Bone-anchored Hearing Aid Research Articles

Auditory development after placement of bone-anchored hearing aids Softband among Chinese Mandarin-speaking children with bilateral aural atresia

ObjectiveTo evaluate auditory developments of Chinese Mandarin-speaking children with congenital bilateral aural atresia after using Bone-anchored hearing aids (Baha) Softband and to compare them with matched peers with normal hearing. MethodSixteen patients (age ranging from 3 months to 6 years) with bilateral aural atresia and 29 children with normal hearing (age ranging from 8 months to 6 years) were studied. Auditory development was assessed at three time intervals: baseline, 6 months and 12 months. Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS) was conducted for children under 4 years old; Meaningful Auditory Integration Scale (MAIS), Chinese Mandarin lexical neighborhood test (MLNT) and sound field pure tone audiometry (PTA) were used for children of 4–6 years old. ResultsMean IT-MAIS scores were 41±24%, 60±22% and 73±7%, respectively at three time intervals. Mean MAIS scores were 66±7%, 90±5%, and 99±2%. Mean speech discrimination scores at the three time intervals were 74±19%, 86±16%, and 95±4% with the easy disyllabic (D-E) list; 48±18%, 73±15%, and 81±7% with the hard disyllabic (D-H) list; 55±17%, 74±22%, and 83±14% with the easy monosyllabic(M-E) list; and 31±14%, 61±15%, and 71±13% with the hard monosyllabic (M-H) list. ConclusionsBaha Softband is suitable for infants and young children with bilateral atresia. Results from these auditory development testing are encouraging. Baha Softband should be used as a bridge for surgical implantations when the temporal bone is thick enough.

Sound source localization from tactile aids for unilateral cochlear implant users

The present research asks whether two tactile aids with directional microphones, by providing additional inter-channel level information and etc., could help unilateral cochlear implant (CI) localize sound sources. For normal hearing subjects, sound source localization based on tactile vibration cues alone can be as accurate as auditory localization in the frontal horizontal plane (Gescheider, 1970). CI users may as well benefit from additional tactile aids just as normal hearing people do. The current study uses two bone-anchored hearing aids (BAHA) as sources of tactile vibration. The two BAHAs, bonded together by a special gadget to maintain a particular distance and angle, both have directional microphones, and are programed so that one point to the front-left side and the other to the front-right side. Unilateral CI users voluntarily participated in the experimental study. Wide band noise stimuli were presented at 65 dB SPL. The subjects hold one BAHA in each hand and do localization tasks with (1) CI only and (2) with CI and tactile sensation combined. Preliminary data shows CI users can get some benefit from the additional information provided by tactile aids in 360 degree localization (45 degree spacing) on the horizontal plane.

Using tactile aids to provide low frequency information for cochlear implant users

Cochlear implant (CI) users have shown benefit from residual low-frequency hearing in the contra-lateral ear (Dorman and Gifford, 2010). One source of this benefit is the enhancement of cues important for identifying word boundaries (Spitzer et al., 2009). However, there are a large number of CI users who do not have residual hearing, but who could presumably benefit from cues available in low-frequency information. Because the frequency sensitivity of human haptic sensation is similar to that of human acoustic hearing in low frequencies, we examined the ability of tactile aids to convey low-frequency cues. Using experimental phrases designed to have low inter-word predictability, and balanced for syllabic stress (trochaic/iambic), 5 CI users and 10 normal hearing participants (simulation) provided transcriptions that were scored for percent words-correct and for errors in word segmentation (lexical boundary errors, LBE). A 350 Hz sinusoid carrier modulated with overall envelope of corresponding acoustic signal drove two bone-anchored hearing aids (BAHA), which participants held while listening. Results showed a small but significant improvement on percent words correct with tactile aid, and fewer word segmentation errors. These findings support the benefit of tactile information in the perceptual task of lexical segmentation.

The Bonebridge semi-implantable bone conduction hearing device: experience in an Asian patient

For over three decades, bone conduction hearing aids have been changing the lives of patients with impaired hearing. The size, appearance and fitting discomfort of early generations of bone conduction hearing aids made them unpopular. The advent of bone-anchored hearing aids in the 1970s offered patients improved sound quality and fitting comfort, due to the application of osseointegration. However, the issue of post-operative peri-abutment pin tract wound infection persisted. The Bonebridge system incorporates the first active bone conduction device, and aims to resolve peri-abutment issues. Implantation of this system in an Asian patient is presented.

