Conventional Hearing Aids Research Articles

Parental Perspective Pre- and Post-Cochlear Implantation in Tanzania

Cochlear implants, as prosthetic devices designed to replace the function of the inner ear, have become a widely used intervention method for people with severe to profound sensorineural hearing losses who gain little or no benefit from conventional hearing aids.

Medical, Technical and Audiological Outcomes of Hearing Rehabilitation with the Bonebridge Transcutaneous Bone-Conduction Implant: A Single-Center Experience.

Bone-conduction implants are a standard therapeutic option for patients with conductive, unilateral, or mixed hearing loss who either do not tolerate conventional hearing aids or can benefit from surgery. The aim of this study was to evaluate long-term medical and technical outcomes, and audiological results with the Bonebridge transcutaneous bone-conduction implant. This retrospective study included all patients implanted with a bone-conduction hearing implant at a tertiary medical referral center between March 2012 and October 2018. Medical and technical outcomes included the mean length of implant usage, medical and technical complications (skin and wound infection, lack of benefit, technical failure), explantations and revisions, coupling approaches, implant failure rate, implant survival and the implant loss for added follow-up years. Auditory results were measured by functional hearing gain and the Freiburger monosyllabic test at 65 dB sound pressure level. Sixty-four patients were included in the study; five of these were implanted bilaterally (69 devices). Five unilaterally implanted patients were lost to follow-up. The mean follow-up was 27.1 months (range: 0.2 months–6.3 years). The mean implant usage was 25.9 months (range: 0.2 months–6.3 years). Fifty-seven implants (89.1%) were in use at the end of the follow-up period. Complications occurred in six ears (9.4%). Five implants (7.8%) were explanted without reimplantation. Device failure occurred in one implant (1.6%), which was possibly caused by recurrent head trauma. The rate of implant loss due to technical device failure (damage to device) was 1 per 72 follow-up years. The mean improvement on the Freiburger monosyllabic test (52.1%, p = 0.0001), and in functional hearing gain across frequencies (26.5 dB, p = 0.0001) was significant. This single-center follow-up reveals the medical and technical reliability of a transcutaneous bone-conduction implant for hearing rehabilitation because complication and revision rates were low. The majority of patients still used the device at the end of the observation period. Implantation resulted in favorable hearing outcomes in comparison to that of unaided conditions. Cautious patient selection mainly regarding co-morbidities, the history of chronic otologic diseases and proper surgical technique seems to be crucial in reducing complications.

Tinnitus Suppression Effect of Hearing Aids in Patients With High-frequency Hearing Loss: A Randomized Double-blind Controlled Trial.

Hearing aids (HAs) with frequency lowering have been used for high-frequency hearing loss (HFHL), but their effects on tinnitus relief have not been studied extensively. This randomized double-blind trial was performed to investigate and compare tinnitus suppression effects of conventional type HAs and frequency-lowering HAs in patients with HFHL. A total of 114 patients were randomized into three groups: conventional HA using wide dynamic range compression, HA with frequency translation, and HA with linear frequency transposition. Participants wore HAs for 3 months and then discontinued their use. The final evaluation was performed at 3 months after cessation of wearing HA (6 mo after the initial visit). The Tinnitus Handicap Inventory (THI) score and additional variables, such as matched tinnitus loudness and visual analog scale scores of subjectively perceived tinnitus loudness, daily awareness, and annoyance, were measured at the initial visit and at 3- and 6-month follow-ups. THI score and most of the additional outcomes were significantly improved at 3 and 6 months (3 mo after HA removal) compared with their initial values in all three groups. The incidence rates of patients with improvements in the THI score by 20% or more were 71.0, 72.7, and 74.3% at 3 months, and 54.8, 51.6, and 59.4% at 6 months for the three groups, respectively. There were no significant differences in primary or additional variables between hearing aid types at either 3 or 6 months. This is a consolidated standards of reporting trials-guided study providing direct evidence for tinnitus suppression effects of HA alone, without accompanying counseling or any other treatments, which lasted for at least 3 months after patients stopped using HAs. HAs effectively suppressed tinnitus in patients with HFHL regardless of the amplification strategy type.

