ANA Discussion Forum
General Category => Hearing Issues => Topic started by: kixit on August 10, 2012, 04:17:37 pm
-
I had my 10 day post-op appt for the Baha surgery today at UVA. Didn't get good news :( The doctor said the bone wasn't growing to the implant, it was loose on one side. He also said that we are just over a week post-op so he's not discouraged yet. I asked what happens if it doesn't osseointergrate--he replied with it will just fall out and we will start over ;D. Possible reason for no growth is weak bone due to AN surgery.
I have to wear the healing cap until next appt (9/14) and it's best not to get the surgical site wet (I'm beach bound next week but was given the okay to go in the water but not submerge my head in the ocean or pool). So it's washing the hair in the shower leaning over to one side (kind of comical due to my balance issues) for another month and gob on the Bacitracin twice daily.
Although I am a little discouraged about the news, I am all so very greatful for the surgery. This year has been a rough one for me but through it all I've seen nothing but God's Grace.
-
Oh my! So sorry!! Not fair after what all you have gone through in this process.
Many, many prayers that it will heal and osseointegrate without further surgery needed!!
Clarice
-
Sorry to hear about this set back.
Although I'm not a doctor and I don't want to second guess yours, I'm puzzled as to why your implant wasn't placed in an area of denser bone right upfront.
I know at least three people who don't have their implant in the "conventional" place (a little bit behind and above the ear), but they only had to go through the implant surgery once. Their docs realized from the start that bone density was an issue for them.
I'm hopeful that your implant will continue to calcify and you won't need to have it placed again.
Prayers,
Jan
-
Thanks for the imput Jan, I was waiting on you to post because of your experience with the Baha. The doctor went further behind the ear>2 1/4 joints of pointer finger< (I wear glasses) and up (like the 1st bend of the finger length), this is the best way I can describe the location.
My daughter watched as he removed the healing cap to inspect the implant. She said it was tight on one side, didn't move at all while the other side was loose just as he had said. He had told me before surgery that he had only had 1 patient not take to it and it was a little boy (childrens bones are thinner?). He re-did that child the day before my appt.
I go back in one month and hopefully all is well. I asked if it was the way I slept (I normally sleep on the AN side but since the surgeries tried not too). When I did catch myself sleeping on the left side somehow subconciously I guess, my hand would cradle the ear/implant site so nothing was touching it.
-
Hmm...
Kixit, I certainly can't give you a medical opinion, but it doesn't sound like your doctor is worried. Do I understand correctly that it takes a full 3 months for complete osseointegration? Seems like ten days is only a small part of that time. A lot can happen between now and 3 months.
I will be thinking about you. Please do give us an update after your next appointment.
Liz
-
I'm not sure how it can be loose on one side and tight on the other. The abutment is titanium, and it screws into your skull. The skin flap might appear loose around the abutment , but the abutment is not just floating around in a hole. I'm sure the bone has not grown into the abutment screw yet...it may have started growing, and 90 days is the norm, but I think some people have plugged in after 60 days. The drill that is used to prep your skull is designed to make a perfect hole, just the right size. It even cuts threads. The most important job for you right now is to tend to your scalp. Keep it clean and dry. You will be really excited when you get to plug in that BAHA!
-
The "equipment" that is implanted isn't just an abutment. It's a titanium rod, which (to my knowledge) doesn't screw into the skull - it's sunken into the skull and depends on the bone of the skull to calcify and hold it in. Which is why poor bone density leads to a loose rod. On top of the titanium rod is the abutment, which is screwed into the rod. The processor is then attached to the abutment. Abutments are easily changed with a screw driver; rods, since they are sunken into the skull, are harder to get out. If the bone calcifies it is very difficult to remove the titanium rod - I read somewhere that they'd actually have to remove the area of the skull that it's sunken into. But rods that aren't calcified aren't that difficult to remove; basically they are "loose".
90 days used to be the norm for calcification, but Cochlear changed their equipment in the not so distance past - the material it's made of now is similar to what is used for dental implants - and supposedly the waiting period is only 60 days. However, not all docs are going with the 60 days, some (like mine who is very conservative) are still sticking to the 90 days.
When I had my first post implant appt. with my doc, he never mentioned whether or not it was calcifying so I can't tell you where my implant was "at" 10 days after my surgery.
As Liz said, 10 days out of 90 is a pretty short time frame and a lot can happen in the interim, plus we all heal differently and at different rates. Maybe what takes one person 10 days to accomplish takes another 20.
In the meantime, I'm keeping my fingers crossed :)
Jan
-
Awww Liz...sorry to hear about your possible issue...I do hope that thing takes. While I didn't have the bone issue, it was the skin around my abutment that I had major issues with. But all is good now and am enjoying the heck out of my BAHA. Let us know how it goes! Take care!
Jay
-
Well peeps it fell off! I cleaned the area last night. I woke up this morning and checked it, it was still there. I made my bed and sat down I felt something hanging in my hair. There it was, the healing cap with abutment.
-
Hey Liz!