A critical review of the bone-anchored hearing aid: Indications, candidate evaluation and efficacy


 

Vibrant soundbridge in aural atresia: does severity matter?

Congenital aural atresia (CAA) poses significant challenges to surgical remediation. Both bone anchored hearing aids (BAHA) and the Vibrant Soundbridge (VSB) have been considered as alternatives or adjuncts to conventional atresiaplasty. A consensus statement on VSB implantation in children and adolescents recommended against implantation when the Jahrsdoerfer score was less than 8. More recent publications suggest that patients with Jahrsdoerfer scores between three and seven may benefit from VSB implantation. The purpose of this study was to further investigate the outcomes of VSB implantation in CAA. The study was a multi-center, retrospective review. A retrospective review of data (patient's demographic, clinical, implant and audiological information) from four collaborating centers that have performed VSB implantation in CAA was performed. Outcomes based on severity of the atresia using the Jahrsdoerfer and Yellon-Branstetter scoring systems were also evaluated. Data from 28 patients from the four centers revealed no iatrogenic facial nerve injuries or change in bone thresholds. Post-operative speech threshold and speech recognition was, respectively, 39 dB and 94%. Jahrsdoerfer and Yellon scores ranged from 4 to 9 and 4 to 12, respectively. The scores did not correlate to or predict outcomes. Three individual elements of the scores did correlate to initial, but not long-term outcomes. Atresiaplasty and BAHA in the management of CAA are not complete solutions. VSB may offer an alternative in these surgically complex patients for achieving amplification, though better metrics for patient selection need to be developed. LEVEL OF EVIDENCE : IV.

Hearing gain with a BAHA test-band in patients with single-sided deafness

PurposeIt is assumed that preoperative use of a bone-anchored hearing aid (BAHA) test-band will give a patient lower gain compared to real post-operative gain because of the reduction of energy through the scalp when using a test-band. Hearing gains using a BAHA test-band were analyzed in patients with unilateral hearing loss. Materials and MethodsNineteen patients with unilateral sensorineural hearing loss were enrolled. A test-band, which was connected to BAHA Intenso with full-on gain, was put on the mastoid. Conventional air-conduction (AC) pure-tone averages (PTAs) and sound-field PTAs and speech reception thresholds (SRTs) were obtained in conditions A (the better ear naked), B (the better ear plugged), and C (the better ear plugged with a test-band on the poorer mastoid). ResultsAir-conduction PTAs of the poorer and better ears were 91±19 and 18±8dB HL. Sound-field PTAs in condition B were higher than those in condition A (54 vs. 26dB HL), which means that earplugs can block the sound grossly up to 54dB HL through the better ears. The aided PTAs (24±6dB HL) in condition C were similar to those of the better ears in condition A (26±9dB HL), though condition C showed higher thresholds at 500Hz and lower thresholds at 1 and 2kHz when compared to condition A. The hearing thresholds using a test-band were similar to the published results of BAHA users with the volume to most comfortable level (MCL). ConclusionOur findings showed that a BAHA test-band on the poorer ear could transmit sound to the cochlea as much as the better ears can hear. The increased functional gain at 1 and 2kHz reflects the technical characteristics of BAHA processor. The reduction of energy through the scalp when using a test-band seems to be offset by the difference of output by setting the volume to full-on gain and using a high-powered speech processor. Preoperative hearing gains using a test-band with full-on gain seems to be similar to the post-operative gains of BAHA users with the volume to MCL.

