Bone Anchored Hearing Aid (BAHA)

Considerations

• • Products

  • Cochlear Baha - Surgical guides

    • • Contains all the information you need for various types of Cochlear BAHA implants 

Preparation

Procedure

Sample operative report

Procedure in detail: 

The patient was transported to the operating room and placed in the supine position. Time out completed. GETA applied.  The head of the bed was rotated 90 degrees. 

The site for abutment placement was marked 60 mm from the EAC at the height of the superior margin of the pinna. The skin thickness was measured to be *** mm. The hair behind the ear was trimmed and taped. The planned site was infiltrated with *** ml of 1% Lidocaine with 1:100,000 Epinephrine. Sterile prep and drape completed.

The initial incision was completed with the 5 mm punch biopsy blade down and through the periosteum. The periosteum was widely removed. Using the BAHA drill and standard setting, a 3 mm deep hole was drilled. Bone was confirmed to be present in the depth of the hole. Therefore a 4 mm deep hole was drilled. The hole was widened. The counter sink was drilled. Copious irrigation was used throughout the drilling. Next, the abutment was set in place taking at 25 -50 Ncm. The skin was then draped over the abutment. Xeroform was wrapped around the abutment, and the healing cap was secured.  

The patient was returned to the care of anesthesia, awoken, and transported to PACU without complication.

Post-op

• • Medications 

    • Analgesic, Tylenol is often sufficient 

    • No antibiotic required 

• RTC POD 10-14

• Wound care and patient instructions 

  • • POD 1

      • Remove the mastoid dressing

      • Leave the dressing and healing cap in situ

      • Avoid water over the wound for at least 2 weeks 

• • POD 10-14

    • Remove and discard the healing cap

    • Carefully remove the dressing

    • Remove the sutures (if applicable)

    • Gently clean the wound with normal saline and gauze

    • Gently remove any dried blood or debris

    • Assess the wound site and treat accordingly

    • If healed, no further dressing is required

    • Provide the patient with aftercare instructions and emphasize the importance of daily cleaning.

      • • Good hygiene is critical to maintaining normal usage of the Baha sound processors

        • Patients who are unable to clean the skin around the abutment need help from their family or caregivers

        • The cleaning should, independent on the method selected, be light

        • Start daily cleaning with an alcohol-free wet wipe after dressing removal

        • Be careful not to interfere with the tissue integration during the healing phase

        • After the initial healing phase (up to 12 weeks), continue to clean once a day with an alcohol-free wet wipe

        • Mild soap and warm water may also be used

        • After the wound has healed, half yearly or yearly checkups at the outpatient clinic are recommended

Pearls & Pitfalls

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