Bone Conduction Hearing Device Research Articles

Auditory Outcomes with Hearing Rehabilitation in Children with Unilateral Hearing Loss: A Systematic Review.

Objective Options for management of unilateral hearing loss (UHL) in children include conventional hearing aids, bone-conduction hearing devices, contralateral routing of signal (CROS) aids, and frequency-modulating (FM) systems. The objective of this study was to systematically review the current literature to characterize auditory outcomes of hearing rehabilitation options in UHL. Data Sources PubMed, EMBASE, Medline, CINAHL, and Cochrane Library were searched from inception to January 2016. Manual searches of bibliographies were also performed. Review Methods Studies analyzing auditory outcomes of hearing amplification in children with UHL were included. Outcome measures included functional and objective auditory results. Two independent reviewers evaluated each abstract and article. Results Of the 249 articles identified, 12 met inclusion criteria. Seven articles solely focused on outcomes with bone-conduction hearing devices. Outcomes favored improved pure-tone averages, speech recognition thresholds, and sound localization in implanted patients. Five studies focused on FM systems, conventional hearing aids, or CROS hearing aids. Limited data are available but suggest a trend toward improvement in speech perception with hearing aids. FM systems were shown to have the most benefit for speech recognition in noise. Studies evaluating CROS hearing aids demonstrated variable outcomes. Conclusions Data evaluating functional and objective auditory measures following hearing amplification in children with UHL are limited. Most studies do suggest improvement in speech perception, speech recognition in noise, and sound localization with a hearing rehabilitation device.

Intermediate outcomes of a transcutaneous bone conduction hearing device in a paediatric population

ObjectiveThe aim of this study was to review the outcomes of Bone Anchored Hearing Aid (BAHA®) Attract implantation in a cohort of paediatric patients. MethodsProspective data collection and case review were undertaken in a paediatric tertiary referral centre. We have included patients under the age of 16 years with unilateral or bilateral hearing loss that met the criteria for BAHA® Attract implantation. The main outcome measures were surgical complications and Patient Reported Outcomes including the ‘Speech, Spatial and Qualities of Hearing scale’ (SSQ-12) and ‘Qualitative Feedback for BAHA® 5 Hearing Aids’. ResultsTwenty-five paediatric patients were implanted with the BAHA® Attract between June 2014 and July 2016. Nine of them had a conversion from a percutaneous Bone Conduction Hearing Device (BCHD). Four children had minor skin problems that settled with conservative measures. Two children with a previous percutaneous BCHD developed skin dehiscence over the magnet after conversion to the transcutaneous version. The SSQ-12 was completed by 6 children and an improvement of 22% was noted between the unaided and aided condition. The patients and their parents were generally satisfied with the BAHA® Attract. ConclusionsThe BAHA® Attract offers a good solution for hearing rehabilitation in appropriately selected and counseled patients. The complication rate was low for primary surgery but higher in cases of conversion from a percutaneous device. Large, prospective data is needed to evaluate the relative risks and benefits of this BCHD.

Response to Comment on “A Systematic Review on Complications of Tissue Preservation Surgical Techniques in Percutaneous Bone Conduction Hearing Devices”

Response to Comment on “A Systematic Review on Complications of Tissue Preservation Surgical Techniques in Percutaneous Bone Conduction Hearing Devices”

Pediatric unilateral sensorineural hearing loss: implications and management.

The purpose of this review is to summarize current studies detailing the impact of unilateral sensorineural hearing loss in children and the most current modalities of treatment used in its management. Current studies corroborate historic views on the impact of unilateral sensorineural hearing loss on patient wellbeing and academic success and stress the use of additional surveillance and studies to diagnose those patients that may pass standard screening practices and suffer from lack of prompt and proper care. With respect to management, notable findings include the continuous development of improved conventional and contralateral routing of signal amplification devices that may act to provide alternatives to percutaneous bone-anchored hearing aid implantation. These include improvements in more conventional hearing aid technology, so as to bridge the performance gap with the classical bone-anchored hearing aid implant, and the development of partially implanted transcutaneous bone conduction hearing devices. Due to dissatisfaction with sound localization, a new and significant development is the burgeoning accumulation of research on cochlear implantation for the treatment of unilateral sensorineural hearing loss in children. With advances in technology in historic modalities of treatment, and the advent of new modalities such as cochlear implantation, the clinician has a wide armamentarium by which to provide treatment to patients based on clinical circumstances and patient desires.

