Bone-anchored Hearing Aid Research Articles

C121 Hearing loss treatment in various acquired and congenital ear malformations with the use of bone anchored hearing aids (BAHA) in children

To modify the excised larynx bench apparatus to accommodate experiments with rabbit larynges.Methodological study using ex vivo rabbit larynges.Rabbit larynges (n = 5) were dissected and mounted on a custom-made phonatory apparatus. The arytenoids were adducted by rods, and humidified air was passed through the larynx to elicit vocal fold vibration. Acoustic, aerodynamic, electroglottographic (EGG), and videokymographic data were collected for each larynx. The same data were collected for five canine larynges for the purpose of comparison, and coefficients of variation were calculated for each parameter in both models.Reliable phonation was achieved in each larynx. Acoustic fundamental frequency (F0), percent jitter, percent shimmer, signal-to-noise ratio, pressure and flow at phonation onset and offset; and F0, closed quotient, speed quotient, jitter, shimmer, and contact quotient, as recorded by EGG; and mucosal wave amplitude and phase difference are reported for rabbit larynges. Coefficients of variation for each parameter are similar in magnitude between the two models.We developed a method for recording reliable acoustic, aerodynamic, videokymographic, and EGG data from rabbit larynges. When data obtained from leporine larynges were compared with data from canine larynges, the intralarynx variability of rabbit larynges was found to be similar to that of canine larynges.

State Budget Cuts Will Affect Members, Services

State Budget Cuts Will Affect Members, Services

B105 Bone-anchored hearing aid (BAHA) implant in children. one stage surgery

B105 Bone-anchored hearing aid (BAHA) implant in children. one stage surgery

Comparison of Hearing Thresholds Obtained with Baha Preoperative Assessment Tools and those Obtained with the Osseointegrated Implant

We conducted a study of the Baha bone-anchored hearing aid system to quantify the difference between (1) hearing thresholds obtained through preoperative testing methods with the Baha sound processor attached to three different bone-conduction testing devices and (2) thresholds obtained postoperatively with the sound processor attached to a surgically placed osseointegrated titanium implant. Twenty-three patients underwent free-field testing in four situations: with the Baha sound processor attached to (1) the Baha Testband (transcutaneous transmission), (2) the Baha Softband (transcutaneous transmission), (3) a test rod (bone conduction via the teeth), and (4) the osseointegrated implant (percutaneous transmission). The main outcome measure was the result of a comparison of the thresholds obtained with the three preoperative test methods and those obtained with the osseointegrated implant. We found that aided thresholds obtained with the osseointegrated implant were significantly better (p < 0.05) than those obtained with the three preoperative test methods. The degree of superiority increased with higher frequencies. We conclude that thresholds of 1 to 18 dB better than those obtained by preoperative test methods can be expected postoperatively with the osseointegrated implant. The damping effect of sound transmission via the teeth or transcutaneously must be accounted for in making predictions of postoperative outcome.

Einseitige Taubheit und Cochlear-implant-Versorgung

Cochlear implantation (CI) is a new form of treatment in the rehabilitation of single-sided deafness. The patient requires thorough initial examination and a full explanation of alternative treatment options prior to determining the indication for CI treatment. To date, we have treated 28 patients with CI, of whom data are available for 11 after 12 months. We examined speech comprehension in background noise and localisation ability 12 months after CI implantation compared to conventional CROS (contralateral routing of signal) hearing aids, BAHA (bone-anchored hearing aid) and hearing in untreated patients. In addition, we determined the subjective handicap (HHIE, hearing handicap inventory for the elderly) and the subjective success (IOI-HA, international outcome inventory for hearing aids; SSQ, spatial and qualities of hearing scale) of each treatment option. After 12 months' experience, the results show a significantly better localisation ability and an improvement in speech comprehension in background noise with CI than with the other treatment options. Subjective results also show a clear benefit with CI. Careful patient selection is a decisive factor for successful treatment of this patient group. Under these conditions, CI is a treatment option with which significant improvement in speech comprehension and localization ability in single-sided deafness is possible.

