If we had a keen vision of all that is ordinary in human life, it would be like hearing the grass grow or the squirrel's heart beat, and we should die of that roar which is the other side of silence - George Eliot
Hearing
Conductive Hearing Loss
Following the surgery to remove my tumour I was left with conductive hearing loss in my right ear. This means that the inner ear is still working but there is no way for the sound waves to reach it. My surgery had removed most of my ear canal and the surrounding bone and left me with a large cavity that was sealed off from the inner ear. It was a small price to pay for removing the tumour but it did mean that I was hearing impaired.
As I returned to work the necessary occupational health assessment reported my need for time to adjust to single-sided hearing loss. At the same time my cancer consultant arranged a referral to an ENT surgeon to discuss my suitability for a bone-anchored hearing aid, often referred to as a BAHA. This type of conductive hearing aid captures sound and then amplifies this directly into the bone near the ear enabling the inner ear to hear. In order to work a titanium abutment has to be surgically anchored into the bone. This then requires a period of three to six months for osseointegration, the process of bone growing in and around the implant. Once this is complete the hearing aid can be loaded on to it.`
In July 2012 I was admitted for my day surgery. I caught an early train as I needed to be at the hospital by 8am. After a little wondering around the hospital due to an error on my admission letter I eventually found where I needed to be. After this everything was generally straightforward. The usual checks that I hadn't eaten or drunk anything since the night before. After signing the paperwork, getting dressed in a hospital gown I had a couple of hours wait before my turn to go down to the operating theatre. I had by now become very relaxed with going in to surgery and after a brief chat with the anaethetist and being told to count to ten I was unconscious. I think that I was in surgery for about an hour or so. I woke up back in my bed a little while later and my first thought was when can I have something to eat and drink.
I was glad of some tea and biscuits as the last traces of the anesthetic wore off. After a while I was allowed to get dressed and I rang Catherine to say that I was ready to be discharged soon. By the time that the staff had talked me through my discharge papers and wound care instructions Catherine had arrived in the car to collect me.
I had opted for the surgery at the end of the school term so I could use my summer holiday for the wound to heal. I had the stitches removed at the hospital a week after surgery and then had been given a little plastic cap to keep the abutment clean. Everything looked good at this stage and at the monthly follow-up. After about three months I was judged ready to have the hearing aid fitted.
A few days later I had an appointment with the very helpful audiologist who had assessed my hearing some months earlier. Then I had discovered that I was not hearing about half of all words when in a noisy environment. I think that I had always had weak auditory discrimination skills and the single-sided hearing loss had compounded an existing weakness. The tests then had also confirmed that I could hear conductively through the bone with my right ear and that this significantly improved my perception and understanding of a greater percentage of words. But now I had arrived for the fitting of the hearing aid.
The audiologist showed me how to click the hearing aid on to the abutment. It was fiddly at first but fairly easy once I knew what to do. The BAHA hearing aid is a digital device meaning it could be very accurately tuned to match the different frequencies that my inner ear was naturally better or worse at hearing. The audiologist patiently tuned and retuned the device until we were both happy that we had the best set up. Wearing the hearing aid opened up the soundscape around me as I became aware of so many environmental sounds. Some of these sounds the audiologist tuned down so that they didn't intrude but generally I had a much better range of hearing than before. As I had cycled to the hospital I carefully stored the hearing aid away in its box before setting off home with it.
The BAHA hearing aid made a significant difference to my ability to hear at work and when out in social groups. I could now have someone sat on my right and be able to have a conversation with them in situations when others were talking. It also made listening to music a more stereo experience. I found that wearing the BAHA while driving took some adjustment as it amplified the sound of passing cars.
The BAHA was positioned just behind my ear. Because of the permanent hair loss, due radiotherapy, my hearing aid was more visible that it is for many people. In spite of this, most people didn't notice it or at least comment on it. However, when working with young children there were a few instances of enquiry about what it was. One memorable occasion, a boy with a range of complex needs including impulsivity and poor understanding of social rules just blurted out loudly in class "what's that thing, mister?". Over the next few years the boy continued to refer to me as 'the man with the thing on his head.'
I did find occasions when I would deliberately point out the hearing aid to people. Firstly, when I was delivering training to groups of teachers and other school staff. I did this partly to eliminate any distraction it might cause in having people wondering exactly what it was. I also felt that in showing that I was overcoming a special need and therefore demonstrating exactly what I was expecting the staff to do in the subject matter of my training i.e. to help children overcome a specific challenge or need. Secondly, I did find that the hearing aid being a clear visual sign of my deafness I could use it as leverage in challenging and overheating meetings to remind people not to talk over one another.
The hearing aid was a great benefit and I used it all the time. Unfortunately, just over a year after the abutment was fitted it came away as I took off a t-shirt. An emergency appointment at the audiology department, a few days later, confirmed that the implant had completely failed and it was mostly likely due to osteoradionecrosis. This bone death was preventing the abutment naturally healing itself and make the abutment solidly and securely anchored to the bone. This was a terrible blow as I relied so much on the hearing aid.
A few weeks later I met with the surgeon and he suggested that we try again with a second abutment. This required the submission of a funding bid and a couple months later I was gratefully given the green light for it. So at the beginning of December I was back in surgery having a second abutment fitted. Again I then had a wait of over three months to let the bone and skin heal around the abutment.
By April I was again using the hearing aid and reaping the benefits of it. I took particular care when getting dress and undressed to ensure that I didn't catch the abutment. However, on Boxing Day my daughter went to give me a hug and bumped heads and dislodged the abutment. It hung precariously for a couple of days but finally dropped off before I got to an emergency hospital appointment. Again osteoradionecrosis was the main reason for its lack of robustness.
At the beginning of the new year I met with the surgeon again. He didn't rule out a third attempt at a BAHA implant but we both agreed that given the failure of each abutment about a year after fitting it was difficult to justify a third attempt. I was also a little reluctant to have another hole in my head. He suggested therefore that I be referred back to the audiologist for a crossover hearing aid.
A few months later I was back at the audiologist being talked through the use of my new hearing aid. This involves wearing a microphone that sits on my right ear and a hearing aid that fits in my good left ear. Sounds that are coming from my right are then wirelessly transmitted by the microphone to the hearing aid making it possible to hear people on my right more clearly. Personally, I have not found it very useful as wearing the hearing aid in my good ear reduces the effectiveness of my natural hearing with that ear and can feel a little uncomfortable. You need to carry two sets of batteries and they don't seem to last very long. Finally, they are not secure enough to wear when do active things. This has led me to use them rarely, when I have anticipated a use and remembered both them and spare batteries.
I feel rather guilty that I have not made a lot of use out of this expensive equipment but I have also become more adapted to my single sided deafness. I have become more confident in reminding people that I can't hear when they are on my right and organising situations so that I can hear best. I try to avoid noisy environments and I still lack any sense of direction of where a sound comes from. This means that sometimes I look around me in all directions trying to work out who has just said something. I can tell when a sound is louder or quieter so can eventually find my mobile phone by moving round the house.
Being hard of hearing does impact on my comprehension. I can find it quite frustrating when I miss an important part of what someone is saying and need to ask them to repeat it. My family are very understanding but there are times when I interrupt to ask them what they are saying because I can't hear and they reply 'nothing important'. Sometimes it is not clear whether I am supposed to be part of a conversation or not. I can often miss out on just overhearing background conversations which are just family chit-chat and thus opportunities to join in and keep up with trivial family news. However, these are relatively minor inconveniences and generally I cope well and can do everyday things like listening to music and watching TV like everyone else.