Which Patients With a Unilateral Hearing Aid for Symmetric Sensorineural Hearing Loss Have Auditory Deprivation?

ObjectivesThe aim of study is to find conditions that aggravate auditory deprivation in patients with symmetric hearing loss after unilateral digital, non-linear hearing aid (HA).MethodsIn the retrospective case-comparison study, we assessed 47 patients with symmetric sensorineural hearing loss (SNHL), wearing unilateral conventional HAs. Audiological outcomes were assessed >1 year after HA fitting (mean duration, 31.0 months). Pure-tone audiometry in HA-aided and HA-unaided conditions was performed over time. Word recognition score (WRS) was evaluated at the most comfortable listening level.ResultsThe initial pure tone average of four frequency thresholds at 500, 1,000, 2,000, and 4,000 Hz (PTA4) did not show a difference of >5 dB HL between HA-aided and HA-unaided ears. WRS progressively decreased for both HA-aided and HA-unaided ears although the extent of decrease was significantly greater for HA-unaided (7.6%) than for HA-aided ears (5.1%, P<0.05). Notably, auditory deprivation in HA-unaided ears was significantly greater in patients with an initial PTA4 ≥53 dB HL (P<0.001).ConclusionBilateral HAs are strongly recommended, particularly for patients with moderate to severe SNHL to prevent auditory deprivation in the contralateral ear.

Evaluation of a photoacoustic bone-conduction vibration system.

This article proposes a bone conduction vibrator that is based on a phenomenon by which audible sound can be perceived when vibrations are produced using a laser beam that is synchronized to the sound and these vibrations are then transmitted to an auricular cartilage. To study this phenomenon, we measured the vibrations using a rubber sheet with similar properties to those of soft tissue in combination with an acceleration sensor. We also calculated the force level of the sound based on the mechanical impedance and the acceleration in the proposed system. We estimated the formant frequencies of specific vibrations that were synchronized to five Japanese vowels using this phenomenon. We found that the vibrations produced in the rubber sheet caused audible sound generation when the photoacoustic bone conduction vibration system was used. It is expected that a force level that is equal to the reference equivalent threshold force level can be achieved at light intensities that lie below the safety limit for human skin exposure by selecting an irradiation wavelength at which a high degree of optical absorption occurs. It is demonstrated that clear sounds can be transmitted to the cochlea using the proposed system, while the effects of acoustic and electric noise in the environment are barred. Improvements in the vibratory force levels realized using this system will enable the development of a novel hearing aid that will provide an alternative to conventional bone conduction hearing aids.

STRESSORS FOR PARENTS OF CHILDREN WITH COCHLEAR IMPLANT IN PAKISTAN

STRESSORS FOR PARENTS OF CHILDREN WITH COCHLEAR IMPLANT IN PAKISTAN

Value of auditory perception of alphabet letters test (Arabic standardized version) in evaluation of Arabic speaking CI children

Background: Cochlear implant (CI) is a hearing device that helps hearing impaired children who did not benefit from conventional hearing aids to restore a satisfactory level of auditory sensation. The proper verification of their auditory speech and language performance helps gain the best outcomes. Speech perception tests are basic assessment tools. They are considered as supra-threshold tests that use different speech materials that are reliable for hearing impaired children.Objectives: The aim of this study is to assess the correlation between the different speech perception tests and auditory skills, language acquisition and speech parameters for cases with CI children in Zagazig University Hospitals. This will help develop an appropriate battery for verification of CI children.Design: This study was applied on 21 children with CI who had implanted before the data collection period. For all participants aided thresholds, APAL, WIPI and PBKG tests were done in the audio-vestibular medicine unit for assessment of audiological outcomes. Assessment of auditory skills, language acquisition and speech parameters were done in the Phoniatric Unit. The results were collected and statistically analyzed.Results: There was a strong positive correlation between APAL and TLA, auditory skills and intelligibility of speech, which was superior to other speech perception tests.Conclusion: APAL can be used as a reliable speech discrimination test that can anticipate the progress in different skills of pre-lingual CI children.

Air- and Bone-Conducted Sources of Feedback With an Active Middle Ear Implant.

