by Neil Bauman, Ph.D.
A concerned mother explained,
My daughter has Large Vestibular Aqueduct Syndrome (LVAS) and is deaf in one ear. Up to now she has not worn hearing aids. She has been given several options for middle school. The two we are considering for both in school and out of school are wearing a bone-anchored hearing aid (BAHA) behind her deaf ear—the sound would travel via bone conduction to her hearing ear. The other option is a CROS aid (where she would wear a BTE transmitter on her deaf side and a BTE receiver on her good ear. Any opinion about these options for an upcoming 11 year old?
The first thing you should consider is your daughter’s hearing history. If she has LVAS what are the chances of her good ear losing hearing in the future?
If she has no hearing in her bad ear and normal hearing in her good ear, then a bone conduction system can work very well. However, if the hearing in her good ear is dropping, then I wouldn’t go for an implanted bone conduction solution such as the BAHA as it will work less and less well as the hearing in her good ear drops. Eventually she will be left with an intrusive (and expensive) implant that won’t do her any good.
There are actually five bone conduction options available—but you seldom hear about all five. Here they are.
1. A body aid with a bone conduction transducer held behind the ear by a headband. These were very popular back in the ’40s and the ’50s and are still available today although they are not common. The latest is instead of wearing a body aid and bone-conduction headband, a BTE hearing aid is fitted on one side of the headband and the bone-conduction transducer on the other side. Since the whole unit is on the headband, there are no cords.
2. The TransEar—a BTE hearing aid that fits snugly in the deaf ear canal and vibrates the skull. It looks like a regular hearing aid but contains a transducer rather than a receiver in the ear. You can learn more about the TransEar here.
3. The SoundBite—a new hearing aid that provides bone conduction via the back teeth. Incidentally, teeth are actually the most sensitive way of conducting sounds through the skull to the good ear. [Note: SoundBite went out of business in 2015.]
4. The BAHA (Bone Anchored Hearing Aid) has a titanium post implanted in the skull and the bone conduction hearing aid snaps onto this post.
5. The brand new Sophono has the transducer completely implanted under the skin. The external part is held there by magnets—much like is done with cochlear implants. I wrote about the Sophono here.
Let’s look at the pros and cons of these.
Numbers 1 to 3 are all external devices so you can change them whenever new technologies come along. You are not tied to the implant. Thus, if hearing in the good ear drops, you can easily switch to other technologies such as a Bi- CROS aid. Furthermore, they are all much cheaper than options 4 & 5.
Numbers 4 & 5 are implanted and consequently have the possible complications that can come with surgery. Also, you are now tied into that one technology. No. 4 has the distinct disadvantage that the post sticks through the skin and thus provides an avenue for infections getting in. No. 5 does away with this problem as the transducer is totally implanted—so once it heals up, their is almost no chance of infection.
That’s a very brief look at the bone conduction options.
The other choice is a CROS aid, or if hearing in the good ear is not normal, you’d get a Bi-CROS aid.
After I had written the above, another mother responded,
Thank you for such a concise and informative response! I have asked many audiologists about the pros/cons of bone conduction aids for our son, who also has LVAS, and no-one has provided such a straightforward breakdown of the benefits and shortfalls of the bone conduction aids. Since our son has also started to lose hearing in his good ear, it sounds like the BAHA is not worth it for him, especially if he loses all his hearing within a year like he did in his other ear.
As you can see, it is very important to consider what will be happening in the future, not just go with the current “darling” at the time. And you need to use effective coping strategies in conjunction with hearing aids to get the best help in understanding speech.
The first mother then continued,
They said that with either the BAHA or the CROS aid she will be able to better hear what is said or going on on her deaf side, although she will never know where it is coming from, and will still have to look around. But in either case, there should be less social isolation. The social isolation is becoming a problem. She is alone a lot and doesn’t have the courage to ask others to speak louder or repeat.
It is true that with the BAHA (and the other bone-conduction hearing aids) or a CROS aid she will better hear sounds coming from her deaf side, but she won’t have true stereo hearing because the sounds from her deaf ear are “piped” into her good ear along with the sounds that ear normally hears. Thus she won’t be able to pinpoint where sounds are coming from.
Social isolation can be a problem if people are talking on her deaf side. Thus, one of the above options can make a big difference. However, if she has normal hearing in one ear, and the person she is talking with is standing on the good ear side, she likely wouldn’t notice much/any difference.
Unfortunately, no matter which option you choose, she will always have the bugbear of all hearing aids—they do not work well in noise. So the noisier the room is, the less benefit any of the above options will give.
For people with single-sided deafness there are some simple (and free) things they can do to greatly help themselves. One is, as I mentioned above, to have the person they are talking with talk to their good side. Another is when sitting in a classroom, church or meeting, to sit on the same side of the room as their bad ear (i.e. if they are deaf in their left ear, then sit on the left side of the room). That way their deaf ear is to the wall and their good ear faces into the room. This allows them to hear much better than sitting on the opposite side.
At the same time, she needs to use all the coping strategies that people with hearing loss in both ears employ—such as getting close, having light on the speaker’s face, reducing background noise, etc., etc.
You need to work with her on her social isolation issues. You need to teach her to be assertive about her hearing needs. She can’t expect people to instinctively know what to do when they aren’t even aware she has a hearing problem. She needs to let people know she has a problem hearing them and then tell them the one (or two) things that will make the most difference in that particular situation. It may be speak slower, clear, louder, or face me, or let’s move to a quieter location, around the corner, etc.
The mother added,
My daughter gets totally lost in the cafeteria with all the noise. I don’t know if a BAHA or CROS aid would cure this.
It’s not too likely. Noisy places like that are a real pain. In such cases, I always heard better if I took my hearing aids off (so I didn’t hear all the racket and get headaches) and relied on speechreading. But when you do this, you always miss a lot too. Fortunately, there is a much better way to cope. In these kinds of noisy situations I’d switch to using a PockeTalker and a super-directional microphone. You point the super-directional microphone at the person you want to hear (keep the microphone within 2 feet or so of the person’s mouth) and this will cut the racket down to near zero.
There are two ways to use the PockeTalker in such situations. If she is wearing a hearing aid that has a t-coil, then switch it to t-coil mode, and plug a neckloop into the PockeTalker’s earphone jack and hear that way. If not wearing a hearing aid, then plug an ear bud into the earphone jack.