Complications of bone-anchored hearing aids in pediatric patients

Objective To describe the range and rate of complications related to bone-anchored hearing aids in pediatric patients. Method We conducted a retrospective review all children 16 years of age or less who were implanted with a bone-anchored hearing aid from 2002 to 2009. The main outcome measures were post Baha ® implantation complications including infection, soft tissue hypertrophy, loss of osseointegration, and need for further surgery. Results Thirty-one patients were identified and 27 had sufficient follow up for complete analysis. Soft tissue reactions were seen in 24 patients (89%), half of which were considered minor. Ten patients (37%) had major complications defined as requiring revision surgery or removal of the implant. Soft tissue overgrowth and infection at the abutment required removal in 5 children (19%) and three implants (11%) failed to osseointegrate. Recurrent antibiotic treatment was required in eight patients (30%). Seven patients (26%) had a history of trauma and one of them lost the implant. To date, three of the children (11%) have been unable to use the device because of chronic infection and overgrowth of the abutment. There was a statistically significant increased risk for major complications in patients from socioeconomically deprived backgrounds and obesity appears to incur additional risk. Conclusions Complications of bone-anchored hearing aid implants are common in our experience and obesity and socioeconomic factors appear to contribute to a higher risk for complications. Frequent follow up and meticulous care of the implant site may minimize complications but can be challenging in this population.

Functional benefit of the bone‐anchored hearing aid with different auditory profiles: objective and subjective measures

To examine sentence recognition and self-report outcomes in hearing-impaired persons with different auditory profiles and who were fitted unilaterally with a bone-anchored hearing aid. Prospective cohort study. Tertiary referral unit. Data were collected of six patients with single-sided deafness (SSD), seven with a mild to severe hearing loss at the bone-anchored hearing aid side and (near-)normal hearing at the other side and six with a severe bilateral hearing loss. Sound field thresholds, and sentence recognition in noise (presented from different angles) with bone-anchored hearing aid, without bone-anchored hearing aid and with bone-anchored hearing aid and other ear occluded. In addition, the Speech, Spatial and Qualities of hearing scale and the Abbreviated Profile of Hearing Aid Benefit questionnaire were administered as self-report measures. Patients with single-sided deafness listened mainly with their non-bone-anchored hearing aid ear, although the bone-anchored hearing aid lifted the head shadow effect. Patients with mild to severe hearing loss at the bone-anchored hearing aid side and (near-)normal hearing at the other side performed significantly differently in aided and unaided conditions and even regained limited binaural sensitivity with the device. The latter was also true for the patients with severe bilateral hearing loss. However, their hearing loss at the non-bone-anchored hearing aid side was too great to contribute to hearing and they listened predominantly with their bone-anchored hearing aid. Self-report outcomes provided useful information on hearing disability, although this information was not significantly differently for the 3 groups of patients. The bone-anchored hearing aid enhanced performance in different hearing configurations, albeit to different extents.

Soft tissue overgrowth in bone-anchored hearing aid patients: use of 8.5 mm abutment

To review outcomes following implantation of an 8.5 mm bone-anchored hearing aid abutment, as regards post-operative management of scalp soft tissue overgrowth. Retrospective chart review of paediatric and adult patients implanted with bone-anchored hearing aids between 2003 and 2008 who subsequently underwent revision surgery for excessive soft tissue growth. A tertiary referral centre and a private otology and neurotology clinic. A total of 80 patients underwent bone-anchored hearing aid placement between 2003 and 2008. Of these patients, 14 had significant scalp soft tissue overgrowth unresponsive to first-line, nonsurgical local wound care. Fourteen patients underwent an average of 2.1 surgical procedures each for soft tissue overgrowth around their bone-anchored hearing aid abutment. The mean time between initial implantation and revision surgery was 13.6 months. Of these 14 patients, 11 were eventually fitted with an 8.5 mm abutment. Following placement of the longer abutment, only one patient required additional surgical reduction of soft tissue overgrowth (mean follow-up time 11.8 months). All patients were able to use their bone-anchored hearing aid. The 8.5 mm bone-anchored hearing aid abutment is successful in preventing the need for additional surgical intervention in the small but significant number of patients with post-implantation soft tissue overgrowth. Early consideration should be given to this option when first-line soft tissue care is inadequate.

