Impact of Early Intervention on Children with Congenital Conductive Hearing Loss: Role of Active Transcutaneous Bone Conduction Implants

Bone conduction devices (BCDs) are advocated as an amplification option for patients with congenital conductive unilateral hearing loss (UHL), while other treatment options could also be considered. The current study compared a transcutaneous BCD (Sophono) with a percutaneous BCD (bone-anchored hearing aid, BAHA) in 12 children with congenital conductive UHL. Tolerability, audiometry, and sound localization abilities with both types of BCD were studied retrospectively. The mean follow-up was 3.6 years for the Sophono users (n = 6) and 4.7 years for the BAHA users (n = 6). In each group, two patients had stopped using their BCD. Tolerability was favorable for the Sophono. Aided thresholds with the Sophono were unsatisfactory, as they did not reach under a mean pure tone average of 30 dB HL. Sound localization generally improved with both the Sophono and the BAHA, although localization abilities did not reach the level of normal hearing children. These findings, together with previously reported outcomes, are important to take into account when counseling patients and their caretakers. The selection of a suitable amplification option should always be made deliberately and on individual basis for each patient in this diverse group of children with congenital conductive UHL.

Education studies admitted that extracurricular activities have played a key role in academic performance and overall education development. Extracurricular involvement among students has been shown to enhance academic performance and increase motivation for further study (Kravchenko and Nygård, 2022). Students who participate in after-school programs at their respective schools are able to apply the skills they learn to other disciplines and to their everyday life (Hayes, 2014). However, gender and education studies asserted that there is gender disparity in participation in extracurricular school activities girls indicated to have poor status compared to boys (Lundh, 2022; (Jägerbrink et al, 2022). This study therefore assessed influence of cultural norms/practices on girls’ participation in extracurricular school activities. Specifically the study was guided by the following objectives: to identify types of cultural norms/practices that hinder girls’ participation in extracurricular activities, assess influence of pointed out cultural norms/practices on girls’ participation in extracurricular school activities and examine effect of limited girls’ participation in extracurricular activities. This study used concurrent mixed methods research design to allow collection of qualitative and quantitative data at the same time. The study used simple random and purposive sampling techniques to obtain a sample size of 120 respondents for quantitative and qualitative data. Data analysis involved thematic analysis for qualitative data and descriptive statistics for quantitative findings. Findings from this study noted that there is gender disparity in extracurricular activities participation whereas girls maintain poor status of participation. The observed gender gap was highly contributed by some of cultural norms/practices, gendered division of domestic roles being the leading factor. Result from this study further indicated that limited participation in extracurricular school deprives girl students an opportunity to grow academically and develop their career.

Introduction: Competing noise in the environment negatively affects speech intelligibility, particularly when listening at a distance. This is especially true for children with hearing loss in classroom environments where the signal-to-noise ratio is often poor. Remote microphone technology has been shown to be highly beneficial at improving the signal-to-noise ratio in hearing device users. Children with bone conduction devices, however, often must rely on indirect transmission of the acoustic signal for commonly used classroom-based remote microphone listening (e.g., digital adaptive microphone) which may negatively affect speech intelligibility. There are no studies on the effectiveness of using a relay method of signal delivery using remote microphone technology to improve speech intelligibility in adverse listening environments in bone conduction device users. Methods: Nine children with irresolvable conductive hearing loss and 12 adult controls with normal hearing were included for study. Controls were bilaterally plugged to simulate conductive hearing loss. All testing was conducted using the Cochlear™ Baha® 5 standard processor coupled with either the Cochlear™ Mini Microphone 2+ digital remote microphone or the Phonak Roger™ adaptive digital remote microphone. Speech intelligibility in noise was evaluated in the (1) bone conduction device processor alone, (2) bone conduction device + personal remote microphone, and (3) bone conduction device + personal remote microphone + adaptive digital remote microphone listening conditions at −10 dB, 0 dB, and +5 dB signal-to-noise ratios. Results and Conclusions: Speech intelligibility in noise improved significantly in the bone conduction device + personal remote microphone condition over the bone conduction device alone, demonstrating significant benefit for listening at poor signal-to-noise ratios in children with conductive hearing loss using bone conduction devices with personal remote microphone use. Experimental findings demonstrate poor signal transparency when using the relay method. Coupling of the adaptive digital remote microphone technology to the personal remote microphone negatively affects signal transparency, and no hearing in noise improvements are observed. Significant gains in speech intelligibility are consistently observed for direct streaming methods and are confirmed in adult controls. Behavioral findings are supported by objective verification of the signal transparency between the remote microphone and the bone conduction device.

