HH/Beck: Good Morning Dr. Metz. It is a pleasure to speak with you.
Metz: Hi Dr. Beck. Thanks for the invitation.
HH/Beck: If you don't mind, before we get to the topics at hand, would you please tell us a little about your education and profession?
Metz: Sure. I'm a 1983 graduate of the National College of Chiropractic, which is located in Lombard, Illinois. I've practiced in Illinois, Idaho, and Connecticut. After practicing 10 years, I began to work for Aetna Health Plans as the medical director responsible for chiropractic services. After working there for a number of years I transferred to American Specialty Health, Inc. in San Diego, California, and I now work for them as their Clinical Director and Health Services Officer.
HH/Beck: Very good, thank you. Let's talk a little bit about your hearing loss and your experiences related to your hearing. When did you first notice your hearing loss?
Metz: I first noticed my hearing loss in late 1995, and it wasn't until 1996 that I actually had it diagnosed! I noticed the hearing loss on a business trip. I was using an airplane headset and I noticed the left side of the headset wasn't working properly. Out of frustration I turned the headset around, changed ears, and found out that the other side of the headset was also not working! That's when I realized it was my left ear that was actually not working. I asked some of the doctors I worked with about sudden sensorineural hearing loss. As you know, and is the case for most male doctors, we tend to defer and deny that there might be something wrong. I did that for quite some time until a colleague convinced me to go see an ear doctor. I finally ended up with an ear, nose and throat doc who diagnosed an acoustic neuroma, about 4 centimeters in size.
HH/Beck: That really is an unusually large acoustic neuroma! Generally they're discovered before they grow to be that large. For the readers not familiar with acoustic neuromas, they are benign tumors. They generally occur within the cerbellopontine angle or the internal auditory canal. If they continue to grow, as yours was doing, they can cause brainstem compression, and the signs and symptoms of a space occupying lesion of that size, in that location are vast and can indeed lead to death.
Metz: Yes, that's what they told me. Generally, symptoms such as tinnitus or unilateral hearing loss, or balance problems bring the patients in to a doctor's office when the tumor is smaller.
HH/Beck: It must've been devastating to receive the diagnosis -- although I'll bet you had an idea as to what the diagnosis was before the MRI came back?
Metz: Yes, I think I probably anticipated the diagnosis, but I am a male, and a doctor, and so denial was an option for a long time! Anyway, I was scheduled for surgery in 1996 and I had a translabyrinthine (TLC) craniotomy procedure. Of course, the TLC approach is the approach of choice to get the entire tumor, but the downside is the total loss of hearing on that side. The surgical operation destroys the cochlea in the process of removing the tumor.
HH/Beck: Where was the surgery performed?
Metz: The first surgery was in San Diego, and then a few years later, in 1999 my tumor returned, it was again about 4 centimeters in size. That time I went to Dr. Derald Brackmann, at the House Ear Clinic in Los Angeles; who I understand was your old boss. He removed the tumor and it appears that the tumor has not returned.
HH/Beck: I think any time a patient hears that they have a brain tumor - it must be simply devastating, but to have to go through it a second time - I can't even imagine that.
Metz: It really was hard to believe.
HH/Beck: Please tell me about your experience with hearing aids and amplification.
Metz: After the first surgery, I tried at least half a dozen different hearing aids to help me get past the Single Sided Deafness that the tumor and the surgery had created. In addition to learning about hearing aids I also learned some important lessons about audiologists. One thing I've told many people about is the critical importance of finding an audiologist willing to customize a hearing solution for the particular patient. I'm convinced after talking to many people about their hearing aid experience that the one-size-fits-all approach to hearing loss has little value. My audiologist worked with me to find a device that had the best tone control, the best volume control, the best positional control based on the microphone type, and we ultimately ended up with a Bi-CROS aid.
HH/Beck: For the readers not familiar with the term, CROS is an acronym, it means Contralateral Routing Of Signal. In essence, a CROS hearing aid involves a hearing aid with a microphone on the bad side, which sends the signal to the good side. The sound from the bad side is transmitted via a wired or a wireless circuit, like an FM signal, to the good side. I hope that made sense! The Bi-CROS aspect means that both aids have a microphone, but the sound is sent to the better ear.
Metz: Yes, that's the idea. I started using a Bi-CROS aid and I did okay with it. Not perfect, but better with it that without it. Some time later, we found out the little piece of tumor the first surgeon left on my facial nerve grew back. That's when I went to the House Ear Clinic in Los Angeles, and Drs. Brackmann and Hitzelberger took it out the second time.