Arkansas BAHA Experience

To determine what factors increase the likelihood of osseointegration failure and implant extrusion with the use of osseointegration surgical hardware, for bone-anchored hearing aids (BAHAs), in children and adults. A total of 60 patients (42 pediatric [≤19 yr] and 18 adult patients [34-69 yr]) who received osseointegration surgical hardware for a BAHA at Arkansas Children's Hospital from October 2003 to May 2009 or at the University of Arkansas for Medical Sciences from November 2005 to May 2009, respectively. BAHA placement using 3- and 4-mm fixtures. Osseointegration failure with implant extrusion. Fifty-seven loaded fixtures in the pediatric population, and 20 were placed in the adults. We had a 21% pediatric and 0% adult osseointegration failure rate. Young age, syndromic status, and failure to penetrate the inner table of the cranium increased the risk of osseointegration failures in children. In some cases, skull thickness provides an inadequate amount of bone for 4-mm fixture placement requiring placement of a 3-mm fixture instead. In these cases, transcalvarial placement of the implanted fixture may decrease the extrusion rate as 3-mm fixtures have been associated with increased rates of implant extrusion. The 3-mm fixtures that were placed in a transcalvarial fashion had a decreased extrusion rate compared with 3-mm fixtures that were surrounded by bone and did not penetrate the inner table of the cranium. Individual patient factors out of the surgeon's control likely play a large role in osseointegration failures as well. This clinical case report encourages transcalvarial fixture insertion when using 3-mm fixtures during placement of osseointegration surgical hardware for BAHAs.

Quality of life improvement for bone-anchored hearing aid users and their partners

Bone-anchored hearing aid recipients experience well documented improvements in their audiometric performance and quality of life. While hearing aid recipients may understate their functional improvement, their partners may be more aware of such improvement. We sought to investigate patients' partners' perceptions of functional improvement following bone-anchored hearing aid fitting. Surveys were sent to 153 patients who had received a bone-anchored hearing aid through the Nova Scotia bone-anchored hearing aid programme. The validated survey asked patients' partners to give their subjective impression of the bone-anchored hearing aid recipient's functional status. Surveys were completed by 90 patients (58.8 per cent), of whom 72 reported having a partner. Partners reported a significant improvement in hearing (p ≤ 0.0001). Partners reported improvement in 87.0 per cent of functional scenarios, no change in 12.6 per cent, and a decline in 0.4 per cent. These findings demonstrate a significant improvement in the emotional and social effects of hearing impairment, as perceived by bone-anchored hearing aid recipients' partners.

Benefit and Quality of Life After Bone-Anchored Hearing Aid Fitting in Children With Unilateral or Bilateral Hearing Impairment

To evaluate the benefits of a bone-anchored hearing aid (BAHA) in the daily lives of hearing-impaired children. Retrospective questionnaire study. Nijmegen Medical Centre, Nijmegen, the Netherlands. Thirty-eight BAHA users with a minimum age of 4 years at BAHA fitting and 1 to 4 years of use, divided into groups with bilateral conductive or mixed hearing loss and either normal cognition or mental disability and a group with unilateral conductive hearing loss. Scores on the Glasgow Children's Benefit Inventory, Abbreviated Profile of Hearing Aid Benefit, and Health Utilities Index Mark 3. The Glasgow Children's Benefit Inventory showed a subjective overall benefit of +32, +16, and +26 in the 3 groups (on a scale of -100 to +100). The Abbreviated Profile of Hearing Aid Benefit also showed an overall mean benefit in the groups. On an individual level, a clinically significant benefit was reported by more children in the group with bilateral hearing loss and normal cognition (7 patients [70%]) than in the unilateral hearing loss group (4 patients [27%]). Overall mean health utility scores and disability index scores on the Health Utility Index Mark 3 were comparable among the 3 groups. Overall, BAHA fitting can be considered effective and beneficial in children with bilateral or unilateral hearing loss.

