Use Of Bone-anchored Hearing Aid Research Articles

Comparative analysis between effective gain and functional gain in bone-anchored hearing aid users.

The cases of ear malformations, conductive, mixed, and single-sided deafness hearing loss are candidates for surgery and use of Bone-Anchored Hearing Aids (BAHA). Commonly, the literature highlights two procedures to assess the benefits and characteristics of amplification in users: functional gain (FG) and effective gain (EG). Estimate and compare the EG and the FG to evaluate the benefits obtained by users of BAHA and, later, to compare tests of speech perception in silence and in noise. The sample (n=79) was divided into four groups, implanted from February 2014 to February 2021. The following tests were analyzed: pure-tone audiometry by air and bone; research of audiometric thresholds in free field; speech perception tests in silence and in noise. EG presented lower values than FG in all frequencies. The positive results of the speech perception tests were correlated with worse FG values. EG is the best method for evaluation, as it allows a proper comparison between devices, as well as a comparison with the prescription of validated rules. A better evaluation of results was observed on the EG values, indicating that it is a relevant method to assess auditory performance. In addition, the FG results were incompatible with the benefits obtained in the speech perception tests, showing that it is not a reliable tool for monitoring the results with the use of BAHA.

Hearing Rehabilitation through Bone-Conducted Sound Stimulation: Preliminary Results.

Introduction The bone-anchored hearing aid (BAHA) is a bone conduction system that transmits the sound directly to the inner ear by surpassing the skin impedance and the subcutaneous tissue. It is indicated for patients with mixed, conductive and unilateral sensorineural hearing loss who did not benefit from conventional hearing aids (HAs). Although the benefits from BAHA are well demonstrated internationally, this field still lacks studies in Brazil. Objective To assess the auditory rehabilitation process in BAHA users through audiological, speech perception and tinnitus aspects. Methods Individuals with hearing loss were assessed before and after the implantation. The participants were subjected to pure tone audiometry in free field, functional gain audiometry, speech perception tests, tinnitus handicap inventory (THI) in open format, and to the visual analog scale (VAS). Results It was found that the participants benefited from the use of BAHA. The difference in the performance of the participants before and after the BAHA surgery was significant in terms of hearing acuity. There was no statistically significant difference in the speech perception tests. The tinnitus assessment showed that 80% of the participants scored slight tinnitus severity in THI after using a BAHA. Eighty percent of the participants classified their tinnitus as absent to mild in the VAS after the surgery. Conclusion Based on the results of the current study, we can conclude that the participants improved both the auditory perception and the tinnitus handicap.

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.

Quality of Life in Patients Implanted With the BAHA Device Depending on the Aetiology

Introduction and objectivesTo assess the improvement of quality of life in osseointegrated implanted patients, taking into account the indication as well as the use of the implant, and the presence of pre- and postoperative tinnitus. MethodsSixty-nine patients implanted between June 2004 and November 2010 were included. The average age of the patients was 40 years. The instruments used to quantify the change in quality of life were the Glasgow Benefit Inventory and a questionnaire including open questions, bone anchored hearing aid (BAHA) use, change in tinnitus and postoperative pain. ResultsThe average total benefit score with the Glasgow Benefit Inventory was 38, and the general, social, and physical scores were 51, 15 and 7, respectively. There was no significant association between sex, age and bilaterality or unilaterality of the process with quality of life. Nevertheless, there were significantly better results in patients with conductive hearing loss than in those with unilateral deafness, and the results were positive although in both groups. The tinnitus rate went from 37.5 to 20.8% following BAHA, with this difference being significant. ConclusionsOur results show that the use of BAHA is associated with a great improvement in quality of life for patients with conductive hearing loss, whereas indications in unilateral deafness have to be individually studied. Moreover, the study shows that BAHA has a positive effect upon tinnitus.

Calidad de vida de pacientes implantados con el dispositivo BAHA según su indicación

Introduction and objectivesAssess the improvement of quality of life in osseointegrated implanted patients, taking into account the indication as well as the use of the implant, and the presence of pre- and postoperative tinnitus. MethodsSixty-nine patients implanted between June 2004 and November 2010 were included. The average age of the patients was 40 years. The instruments used to quantify the change in quality of life were the Glasgow Benefit Inventory and a questionnaire including open questions, bone anchored hearing aid (BAHA) use, change in tinnitus and postoperative pain. ResultsThe average total benefit score with the Glasgow Benefit Inventory was 38, and the general, social, and physical scores were 51, 15 and 7, respectively. There was no significant association between sex, age and bilaterality or unilaterality of the process with quality of life. Nevertheless, there were significantly better results in patients with conductive hearing loss than in those with unilateral deafness, the results were positive although in both groups. The tinnitus rate went from 37.5 to 20.8% following BAHA, with this difference being significant. ConclusionsOur results show that the use of BAHA is associated with a great improvement in quality of life for patients with conductive hearing loss, whereas indications in unilateral deafness have to be individually studied. Moreover, the study shows that BAHA has a positive effect upon tinnitus.

