Successful management of a mixed hearing loss: hearing performance with two different implantable bone conduction devices and criteria for its application

Abstract

Introduction: Patients with a mixed hearing loss present special challenge. The amplification demands of mixed hearing loss can drive digital hearing aids to their limits and introduce distortion. Bone-anchored devices effectively bypass the conductive component and focus on compensating for the sensorineural component.Case report: Four-year-old child with a moderate mixed hearing loss in the right ear and total hearing loss in the left ear, rehabilitated with conventional hearing aids in the right ear. At 17 years old, she developed chronic otitis media and decreased auditory gain. She was proposed to place a direct-drive bone-conduction device (BCD) initially with a BAHA® BP110, however, with insufficient results. Then she placed a BAHA® 5 Super Power, with an excellent adaptation and auditory gain optimization.Conclusions: Bone-anchored hearing aids (BAHA) are relatively expensive devices. Therefore, it is important to assess the quality of life in BAHA users and to identify the group of patients who are likely to derive maximum benefit. We summarize the otologic and audiological criteria applied in the Centro Hospitalar Universitário do Porto for the placement of bone conductive devices in patients with mixed hearing loss. In patients with adequate sensorineural reserve measured by a bone curve of at least 45 dB and unaided speech discrimination score ≥60%, bone-anchored devices with adequate power should be considered. Given the increased output force of the new powerful BAHA and the efficacy of bone conduction, BAHA should be increasingly considered for any patient with a significant mixed hearing loss.