To present a different location, lateral to the middle fossa, as a new surgical alternative for an active transcutaneous bone conduction implant (ATBCI) in children with microtia and external auditory canal atresia (EACA) who cannot undergo traditional surgery due to altered anatomy or desire for future aesthetic reconstruction. Prospective, longitudinal, descriptive study. The surgical technique was developed. Preoperative and postoperative information was analyzed. Tertiary pediatric hospital in Santiago, Chile. Eight children with unilateral EACA and microtia. ATBCI lateral to the middle fossa. Surgical, audiological, and quality-of-life outcomes. Eight children with EACA were implanted. Surgery was uneventful except for one seroma. This placement is lateral to the middle fossa, serving as a location marker. Their average age was 13 years old. The average follow-up was 21 months. All patients had conductive hearing loss. The audiological and quality-of-life results were as expected for this device. This location for the ATBCI was proven to be safe and effective for treating pediatric patients with EACA who desire future aesthetic reconstruction. This new surgical technique is safe and faster than the one suggested by the manufacturer due to the flat bone in this region of the skull. The outcomes are comparable to those obtained with the traditional location described for this device.

This study attempted to examine the relationship between participation in extracurricular activities and levels of Communication Apprehension (CA) among English as a foreign language (EFL) students and explore the students’ perspectives of how extracurricular activities affect their communication skills. The study addressed the following two questions: a) what is the relationship between EFL students’ involvement in extracurricular activities and their level of Communication Apprehension?, b) What are the EFL students’ perspectives regarding the effect of extracurricular activities on their communication skills?. The participants were 40 EFL students among 80 who participated in extracurricular activities at the College of Languages and Translation at Imam Mohammed bin Saud Islamic University in Riyadh. The participants were asked to complete a Personal Report of Communication Apprehension (PRCA-24) to examine their levels of CA as well as a questionnaire about their attitudes toward extracurricular activities. Additionally, semi-structured interviews were conducted with 8 participants to explore their perspectives in depth. The findings showed that most participants had moderate levels of CA and that 100% of the participants agreed that participation in extracurricular activities helped them reduce CA and improve their communication skills. The study also showed that extracurricular activities were more helpful than classroom activities in improving communication skills. This study is significant in that it shed the light on the importance of involvement in extracurricular activities and their role in improving EFL students’ communication skills and lowering CA levels. Thus, it is recommended to encourage EFL students to participate in extracurricular activities and consider including such activities in course requirements and teaching materials.

To describe the early surgical and audiometric outcomes in pediatric patients implanted with a new active transcutaneous bone conduction implant system. Retrospective case review. Tertiary pediatric hospital. Pediatric patients (18 or younger) with conductive or mixed hearing loss that completed postoperative aided testing following implantation with the Cochlear Osia system from December 2019 to December 2020. Rehabilitative. Preoperative air conduction (AC), preoperative bone conduction (BC), and postoperative aided thresholds were compared. Pure-tone averages (PTA), air-bone gap (ABG), and functional gain were calculated. Surgical complications and patient satisfaction were summarized from the chart review. Sixteen patients (20 implants) met the inclusion criteria. The average age at the time of implantation was 12.9 ± 2.4 years. The preoperative AC and BC thresholds were 64.4 dB (±11.9 dB) and 7.9 dB (±4.90 dB), respectively, with an average ABG of 56.5 dB (±12.8 dB). The average postoperative aided threshold was 21.2 dB (± 4.25 dB) with a mean functional gain of 43.1 dB (±10.2 dB). One patient developed seroma postoperatively, which was treated conservatively. No other complications were reported over a mean follow-up time of 7.1 ± 4 months. For 13 patients with previous passive bone conduction implants or devices, the Osia system was universally favored. The new active transcutaneous bone conduction system showed favorable early clinical and audiometric outcomes. Repeated processor connectivity issues represent a potential area for future device development. This is the largest pediatric case series to date.Level of Evidence: Level 4-Retrospective Review.