Active middle ear implants (AMEI) have been used to treat hearing loss in patients for whom conventional hearing aids are unsuccessful for varied biologic or personal reasons. Several studies have discussed feedback as a potential complication of AMEI usage, though the feedback pathway is not well understood. While reverse propagation of an acoustic signal through the ossicular chain and tympanic membrane constitutes an air-conducted source of feedback, the implanted nature of the device microphone near the mastoid cortex suggests that bone conduction pathways may potentially be another significant factor. This study examines the relative contributions of potential sources of feedback during stimulation with an AMEI. Four fresh-frozen, hemi-sectioned, human cadaver specimens were prepared with a mastoid antrostomy and atticotomy to visualize the posterior incus body. A Carina active middle ear implant actuator (Cochlear Ltd., Boulder, CO) was coupled to the incus by two means: (1) a stereotactic arm mounted independently of the specimen and (2) a fixation bracket anchored directly to the mastoid cortical bone. The actuator was driven with pure-tone frequencies in 1/4 octave steps from 500 to 6000 Hz. Acoustic sound intensity in the ear canal was measured with a probe tube microphone (Bruel & Kjær, Nærum, Denmark). Bone-conducted vibration was quantified with a single-axis laser Doppler vibrometer (Polytec Inc., Irvine, CA) from both a piece of reflective tape placed on the skin overlying the mastoid and a bone-anchored titanium screw and pedestal (Cochlear Ltd., Centennial, CO) implanted in the cortical mastoid bone. Microphone measurements revealed ear-canal pressures of 60-89 dB SPL, peaking in the frequency range below 2 kHz. Peak LDV measurements were greatest on the mastoid bone (0.32-0.79 mm/s with mounting bracket and 0.21-0.36 mm/s with the stereotactic suspension); peak measurements on the skin ranged from 0.05 to 0.15 mm/s with the bracket and 0.03 to 0.13 mm/s with stereotactic suspension. AMEI produce both air- and bone-conducted signals of adequate strength to be detected by the implanted device microphone, potentially resulting in reamplification. Understanding the relative contribution of these sources may play an important role in the development of targeted mitigation algorithms, as well as surgical techniques emphasizing acoustic isolation.

Applying the COM-B Model to Assess the Usability of Smartphone-Connected Listening Devices in Adults with Hearing Loss.

Unlike conventional hearing aids, smartphone-connected listening devices may require limited or no input from a trained audiologist in terms of device programming and adjustment. However, there is a lack of peer-reviewed evidence assessing the real-world perspectives of people living with hearing loss toward such technological innovations. This study assessed the everyday experiences of adults living with hearing loss toward a range of smartphone-connected listening devices using the Capability, Opportunity, Motivation, Behaviour (COM-B) model as a theoretical framework. A qualitative study where participants trialed one of the following smartphone-connected listening devices for two weeks in their everyday lives: made-for-smartphone hearing aid, personal sound amplification product, and smartphone "hearing aid" app with wired earphones or wireless hearable. Individual semistructured interviews were conducted. Twenty adults (13 male and 7 female; mean age = 62.25 years, SD = 11.59) with mild-to-moderate hearing loss (mean better ear pure-tone average = 30.49 dB HL, SD = 17.51) were recruited using a convenience sampling strategy. All participants owned conventional hearing aids. The data were analyzed using an established deductive thematic analysis procedure within the context of the COM-B model. The model stipulates that for individuals to engage in a particular behavior (B), they must have sufficient capability (C), opportunity (O), and motivation (M). Capability: One of the key advantages facilitating use and adherence of smartphone-connected listening devices was the ability for participants to make fine-tune adjustments in any listening situation. Opportunity: Participants commented that these devices could address issues surrounding stigma as smartphones are ubiquitous in everyday life. Motivation: Participants consistently reported that the ability to make adjustments via a smartphone provided them with a greater sense of autonomy and empowerment. As a result, they felt more in control of their hearing loss. This study lays the foundation for further high-quality research to explore whether smartphone-connected technologies have the potential to yield optimum benefits for people living with hearing loss.