A Systematic Review on Complications of Tissue Preservation Surgical Techniques in Percutaneous Bone Conduction Hearing Devices.

To investigate skin-related postoperative complications from tissue preservation approaches in percutaneous bone conduction device (BCD) implantations. PubMed, Embase, and Cochrane Library. We identified studies on BCDs including the opted surgical technique and derived complications. Retrieved articles were screened using predefined inclusion criteria. Critical appraisal included directness of evidence and risk of bias. Studies that successfully passed critical appraisal were included. Outcome measures included patient demographics, surgery time, follow-up time, and complications reported by Holgers classification. We selected 18 articles for data extraction; encompassing 381 BCDs implanted using non-skin thinning approaches. Four studies reported an implantation technique using the punch method (81 implants), 13 studies applied the linear incision technique without soft tissue reduction (288 implants) and one study used the Weber technique (12 implants). Holgers 3 was described in 2.5% following the punch technique, in 5.9% following the linear incision technique, and in no implants following the Weber technique. One patient was mentioned having Holgers 4, skin overgrowth was reported in 6 patients, and 10 studies compared their non-skin thinning technique with a skin-thinning technique. Overall, the soft tissue preservation technique had a similar or superior complication rate, shorter surgical time, and better and faster healing, compared with the soft tissue reduction technique. Tissue preservation surgical techniques for percutaneous BCDs have limited postoperative skin complication rates. Moreover, these techniques are suggested to have at least similar complications rates compared with skin-thinning techniques.

Use of bone conduction hearing devices in management of patients with congenital aural atresia and microtia- Experience in Hong Kong Chinese

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Which device - when and why? The controversial role of bone conduction hearing devices in the rehabilitation of unilateral sensorineural hearing loss

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Objective and Subjective Outcome of a New Transcutaneous Bone Conduction Hearing Device: Half-year Follow-up of the First 12 Nordic Implantations.

To examine the objective and subjective outcome of a new transcutaneous bone conduction hearing device. Prospective, consecutive case series. Twelve patients were implanted. Eight patients had a conductive/mixed (con/mix) hearing loss. Four had single sided deafness. At half-year follow-up, aided and unaided sound field hearing was evaluated by 1) warble tone thresholds, 2) pure-tone average (PTA4), 3) speech discrimination score (SDS) in quiet, and 4) speech reception threshold 50% at 70 dB SPL noise level (SRT50%). Subjective outcome was evaluated by three questionnaires: 1) International Outcome Inventory for Hearing Aids, 2) Speech, Spatial and Qualities of Hearing Scale 12, and 3) a questionnaire on frequency and duration of use. No major complications occurred. The mean aided PTA4 was lowered by 23dB. SDS was increased by 40% at 50dB, by 34% at 65dB, and by 12% at 80 dB SPL. SRT50% in noise improved 5.2 dB. 58% of the patients used the device daily and 83% at least 5 days a week. 50% used the device ≥ 8 hours and 75% ≥ 4 hours a day. Mean International Outcome Inventory for Hearing Aids score was 3.7, corresponding to beneficial outcome. In Speech, Spatial and Qualities of Hearing Scale 12, "quality of hearing" scored especially high. The con/mix hearing loss group showed larger benefit especially in SDS, SRT50% in noise and the subjective evaluations, whereas frequency and duration of use were similar. This study on the first 12 Nordic patients implanted with a new transcutaneous bone conduction hearing device demonstrates significant objective, as well as subjective hearing benefit. Patient satisfaction was high, as was the frequency of use.

