Monthly Archives: August 2013

Aaron’s Story, Part III: The Journey to Getting a Ponto

We spoke to Aaron not too long ago, a couple weeks before he was set to get his Ponto. Those weeks moved slowly for Aaron as he eagerly anticipated the day that finally came last week– the day that he got to snap on his new Ponto Pro.

So, what’s changed for Aaron?

A lot. But, what he’s realized is that it’s many little things that are making up a very big change. It started with getting used to the volume of his own voice.  “I was overwhelmed at how I could hear. I had to take a moment in the elevator to collect myself,” Aaron shared.

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Then, he focused on what he could hear. He was surprised at the distinct sound of tires bumping along the freeway as he road to the airport for a trip to Vegas. “I went to the airport after I got setup, and I couldn’t believe how loud the concrete was while driving on the highway. I had ask, ‘is that normal?'”

What he could hear became even more apparent while doing one of the things he loves most– listening to music. Throughout each conversation we’ve had with Aaron, he’s mentioned his love for music. He’s now noticed that listening to songs he’s heard before might take some getting used to. “When I hear songs that I know, I hear instruments that I didn’t pick up on before. I even asked my wife, is that a remix?” Aaron’s been experimenting with his playlist, seeing which songs are changed now, just by sounding so slightly different.

While Aaron is personally exploring changes, others are taking notice too. One of the benefits that many Ponto users experience is being able to hear well in a group. Particularly, a meeting room or dining table with many people. So, this time, it wasn’t Aaron pointing out the change, it was the group members he met with. “I went to a meeting with a long board-room-like table, the table was long enough to fit about 20 people. When we finished the meeting, the group mentioned that they could actually tell that I could hear better. I would turn my head as a new person spoke, paying attention in a quicker and more focused way.”

A not-so-subtle change that Aaron was expecting is the noise level around his house. He knew that living in downtown Dallas would be a different experience with his Ponto Pro. “Of course I expected to hear the crowds on the weekends, but I can also hear the cars driving down the service road. It’s louder to live here than I thought,” Aaron realized.

Although Aaron will tell you, he’s still adjusting to his Ponto, he’s learning a lot and has a very valuable suggestion. That’s to use the clip that ensures the device won’t fall to the ground if it comes off– at least for the first couple of weeks. “I’d only had my Ponto for about 20 minutes, and as I was getting into the car, I bumped my head on the window. It didn’t get damaged when it feel to the floor, but I don’t want to have to live without it now that I finally have it.”

One of the parts of the experience that Aaron enjoyed the most was getting his device programmed by Johanna Whitson, Au.D., CCC-A of Southwestern Medical Center. “I’ve heard that the software makes a huge different in the sound quality,” Aaron mentioned. And, he’s right, not only is it incredible and interesting, we spend a lot of time ensuring that the software is part of the quality experience. (Foreshadowing: We see a blog post of its own on this topic coming up soon).

We’ll continue to follow Aaron throughout his journey of getting used to all of the little things that have changed. He’s already inspired by how much those little things have contributed to such a different way of living life.

Do you have a question for Aaron? You can always ask him in the comments section below. Also, we’d like to take the time to thank Aaron for sharing his experience. It’s been incredible to be a part of the change in a Ponto user’s life in a whole new way. You can read the full series here.

If you’d like to share your story, you can let us know here.

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Minimally Invasive Procedure Increases Tissue Preservation for Better Patient Outcomes

Daniel H. Coelho, MD, FACSDaniel H. Coelho, MD, FACS specializes in Otologic & Neurotologic Surgery. He is assistant professor of Otolaryngology, Physiology and Biophysics, and he’s the director at the Cochlear Implant Center at Virginia Commonwealth University School of Medicine in Richmond, Virginia. Following his training in Otolaryngology, Dr. Daniel Coelho completed a two-year fellowship in skull-base surgery. He began practicing minimally invasive linear surgery 5 years ago, and was an early developer of the punch method about two years ago. 

“On day one of medical school we learned that you have to respect the tissue.”

Progressive surgeons like Dr. Coelho spend a great deal of their time studying outcomes and working together to improve surgical procedures. Yet, very few patients are aware of the surgical implant techniques used for bone anchored hearing devices. Many only know of the traditional skin-graft technique, which causes a visible scar and frequently results in skin overgrowth and post-surgical irritation. Today, we’re sharing information about a new technique that Dr. Coelho uses. It’s a minimally invasive technique to optimize tissue preservation.