This study aimed to examine auditory outcomes in young children implanted with active bone conduction implants. Prospective cohort study. A single tertiary referral academic center. Fourteen patients younger than 5 years of age who were implant with a piezoelectric active transcutaneous bone conduction implant (OSI) with a follow-up of at least 1 year. Demographics, surgical techniques, duration of surgery, hospital stay, auditory outcomes, postoperative complications, and device use were collected. After OSI surgery, patients were followed up for 1 week post-surgery, with devices switched on at 3 weeks postoperatively. Surgery and audiology follow-up occurred at 1, 3, 6 months, and 1 year. Perioperative course, surgical complications, aided audiograms, and speech discrimination scores were obtained 6 months and 1 year after implantation. Fourteen children received 18 implants (4 patients received bilateral simultaneous implants). The median implantation age in this study was 4.07 years (IQR=0.875). The indication for implantation was congenital conductive hearing loss (cCHL) due to external auditory canal atresia in 15/18 ears, and congenital single-sided deafness (SSD) in 3/18 ears. No patients experienced serious intraoperative or postoperative complications. For patients with cCHL, there was a significant postoperative improvement in hearing, marked by a median pure-tone average gain of 45 dB. All 14 patients regularly used their sound processors, with a median utility time of 10.6 h/day. There was no decline in the auditory performance in any ear throughout the median follow-up period of 2.36 years. Active transcutaneous piezoelectric bone conduction implants are a safe option for young children and provided significant and stable improvements in auditory function.

Bone Conduction: Benefits and Limitations of Surgical and Nonsurgical Devices

The main objective of this paper is to present the factors with influence on the sustainable university management and the relationships between them. In the scientific approach we begin from a graphical model, according to which the extracurricular activities together with internal environmental factors influence students’ involvement in such activities, the university attractiveness, their academic performance and their integration into the socially-economic and natural environment (components related with sustainable development). The model emphasizes that individual performances, related to students’ participation in extracurricular activities, have a positive influence on the sustainability of university management. The results of the study have shown that the university sustainability may be influenced by a number of factors, such as students’ performance, students’ involvement in extracurricular activities or university’s attractiveness and can in turn influence implicitly also the sustainability of university management. The originality of the paper consists in the relationships study using the modeling method in general and informatics tools of modeling in particular, as well as through graphical visualization of some influences, on the sustainability university management.

In order to prepare students for adulthood and responsible citizenship, most high schools offer extracurricular activities designed to facilitate the learning of a wide range of competencies. The purpose of this study was to examine how participation in a single or a combination of extracurricular school activities for high school students may impact both their developmental outcomes and their level of school engagement. Results indicated differences between youth who participated in a combination of both sport and nonsport activities as well as sport only activities compared to youth not involved in extracurricular activities on a number of developmental assets and school engagement. It is recommended that parents and adult leaders encourage and support students in their involvement in various extracurricular activities, including high school sport, in order to facilitate positive youth development.

The results of the scientific article represent a certain contribution to the study of extracurricular activities in the system of domestic higher education. The authors analyze the features of the implementation of extracurricular activities at the university and explore the motivational potential that can encourage students to participate in extracurricular activities. The authors of the article proposed a methodology for sociological research devoted to the study of extracurricular activities in the aspect of their motivational potential. As part of the research, the authors conducted a questionnaire survey of students to find out what motives most encourage them to participate in extracurricular activities. Also, the intensity index of the main motives for student participation in extracurricular activities was calculated. Analysis of the results of the sociological study allowed the authors to conclude that the motivational potential of students to engage in extracurricular activities is significantly underutilized. The results of the study showed that the prevailing motives that encourage students to participate in extracurricular activities are the desire for individual achievements and the high priority of personal values, which in turn indicates the dominance of individualistic attitudes among the surveyed students and insufficient emphasis on collective and social values.

