She struggled to stay at her job, directing activities at The Fountains at La Cholla, a senior community. One thing she loved most was the stories elderly residents would tell about their pasts.

Finally, four years ago, she decided her hearing loss kept her from doing a good job, and she resigned.

The situation was a huge life change. Shirley, normally outgoing, began to feel insecure about being in groups, biking, eating at restaurants, crossing streets and driving. Try as she might, she became withdrawn and reclusive.

But a smile of delight lighted her face Monday, the day audiologist Stephanie M. Salcido installed a removable sound processor to a small titanium implant.

The implant was surgically placed into her skull in January by otolaryngologist Robert B. Cravens Jr. After the wound healed, the way was clear to turn on the juice to her bone-anchored hearing aid.

The BAHA procedure for single-sided deafness, approved in 2002 by the U.S. Food and Drug Administration, provides a pathway for sound to travel to the inner ear on her left side over the top of her skull. Though she has only about half of normal hearing in her good ear, the alternative pathway for vibrations - sound - effectively doubles her hearing and allows her to hear from both sides.

With BAHA, the sound from her right side does not pass through the right ear. It goes directly to the inner ear, or cochlea, on the left side.

Because the brain has the ability to differentiate between sounds coming the normal way versus sounds coming via bone conduction from the sound processor, patients can tell the direction the sound is coming from.

"The first thing I noticed was, I could hear my own voice better," said Shirley, 62. Then a child began to cry just outside the audiologist's examination room.

"Never before had I been so delighted by the crying of a child," she said Wednesday. "The little boy apparently was frightened of being at the doctor's office. He was screaming.

"Before, the child's voice would have drowned out any other noises, and I would have been overwhelmed with the single sound," she said. "But I was able to hear the direction of the crying, and I could still hear my audiologist."

The evening after the sound processor was installed, Shirley hosted a Seder at The Fountains, where she used to work full time.

She was again able to banter with residents, many of whom have their own challenges in hearing.
"Already I think my speech is clearer," she said later. "I don't tend to talk too loudly as I used to."
Shirley's single-sided deafness probably is due to striking her head on a tile floor when she was knocked down in a restaurant or to a virus that might have attacked her ear. In recent years, she also had lost more than half of the hearing in her left ear.

It happens more often than we might realize. About 15 percent of baby boomers have hearing loss, and 6 percent of younger adults also have some hearing loss, experts say.
The BAHA technique is based on the same technology used in dental implants, Dr. Cravens said.

"We use a titanium screw that goes into the bone, and it actually becomes integrated into the bone. (The bone) grows right into the titanium. It's a very biocompatible material for bone," Cravens said. "In fact, if you want to take the implant out, that's what's difficult.

"I have only seen one (implant) come out. That was in a child in a situation where the parents were not really taking care of the implant. It was a neglect situation.

"The use of the system for single-sided deafness is by far the widest application," Cravens said.
He has done about 35 BAHA surgeries, including the first in the state. He is the only physician in Tucson who does the procedure.

But Cravens cautions: "It will not do anything better than the good ear will allow."

Hearing ultimately depends on the inner ear. But a child, one born without ear canals on both sides yet possessing healthy cochlea, can get good quality hearing, said Cravens, who also does work at Children's Clinics for Rehabilitative Services.

"In that clinic, we have done a fair number of bone-anchored hearing aids, largely for treatment of conductive hearing loss as opposed to single-sided deafness like Shirley was treated for.

"They do very well. There are some limitations with age. We do not do children under the age of 5, an age established by the FDA, for a good reason. The thickness of the bone needs to be a minimum of 3 millimeters of solid cortical bone in the skull."

The technology originated in Sweden and has been available in parts of Europe for about 20 years, Cravens said. Some insurance plans cover much of the surgical procedure, but the processor is paid for by the patient, he said. The total cost of surgery and equipment is $9,000 to $10,000.

Medicare approved payment for the surgery in single-side deafness in December, Cravens noted.
The surgery is done on an outpatient basis and creates very little pain, Shirley said.

Whether Shirley ever gets back into a mainstream work situation remains to be seen.
"I miss those days when I woke up each day eager to get to work," she said. "And I miss the end of each day, when I came home filled with stories about the residents, folks who had survived the Great Depression, the Dust Bowl days, World War II and other events we read about in history books."

By Larry Copenhaver
http://www.tucsoncitizen.com/daily/local/9349.php