Validation of the Egyptian Arabic Assessment of Auditory Skills development using children with Cochlear Implants

IntroductionAudition is the gateway to spoken language, and infants' early accomplishments in acquiring the sound structure of their native language lays a critical ground work for subsequent learning. The development of pre-lingual auditory perceptual skills for cochlear implanted children is crucial for initial development of oral language. ObjectiveThe aims of the present study were to validate the Egyptian Arabic Assessment of Auditory Skills, and to track the development of auditory skills in Egyptian children fitted with CI during the first three years post implantation. MethodsThe study included 90 Arabic Egyptian children attending the phoniatric unit, Kasr El Aini hospital. Their chronological age ranged from 36 to 72 months. The study lasted for 18 months from July 2015 to January 2017. The children were divided into six groups according to their cochlear age i.e., amount of implant experience. An Arabic assessment chart of auditory skills was tailored that included six auditory skills' domains; detection, identification, short term auditory memory, supra-segmental discrimination, segmental discrimination and linguistic auditory processing. This chart was then used to develop an assessment tool which was then applied to all the study participants. All children had bilateral Sensorineural Hearing Loss (SNHL) since birth. None of the participants had prior Cochlear Implant (CI), but all had tried conventional hearing aids. All participants were implanted unilateral, with CI devices. All met selection criteria applied in the Egyptian national insurance committee for cochlear implantation. ResultsAll auditory skills domains improved with cochlear age. There was significant improvement between 1-6 and 7–12 months in the scores of the Detection (DET) domain. There was significant difference between 1-6 and 7–12 months, 7–12 and 13–18 months, 19–24 and 25–30 months in the scores of the Identification (IDENT) domain. Regarding the Short Term Auditory Memory (STAM) domain scores and the Supra-segmental Discrimination (SSD) domain scores there was significant difference between all the groups. Regarding the Segmental Discrimination (SGD) domain scores, there was significant difference between group 1–6 and 7–12 months, 7–12 and 13–18 months, 19–24 and 25–30 months, 25–30 and 31–36 months. Regarding the Linguistic Auditory Processing (LAP) domain, there was significant difference between group 1–6 and 7–12 months, 7–12 and 13–18 months, 25–30 and 31–36 months. ConclusionsChildren fitted with Cochlear Implants (CIs) appeared to show improvement in acquisition of auditory skills over a period of three years that followed a hierarchy of development dependent on the cochlear age.

Electro-Natural Stimulation in Partial Deafness Treatment of Adult Cochlear Implant Users: Long-Term Hearing Preservation Results

Background: Due to the constant development of technology and medicine, the eligibility criteria for cochlear implantation (CI) are undergoing gradual expansion. Objectives: To provide long-term hearing preservation (HP) results for partial deafness treatment (PDT) of a group of adults using electro-natural stimulation (ENS). Methods: We examined a database of medical records of patients who underwent CI in a single ENT center. We identified 12 adults (3 men and 9 women) who fitted the PDT-ENS classification. To calculate HP, we used the ­HEARRING consensus and conducted statistical analyses using SPSS v24. Results: In the long-term follow-up, 7 of 12 patients had complete HP and the remaining 5 had partial HP. None of the patients experienced significant hearing impairment. A significant improvement in speech understanding in both quiet and noise conditions was also observed. Conclusions: The use of minimally invasive surgery leads to excellent HP results in PDT-ENS patients, enabling them to enjoy the benefits of good speech discrimination which they would be unable to get from traditional hearing aids. Our findings support extending the inclusion criteria for CI to include this new group of patients who would otherwise obtain only limited benefit from conventional hearing aids.

The speech perception gap in cochlear implant patients

ObjectiveTo determine how commonly word recognition scores obtained using insert microphones (PB max) overestimate word recognition scores obtained through appropriately fit hearing aids (A-WRS).MethodsAided speech recognition tests may not be performed during routine hearing aid fittings; however, they are regularly performed for cochlear implant (CI) candidacy evaluation. Therefore, audiologic data from CI recipients were queried in a retrospective cohort study at a tertiary care center. PB max and A-WRS were obtained. The Speech Perception (SP) gap, defined as PB max minus A-WRS, was calculated for each patient and a high SP gap was defined as ≥20%.ResultsAnalyzing 78 patients with complete data, 30 patients had PB max ≥20%. Of these, 18 (60%) had a high SP gap. Eighteen of the 78 patients had PB max ≥40%, and of these patients, 15 (83%) had a high SP gap.Discussion/conclusionA Speech Perception Gap of ≥20% may exist in a sizable percentage of patients with hearing loss. Our pilot study suggests that over 80% of these patients could have Class D hearing (speech recognition <50%) using conventional hearing aids and may be better served using alternate rehabilitation strategies such as middle ear or cochlear implants. Therefore, aided speech testing should be performed as part of a verified hearing aid fit in all patients, especially those with PB Max ranging from 40% to 70%.