Objectives:Bone conduction devices (BCD) have been commercially available since the 1980s for patients with conductive hearing loss (CHL), mixed hearing loss (MHL), or single-sided deafness (SSD). BCDs significantly improve the hearing capacity of patients regardless of age, which has a positive impact on their quality of life, mental health, education, and work performance. BCDs are categorized as percutaneous or transcutaneous solutions based on the attachment method. Selecting the optimal solution for patients requires consideration of audiological outcomes, guidelines, safety, patient preferences, and costs. This study evaluated the cost-effectiveness of an active transcutaneous solution (Osia System, Cochlear Ltd.) compared with percutaneous solutions to treat adult patients in Sweden.Materials and methods:A Markov model was developed to simulate a cohort of adult patients aged 59 years or older receiving Osia or percutaneous BCDs. The model considered 3 health states: patients who have received a BCD, patients without a device due to explantation (without reimplantation) or elective device non-use, and an absorbing state (death). The final state was based on age-dependent mortality, assuming hearing loss does not impact mortality. Probabilities were determined for transition between the health states with 6-month cycles and a lifetime horizon. Utility scores for each health state were derived from published literature using the Health Utilities Index Mark III (HUI3). Complication rates were also sourced from the literature, and the cost of complications and implantation from the National Board of Health and Welfare in Sweden, Socialstyrelsen. The perspective of the model was the Swedish health care system, and the main outcome was incremental cost per quality-adjusted life year (QALY) gained. Deterministic and probabilistic sensitivity analyses were conducted to assess the robustness of the results.Results:Osia was associated with an increase in cost of 79,293 SEK and an increase in QALYs of 0.73 compared with percutaneous devices, resulting in an incremental cost-effectiveness ratio of 108,318 SEK per QALY gained. The main drivers of cost-effectiveness were baseline age, the cost of surgery, and the difference in utility scores between the two interventions. The differences in HUI3 scores may be linked to the reduced risk of complications, improved cosmetic appearance, and improved hearing with Osia.Conclusions:Osia is cost-effective compared with percutaneous devices over a lifetime horizon, when applying low to moderate cost per QALY willingness-to-pay thresholds indicated by the Swedish Agency for Health Technology Assessment and Assessment of Social Services. This analysis provides information on the economic impact of different hearing solutions to support decisions on which BCD best meets the needs of patients and health care budgets.

Bone conduction devices (BCDs) are widely used in the treatment of conductive hearing loss (CHL), but their applications on unilateral CHL (UCHL) patients remain controversial. To evaluate the effects of BCDs in UCHL, a systematic search was undertaken until May 2023 following the PRISMA guidelines. Among the 391 references, 21 studies met the inclusion criteria and were ultimately selected for review. Data on hearing thresholds, speech recognition, sound localization, and subjective questionnaire outcomes were collected and summarized. Moderate hearing threshold improvements were found in UCHL patients aided with BCDs. Their speech recognition abilities improved significantly. However, sound localization results showed wide individual variations. According to subjective questionnaires, BCDs had an overall positive influence on the daily life of UCHL patients, although several unfavorable experiences were reported by some of them. We concluded that the positive audiological benefits and subjective questionnaire results have made BCDs a credible intervention for UCHL patients. Before final implantations, UCHL patients should first go through a period of time when they were fitted with non-implantable BCDs as a trial.

Behavioral regulation and approaches to learning: Moderators of the association between extracurricular involvement and academic readiness

This study was conducted to determine the effects of extracurricular activities on academic performance of two selected secondary schools of Male. The study was carried out utilizing quantitative research design. The study attempted to find out whether there was any difference in academic performance between the students who spent more than five hours and less than five hours for extracurricular activities, whether there was any difference in academic performance between the students who participate and do not participate in extracurricular activities, whether there was any difference in academic performance between the students who participate in sport, pro-social activities and clubs and whether there was any difference in academic performance between female and male students who participate in extracurricular activities. This study's sample frame comprised all ninth-grade pupils. Two hundred and sixty-nine students from grade nine of both the schools made up the study group. Each student completed a questionnaire which gathered information about their participation in extracurricular activities. Using specific criteria students who were involved and those who do not involved were found. The differences between groups were analyzed statistically using Mann Whitney U test for the first, third and last research question and Kruskul test for the second research question. Results of data analyses indicated that no significant differences were found between the students who spent more than five hours‟ for extracurricular activities and those who spent less than five hours, between the students who participate in sport, pro-social activities, and clubs and between female and male students who participate in extracurricular activities. However, there was a significant difference in academic performance between the students who participate and who do not participate in extracurricular activities.