AUDIOLOGICAL EVALUATIONS & HEARING IMPLANT MAPPING
At Barrie Tan Hearing and Cochlear Implant Centre, we are equipped with a full suite of various modern audiological evaluation technologies to be able to accurately diagnose the pattern and severity of your hearing loss. This is done in a luxuriously appointed premises where there is ample space to comfortably fit both the patient and also the entire family. The entire audiological evaluation room is professionally sound treated, not just a small booth. Children can therefore be comfortably examined with Auditory Verbal Therapists, Audiologists and Family all in the same room so as to optimise the evaluation by allowing all the various hearing professionals to be in the evaluation setting together at the same time.
Digital plot of a Pure Tone Audiogram
Automated Tympanometry
We are equipped to handle all adults and accommodate wheelchair access comfortably. The following audiometric investigations are offered in our centre:
Pure Tone Audiogram (Bone and Air Conduction)
Tympanograms
Stapedial Reflexes
Speech Discrimination Tests
Aided Audiograms and Speech Discrimination Tests
Our centre is also specially designed and outfitted to perform the entire range of Paediatric Audiological Evaluations for children of all ages from newborns to 16 years of age. The investigations offered include the following:
Otoacoustic Emissions (OAEs)
Auditory Brainstem Responses (ABR)
Auditory Steady State Responses (ASSR)
Visual Response Audiometry (VRA)
Play Audiometry
Central Auditory Processing Disorder (CAPD) Diagnostics
Performing a Pure Tone Audiometry
Large sound-treated room to allow for paediatric evaluations with the whole family in attendance
Our Cochlear Implant centre also provides education of all the available cochlear implant technologies and their accessories. It also affords a comfortable space for the implant technology and rehabilitation professionals to run the necessary mapping (tuning) services in a quiet and large room to accommodate patients and their relatives. There is plenty of education material onsite to facilitate the education and mapping process.
COCHLEAR IMPLANTS
The earliest recipient of the Advanced Bionics Ultra 3D cochlear implant in Singapore with Dr Barrie Tan and the support team from Advanced Bionics
Cochlear implants are a special type of hearing technology that allows patients with profound sensorineural hearing loss to hear well again. From babies born deaf to very elderly patients in their nineties, it is a safe procedure that allows for reliable and high quality hearing for the rest of the patient’s life. What previously was deemed as an irrevocable life of silence is now a world of possibilities with this modern hearing technology.
Most forms of sensorineural hearing loss occurs because the cochlea (hearing organ) does not function properly and it is not able to activate the hearing nerve to pass on the hearing signals. Cochlear implants have a thin electrode inserted into the cochlea that work to directly stimulate the nerve endings of the hearing nerve (cochlear nerve) within the cochlea. This bypasses the cochlear hair cells which are usually the site of the damage. The cochlear nerve is usually functioning well and is able to carry the new hearing signals (electrical stimuli) onwards to the brain for hearing perception.
Immediately after cochlear implant surgery
Wearing the external speech processor
Switch on session of the cochlear implant
Cochlear Implant surgery takes approximately 3 hours to be completed for one side. It requires only a one night overnight stay in hospital. The head bandage is removed the next morning before discharge. Most patients only report mild pain over the wound site. Nowadays, cochlear implant surgery is very safe when it is performed by experienced surgeons. After discharge, the wound is examined 1 week later in clinic and sutures are removed. In children, the sutures are absorbable and there is no need to remove them. Minimal wound care is needed. At 3 weeks after surgery, the cochlear implant device is switched on with an experienced team of audiologists. The device is specially programmed and the patient starts to hear immediately. Now begins the exciting journey of discovering sounds, for some patients it will be for the first time, for others it will be rediscovering sounds all over again that they had not heard for a long time!
Nowadays it is common to perform cochlear implant surgery simultaneously on both ears and even children as young as 1 years old are suitable to undergo such surgery. This affords them the best opportunity to start their hearing journey so that they do not lose out on the precious learning opportunities and the potential of their young brains to develop speech and language. Children born deaf but implanted with cochlear implants have been able to go to mainstream schools and speak like normal children. There is also now a trend towards implanting very elderly patients. The oldest patient that Dr Barrie Tan has personally implanted was 86 years old at the time of the surgery. Do not subscribe to the myth that hearing loss is part and parcel of aging and that you have to just accept it. Even the very old can hear well with all the hearing technologies available today!