Bone anchored hearing aid in single sided deafness: Outcome in right-handed patients

To assess the benefits in terms of sound localization, to evaluate speech discrimination in noise, to appraise the prosthesis benefit and to identify outcome in right and left handed patients when BAHA are implanted on the right or on the left deaf side. Two years prospective study in a tertiary referral center. Tests consist on Hearing in Noise Test (HINT) and sound localization after 6 months of BAHA use. Quality of life was assessed by the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire. The paired T-test and the analysis of variance were used for the statistical measures. Twenty-one subjects participated in this study. HINT: patients score better when speech and noise are spatially separated and noise is not presented to the healthy ear. In the right-handed group (left dominant brain), unaided left-implanted patients performed better than right-implanted patient when speech is in front and noise to the good ear; when speech is presented to the good ear and noise to the front, aided right-implanted patients performed better than aided left-implanted patients. Sound localization: correct answers attain 35% at best. No statistical difference between the frequencies was found, neither between the left and right implanted patients. APHAB: the score improvement is statistically significant for the global score, the background noise subscale at 5 weeks and for the reverberation subscale at 6 months. It seems that left dominant hemisphere is able to filter crossed noise better than the right hemisphere. Results of uncrossed speech to the dominant left brain are better than the uncrossed speech to the non-dominant right brain.

Technology-Limited and Patient-Derived Versus Audibility-Derived Fittings in Bone-Anchored Hearing Aid Users: A Validation Study

Current approaches to fit bone-anchored hearing aid (Baha) rely heavily on patient feedback of "loudness" and "sound quality." Audiologists are limited to this approach for two reasons: (1) the technology in current models of Baha does not allow for much fine-tuning of frequency response or maximum output on an individual basis and (2) there has not been a valid approach to verify the frequency response or maximum output on an individual basis. The objectives of this study are to (1) describe an alternative approach to fit Baha, an "audibility-derived (AD)" fitting, and (2) test whether outcomes improve with this new fitting compared with the current "patient-derived (PD)" fitting. This study used a repeated measures design where each subject experienced both the AD and PD fittings in random order. Subjects were tested on a variety of outcome measures including output levels of aided speech, hearing in noise test (quiet and in noise), consonant recognition in noise, aided loudness, and subjective percentage of words understood. Electromechanical testing revealed significantly higher aided output with the AD fitting, especially in the high frequencies. Subjects performed significantly better in all outcome measures with the AD fitting approach except when testing aided loudness and subjective perception for which the differences were nonsignificant. When the input levels to the Baha were soft, advantages for the AD fitting were emerging on these tests, but they did not reach significance. This study presents a more objective, fitting approach for Baha that leads to better outcomes in the laboratory. The next steps will be to test these fittings in the real world and to make the approach generally available to clinicians fitting Bahas.

Benefits of Low-Frequency Attenuation of Baha® in Single-Sided Sensorineural Deafness

To investigate the effect of low-frequency attenuation of Bone-Anchored Hearing Aids (Bahas) in users with single-sided sensorineural deafness (SSD). The underlying notion is that low-frequency sounds up to approximately 1500 Hz reach the contralateral ear without significant attenuation and that Bahas tend to show more distortion at lower frequencies. Furthermore, to transmit low frequencies, higher moving masses are needed when compared with high frequencies. A prospective study with 10 adults, experienced Baha Divino users with SSD. Speech understanding in noise was measured without Baha and with Baha, with three different settings of low-frequency attenuation, namely up to 270, 630, and 1500 Hz. Tests were performed in two different spatial arrangements. In one placement, speech was emitted from a loudspeaker on the side of the Baha ear and noise from a loudspeaker in front of the listener (S90N0). In the other placement, the sound sources were switched (S0N90). Participants rated the subjective sound quality of the two most extreme Baha settings using analog visual scales after a short acclimatization time of 15 mins. In setting S90N0, the use of a Baha improved speech understanding in noise significantly (average improvement 2.8 to 3.1 dB, p = 0.006). These improvements did not vary significantly with the chosen low-frequency attenuation. In setting S0N90, a smaller but detrimental effect of the Baha was found (-0.9 to -1.7 dB, p = 0.006 to 0.03). This detrimental effect was significantly smaller at the highest cutoff frequency of 1500 Hz than at 270 Hz (p = 0.013). At the cutoff frequency of 270 Hz, loudness and reverberation were judged higher than at 1500 Hz. There was no significant difference in brightness, softness, clarity, or fullness. High cutoff levels of up to 1500 Hz for low-frequency signals do not compromise the benefit of Baha in SSD for noise arriving from the front and speech presented on the side of the Baha. If noise is presented from the side of the Baha, the detrimental effect on speech understanding can be reduced by higher cutoff frequencies. If frequencies <1500 Hz do not need to be transmitted, lower moving masses of the Baha are required and smaller devices for patients with SSD may be possible.