Visualisation of the Bonebridge by means of CT and CBCT

BackgroundWith the Bonebridge, a new bone-anchored hearing aid has been available since March 2012. The objective of the study was to analyse the visualisation of the implant itself as well as its impact on the representation of the bony structures of the petrosal bone in CT, MRI and cone beam CT (CBCT).MethodsThe Bonebridge was implanted unilaterally in two completely prepared human heads. The radiological imaging by means of CBCT, 64-slice CT, 1.5-T and 3.0-T MRI was conducted both preoperatively and postoperatively. The images were subsequently evaluated from both the ENT medical and nd radiological perspectives.ResultsAs anticipated, no visualisation of the implant or of the petrosal bones could be realised on MRI because of the interactive technology and the magnet artefact. In contrast, an excellent evaluability of the implant itself as well as of the surrounding neurovascular structures (sinus sigmoideus, skull base, middle ear, inner ear, inner auditory canal) was exhibited in both the CT and in the CBCT.ConclusionThe Bonebridge can be excellently imaged with the radiological imaging technologies of CT and CBCT. In the process, CBCT shows discrete advantages in comparison with CT. No relevant restrictions in image quality in the evaluation of the bony structures of the petrosal bones could be seen.

Single‐Stage Surgery for Placement of Pediatric Bone‐Anchored Hearing Aids

Objectives: 1) Determine the incidence of skin overgrowth and failure of osseointegration in pediatric patients undergoing single-staged placement of a bone anchored hearing aid. 2) Compare these results to patients undergoing staged surgery. Methods: Pediatric patients who underwent placement of a bone anchored hearing aid in an academic pediatric medical center from July 1, 2006, to December 2012 were identified in a retrospective manner using CPT code 69714. Cause of hearing loss, surgical technique, staging of surgery, and postoperative findings including skin overgrowth and failure of osseointegration were recorded. Results: Sixty-six patients underwent placement of a bone anchored hearing aid, with 11 patients undergoing bilateral surgery. Sixty-four sides were performed in 1 stage and 13 sides in 2 stages. The overall osseointegration failure rate was 4.5%, all in patients who underwent single-staged surgery. Two of these patients had Treacher-Collins syndrome, and the other patient had craniofacial abnormalities. Five patients (7.5%) required revision surgery for skin overgrowth, with 4 having single-stage surgery and the other having staged surgery. Conclusions: Single-staged surgery placement of a bone anchored hearing aid is an acceptable alternative to staged surgery with low rates of osseointegration failure or skin overgrowth.

Round Window Vibroplasty in Infants and Children with Atretic Ear

Objectives: Evaluate long-term safety and outcome of round window vibroplasty (RWVPL) by the placement of the floating mass transducer (FMT) on the round window membrane in infants and children with congenital aural atresia (CAA). Methods: External auditory canal and middle ear malformation, accompanied by more or less severe conductive or mixed hearing impairment characterize children and infants with CAA. Several atresiaplasty procedures have been proposed without evidence of long-term air-bone gap closure despite initial satisfactory outcome. Prospective study at atertiary referral center. Seven infants and 10 children with CAAwere judged not to be candidates for air and bone conductive hearing aids and their parents declined bone-anchored hearing aids. Intervention: RW implantation with the Med-El VSB. Main outcome measures: Pure tone audiogram and free-field speech testing, free-field Auditory Brainstem Response (ABR). Results: Significant improvements were observed in pure-tone threshold and speech perception immediately after surgery and at follow-up intervals (12 to 60 months) in older children ( P <0.01). In infants and younger children free-field ABRs showed a significant shift of the mean air conduction threshold from 110 dB sound pressure level (SPL) preoperatively to 40 dB SPL ( P < 0.05) and 30 dB SPL ( P < 0.01), respectively postoperatively and at the last follow-up. No complications or instances of device extrusion were observed in this series of patients. Conclusions: RWVPL offers a safe, viable and improved treatment option for infants and children with CAA.

Ocena niedosłuchu u osób powyżej 60. roku życia korzystających z aparatów słuchowych

