Implantation or replacement of electromagnetic bone conduction hearing device in temporal bone
CPT4 code
Name of the Procedure:
Implantation or Replacement of Electromagnetic Bone Conduction Hearing Device in Temporal Bone
Common name(s): Bone Conduction Hearing Implant, Bone-Anchored Hearing Aid (BAHA), Magnetic Bone Conduction Device
Summary
This procedure involves surgically implanting or replacing a bone conduction hearing device into the temporal bone, located behind the ear. The device helps transmit sound directly to the inner ear through bone vibrations, bypassing the outer and middle ear.
Purpose
This procedure is performed to address hearing loss that is caused by damage or abnormalities in the outer or middle ear, but where the inner ear (cochlea) is still functional. The goals include improving hearing clarity and enabling better communication and overall quality of life.
Indications
- Conductive hearing loss: where sound cannot travel through the outer or middle ear.
- Mixed hearing loss: a combination of conductive and sensorineural hearing loss.
- Single-sided deafness: total hearing loss in one ear.
Specific patient criteria include those who are unable to wear traditional hearing aids due to anatomical reasons or chronic ear infections.
Preparation
Prior to the procedure, patients may need:
- Comprehensive hearing tests to determine eligibility.
- Imaging studies (CT or MRI) to assess the temporal bone structure.
- Instruction to fast (usually starting the night before the surgery) if general anesthesia will be used.
- Possible adjustment or cessation of certain medications as advised by the healthcare provider.
Procedure Description
- Under general or local anesthesia with sedation, an incision is made behind the ear.
- A small hole is drilled into the temporal bone to accommodate the implant.
- The internal component of the bone conduction device is placed and secured in the drilled hole.
- The external component, which captures and processes sound, is magnetically or abutment-attached to the internal implant.
- The incision is closed with sutures.
Tools utilized may include surgical drills, specialized implants, and magnetic connectors.
Duration
The procedure typically takes about 1 to 2 hours.
Setting
It is performed in a hospital, surgical center, or specialized outpatient clinic.
Personnel
- Otolaryngologist (ENT Surgeon): performs the surgery.
- Anesthesiologist: administers anesthesia and monitors the patient.
- Nurses and surgical technologists: assist during the procedure.
Risks and Complications
- Infection at the implant site
- Skin irritation or breakdown surrounding the implant
- Device malfunction or failure
- Possible need for revision surgery
- Rarely, hearing may not improve as expected
Benefits
- Improved hearing ability and clarity
- Enhanced communication and social interaction
- Better quality of life Benefits are usually noticed within weeks after the device is activated and fine-tuned.
Recovery
Post-procedure, patients may need:
- Pain management with prescribed medications
- Keeping the surgery site clean and dry to prevent infection
- Avoiding heavy physical activity for a few weeks
- Follow-up appointments for monitoring, device activation, and adjustments Expected recovery time is approximately 2-4 weeks.
Alternatives
- Traditional hearing aids (if feasible)
- Middle ear implants
- Cochlear implants, in cases where the cochlea has hearing potential but the procedure has different candidacy requirements.
Each alternative has its own set of pros and cons, which should be discussed with the healthcare provider.
Patient Experience
Patients will feel the effects of anesthesia during the procedure, resulting in minimal discomfort. Postoperatively, some pain and swelling at the surgical site are expected, manageable with prescribed medications. It may take a few weeks for the swelling to subside and for the device to be activated and adjusted.
Pain management and comfort measures are provided to ensure a smooth recovery process.