Bone-anchored hearing aids (Baha) in congenital aural atresia: Personal experience

Aims Aural atresia is a congenital disease constituted by partial or complete lack of development of the external auditory canal, which is generally associated with malformations of the auricle and middle ear. Reconstruction of the auditory canal and correction of any deformities of the middle ear have yielded unpredictable results and variable functional outcomes, and there is a high rate of complications. Therefore, the use of bone-conduction hearing aids, such as the Baha, may represent a valid alternative for subjects who have conductive hearing loss with cochlear reserve that, as a rule, is fully conserved. The aim of this work is to reexamine our experience with the management of conductive and mixed hearing loss using the Baha system in children with bilateral aural atresia. Methods We examined 31 patients with bilateral congenital aural atresia in whom a Baha system had been implanted. The patients, 16 males and 15 females, were between 5 and 14 years of age (mean 8.7). The following parameters were assessed for each patient: mean preoperative air and bone conduction for frequencies between 0.5 and 4 kHz; mean preoperative threshold with conventional bone-conduction hearing aids; mean postoperative threshold with the Baha system; improvement in quality of life evaluated with the Glasgow Children's Benefit Inventory; rate and type of surgical complications. Results The mean preoperative air- and bone-conduction thresholds were 51.2 ± 12.5 and 14.1 ± 6.3 dB HL, respectively. The mean preoperative threshold with a conventional bone-conduction hearing aid was 29.3 ± 7.2 dB HL, and the mean postoperative threshold with the Baha system was 18.1 ± 7.5 dB HL. Quality of life improved for all operated patients. Conclusions The results of our study of the Baha system to treat patients with bilateral aural atresia were extremely satisfactory compared both with those of surgical reconstruction of the auditory canal and those of traditional bone-conduction hearing aids. Furthermore, great improvement was noted in quality of life, while the rate of complications was very low. Therefore, we are convinced that the Baha system is the treatment of choice for hearing loss due to bilateral congenital aural atresia.

先天性外耳道閉鎖症例における埋め込み型骨導補聴器（Ｂｏｎｅ‐Ａｎｃｈｏｒｅｄ Ｈｅａｒｉｎｇ Ａｉｄ：ＢＡＨＡ）の有効性に関する検討

The effectiveness of bone anchored hearing aid (BAHA) for the patients with congenital aural atresia was evaluated by multicenter clinical study in Japan. Twenty patients (17 bilateral and 3 hemilateral) of congenital auricular atresia were registered for this study and finally, 18 of them (15 bilateral and 3 unilateral) were subjected to further evaluation. Primary endpoint of this study was free sound-field pure-tone audiometory and speech threshold hearing test in quiet and noisy circumstances. Secondary endpoint of this study was patient's satisfaction based upon APHAB (Abbreviated Profile of Hearing Aid Benefit) questionnaire survey. These results were compared between before and 12 weeks after BAHA surgery. Both hearing level of pure tone and speech threshold significantly improved after BAHA surgery. APHAB scores also suggested the improvement of the QOL after BAHA usage, except for the scores that concerned with unpleasantness of noisy sound. BAHA is one of the useful options for the treatment of congenital auricular atresia.

埋め込み型骨導補聴器の聴覚成績と術中，術後合併症の検討

The bone-anchored hearing aid (BAHA) has advantages over conventional hearing aids in sound quality and speech reception in silence, but requires surgery and may have peri-and postoperative complications. We evaluated audiological findings and complications in 12 subjects (13 ears)-8 men and 4 women aged 20-71--undergoing BAHA surgery from September 2001 to October 2005. Surgery was for single-sided deafness in one subject. Mean warble tone thresholds with BAHA were 29.9dB and 65.2dB without. Functional gains ranged from 16 to 52dB (mean: 35.3dB). Dural exposure or venous hemorrhage was seen in 4 ears, and mastoid cells opened and a skin flap was damaged in 1 ear each. No severe complications occurred perioperatively. Skin reactions categorized into grade 1 or more were recognized in nearly 70% of ears during the first postoperative year but most were a grade 1 reaction and skin reactions decreased with time. Skin overgrowth occurred in 1 ear immediately after an abutment separated accidentally from the fixture. All complications were treated in outpatient clinics. No fixture extrusion occurred. The decision to proceed with BAHA surgery thus required fully informed consent based on knowledge of peri-and postoperative complications.