I was typing and you replied that it fell off! That's awful! I'm still going to post what I typed though, because I hope you'll do it again, just maybe this time he'll find better bone. My quack ENT that I didn't use actually did a CAT scan to "find bone" - I personally think it's because he has a private scanner and staff and needs to fund them....but maybe there's something to this procedure in your case?
Before you posted about it falling out............
I'm somewhat where you are in the surgical journey, but am blessed with a great implant happening. (implant 8/3/12) Here's my question - would you taking additional calcium (I do because I have osteopenia) and also something I take called Strontium that promotes building of healthy bone..... I would also think maybe allowing a little sun exposure in the earliest part of the day would be healthy as well to encourage healing....? I'm not sure if this has had any impact on my healing because the surgeon was crowing about how great the bone was that he put the implant into....but I would think logically if the body can heal broken bones to the point where the break is stronger than the original bone was, it just might....
Pam
-
Sorry to hear it fell out. Jan, a titanium screw is screwed into the skull, after the skull is drilled into and then threaded. The abutment is then screwed into the titanium implant. You can see pictures of it on Cochlear's web site. The implant is not just left in a void, hoping the bone will grow into it.
-
I'm just learning, but since bone is a growing living thing I would imagine that the "snugness" (if that's a word) is the issue alng with the bone incorporating this new foreign object and growing around it to "firm" up the implant? I know from feeding animals raw meat that bone is really quite soft when not cooked - resulting in a need for the body to make its own changes around the implant. Otherwise we'd get a processor the day of the implantation surgery....right? So helping the body to do this nutritionally isn't too far off the mark....right?
Pam
-
I just heard back from UVA. I am to keep the area clean and continue to apply the Bacitracin ointment. I hope the insurance company doesn't give me any flak about fixing or re-doing the Baha implant.
Thanks for your support everyone!
Rhonda (not Liz..lol)
-
Rhonda .....
So very puzzled as to how that could happen ..... certainly not the norm for these things. UVA should not charge you for a redo if the doctor did not place it in solid bone ..... just my humble opinion.
When do you return to the doctor to have it checked?
Clarice
-
I am sure this will work out for you. There are always a few bumps in the road, and this one will soon be in the past. UVA is a beautiful school, and you will get the best treatment available. My fingers are crossed for you!
-
Clarice,
I return for a recheck Sept 14th. I am assuming this Baha surgical site will need to heal before another attempt. I bought some calcium supplements to help strengthen my bones.
-
Jan, a titanium screw is screwed into the skull, after the skull is drilled into and then threaded.
Just looked all over the Cochlear website and find nothing that talks about the titanium implant being a screw or being screwed into the skull. Yes, it has threads but they talk about it being "placed" in the skull. Whatever.
Back to the topic at hand.
Rhonda -
sorry to hear that your implant has fallen out, but on the bright side at least now the doc won't have to remove it in order to start over.
He should be able to find another place on your skull where the bone is denser and hopefully that will give you the end result you need.
My partner in crime, Lori (lori67) has her implant placed way back on her skull - pretty much at the base where you'd typically put a rubberband when putting your hair in a pony tail. The placement works well for her; she's had it for years.
Best,
Jan
-
Wow, Rhonda, you sure have had more than your share of bumps in this road to BAHA. I agree with Clarice - UVA should not charge you for a redo, so there should be no problem with your insurance. UVA and your surgeon should take full responsibility.
Just want to make sure I understand exactly what happened - the actual implant came out of your skull - it's not just that the abutment came off of the rod?
Liz
-
There are several BAHA videos on the net that show a hole being drilled into the skull. A long rod is attached to the drill that shows the doc that a vertical hole is being drilled. The hole is then sized and the titanium screw is attached to the drill, and screwed into the skull. Water is dripped onto the skull to keep the skull cool. The screw should not fall out on its own. I am sure it can be reinstalled in a better place, and life will go on.
James
-
@Liz-
What I have in a baggie is the healing cap with the abutment with a triangular (3 to 4 mm) end. I don't know if the triangular end is the part screwed into the bone. I was told there was nothing to do at this point just keep the area clean and apply copious (sp?) amounts of Bacitracin. I am assuming that the area will have to heal before the next Baha attempt. My second recheck appt is 9/14 for this Baha surgery.
-
I have heard from reliable sources that Cochlear changed the abutment formation to prevent cross use of the processor with Oticon's version.....curious if the changed the screw or just the abutment. Have an appointment today with my ENT and will ask!!!!
Pam
-
There are 3 components that make up what most of us call the abutment, and to call it that is just a generic term to me. There is a titanium post that is threaded. There is a tiny gold screw, and there is the abutment. The titanium post is screwed into a hole that is drilled in the skull. The abutment looks like a small coffee cup that does not have a handle. The gold screw runs through the abutment, and is screwed into the titanium post. Your skull grows into the titanium post. The BAHA snaps onto the abutment, and then you can hear.