Development and performance analysis of a low-cost MEMS microphone-based hearing aid with three different audio amplifiers

In this paper, MEMS-based capacitive microphone and low-cost amplifier are designed for low-cost power-efficient hearing aid application. The developed microphone along with the associated circuitry is mounted on a common board in the form of pocket-type (body-worn) device. The designed microphone consists of a flexible circular silicon nitrite (Si3N4) diaphragm and a polysilicon-perforated back plate with air as dielectric between them. The incident acoustic waves on the sensor cause deflection of the diaphragm to alter the air gap between the perforated back plate (fixed electrode) and the diaphragm (moving plate) which causes a change in capacitance. The acoustic pressure applied to the microphone is from 0 to 100 Pa for an operating range of 100 Hz–10 kHz which corresponds to the audible frequency range in case of human beings. The main purpose of this work is to increase the longevity of battery used in conventional hearing aids. The designed MEMS microphone with Si3N4 diaphragm is capable of identifying acoustic frequencies (100 Hz to 10 kHz) which correspond to a specific change in absolute pressure from 0 to 100 Pa for 2-micron-thick diaphragm with a sensitivity of about 0.08676 mV/Pa. The design of the sensor and the characteristics analysis are performed in FEM-based simulation software, which are later validated in real time. The prototype is designed using MEMS microphone and low-cost amplifier ICs with biasing components in the form of pocket-type (body-worn) hearing aid. In order to study the performance of proposed device, three different market-available amplifiers with controllable gain are used. Finally, the performance of the hearing aid is studied through audio spectrogram analysis to choose the best-suited amplifier among the three.

Long-Term Outcomes of Vibroplasty Coupler Implantations to Treat Mixed/Conductive Hearing Loss

Objective: To evaluate the long-term safety and performance of four different vibroplasty couplers (round window, oval window, CliP and Bell coupler) in combination with an active middle ear implant. Methods: This was a multicentre, prospective, long-term study including 5 German hospitals. Thirty adult subjects suffering from conductive or mixed hearing loss were initially enrolled for the study, 24 of these were included in the final analysis with up to 36 months of postsurgical follow-up data. Bone conduction and air conduction were measured pre- and postoperatively to evalu ate safety. Postoperative aided sound field thresholds and Freiburger monosyllable word recognition scores were compared to unaided pre-implantation results to confirm performance. Additional speech tests compared postoperative unaided with aided results. To determine patient satisfaction, an established quality-of-life questionnaire developed for conventional hearing aid usage was administered to all subjects. Results: Mean postoperative bone conduction thresholds remained stable throughout the whole study period. Mean functional gain for all couplers investigated was 38.5 ± 11.4 dB HL (12 months) and 38.8 ± 12.5 dB HL (36 months). Mean word recognition scores at 65 dB SPL increased from 2.9% in the unaided by 64.2% to 67.1% in the aided situation. The mean postoperative speech reception in quiet (or 50% understanding of words in sentences) shows a speech intelligibility improvement at 36 months of 17.8 ± 12.4 dB SPL over the unaided condition. The signal-to-noise ratio (SNR) improved by 5.9 ± 7.2 dB SNR over the unaided condition. High subjective device satisfaction was reflected by the International Inventory for Hearing Aids scored very positively. Conclusion: A significant improvement was seen with all couplers, and audiological performance did not significantly differ between 12 and 36 months after surgery.

ACTIVE MIDDLE EAR VIBRANT SOUNDBRIDGE SOUND IMPLANT.