Comparison of Pseudobinaural Hearing to Real Binaural Hearing Rehabilitation After Cochlear Implantation in Patients With Unilateral Deafness and Tinnitus

Up to now, treatment modalities of unilateral deafness consist of no treatment, conventional contralateral routing of signal (CROS), or Bone-Anchored Hearing Aid (BAHA) hearing aid. Cochlear implantation makes a new treatment modality available for patients with single-sided deafness. The aim of this study is to evaluate the use of unilateral electrical stimulation with normal hearing on the contralateral side after a period of 6 months compared with the preoperative unaided situation, conventional CROS, or BAHA hearing aids. Prospective design. Tertiary referral center; cochlear implant (CI) program. Eleven adult subjects with unilateral deafness of various causes were enrolled in the study. Only those patients were included in whom therapy with CROS hearing aid or BAHA was not successful and in whom the auditory nerve was found to be intact and the cochlea patent for cochlear implantation. All subjects were fitted in random order with a BAHA Intenso mounted on the softband/tension clamp or with a CROS hearing aid. After test periods with both devices, the subjects received a CI. The Hochmair-Schulz-Moser sentence test and the Oldenburg sentence test were used to test speech comprehension in 3 presentation configurations in the unaided situation, with conventional CROS and BAHA hearing aids before cochlear implantation as well as after 6 months with CI. Localization was assessed using an array of 7 speakers at head level in a frontal semicircle. Subjective improvement in daily life was evaluated using the Speech, Spatial and Qualities of Hearing Scale, the Health Utilities Index 3 and the International Outcome Inventory for Hearing Aids questionnaires. Tinnitus distress was measured with a tinnitus scale before and after CI implantation. The results show significant improvement in localization ability as well as in speech comprehension in most presentation configurations with the CI. Especially, there is no negative effect on speech comprehension if the noise is presented to the CI ear and speech to the normal hearing ear. With the CI, the summation and squelch effects are not significant, but a significant combined head shadow effect is seen. Speech, Spatial and Qualities of Hearing results show an overall benefit of wearing the CI compared with the other treatment options. The tinnitus scale revealed a positive effect of CI stimulation in cases of preoperative tinnitus. The results in these patients suggest that cochlear implantation improves hearing abilities in people with single-sided deafness and is superior to the alternative treatment options. The use of the CI does not interfere with speech understanding in the normal hearing ear. Our data suggest that the binaural integration of electric and acoustic stimulation is possible even with unilateral normal hearing.

Long-Term Benefit Perception, Complications, and Device Malfunction Rate of Bone-Anchored Hearing Aid Implantation for Profound Unilateral Sensorineural Hearing Loss

Long-Term Benefit Perception, Complications, and Device Malfunction Rate of Bone-Anchored Hearing Aid Implantation for Profound Unilateral Sensorineural Hearing Loss

Better performance with bone‐anchored hearing aid than acoustic devices in patients with severe air‐bone gap

A study performed in the 1990s with analogue linear hearing aids showed that in patients with mixed hearing loss and an air-bone gap that exceeded 25 to 30 dB, speech perception was better with a bone-anchored hearing aid (Baha) than with a conventional behind-the-ear (BTE) device. The objective of the present study was to investigate whether this conclusion applies to today's digital BTEs with feedback cancellation and whether the crossover point still occurs at an air-bone gap of 25 to 30 dB. Case control. Experienced unilateral Baha users with the latest digital Baha processors were fitted with a powerful BTE with feedback cancellation. After an acclimatization period of 4 weeks, aided thresholds and speech recognition scores were determined and compared to those recorded previously with the Baha. To obtain patients' opinions, a disability-specific questionnaire was used. Participants comprised 16 subjects with bilateral mixed hearing loss participated Audiometric and speech recognition data showed similar trends to those described previously, but the crossover point had shifted to an air-bone gap of 30 to 35 dB. In the questionnaire, the BTE was rated higher than the Baha, except by the patients with an air-bone gap that exceeded an average of 45 dB. In patients with mixed hearing loss whose air-bone gap exceeded 35 dB, speech recognition is likely to be better with a Baha than with a BTE. Therefore, the Baha should receive greater consideration when mixed hearing loss is combined with a significant air-bone gap, even when there are no contraindications for BTEs.