Hope for Ossified Cochlea?
June 2, 2014 8:50 AM   Subscribe

When my boyfriend was a child, the bones in his inner ear fused. They were removed and he now has a giant hole where his eardrum used to be. Is there anything that will restore hearing if the bones are gone?

I keep seeing news items about new hearing aids and implants, but I don't know if they would even help him.
As a secondary question, are there improved technologies for sealing up the ear canal? The hole is rather large (he can stick his whole finger in it), and attempts to create an eardrum with a flap of transplanted skin failed. He currently cannot submerge his head in water because it will flood his sinuses and possibly cause infection.
posted by domo to Health & Fitness (9 answers total) 1 user marked this as a favorite
A bone-conducted hearing aid. They bypass the eardrum entirely, using vibrations through the mastoid bone. They are surgically implanted and on the expensive side (I have no idea about insurance).

Most hearing implants like the cochlear require a severe sensorineural hearing loss - that is the problem must originate in the organ of hearing, the cochlea. So I don't think he would qualify since he has a conductive hearing loss (the loss is due to the transmission to the cochlea, not the cochlea itself).
posted by Aranquis at 9:12 AM on June 2, 2014

He has great insurance and a lot of money in his HSA. The last time he had a bunch of money in there he got Lasik eye surgery. He is really happy with the results from that, so I was going to suggest fixing his ear issues next. We are really fortunate to be living in a time when near blindness and deafness can sometimes be fixed medically.
posted by domo at 9:22 AM on June 2, 2014

I just meant I don't know if insurance typically pays for adult implants. Hearing loss in children can drastically impact their language development (even mild hearing loss) so insurance typically covers children but adults with hearing loss often get shafted. The severity of his loss will also be a factor. You often need to have a loss at a certain threshold in the frecuencies used in speech to qualify. So it really depends on the insurance and his hearing loss.

I meant to give you the name of this implant, it's the BAHA (bone ancchored hearing aid)
posted by Aranquis at 9:43 AM on June 2, 2014

Thanks! His hearing loss is complete in his right ear, but he can hear through the left. His hearing on the left side seems to be getting worse as time goes on, so I worry.
posted by domo at 9:53 AM on June 2, 2014

My qualifications are that I am a speech language pathology student who has taken an audiology class.

But our professor did talk about both prosthetic middle-ear bones and surgery to replace a damaged eardrum using tissue from another part of the body. I'd say it's worth consulting a specialist to find out what's possible.
posted by not that girl at 10:16 AM on June 2, 2014

Can you clarify a few things? Is the lack of eardrum the issue, does he have ossified middle ear bones, or an ossified cochlea, or all of the above? Because these are very different problems. The first are conductive problems, the ossified cochlea is a sensorineural. They all have different treatments.

If it's merely a lack of eardrum, yes, that can be solved with a BAHA. They work pretty well. They start you out with one that fits on your head like a headband. Eventually you can get it implanted. It's pretty nifty - the new ones have aux jacks built right into your head so you can literally plug your ipod directly into your ear.

If his middle ear bones fused, a BAHA may not work, depending on the fusion. There are options for synthetic ossicles to be implanted, at which point a BAHA might then be an option.

If his cochlea fused (which is not a bone per se but a cavity with various parts - though sometimes cochleas do not form properly in any number of ways), then his only option is a cochlear implant. Though if he still has good hearing in his left ear, a cochlear implant in one ear might not be a very good option. Hearing with an implant is quite different than normal hearing.

There are many cosmetic surgeries available for the ear canal. Does he have a pinna? Those can be easily reconstructed. As far as sealing the ear canal, is it just a matter of swimming and keeping things from getting into his eustachian tubes and causing sinus issues? That might be a tougher situation, as he's basically looking for a surgically constructed aural atresia. Certainly possible, though uncommon.

As far as money goes, I can only speak for Oregon. Most insurers in Oregon will cover one hearing aid for adults, two for children under 18. BAHAs are typically covered. Cochlear Implants for adults it really depends. They are almost always covered for kids. Not always for adults. An external BAHA will probably run you between 5-10k. An implanted BAHA 25-40k, cochlear implant 50-100k. No idea what surgery for synthetic ossicles would cost.

All of the above said, my advice would be to talk to an ENT. IAN(yet)AAudiologist.
posted by Lutoslawski at 10:58 AM on June 2, 2014 [2 favorites]

Oh, and unless the issue on the right side was caused by a more general syndrome or health issue, it's probably unlikely to be related to hearing loss on the left. Hearing loss on the left is more likely to be age or noise related, and not caused by the same issues as malformations on the right.
posted by Lutoslawski at 10:59 AM on June 2, 2014 [1 favorite]

Only a trip to the ENT and audiologist would say for sure what (if any) aid is available for his type of loss.

Not to contradict the above posters, but from personal experience I would not be optimistic that insurance will cover the surgery. For kids or adults (especially adults). I'm in VA and companies do not have to cover hearing aids under insurance . I'm lucky that my company covers up to $1000 every two years. My son's HA's cost $7000 last time, but I suppose it's better than nothing. BTW, my son was born with hearing loss and it's always irked me to no end that if he needed a wheelchair or crutches, they would be covered. That said, my son's HA are worth every penny!

Good luck!
posted by jraz at 12:22 PM on June 2, 2014

I'm an ear, nose, and throat doc. I agree with everything Ludoslawski said above, except for the part about the ossified cochlea. If his cochlea (inner ear organ of hearing) is truly "ossified" in the textbook sense, then an implant will not be able to be placed. The electrode has to be surgically passed into a natural curled tube, like threading a wire into a snail shell. If the cochlea is ossified, then this tube is full of bone and cannot be implanted.

Additionally, most surgeons would not implant a unilateral deaf ear. He would not want that, either.

BAHAs are GREAT when patients are appropriately selected. I'm n-thing everyone who says he needs an ENT evaluation, preferably by a "neurotologist" (an ENT who specializes in only ears). PM me with any questions and I'd be happy to help.
posted by robstercraw at 1:20 PM on June 2, 2014 [1 favorite]

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