During the course of that second surgery Dr. Brackmann indicated to me that he was looking into an experimental hearing treatment, and he asked if I would be interested in looking into that at some future date. I said Yes. Although I liked my Bi-CROS hearing aid, if something better came along, I was willing to give it a try.
About two years after my second surgery, his office contacted me and said they were engaged in a research study on a treatment for Single Sided Deafness called the Baha System. The manufacturer was working towards FDA submission and clearance of the device. Dr. Brackmann asked if I would be interested in having it implanted as one of the study participants. I said Certainly, let's give it a try. So that's how I got the Baha System.
HH/Beck: When was it that you had the titanium implant for the Baha System placed?
Metz: I believe it was in the spring of 2001.
HH/Beck: So you've had the Baha System for almost three years. Please tell me how it compares to the Bi-CROS hearing aid, and please tell me your clinical and personal reflections on the Baha?
Metz: I have found a number of things. The first is the Baha is a very useful device. I find it to be increasingly more effective the longer I've had it. I think my brain is getting used to the sound it produces and when I put it on in the morning I don't even know it's there. That's one major difference between the Baha System and the CROS aid, with the Baha you don't have anything hanging on your ear. In addition, it produces a much clearer sound than the CROS aid. If I put the CROS aid on right now, it sounds like an old radio -- kind of a high treble, crackling sound. The Baha is very clear and has a precise, normal, natural sound. The Baha is exceptionally useful in my work environment. I spend a lot of time in one-on-one chats and committee meetings, and with the Baha, I have hearing capacity from both sides and front and back. I'm able to recognize the person speaking on my bad side and I'm able to acknowledge them and listen to them. Before I had the Baha, I essentially ignored them, not knowing they were there, unless they tapped me on the shoulder.
HH/Beck: Can you localize with the Baha? That is, can you tell where the sound is coming from?
Metz: The more I got used to the Baha System, the better I have been able to localize in small areas. If somebody is within five or six feet of me in a reasonably quiet to slightly noisy environment, I can tell whether that person is on my left or right or in front of me. In a large open space, if somebody were to call my name from across a gymnasium or across a store, I still do my standard pirouette looking around to try to identify where the person is calling from! But again, if there are three or four people standing in a circle talking to each other, I'm able to engage in the full conversation with people on my right and left, even with multiple people talking at the same time.
HH/Beck: Have you tried the Baha directional microphone?
Metz: Yes. It helps substantially because it buffers some of the noise coming in from behind my head, such as a noisy cocktail party environment. I can't say it's perfect, but I am much more socially adept with the directional microphone in a challenging environment, than I am without it.
HH/Beck: With bone conduction hearing, all of your hearing is actually occurring on your good side. So I wonder - do you hear a qualitative difference when somebody's speaking on your right side versus your left side?
Metz: I would say yes, but it's not qualitative, it's quantitative. It's kind of an unusual splitting of hairs, but I do hear a difference. The sound coming in from the Baha side is slightly softer than the nearly identical sound coming in from the hearing side. If I may, it's qualitative in a quantitative sense. The volume of the sound is a little bit quieter on the Baha side. It's a very clear sound, but it's just not as loud.
HH/Beck: So what would happen if you just turned up the volume a little bit?
Metz: If I turn up the volume it would solve that problem, but I would also pick up additional background noise, and that would be distracting, so I prefer it a little quieter.
HH/Beck: Okay, before I let you run, any other points or observations you'd like to make?
Metz: I would like to say there is a perception that skull surgery is risky and dangerous and potentially painful, and debilitating. And certainly brain surgery should be categorized in that manner! But I really would like to emphasize, that for this particular device, the surgery was not even a small problem. Having survived two brain surgeries, the implantation of the Baha System, from my perspective as the patient, was easier than getting a cavity filled. It was an outpatient procedure, I had no pain, no infection. The healing occurred exactly as expected. The device is very easy to maintain on a daily basis and can be worn during all my waking hours, with the exception of when I take a shower, obviously you can't get it wet.
HH/Beck: Do you feel it when you're sleeping? If you roll over on it, do you feel it?
Metz: The external processor is removed at night but the abutment remains anchored in the skull. Regarding the abutment, I can absolutely not tell it is there unless I reach up and touch it. In addition, I can actually hit the abutment with the palm of my hand and I can't feel any sensation or pain difference between the two sides of my head.
HH/Beck: Dr. Metz, it has been a pleasure getting to know you. Thanks for your time and for telling us your story.
Metz: Thank you too, Dr. Beck. The pleasure has been mine.
For more information about the BAHA system, click here.
HH/Beck: Good Morning Dr. Metz. It is a pleasure to speak with you.