Preoperative headband assessment for semi-implantable bone conduction hearing devices in conductive hearing loss: is it useful or misleading?

To establish whether preoperative assessment using a conventional, percutaneous bone conducting implant (pBCI) processor on a headband accurately represents postoperative performance of a semi-implantable BCI (siBCI). Retrospective case series. Tertiary otology unit. Five patients with chronic otitis media (implanted unilaterally) and one with bilateral congenital ossicular fixation (implanted bilaterally). Semi-implantable bone conduction hearing implant. Functional hearing gain; preoperative (headband) versus postoperative (aided) speech discrimination; unaided bone conduction (BC) versus postoperative (aided) soundfield threshold. Significant functional gain was seen at all frequencies (one-tailed t test p G 0.01; n = 7). There was a 50 dB improvement in median speech reception threshold (SRT) from 70 dB unaided to 20 dB aided. Compared to the preoperative BC, aided siBCI thresholds were worse at 0.5 kHz, but at frequencies from 1 to 6 kHz, the siBCI closely matched the bone curve ( p G 0.01). The siBCI performed better than both pBCI processors on a headband at 3 to 4 kHz, except 1 kHz ( p G 0.01). BC thresholds may be a better indicator of implant performance than headband assessment. Candidacy assessment for siBCI implantation that relies on headband testing with pBCI processors should be interpreted with caution because the headband may under-represent the implanted device. This seems to be especially true at 3 kHz and above and may make it difficult for surgeons to conduct accurate informed consent discussions with patients about the realistic anticipated outcomes and benefits of the procedure.

三分频式压电骨传导助听装置的仿真与测试

三分频式压电骨传导助听装置的仿真与测试

Bone-Conduction Calibration

The audiogram is one of the most powerful tests in health care. It is one of the few that can lead to a diagnosis on its own. Bone-conduction testing gives the audiogram its diagnostic power. Bone-conduction audiometry requires calibration methods that are expensive, cumbersome, and often misunderstood. Because the stimulus is a mechanical vibration, the quantities that are measured (force and acceleration) differ from the sound pressure measurements used to calibrate air-conducted tonal and speech stimuli. This article reviews the history of bone-conduction testing from its Renaissance beginnings, standard and alternative bone-conduction calibration methods, problems in current calibration standards, and the measurement of the performance of wearable and surgical bone-conduction hearing devices.

Individual computer-assisted 3D planning for surgical placement of a new bone conduction hearing device.

To evaluate the benefit of a preoperative three-dimensional (3D) planning tool for surgically placing the bone conduction floating mass transducer (BC-FMT) of the Bonebridge (BB) bone conduction implant. Adult patients (n = 5) and one pediatric patient (n = 1) with conductive or mixed hearing loss caused by chronic ear disease, malformation, or single-sided deafness. Development of a preoperative planning tool that allowed free adjustment of the implant in an individual 3D model of the skull to evaluate completely fitting the BC-FMT into a bony bed and to identify an optimal implant position. Implantation of the BB with mastoid or retrosigmoid placement after individual preoperative planning and "virtual surgery". Feasibility of the preoperative 3D planning process, transfer into the intraoperative situation, and audiologic results after BB implantation. Individual preoperative planning was considered beneficial especially in cases of small mastoid bone volume, for example, because of previous canal wall down mastoidectomies, and in the case with malformation. For optimal placement of the BC-FMT of the BB, preoperative 3D planning is recommended especially in primarily small poorly pneumatized mastoids, hypoplastic mastoids in malformations, reduced bone volume after canal wall down mastoidectomy, or the small mastoids in children. Effort should be made to reduce segmentation and surgical planning time by means of automation.

A new transcutaneous bone anchored hearing device - the Baha® Attract System: the first experience in Turkey.

