BAHA Site Swelling - Help

[Ancora Imparo Girl]

I had the BAHA sleeper insertion at the same time I had my tumor removal on 5/4/11. Healing of the incision was great and recovery superb. On 8/10/11 I had another surgery to have the BAHA abutment put in. Doctor was able to use same translab incision as the May surgery and everything went off without a hitch.

Here are my questions. First of all, let me state that I hate anything medical and I am not one to call the doctor unless I feel like I am dying or unless I am gushing blood.

1. My head (skull) around the abutment seems very swollen and the abutment seems very concave. From what you have experienced, is this normal?
2. I can feel the swelling go up and down. I've tried ice and it seems to help a little. My doctor prescribed Clobetasol cream to help with the swelling. It's helping a little.
3. When I lay down my BAHA side of my head seems to get really tight and uncomfortable (never really painful). I sometimes feel like I have to hold my hand over it when I get up.
4. This is going to sound weird, but I feel like the whole abutment area has dropped slightly from the date of surgery and is closer to my ear. Is this possible?
5. I am four weeks postop from getting the abutment and it's still red and scabby and slightly oogie looking (so girly, I know). Is that normal?

I am set for activation on the 14th and I am nervous that the device won't fit due to the swelling.

What are your thoughts on these questions and your experience? Am I being paranoid? Is this all normal? Advice?

Thank you.

Joey Mechelle

[leapyrtwins]

Joey -

not sure what a BAHA "sleeper" is, but my implant was done 9 months after my AN surgery.  I'm guessing that the sleeper is part of the combo surgery.

The BAHA "site" (the area where the rod and abutment lie) does sink after the implant, leaving a concave spot.  As the sinking occurs, the abutment actually gets closer to the skull; this is normal.

Red, scabby, oogie aren't normal - sounds like an infection; call your doctor as much as you hate to.  Better safe than sorry.

I didn't experience the side of my head feeling tight and uncomfortable, so to me this isn't normal but maybe it's normal for others (?)  I'll let them speak for themselves.

The whole abutment area "dropping" and becoming closer to your ear isn't normal.  This didn't happen to me and IMO it shouldn't happen to anyone.  While the site sinks, the abutment doesn't move; even when it's calcifying.

I never experienced swelling, but know others who did and used Clobestasol cream - it's normally prescribed.  If it's only helping a little, ask your doc if he can give you something else (maybe something stronger).

I would not wait until the 14th to touch base with your doctor.  If things continue the way they are IMO you won't be able to wear your processor on the 14th.  Better to call your doc now so you get the issues resolved so you're on track for the 14th.

Docs are used to getting calls about things, especially about issues like this.  Don't feel bad, don't hesitate - it's all part of their job.

Good luck - and, please keep us posted.

Best,

Jan

[mellowrama]

You might be have "skin sag"...my new doc (the initial surgeon never acknowledged a problem) diagnosed me...has to do with your head position during surgery, having excess flesh around the post.  When I wore the BAHA, it would rub up against the area irritating it even more.. I went on with this situation for more than a year after the surgery with multiple complications.  In my case a revision surgery fixed it. 

I too had a lot of inflammation, etc.  I would clean the area well a couple of times daily, and treat the new skin delicately.  Clobetasol is a steroid right?  I'm using it now to help the skin grow closer to the abutment...maybe you're using too much?  I was told to use it lightly...

[CHD63]

Joey Mechelle .....

I'm with Jan ..... I would get in touch with my doctor.  I've never heard of a BAHA sleeper insertion either.  My Oticon Ponto abutment was put in at the same time as my translab surgery.  I never had any swelling nor oozing from it ..... but I know others have.

If it is an infection, the skin can degrade very rapidly, so you need to have a doctor look at it soon.  Much better than riding it out, thinking it will get better, and if it doesn't ...... causing a whole lot more problems.

Many thoughts and prayers.

Clarice

[lori67]

The sleeper screw is an extra screw put in just above or below the actual abutment.  I'm not sure if all doctors do it, but mine did.  It's kind of like a "Plan B".  If anything ever happens to the post the abutment is attached to, all they'd have to do is make a small incision in the skin and reattach the abutment to the sleeper screw.  It keeps them from having to do another surgery and waiting until it heals and ossifies if anything ever happens to the first one.  It's like having a spare tire.  I can feel mine under the skin.  I've never had any problems with it.

Clobetasol is a steroid cream.  It helps to keep the skin from growing up over the abutment.  I had some problems the first year with just random incidents of swelling.  I'd put the clobetasol on at night and it would usually be fine by morning.  I keep it on hand now just in case.  Sometimes if I feel the area is getting a little irritated or anything, I'll put some on.

Joey Mechelle,  if the area is still red and oogy looking, you might need to be using an antibiotic ointment on there.  If Neosporin doesn't help, you might need something stronger like Bactroban (prescription cream).  Make sure you're gentle with the area when shampooing your hair so you don't irritate it even more.  Definitely have your doctor look at it so it won't delay your "gotcha" day for your processor.  I used to just e-mail pictures of the site to my doctor so he could let me know if it was something he needed me to come in for or something I could manage on my own.  Saved me a few trips!

