Bilateral BAHAs – Is Bilateral Better?

After using a Bone Anchored Hearing Aid (BAHA) for 6 years, our 14 year old son Jesse recently received his second BAHA – he “went bilateral.”  He was born with bilateral atresia (no ear canals or openings on either side) and has a bilateral severe to moderate conductive hearing loss.

In spite of having bilateral atresia and bilateral hearing loss, Jesse wore just one hearing aid for the first 14 years of his life, and for the most part it worked out well.  He had a bone conduction hearing aid until he was 8, when he was fitted with his first BAHA (after two surgeries to implant the titanium screw and “abutment”).  Jesse has always used an FM system in school, and has done very well.  Listening in noise was (and is) challenging, but Jesse has always seemed to hear better than we expected him to, given his hearing loss.  As long as we got his attention first, he seemed to be able to hear us over the background noise, and when that didn’t work, we used a little sign language as a back-up.

While Jesse did well, we always wondered if life would be easier for him if he had bilateral hearing aids.  For one thing, having a single hearing aid is a real pain when it breaks.  He would either have to use his old bone conduction aid, which he no longer liked after getting the BAHA, or we would have to fit in an urgent trip to the audiologist to get a loaner.  Secondly, Jesse had practically no ability to localize where a sound was coming from.  When he was little, we were always concerned for him around traffic and in parking lots.  And then he always had a “good side” and a “bad side,” and I have never been good about remembering to sit on the good side of him – and, to be honest, I always had to concentrate to remember which side his BAHA was even on!   Lastly, and perhaps most importantly to Jesse, were issues related to music.  Jesse is a great fiddler, and plays in a Celtic Ensemble with twenty other teens.  With one hearing aid, which is situated very close to his violin, he often has difficulty hearing the guitar or the other fiddlers over the sound of his own violin.  We wondered if having a hearing aid (and thus microphone) on the opposite side would allow him to hear his fellow musicians more easily.

So, we sat down with Jesse to see what he thought about the whole idea.  He was not too keen on the idea of another surgery (he has also had two other unrelated surgeries) and in general didn’t really want to get it.  However, we talked with a few people, including his audiologist, who pointed out that it was hard for Jesse to know what he was saying “no” to.  She used the analogy of pizza – if you had never tried pizza, you wouldn’t even know how much you love it.

At one point Jesse said to us that it didn’t really feel like we were giving him a choice.  We told him that if he strongly opposed it, he definitely did not have to get it.  But if he was just put off by the idea of the surgery (which is really not that major, but does mean going under anaesthetic and wearing a very itchy head bandage for a couple of days), then we would rather he not make his decision based solely on that.  We said we would push him in that direction because we thought it would be something that would be a benefit for him, but would never make him have the surgery against his will.  In the end, he decided that he would get the second BAHA.

The surgery went well, and he was able to have it done in one stage rather than two this time, since he was older and the bone was thicker.  While he was healing, we learned that the new BP100 was being released, which is the latest version of the BAHA from Cochlear.  There were some delays, so we had to wait awhile, but he finally got his hearing aid in November, five months after his surgery.

We encouraged Jesse to start a blog to document his experience, both with “going bilateral” and with the new BP100.   You can read about his early impressions (http://bahadude.wordpress.com/) – he makes some interesting observations.

At this point Jesse has been wearing his two BAHAs for 7 weeks (his old BAHA compact on one side and the new BP100 on the other).   Between school work and music, he is a busy kid, so I thought the best way to get his input for this article was to interview him.

TK:  “What do you think of having bilateral BAHAs so far?  Do you notice much difference from when you just wear the one BAHA?”

JK: I like having two BAHAs now.  At first it was a little bit weird, and I had to get used to it, but it’s normal now, and sometimes I don’t notice that I even have the new one on.   I find that most sounds seem louder now than when I only had one hearing aid.  Sometimes this helps, but sometimes in places where there’s a lot of background noise, it makes it harder to listen to the person speaking just because everything seems louder.  I am getting used to it, though.

One advantage I have found is when I am walking with my friends.   I don’t have to position myself so that the side with my hearing aid is towards them anymore.

Also my mom says that I don’t say “what” or “pardon” as much when I’m wearing both hearing aids.

TK: Did it take long to get used to wearing two hearing aids?

JK: It took me about a month and a half to fully get used to it.  At first I had to take breaks from the new hearing aid because it was really different and really weird sounding, sort of overwhelming.  Gradually I started using it more and more (over a period of about 2 weeks), and then I started using it full time.  Just about a week ago is when I noticed that it sounds normal now.

TK: How do you find the sound quality of your new BP100 compared to the older Compact BAHA?

JK: The BP100 is a lot clearer than the Compact.  Another thing I noticed is when I use the background noise setting (directional microphone) on my new hearing aid, I find it a lot easier to hear in noisy situations.

TK: You were hoping that having two hearing aids would help you when playing in the fiddle ensemble.  How has that been?

JK: I was hoping that having two hearing aids would help me hear other musicians when I am playing in my fiddle group.  Unfortunately, there was something wrong with my BP100, and I got feedback whenever there was a loud noise, like my violin, so I couldn’t wear it at rehearsal.  We went back to the audiologist today and got a new one, but it doesn’t seem to work any better than the first one.  Hopefully they will eventually come out with new software and be able to fix it.

TK: Have you noticed any difference when you are talking on the phone?

JK: Yes I have noticed one major difference; in noisy situations, it is way harder to hear because the background noise is twice as loud (coming through two hearing aids) but the person speaking on the other end of the phone is the same volume (only coming through one hearing aid).  I have decided that from now on whenever I find myself in this situation I will turn off the hearing aid I’m not using for the phone.

TK: Has your ability to localize sounds improved at all?

JK: I can localize a little bit now – not easily, but I can a little bit.  We’ve tried it a couple of times – I close my eyes and somebody talks to me and I try to localize the sound.  Mostly I can find the general direction of the source of the sound, but I have troubles localizing behind me.  My ability to localize sound has improved slightly since the first time we tried it – my audiologist recommended we practice localizing to see if I can improve my skills.

TK: If you had to decide all over again knowing what you know now, would you decide to get bilateral BAHAs?

JK: Yes.  The only part that discouraged me in the beginning was the possibility that the surgery could go wrong and the knowledge that I would have to wear that really, really itchy head bandage.  Since the bandage is only temporary, and the risk of something going wrong isn’t very high, I think the advantages outweigh the disadvantages.

TK: Do you have any advice for other BAHA users who are considering going bilateral?

JK: Personally I think it’s a good idea, even though the prospect of getting surgery may be daunting.  It’s a lot easier not having to always accommodate for only being able to hear on one side.

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