Soon after surgery
Just before bilateral cochlear implant surgery
Follow up 1 year later, using the implants everyday
Dr Barrie Tan is an expert cochlear implant surgeon, having performed hundreds of cochlear implant surgeries in his career. He is frequently invited to international and regional cochlear implant symposiums and conferences to share his experience. At the same time, he travels overseas to teach and perform cochlear implant surgeries in countries such as Vietnam, Indonesia and Bangladesh. He brings the wealth of his experience in cochlear implant surgery together with his compassion towards patients and their families. He believes that every patient deserves the right to good hearing, that when you give the gift of good hearing, you give the gift of communication and relationships back to the patient and their entire family.
In Barrie Tan Hearing and Cochlear Implant Centre, a fully trained specialist team of Implant Audiologists, Auditory Verbal Therapists and nurses all come together closely in the cochlear implant journey for each patient. Every patient is carefully attended to and the team communicates closely with each other on the progress achieved during the post implantation journey.
BONE CONDUCTION IMPLANTS
Happy and smiling after Bonebridge Implant surgery
Bone conduction implants are another different class of surgical hearing implants. These implants work by transmitting sound signals as vibrations through the skull bone to reach the cochlea (inner ear). The sound signals bypass the usual acoustic pathway where sound waves are carried in the air through the ear canal and vibrate the ear drum and middle ear bones before eventually stimulating the inner ear.
They are used to restore hearing to patients with 2 main types of hearing loss. The first group are those who have conductive hearing loss. In this type of hearing loss, there is a problem either in the outer ear or the middle ear that impedes the transmission of the sound wave vibrations and prevents them from reaching the inner ear well. Since Bone Conduction Implants send the signals directly to the inner ear, they will bypass all these problems. These would include conditions like microtia and atresia of the ear, previous radical mastoidectomy cavities and ossicular chain abnormalities.
The youngest Singaporean recipient of the Bonebridge Implant at the time
The second group of patients which this helps is in those who have single-sided deafness. In these individuals, they are deaf in one ear but the other ear still hears well. These patients often struggle to hear when sounds are coming from the side where the ear is deaf. They often have to turn their heads towards the deafened side so that they can hear with their good ear.
Bone Conduction Implants help to route the sound signals from the deafened side over to the good ear. These implants vibrate the skull and these skull vibrations transmit to both the deafened inner ear as well as to the inner ear on the other side which is the good ear. This allows the good ear to perceive sounds received from the side where the ear is deaf. This is called pseudo-binaural hearing and it allows these patients to be able to hear sounds that otherwise would have been missed since they would have come into the deaf ear. Only 1 device is worn as compared to the other technology that routes signals to the good ear, which are the Contralateral Routing of Signal (CROS) Hearing Aids. In the CROS hearing aid system, patients have to wear 2 hearing aid - one on the deaf ear to collect the sound, another on the good ear to receive the wireless transmission of signals and present the sound into the good ear.
There are several different Bone Conduction Implant models and brands. There are broadly 2 main types. The first type is where the external speech audio processor actively vibrates and transmits the vibrations to a screw that is implanted into the skull. These include the Bone Anchored Hearing Aids by Cochlear Ltd and the Ponto System by Oticon Medical. The second type is where the external speech audio processor does not vibrate but merely transmits the signals to the internal device that is implanted into the skull. The internal device is the one that actively vibrates the skull. This is known as Direct Drive Bone Conduction. An example of this would be the Bonebridge Implant by MedEl. Nowadays, many patients are opting for the Transcutaneous Bone Conduction Implant systems where there is no exposed screw that is visible coming out from the skull. Instead, the screws and magnet of the internal device is entirely hidden under the skin. Users wear the external speech audio processor that magnetically couples with the internal magnet through an intact skin. This is cosmetically more appealing than seeing an exposed screw. It is also generally safer as it has less wound complications and skin problems. There are also fewer complication with skull fractures from inadvertent falls onto an exposed screw.
Internal Bonebridge Floating Mass Transducer (FMT)
External Speech Audio Processor being worn
Audio Processor magnet attraction on the skin
Bone Conduction Implantation Surgery is a generally safe surgical procedure and it can be performed in children as young as 4 years of age. There is no upper age limit and very elderly patients can undergo this surgery as well. Operative time usually takes about an hour under general anaesthesia. After surgery, the head is bandaged with a compression bandage for 1 night and this is removed the next day and the patient discharges. 1 week later, the sutures are removed. The device is then switched on and the patient starts wearing the device at 3 weeks post surgery.