SUMMARYThe Vibrant Soundbridge represents a new approach to hearing improvement in the form of active implantable middle ear hearing device. Unlike conventional acoustic hearing aids, which increase the volume of sound that goes to the eardrum, the Vibrant Soundbridge bypasses the ear canal and eardrum by directly vibrating the small bones in the middle ear. Because of its design, no portion of the device is placed in the ear canal itself. The Vibrant Soundbridge has been approved by the FDA as a safe and effective treatment option for adults with moderate to severe sensorineural, conductive or mixed hearing losses who desire an alternative to the acoustic hearing aids, for better hearing. The paper presents a review of the active middle ear implant Vibrant Soundbridge, which has been also implanted at the Department of Otorhinolaryngology and Head and Neck Surgery, Sestre milosrdnice University Hospital Center, which is the Referral Center for Cochlear Implantation and Surgery of Hearing Impairment and Deafness of the Ministry of Health, Republic of Croatia.

The Cost-Effectiveness of Bimodal Stimulation Compared to Unilateral and Bilateral Cochlear Implant Use in Adults with Bilateral Severe to Profound Deafness.

An increasing number of severe-profoundly deaf adult unilateral cochlear implant (CI) users receive bimodal stimulation; that is, they use a conventional acoustic hearing aid (HA) in their nonimplanted ear. The combination of electric and contralateral acoustic hearing provides additional benefits to hearing and also to general health-related quality of life compared with unilateral CI use. Bilateral CI is a treatment alternative to both unilateral CI and bimodal stimulation in some healthcare systems. The objective of this study was to conduct an economic evaluation of bimodal stimulation compared with other management options for adults with bilateral severe to profound deafness. The economic evaluation took the form of a cost-utility analysis and compared bimodal stimulation (CI+HA) to two treatment alternatives: unilateral and bilateral CI. The analysis used a public healthcare system perspective based on data from the United Kingdom and the United States. Costs and health benefits were identified for both alternatives and estimated across a patient's lifetime using Markov state transition models. Utilities were based on Health Utilities Index estimates, and health outcomes were expressed in Quality Adjusted Life Years (QALYs). The results were presented using the Incremental Cost-Effectiveness Ratio and the Net Monetary Benefit approach to determine the cost-effectiveness of bimodal stimulation. Probabilistic sensitivity analyses explored the degree of overall uncertainty using Monte Carlo simulation. Deterministic sensitivity analyses and analysis of covariance identified parameters to which the model was most sensitive; that is, whose values had a strong influence on the intervention that was determined to be most cost-effective. A value of information analysis was performed to determine the potential value to be gained from additional research on bimodal stimulation. The base case model showed that bimodal stimulation was the most cost-effective treatment option with a decision certainty of 72 and 67% in the United Kingdom and United States, respectively. Despite producing more QALYs than either unilateral CI or bimodal stimulation, bilateral CI was found not to be cost-effective because it was associated with excessive costs. Compared with unilateral CI, the increased costs of bimodal stimulation were outweighed by the gain in quality of life. Bimodal stimulation was found to cost an extra £174 per person in the United Kingdom ($937 in the US) and yielded an additional 0.114 QALYs compared with unilateral CI, resulting in an Incremental Cost-Effectiveness Ratio of £1521 per QALY gained in the United Kingdom ($8192/QALY in the United States). The most influential variable was the utility gained from the simultaneous use of both devices (CI+HA) compared with Unilateral CI. The value of further research was £4,383,922 at £20,000/QALY ($86,955,460 at $50,000/QALY in the United States). This study provides evidence of the most cost-effective treatment alternative for adults with bilateral severe to profound deafness from publicly funded healthcare perspectives of the United Kingdom and United States. Bimodal stimulation was found to be more cost-effective than unilateral and bilateral CI across a wide range of willingness-to-pay thresholds. If there is scope for future research, conducting interventional designs to obtain utilities for bimodal stimulation compared with unilateral CI would reduce decision uncertainty considerably.