I routinely refer to the components as the abutment. Jan and I have the old style abutment and it will accept other BAHAs. You very likely have the new abutment, and only the Cochlear BAHA will fit it. You can watch a BAHA surgery on youtube...very interesting.
I am a Virginia boy...Norfolk. I went to Va Tech and my brother has a bachelor and masters from UVa. That is beautiful country out there. I am wishing you the very best luck. It will all work out well in the end.
James
-
Thanks James! I am actually in your area this week vacationing at Va Beach (I am from Roanoke). I looked at the abutment again and well everything is there, the abutment and screw. It wasnt backwards it just didnt drop through the triangular area because of dried debris.
UVA is a wonderful medical facility and they treat me well there.
-
Just returned from my followup appt. and asked about this whole situation. ENT gave a few reasons that this could happen.....none of which was that the bone location wasn't good. He said:
1. Infection in the site can cause the bone to reject the implant
2. poor healing in general
3. bone that has been irradiated....it doesn't heal well at all....
Pam
-
The Baha site is healing nicely. No sign of infection but I am having some on/off stabbing pain around the area but the not surgical site itself. I do see the permenant hairloss area :( where it was to be.
I wonder how long I will have to wait before another attempt? I guess I'll find out when I have my follow appt on 9/14 but the waiting is killing me, lol.
Family and friends are "trying" to be funny by saying "she really does have a screw loose". My reply is --no I lost my screw and the contents that went with it!! Ahhh, all I can do is laugh at this point :D
-
I can't imagine having to wait that long! Have they given you a reason why such a long wait? To let it heal?
Pam
-
I have heard from reliable sources that Cochlear changed the abutment formation to prevent cross use of the processor with Oticon's version.....curious if the changed the screw or just the abutment.
This is something that happened approximately 2 years ago. Cochlear changed their "equipment" - rod, abutment, etc., - so that those that opt for a Cochlear BAHA implant can no longer use an Oticon processor; the processor won't fit.
I use the word "equipment" because it's not just the abutment - which is the part that the processor attaches to. Abutment changes are very simple - done with a screw driver in the doc's office. When Cochlear bought out Entific they changed abutments and those with Entific abutments who wanted to upgrade had to have their abutments changed to Cochlear ones.
This isn't possible with the new Cochlear equipment; you can't just have an abutment change and use an Oticon processor. Seems Cochlear decided they didn't want to share their BAHA processor monopoly with Oticon when they entered the market a few years ago.
As James mentioned, he and I have the older Cochlear equipment so we can use Oticon as well as Cochlear processors; but at this point, I have no intention of switching. I never had an issue with my Cochlear Divino - which still works - and although I had some slight issues with my Cochlear BP100 when I first got it, they were all resolved.
Jan
-
Just returned from my followup appt. and asked about this whole situation. ENT gave a few reasons that this could happen.....none of which was that the bone location wasn't good.
I know someone with bilateral BAHAs - not an AN patient, he was born with Treacher Collins Syndrome - who had both of his implants fall out years after they were implanted. So, bone location / density can definitely be an issue.
Jan
-
Ok Baha veterans I need some imput. I just located a picture of abutment with titanium screw. I was oh so wrong (happily I think). The whole implant didn't fall out, just the abutment with healing cap. The screw is still in-somewhere. The hole is closing up. Any imput on what could possibly happen next? Can they surgeon open it back up and screw the abutment back on? I will contact him in the morning but would like your opinion.
Thanks!!
-
You are lucky. Yes they can open your scalp, and put a new abutment and gold screw in! I had a translab surgery just like you did, and my doc also did my BAHA surgery at the same time. He installed the titanium post and sewed me back up. Three months later, he scalped me, and installed the abutment and screw. Get your doc to look at the post and make sure the angle is correct. Lucky You!!!!!!!
James
-
I had my veterinarian peeps take an xray of my head this evening. I'm sad to report--no screw located just the hole in the skull where it was :'( So it's surgery #3 for me I suppose. I'm sure that will be topic #1 at my recheck appt on 9/14. I'm asking myself what did I do wrong, if anything? I cleaned it as instructed, didn't mess with it, didn't sleep on it, kept it as dry as possible--it just fell out.
The doctor said he would do a re-do. I asked him if I was going to have to fight Anthem again. He said no, they HAVE TO fix it. I said you tell them that >:D
-
So sorry you are having to go through all this again.
I just came back from a Patient Advocacy week-end at the Oticon Medical headquarters in New Jersey. There was some discussion about patients who failed to osseointegrate, like you. In some cases, patients have very porous bones and have more problems with this. Oticon now has different diameter posts (screw same size so all Oticon abutments will fit on all) to accommodate those patients who need it. I have no idea about Cochlear posts, but wondering if you can ask your surgeon if that is an option for the re-try.
Just my thoughts .....
Many prayers!
Clarice
-
Titanium screw still in place! Defective abutment--will insert a new one and get the processor the first week in November!! 8)
-
I read your other post ..... what a weird thing to have happen. Hopefully the rest of it will go smoothly!!
Prayers.
Clarice