ENDOSCOPIC EAR SURGERIES
Dr Barrie Tan performing an Endoscopic Laser Stapedotomy surgery
The set up in an Operating Theatre when performing Endoscopic Ear Surgery
Endoscopic Ear Surgery is a minimally invasive technique of performing ear surgery with the use of surgical endoscopes. Traditionally, ear surgery is performed using the operative microscope but often this requires a large incision behind the ear and the removal of a significant amount of healthy mastoid bone before reaching the area of disease to remove the disease. This leads to a disruption of the normal physiology of the mastoid bone and middle ear. Endoscopic Ear Surgery approaches aim to preserve more normal tissues as the surgery begins at the site of the disease and only small amounts of bone are removed in order to visualise the disease and remove it safely. Endoscopic Ear surgeries are therefore generally associated with smaller incisions, less post-operative pain and quicker recovery. Post surgery, patients do not need a compression bandage to be placed around their heads which conventional microscopic ear surgery usually requires.
Endoscopic Laser Stapedotomy
Endoscopic Tympanomastoidectomy
Nurse and Assistants watching EES
Endoscopic Myringoplasty
Dr Barrie Tan is an expert in Endoscopic Ear Surgeries and has performed numerous different types of surgeries using the Endoscopic Ear Surgery technique. These include the following surgeries:
Endoscopic Tympanomastoidectomy
Endoscopic Myringoplasty
Endoscopic Ossiculoplasty
Endoscopic Laser Stapedotomy
Endoscopic Facial Nerve Decompression
Dr Barrie Tan has been performing these surgeries regularly since he introduced this technique to Singapore General Hospital in 2014. He has been invited internationally and regionally to lecture on this topic and also to train surgeons in this technique. He organised the inaugural Singapore General Hospital Endoscopic Ear Surgery Instructional Course in 2017 and then again in 2018. Apart from the benefits to the patient from the Endoscopic Ear Surgery technique, there are also numerous benefits for the nurses and the Residents in training in watching these surgeries as they afford a clearer view of the surgery compared to Microscopic Ear Surgery.
HEARING AIDS
Different models of Behind the Ear (BTE) Hearing Aids
Hearing Aids are able to provide better hearing for a large number of people. They are simple to wear and they have changed considerably over the past few decades. Most hearing aids nowadays are small and discreet. There are many different shapes and forms ranging from behind the ear (BTE) hearing aids, to the completely in the canal (CIC) hearing aids which are extremely small and can be inserted entirely into the ear canal so as not to be easily visualised or seen.
Hearing Aids are amplification devices that are able to collect the sound signals from the environment and project the sounds at a louder intensity to the ear canal, thereby allowing patients to hear better without the need for speakers to raise their voices. The hearing aid does all the amplification instantly within their ears.
Modern Hearing Aids nowadays are comfortable to put on and easy to use. They are digitally programmed according to your unique pattern of hearing loss. This means that they will amplify sounds to different degrees at different frequencies so as to provide a comfortable level of hearing that matches your degree of hearing loss. They are also now made more convenient in that they can be paired wirelessly to smartphones to allow you to control the various aspects of the hearing aid such as the volume control. They can even pair wirelessly with smartphones or music players to allow you to listen wirelessly to your favorite music.
Small In-the-ear and In-the-Canal Hearing Aids
Various Hearing Aid models
Many people have the misconception that the sounds heard using a hearing aid are distorted. They do not sound distorted if the hearing aids are properly tuned and adjusted to your pattern of hearing loss. This requires a hearing test (Audiogram) to be performed before you purchase and fit on the hearing aid as it allows the audiologist to tune the performance of the hearing aid to match your hearing loss. At Barrie Tan Hearing and Cochlear Implant Centre, we have Masters of Audiology trained audiologists who will perform an accurate Audiogram and provide you with a professional fitting and programming of your hearing aids to suit your hearing needs. Prior to purchasing the Hearing Aids, you may opt for a Free (with a refundable deposit) trial period with a pair of programmed hearing aids to try the hearing aid performance in real life situations before you decide to purchase the aids.