The Bonebridge implant in older children and adolescents with mixed or conductive hearing loss: Audiological outcomes

IntroductionFor children with conductive or mixed hearing loss, in whom use of conventional hearing aids is impossible or limited, use of bone conduction devices is recommended. The choice between the available types of devices depends mostly on the degree of hearing loss, age, and anatomical conditions. One device application in children older than 5 years is the Bonebridge implant. The aim of this study is to assess the benefits and safety of this device in children. MethodsThe material was a group of 11 older children and adolescents aged 10–17 years (mean = 14.7, SD = 2.45) with single-sided or bilateral conductive or mixed hearing loss, implanted unilaterally with the Bonebridge system at the World Hearing Center in Kajetany near Warsaw between 2014 and 2016. Benefits of the Bonebridge were assessed with warble tone audiometry and word audiometry in free field, as well as an APHAB (Abbreviated Profile of Hearing Aid Benefit) questionnaire before and after implantation. ResultsHearing tests showed a statistically significant improvement in hearing sensitivity and speech discrimination. Results of the questionnaire confirm the benefits of Bonebridge implantation to the older children in terms of their auditory performance under various acoustic conditions. ConclusionsAt a one-year follow up the Bonebridge system was found to be a safe, efficient, and effective tool for compensating for conductive or mixed hearing loss in older children and adolescents. For good anatomical conditions the Bonebridge implant provides a safe alternative to other popular bone conduction systems.

An Application of the Medical Research Council's Guidelines for Evaluating Complex Interventions: A Usability Study Assessing Smartphone-Connected Listening Devices in Adults With Hearing Loss.

The purpose of this study is to provide an example of the Medical Research Council's guidelines for evaluating complex health care interventions in the context of smartphone-connected listening devices in adults with hearing loss. Twenty existing hearing aid users trialed 1 of the following smartphone-connected listening devices: made-for-smartphone hearing aids, a personal sound amplification product, and a smartphone "hearing aid" application used with either wireless or wired earphones. Following 2 weeks of use in their everyday lives, participants completed self-report outcome measures. Relative to conventional hearing aids, self-reported use, benefit, and satisfaction were higher, and residual disability was lower for made-for-smartphone hearing aids. The converse was found for the other smartphone-connected listening devices trialed. Similarly, overall usability was judged to be "above average" for the made-for-smartphone hearing aids, but "below average" for the remaining devices. This developmental work, guided by the Medical Research Council's framework, lays the foundation for feasibility and pilot studies, leading to high-quality research assessing the effectiveness of smartphone-connected listening devices. This future evidence is necessary to guide health care commissioners and policymakers when considering new service delivery models for adults living with hearing loss.

Cochlear Implant Children Auditory Skills: A Study

Cochlear implants are now established as the treatment of choice in the rehabilitation of children with bilateral profound sensori neural hearing impairment. This study objective is to analyze and the development of auditory skills for the cochlear implantation children. This study included 50 children attending the Therapy centre, Tiruchirappalli. Their age ranged below 24 months. All children had bilateral sensori-neural hearing loss since birth. None of the subjects had prior Cochlear implant, but all had tried conventional hearing aid. All subjects were implanted unilateral and bilateral, sequential/simultaneous with CI devices including MED EL and Nucleus. All met the criteria of cochlear implant. All items of the studied auditory skills improved significantly by time. There is significant improvement between 4 to 8 months in the scores of detection, discrimination, identification and comprehension skills. Significant improvement in comprehension is also found between 10 and 11 months interval. PAS score had weak negative correlation with age. Children fitted with cochlear implants showed significant improvement in acquisition of auditory skills over a period of below 1year. The age and the side of the implant are the most significant factors.

The Use of Frequency Lowering Technology in the Treatment of Severe-to-Profound Hearing Loss: A Review of the Literature and Candidacy Considerations for Clinical Application.

This article provides a review of the current literature on the topic of frequency lowering hearing aid technology specific to the treatment of severe and profound levels of hearing impairment in child and adult listeners. Factors to consider when assessing listener candidacy for frequency lowering technology are discussed. These include factors related to audiometric assessment, the listener, the type of hearing aid technology, and the verification and validation procedures that can assist in determining candidacy for frequency lowering technology. An individualized candidacy assessment including the use of real-ear verification measures and carefully chosen validation tools are recommended for listeners requiring greater audibility of high-frequency sounds, when compared with amplification via conventional hearing aid technology.