ObjectiveTo assess the hearing impairment in people over 60 years old using hearing aids. This was a single-center study, but it is planned to extend it further to the whole country. Materials and methodsThe study was focused on patients with hearing aids. During the assessment 57 people were included in the observation in order to control the status of their hearing loss and benefit from traditional hearing aids as well as the possibility to apply the auditory implants in case of a little benefit from hearing aids. The otoscopy and pure tone audiometry were performed as well as the questionnaires on demographic and epidemiological data of patients were collected as well as the quality of their life with hearing aids was subjectively assessed. ResultsThe results show that 91% of patients have sensorineural hearing loss (SHL), the remaining 9% – severe mixed hearing loss. Severe SHL was found in 22 patients, the moderate hearing loss was observed in 37%, and the profound SHL was the case in 5 patients. Minimal SHL was observed in 7% of patients (n=4). More than 73% of the study subjects were male (n=38). The average age of the patients who completed the survey was 74 years old. Thirty-five patients used their hearing aid over 3 years and less than 70% of them used it every day all day. Hearing aid was not actively used by 10 patients. Over the last year 51.92% of the patients underwent a hearing examination. ConclusionsThe bone anchored hearing aid was suggested to 2% of subjects and the cochlear implant was offered to 10 patients. The data analysis shows the need to educate and inform the elderly about alternative methods of hearing loss treatment.

A Meta-analysis of the Complications Associated With Osseointegrated Hearing Aids

To summarize available peer-reviewed literature to describe the range and rate of complications related to osseointegrated hearing aids in adult and pediatric patients. We searched PubMed using the terms bone-anchored hearing aid for articles published in English between 2000 and 2011. We included all articles reporting complications rates, except those that were case reports, general review (not systematic review), or commentary, as well as those that did not include patient outcomes, that reported outcomes associated with nonstandard implantation (e.g., 8.5-mm abutment) or were of poor study or reporting quality. After excluding articles that did not meet criteria, 20 articles were identified, comprising 2,134 patients who underwent a total of 2,310 osseoimplants. Complications reported in the literature were typically minor in nature. Skin reactions from Holgers Grade 2 to 4 ranged from 2.4% to 38.1%. Failure of osseointegration ranged from 0% to 18% in adult and mixed populations, and 0% to 14.3% in pediatric populations. The rate of revision surgery ranges from 1.7% to 34.5% in adult and mixed populations and 0.0% to 44.4% in pediatric patients, whereas the total rate of implant loss ranged from 1.6% to 17.4% in adult and mixed populations and from 0.0% to 25% in pediatric patients. Overall, the quality of large scale and/or prospective studies reporting the incidence of complications after osseointegrated hearing aid surgery is poor and lacks uniformity. However, based on available data, which shows a lack of major complications, osseointegrated implantation is a safe procedure in both adult and pediatric populations. Well-designed, prospective studies with uniform reporting standards would allow greater comparison between techniques and more reliable analysis of complications of osseointegration surgery of the temporal bone for cochlear stimulation.

Helmet modification for soft-band bone-anchored hearing aid use during cranial orthosis

Helmet modification for soft-band bone-anchored hearing aid use during cranial orthosis

The Views and Experiences of Families on Bone Anchored Hearing Aid use with Children: A Study by Interviews

This study qualitatively explores the views and experiences of families on obtaining and using a bone-anchored hearing aid (BAHA) device. A semi-structured interview format was used to collect responses from 10 families from different geographical regions of the UK. Findings indicate how the use of BAHA was valued by families. Although participants identified that BAHA devices improve both the clarity and directionality of sound, the most consistently reported benefits related to social, psychological, and educational functioning. BAHA devices were perceived to give children the opportunity to interact with others reducing isolation and improving self-esteem and self-identity. However, the findings also demonstrate that BAHA devices are not without challenges. Responses identified how professionals need to provide accurate information to families to aid them with the complicated decision-making process they are working through in deciding whether to have a BAHA or not. Managing the expectations of what BAHA devices can and cannot do is vital to ensure that families are able to make a fully informed decision. The availability of appropriate advice, information, and support (including peer support) is an important part of this process. Families involved in this study were clear that in many circumstances there were system errors in relation to their care package and these experiences can have a negative impact on their experiences of the device itself.