In this study, we reported our experience with a new transcutaneous bone conduction hearing device, the Baha® Attract System. This multi-center clinical study included the first 12 patients (8 females, 4 males; mean age 27.6 years; range 5 to 65 years) in whom a new transcutaneous bone conduction system was implanted in Turkey. The mean air-bone gap was 41 dB. Bone smoothing around the implant was needed in five patients. We placed a sound processor in the fourth postoperative week for all patients. Our study results suggest that the new bone conduction implant is promising for the patients with conductive or mixed hearing loss who are unable to wear conventional air conduction hearing aid and comparable to percutaneous systems.

Preliminary Functional Results and Quality of Life After Implantation of a New Bone Conduction Hearing Device in Patients With Conductive and Mixed Hearing Loss

To review functional results and quality of life of the first patients implanted with a newly introduced bone conduction implant system. Retrospective chart analysis of 6 patients (6 ears) implanted for conductive hearing loss (CHL) and mixed hearing loss (MHL) in 1 tertiary referral center between July 2012 and February 2013. Implantation of a new bone conduction hearing device. Pure tone audiometry (air conduction and bone conduction thresholds, pure tone average, air-bone gap, and functional gain), speech audiometry (Freiburg Monosyllabic Test), intraoperative and postoperative complication rate, and patient satisfaction (Glasgow benefit inventory [GBI]) were assessed. Air-conduction pure tone average (PTA) was 58.8 ± 8.2 dB HL. Unaided average air-bone gap (ABG) was 33.3 ± 6.2 dB. Aided air-conduction PTA in sound field was 25.2 ± 5.1 dB HL. Aided average ABG was -0.3 ± 7.3 dB. Average functional gain was 33.6 ± 7.2 dB. Mean improvement of GBI was +36.1. No intraoperative complications occurred. During a follow-up period of 8.5 ± 2.2 months, no device failure and no need for revision surgery occurred. Audiometric results of the new bone conduction hearing system are satisfying and comparable to the results of devices that have been applied previously for CHL and MHL. Intraoperatively and postoperatively, no complications were noted.

弹性支撑式压电骨传导听觉装置

A novel circular piezoelectric bone-conduction hearing device with a leaf spring support was proposed to improve its lower-frequency response performance.The equivalent dynamic system containing a support spring and a piezoelectric vibrator was analyzed theoretically by building the dynamic-model of the hearing device.The structure of the support spring was designed after selecting an optimum spring with the thickness of 0.9mm as the support element.A prototype of piezoelectric boneconduction hearing device was developed and the test system was built.The experimental test on amplitude-frequency characteristics and loudness-frequency characteristics were conducted.The results show that the maximum response amplitude of the piezoelectric system has reached up to 22.21μm at550 Hz.Furthermore,the loudness of the hearing device is between 60 dB and 70 dB in the low-frequency region,and that is stabilized at about 80 dB in the high-frequency region.The noise of the de-vice is within a basically reasonable level of 35-40 dB at one meter away.It concludes that the response amplitude of the hearing device is larger in the low-frequency region;the loudness of the device basically meets the requirements of the wearers with a smaller noise.

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 New Semi-Implantable Transcutaneous Bone Conduction Device

Patients with air-bone-gaps that cannot be corrected successfully by tympanoplasty or with mixed hearing loss may be treated with bone conducting hearing aids. Their disadvantages are the obvious external fixation components or the biological and psychosocial problems of open implants. We have developed a new partially implantable Bone Conduction Hearing Device (BCHD) without a percutaneous abutment and have been using them clinically for over 6 years. The principle of these BCHD is a magnetic coupling and acoustic transmission between implanted and external magnets. The goal of this study was to evaluate its clinical and audiologic results in patients with unilateral or bilateral congenital aural atresia. Magnets are implanted into shallow bone beds in a 1-step procedure. The skin above the magnets is slightly thinned. The external device fixed with counter magnets in a base plate. Twenty-one patients who have been implanted due to congenital atresia showed up for this follow-up study. The follow-up period was 19.3 ± 12.2 months, with a range of 0.2 to 46.6 months. The average age of the patients at the time of implantation was 12.4 years with a wide range from 6.0 to 50.0 years. The average hearing gain was 31 ± 8 dB, and the suprathreshold word recognition tests increased by 57% ± 23%. Strength of the magnetic force that the patients had chosen themselves measured 0.9 ± 0.4 N with a range from 0.3 to 1.8 N. Skin thickness over the implants measured sonographically was 3.9 ± 0.8 mm (range, 2.5-5.6 mm). This new bone conducting hearing device only needs one operation, has a very low risk for complication, and a hearing gain similar to other bone conducting hearing aids. We have found high comfort and safety of this system and conclude that it could be a valuable alternative to other conventional or percutaneous bone conducting hearing solutions.