The procedure takes about 10 minutes and is typically done under local anesthesia. As most users have experienced, patients can expect a bit of soreness for a few days afterward. But, with little pain and no narcotics, patients can go back to work or normal routines the day after the procedure. This is all because the whole process is designed with tissue preservation in mind.

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Tissue preservation is important for several reasons. It contributes to a very short amount of recovery time, and there’s little -to-no scaring and no hair removal. The bottom line is that the tissue preservation is minimally invasive, which improves overall results.

The fact that the procedure is minimally invasive is the most important aspect of a surgical procedure. “The more trauma there is, the more inflammation and scarring. While scarring isn’t ideal cosmetically, it also means less predictable tissue – the implant and the abutment are foreign objects that the tissue can work to reject,” Dr. Coelho explained.

Tissue preservation is incredibly important in function—it’s one of the most important aspects of the surgery. And it’s all possible since the introduction of longer abutments. “The Ponto is an excellent product and a major advancement was the development of the longer abutment. With a longer abutment, it’s no longer necessary to thin out the tissue to prevent the processor from touching the skin. If you’re going to be doing tissue thinning and suturing, those are traumatic to the skin and soft tissue and may result in an increased inflammation. Inflammation can lead to scarring, tissue overgrowth, loss of sound quality and eventually to non-use.” As as an added benefit, less tissue inflammation also yields excellent cosmetic outcomes.

In the 70-80’s, an abutment was 5 mm or less. “The only way to get the processors to function without rubbing against the skin (and compromising sound quality) was by undermining the skin” Dr. Coelho recalls. “Once the new, longer abutment came out, and the sound quality was shown to be equal, it showed that any additional skin manipulation was not necessary.” Oticon Medical was a leader in introducing the longer abutments, giving surgeons increased flexibility to adapt to individual variations in skin thickness and accommodating new clinical developments in surgical techniques, including tissue preservation.

The improved technology enables medical providers to focus on other factors like continuously iterating surgery to be as minimally invasive as possible. “Patients are happy with the functionality and the great cosmetic outcomes— it’s truly as minimally invasive as you can get.”

Melissa Tumblin, founder of Ear Community asked Dr. Coelho, “What are the common concerns about skin irritation? What do you recommend other than the cortisone cream and general cleanly maintenance?”

“First of all, hygiene shouldn’t be blamed for everything. Some people just have a more robust reaction to that foreign object—just like people have allergies worse than others.” Dr. Coelho explains that some people even clean too frequently, which can irritate the area even more.

Dr. Coelho has had no skin overgrowth, as of 2-year follow-ups, with his own patients that received their implant via the punch technique. When he does treat overgrowth, it’s in patients who had the traditional technique. For overgrowth, Dr. Coelho uses clobetasol cream, a topical steroid to help reduce the number of surgical revisions. But, he points out that there is a longer term solution. “Surgical revisions only buy time, they do not actually fix the underlying problem. But, the longer abutments theoretically do. Because it’s such a simple procedure to switch, people who were getting the steroid shots are now making the change. The abutment change procedure is done in the office and takes seconds—some insurance companies are covering the abutment switch.” Patients can also immediately go back to wearing their processor unlike some of the corrective treatments.

Overall, more surgeons are slowly, yet surely, implementing the minimally invasive procedure. Dr. Coelho predicts that within 5 years it will be the standard. “Surgeons learn from colleagues, conferences, journals and the industry as well. People expect to see a divide between industry and medical providers, but many technological advances are made by industry organizations or through a collaboration with clinical professionals – this open line of communication benefits everyone.”

Help us spread the word about tissue preservation by sharing this post. If you have questions about Ponto, bone anchored devices or implant surgery, let us know in the comments below or on Facebook or Twitter.

Regan Lee’s Big Day

We were lucky enough to take part in Regan Lee’s big day– his device fitting. Tricia Nechodom, Au.D., F/AAA, Doctor of Audiology at Trinity Health Center was kind enough to share photos.

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“We saw Regan Lee for his device fitting yesterday and here are some pictures of the day! I [Tricia] am on the left, Sarah (Regan’s mom) is holding him and Dr. Jerrica Maxson, Audiologist, is on the right. Jerrica was the audiologist who diagnosed initial hearing loss via ABR and did much of the initial counseling with Regan’s family prior to my arrival at Trinity, Tricia shared. “As I fit all of our osseo-integrated devices, I am his lead Audiologist but we team on all of our kids with hearing loss for best outcomes.”

Do you have photos of your big day? We’d love for you to share in the comments section below, or on Facebook or Twitter.