Survival of the 8.5 mm osseointegrated abutment, and its utility in the obese patient

Most of the literature regarding osseointegrated implantation for hearing rehabilitation focuses on the 5.5 mm abutment. This study aimed to add to the data available on the survival of the 8.5 mm abutment, and to describe its utility in obese patients. To review the outcomes of patients who received a bone-anchored hearing aid implant, and create a model comparing the mechanical forces acting upon combinations of fixture and abutment lengths. Retrospective chart review and mathematical modelling. In this retrospective cohort study comprising 25 patients, less abutment overgrowth was observed in the 8.5 mm abutment recipients versus recipients of the 5.5 mm abutment. When the principle of equilibrium of a rigid body was applied, the 8.5 mm abutment was at a calculated mechanical disadvantage compared with the 5.5 mm abutment. The 8.5 mm abutment may be useful in patients with copious subcutaneous soft tissue as in the obese population. The 8.5 mm abutment has a calculated mechanical disadvantage, potentially putting the implant under greater mechanical stress; however, the clinical relevance of this is unclear.

Risk analysis of unilateral severe-to-profound sensorineural hearing loss in children

ObjectiveTo explore the etiology of pediatric unilateral severe-to-profound sensorineural hearing loss (USPSNHL) and the risk of hearing loss in the contralateral ear. MethodsPediatric patients with USPSNHL referred to a tertiary children's hospital for unilateral bone-anchored hearing aid implantation were identified for study. Clinical charts, audiograms, and radiographic imaging of the temporal bones were reviewed. ResultsEighty-four children with USPSNHL were reviewed (40 male, 44 female). The etiology of USPSNHL could be identified in 35 patients (41.7%), with perinatal events (16.2%) and family history of hearing loss (10.0%) being the most common identifiable risk factors. Forty percent of children with available newborn hearing screens passed in both ears but later developed USPSNHL. Progressive unilateral hearing loss leading to USPSNHL was found in 21% percent of patients. No patient experienced worsening hearing in the contralateral ear (mean follow-up=31.9 months). Of the 49 temporal bone scans available for review, 40.8% demonstrated aberrant inner ear anatomy, including semicircular canal dysplasia (10.2%), cochlear aperture stenosis (10.2%), hypoplastic cochlea (8.1%), enlarged vestibular aqueduct (14.3%), incomplete partition I/II (6.1%), and anomalous internal auditory canal (2.0%). ConclusionPediatric USPSNHL can be attributed to a variety of sources with a cause identifiable in approximately 40% of patients. Temporal bone CT scan acquisition appears to be relatively high yield in this patient population, but only rarely do results have clinical implications. Early follow-up suggests that this population of children with USPSNHL does not appear to have a significantly increased risk for hearing loss in the contralateral ear.

Simplified bone-anchored hearing aid insertion using a linear incision without soft tissue reduction

Numerous techniques have been described to manage the skin and other soft tissues during bone-anchored hearing aid insertion. Previously, generally accepted techniques have sometimes led to distressing alopecia and soft tissue defects. Now, some surgeons are rejecting the originally described split skin flap in favour of a less invasive approach. To investigate bone-anchored hearing aid placement utilising a single, linear incision with either no or minimal underlying soft tissue reduction. Thirty-four adults were prospectively enrolled to undergo single-stage bone-anchored hearing aid placement with this modified technique. A small, linear incision was used at the standard position and carried down through the periosteum. Standard technique was then followed with placement of an extended length abutment. Patients were reviewed regularly to assess wound healing, including evaluation with Holgers' scale. Only 14.7 per cent of patients had a reaction score of 2 or higher. Most complications were limited to minor skin reactions that settled with silver nitrate cautery and/or antibiotics. None required revision surgery for tissue overgrowth, and there were no implant failures. Our results suggest this to be a simple and effective insertion technique with favourable cosmesis and patient satisfaction.