Transcutaneous bone-conduction hearing device: audiological and surgical aspects in a first series of patients with mixed hearing loss

Conclusions: The Bonebridge® (BB) transcutaneous bone conductive implant (BCI) may overcome some of the issues related to a percutaneous BCI, such as management of the external screw, delayed activation or possible skin complications. Moreover, it has been shown to enable a functional outcome similar to percutaneous BCI in both conductive and mixed types of hearing loss. Objectives: To obtain clinical data from a preliminary series of patients implanted with a new transcutaneous BCI. Methods: Four subjects affected by conductive/mixed hearing loss underwent implantation of the BB by two approaches: the transmastoid, presigmoid approach and the retrosigmoid approach. Soundfield thresholds were assessed with warble tones in a soundproof audiometric booth, and word recognition scores (WRSs) as speech reception thresholds (SRTs) were used to compare the unaided versus the post-implantation condition. Results: The surgical procedure was completed in all cases, with only minor intraoperative divergence from the CT-based planning and no postoperative complications. The average improvement of the SRT in quiet with the BB in comparison to the unaided condition was 36.25 dB. All the implanted subjects reached SRT values below 65 dB, indicating a better understanding in quiet, with 100% word recognition.

FITTING AND VERIFICATION PROCEDURE FOR DIRECT BONE CONDUCTION HEARING DEVICES

The present invention relates to a method for fitting and verification of direct bone conduction hearing devices to a patient, wherein a. in a first step the hearing threshold and loudness discomfort levels are measured directly on a titanium implant of a patient, b. in a second step these hearing threshold and loudness discomfort levels are converted to equivalent force thresholds (F HT ) and loudness discomfort levels (F LDL ) on an artificial skull force measuring device, c. in a final step the output force levels of the direct bone conduction hearing device is measured in a free sound field with the device attached to the said artificial skull force measuring device and compared to the F HT and the F LDL as the base for final adjustments of the device.

Imaging of Osseointegrated Implants in the Temporal Bone by Accuitomo 3-Dimensional Cone Beam Computed Tomography

Follow-ups of osseointegrated implants in the temporal bone have been limited to clinical stability and resonance frequency measurements. Standard computed tomographic scanning is restricted because of the high radiation doses to the brain and the presence of disturbing metal artifacts. The present study was undertaken to evaluate the use of cone beam computed tomography preoperatively and postoperatively. Prospective investigation of patients intended for implant surgery and patients participating in a follow-up protocol. Tertiary referral center. Patients with osseointegrated implants and patients intended for implants in the temporal bone for bone-anchored epistheses and bone conduction hearing devices were investigated by a 3-D Accuitomo cone beam computed tomography machine. Images in sagittal, coronal, and axial planes were obtained and analyzed in a personal computer. Preoperative and postoperative views were analyzed regarding implant integration, bone resorption, anatomic landmarks, and implant failure. Eighteen patients were included in the study. With the used technique, it was easy to detect air cells, the sigmoid sinus, and posterior fossa and to recommend an ideal implant installation site. Bone resorption, bone overgrowth, and implant connex to air cells and dura were easy to detect. Accuitomo cone beam tomography showed to be a reliable method for investigating osseointegrated implants in the temporal bone.