Good luck!!
Lori

[Ancora Imparo Girl]

Thank you all so much for your responses, thoughts and suggestions! You are the best! And so darn knowledgeable.

I called my doctor, and as suggested, I emailed a picture. He says it looks just fine and told me to keep applying the cream. He did cancel my activation date next week and I will see him on the 19th and we will go from there. I am bummed, but better safe than sorry.

I am so excited about my "turn on" date, I can't stand it.

This forum is such help for me and others - thank you all for being here and sharing. I feel less alone in this journey knowing you are all with me.

xo,
Joey Mechelle

[leapyrtwins]

Lori -

thanks for the explanation of the sleeper.  After reading your post I remembered hearing about this before.  I don't have a sleeper; don't think my doc believes in them.

Joey -

glad things are okay with your site.  Sorry to hear your Gotcha Day has been delayed, but if that's the worst of it that's not too bad.

Hang in there, it's well worth the wait.  In the meantime if you gently rub your fingertip across your abutment you'll hear that sound, which always made me smile while awaiting my own Gotcha Day 

Best,

Jan

[Ancora Imparo Girl]

Hi Jan!

My doc hasn't done too many simultaneous tumor removal/BAHA insertions, but I (and he) know they are doing a lot at the House Clinic. I think his thinking was that I could heal from both surgeries at the same time and the implant could heal to the bone (or whatever that fancy word they use is) and then the second stage would be simple. Oddly, the second surgery seems to be slightly harder on me. Not hard enough for me to stay home from work or anything, but the heeling has been more of a pain. I wonder why.

When I rub my fingertip over it, or even when my hair brushes against it, I can hear it and I get so giddy. I can't wait to be activated. It may be next Monday - fingers crossed.

Thanks and have a great week,
Joey

[nftwoed]

Hi Jan;

  Must say my Neurotologist told me 3 surgeries is about where diminising results and complications begin to arise. assuming you had Translab, there probably is quite a bit of scar tissue from each surgery, whether Translab, or MCF.
  Multiple surgeries is often an area those with NF-2 find themelves in ( 5+ ) and also more morbidities.
  Best wishes with the BAHA!


 

Hi Jan!

My doc hasn't done too many simultaneous tumor removal/BAHA insertions, but I (and he) know they are doing a lot at the House Clinic. I think his thinking was that I could heal from both surgeries at the same time and the implant could heal to the bone (or whatever that fancy word they use is) and then the second stage would be simple. Oddly, the second surgery seems to be slightly harder on me. Not hard enough for me to stay home from work or anything, but the heeling has been more of a pain. I wonder why.

When I rub my fingertip over it, or even when my hair brushes against it, I can hear it and I get so giddy. I can't wait to be activated. It may be next Monday - fingers crossed.

Thanks and have a great week,
Joey

[leapyrtwins]

As I mentioned earlier, some docs combine AN surgery and BAHA surgery and some don't.  It's a personal preference.

My doc doesn't combine the surgeries, but I never asked him why.  I have heard that some docs think it's enough for a patient to recover from AN surgery and don't want to add BAHA recovery to the mix - although it's typically a fast healing without complications.

Joey, the word you are looking for is calcification.

Nftwoed, I've had my BAHA for over 3 years now; but I'll still take the best wishes 

Jan

[CHD63]

My doctor used the word "osseointegration."  Wikipedia says:  Osseointegration derives from the Greek osteon, bone, and the Latin integrare, to make whole. The term refers to the direct structural and functional connection between living bone and the surface of a load-bearing artificial implant. Osseointegration has enhanced the science of medical bone, and joint replacement techniques.

It was explained to me in laymen's terms that the skull has to accept the titanium and fully integrate it into the bone and that can take anywhere from 4 to 12 weeks ..... sometimes longer.  That's why the FDA would only give approval for the processors to be attached three months after post implant.  (Although I know of a few people who have attached them sooner.)

Clarice

[leapyrtwins]

That's why the FDA would only give approval for the processors to be attached three months after post implant. 

The "old" waiting period was 90 days, but about a year ago Cochlear started to use different implantation "material" - the same stuff used for dental implants - which doesn't require as long a waiting period because calcification or osseointegration occurs faster.  I can't recall what the "new" waiting period is, but I know it's less than 90 days and to my knowledge the FDA has approved it, at least for Cochlear products; I can't speak for Oticon products as I don't keep up with their practices.

From what I've heard, even though Cochlear doesn't think 90 days is necessary, most docs are still making their patients wait that long.  Seems they typically like to err on the side of caution.  Can't say I blame them.

Jan

[james e]

My abutment was installed during my tumor removal, and the site was closed over without exposing the abutment. Only a small slit was made in my scalp instead of the flap, and the area was not hollowed out. About three months later, I had the scalp opened, and the area around the abutment was hollowed out, and I plugged in about a week later. My scalp stayed numb for almost a year, and it now feels totally normal. No problem with infection, but the numb scalp bothered me at times. I had some swelling months later, but it was some stitches  that were working their way out. I think I still have one small one trying to work its way out, and I hope it is the last one.

James