
• 12 Lustig LR, Arts HA, Brackmann DE, Francis HF, Molony T, Megerian CA, Moore GF, Moore KM, Morrow T, Potsic W, Rubenstein JT, Srireddy S, Syms 3rd CA, Takahashi G, Vernick D, Wackym PA, Niparko JK. Hearing rehabilitation using the BAHA bone-anchored hearing aid: results in 40 patients. Otol Neurotol 2001; 22 (3) 328-34
• 13 Sánchez-Camón I, Lassaletta L, Castro A, Gavilán J. Quality of life of patients with BAHA. Acta Otorrinolaringol Esp 2007; 58 (7) 316-20