Benefit of a new hearing device utilizing cartilage conduction

Our previous study demonstrated that sound was effectively transmitted by attaching a transducer to the aural cartilage even without fixation pressure. This new method for sound transmission was found by Hosoi in 2004, and was termed cartilage conduction (CC). CC can be utilized even in hearing-impaired patients who cannot use air-conduction hearing aids owing to continuous otorrhea or aural atresia. A prototype hearing aid employing CC was investigated in this study. Four patients with conditions such as continuous otorrhea and acquired aural atresia after surgery participated in this study. The CC hearing aid was fitted, and its benefits were assessed by audiometric tests and interview. Thresholds and speech recognition scores improved in all subjects. However, in subjects with continuous otorrhea, it was difficult to obtain the gains according to the target gains owing to their severe hearing loss and the limitation of the output level. On the other hand, unexpectedly large gains were obtained below 2kHz in the patient with acquired aural atresia. These large gains were probably caused by soft tissue filling the postoperative space. No subjects complained of pain associated with the attachment of the transducer, although such problems are usually observed for a bone-conduction (BC) hearing aid. This feature is considered one of the advantages of the CC hearing aid. The results of the audiometric tests and interview suggest that the CC hearing aid has potential as a useful amplification device for hearing disability. Unfortunately, if the soft tissue pathway is not involved, the current device is insufficient for the patients with severe hearing loss. The improvement of the output level will lead to develop a reliable CC hearing aid as an alternative to BC hearing aids or bone anchored hearing aids.

Surgical Outcome of Bone Anchored Hearing Aid (Baha) Implant Surgery: A 10 Years Experience

Bone anchored hearing aid (Baha) implant is an option for patient with canal atresia, single sided deafness(SSD) and chronically discharging ears despite treatments. This retrospective study was conducted from 2001 to 2011 to evaluate the surgical outcome of Baha implant surgery. Thirty-three patients were identified during this study period. Their age at implantation ranged from 5 to 40 years. Of 33 patients, 29 (87.9%) patients had bilateral microtia and canal atresia, 3 (9.1%) patients had unilateral microtia and canal atresia and 1 (3.0%) patients have SSD following labyrinthitis. One patient (3.2%) had major complication which is lost of implant due to failure of osseointegration. Soft tissue reactions were seen 7 patients (21.1%). Of these 7 patients, 4 patients required 3-4 procedures as day care operation for excision of the skin overgrowth surrounding the abutment. Recurrent antibiotic treatment was required in 3 patients (9.7%). None of our patient had history of intraoperative or peri-operative complication following Baha surgery. The commonest complications are local infection and inflammation at the implant site. None of our patient had history of intraoperative or peri-operative complication following Baha implant surgery.

Re: Bone‐anchored hearing aids for people with bilateral hearing impairment: a systematic review

The improvement in quality of life from bone-anchored hearing aids Sir, Colquitt et al.’s 1 comprehensive review of bone-anchored hearing aids (BAHAs) emphasized the overall lack of evidence on quality of life (QoL). They reported just one study 2 of the effects on QoL, when measured using generic instruments (a further study was found, but was not reported because of limited data). This study compared BAHAs to both previously-worn air-conduction hearing aids (36 patients) and previously-worn bone-conduction hearing aids (20 patients). With all patients combined, a statisticallysignificant effect of BAHAs was found in only one of the 8 domains (mental health) of the SF-36 questionnaire; there were no effects on the EQ-5D questionnaire. When the patients were grouped by their previous aids, the only statistically-significant effect found was on one of the five dimensions (anxiety/depression) of the EQ-5D in the air-conduction group. We had independently conducted a survey of QoL with bone-anchored hearing aids. We found two other papers 3, 4 that considered the SF-36 questionnaire. The SF-36 which has 8 scales (physical functioning, physical limitation, bodily pain, general health, vitality, social functioning, emotional limitation, and mental health), each of which are measured on a scale from 0 to 100. Neither study found any statistically significant effects of BAHA fitting, either for BAHAs vs. previously worn air-conduction hearing aids (1213 patients) 3 , or for BAHAs vs. pre-fitting in previously-unaided patients (8 patients) 4 . We found no studies that have used the other common generic measure of QoL, the Health Utilities Index. In general, these results support Colquitt et al.’s review. We conclude that there is an absence of evidence that BAHAs lead to any improvement in QoL — when measured with generic instruments. That does not necessarily mean that there is no effect, as no evidence of difference does not imply evidence of no difference. The qualification 'when measured with generic instruments' is crucial here: the problem is that the generic instruments themselves are mostly insensitive to either hearing impairment or its management. The HUI-3 is the most responsive, but there are only minimal changes in EQ-5D scores as a result of cochlear implantation, 5 even though it is self-evident that a cochlear implant often leads to a dramatic improvement in a patient’s life. We therefore agree with Colquitt et al. in their call for more research on the potential benefits of BAHAs on quality of life.