The first reported treatment of Nager syndrome associated hearing loss with bone-anchored hearing aids: case report

To report the first case of treatment of Nager syndrome associated conductive hearing loss with bone-anchored hearing aids, in a three-year-old boy. Clinical case report and current literature review regarding the use of bone-anchored hearing aids in the treatment of conductive hearing loss in children. A three year eight month old boy with Nager syndrome was successfully treated for conductive hearing loss using bilateral bone-anchored hearing aids. This is the first case report of the use of bone-anchored hearing aids to treat Nager syndrome associated conductive hearing loss. Treatment was safe and successful in this case.

Practice guidelines for bone-anchored hearing aids in children

After more than 20 years of clinical experience in children, bone-anchored hearing aids, essentially BAHA(®), have become the standard treatment for conductive or mixed hearing loss. Based on a general review of the literature and the authors' own experience, this article reviews the use of bone-anchored hearing aids in children. The main indications for bone-anchored hearing aids are a minimum age of 5 years at the time of implantation and/or cortical bone thickness ≥ 3 mm. Fixture loss is observed in 40% of children under the age of 5 years versus 8% for children aged 5 to 10 years and 1% for children over the age of 10 years, i.e. identical to the rate observed in adults. Skin complications are similar to those observed in adults and must be prevented by parental education and regular follow-up. Surgery is generally performed in two stages or as a one-stage procedure for fixtures ≥ 4 mm. The functional success rate, correlated with medium- and long-term use of BAHA(®) is about 96%. BAHA(®) may be indicated in children with profound unilateral hearing loss following a trial period wearing a BAHA(®) headband for several weeks with the child's active participation. Sequential bilateral implantation requires complementary investigations and appears to provide improved perception in noise. This type of hearing aid provides an improvement of the quality of life of children with bilateral conductive and/or mixed hearing loss which should be further improved as a result of recent technical developments.

Bone-anchored hearing aids in children and young adults: the Freeman Hospital experience

To investigate the utilisation of bone-anchored hearing aids and Softband, as well as the effects on quality of life, amongst the paediatric and young adult population of Freeman Hospital, Newcastle Upon Tyne, UK. Retrospective, anonymised, cross-sectional survey using the Glasgow Benefit Inventory and Listening Situation Questionnaire (parent version), administered at least three months following the start of bone-anchored hearing aid or Softband use. One hundred and nine patients were included, of whom syndromic children made up a significant proportion (22 of 109). Patients using bone-anchored hearing aids obtained significant educational and social benefit from their aids. The mean Listening Situation Questionnaire difficulty score was 17 (15 patients), which is below the trigger score of 22+ at which further reassessment and rehabilitation is required. 87% (of 15 patients) did not require further intervention. The overall mean GBI score for the 22 patients (syndromic and non-syndromic) was +29. The use of bone-anchored hearing aids and Softband results in significant improvements in quality of life for children and young adults with hearing impairment. There is significant under-utilisation of bone-anchored hearing aids in children with skull and congenital abnormalities, and we would advocate bone-anchored hearing aid implantation for these patients.

Benefit and Quality of Life in Older Bone-Anchored Hearing Aid Users

Benefit and quality-of-life analysis in the older adult bone-anchored hearing aid (BAHA) users. Retrospective evaluation. Four questionnaires (Glasgow Benefit Inventory, Abbreviated Profile of Hearing Aid Benefit [APHAB], Nijmegen Cochlear Implant Questionnaire [NCIQ], and the Hearing Handicap Inventory for the Elderly screening version [HHIE-S]) were used. The response rate was 80%, mean age was 75 years (range, 62-93 yr), and mean pure-tone average at frequencies of 500, 1,000, 2,000, and 4,000 Hz for bone conduction was 42 +/- 13 dBHL. More than 80% of the patients were using their BAHA for more than 8 hours a day. To obtain a "snapshot" of current BAHA use, the NCIQ, HHIE-S, and the APHAB were used. The NCIQ showed good disability and handicap results (score range, 49-64). The HHIE-S showed that 60% of the patients had a mild to moderate handicap. The APHAB aided scores ranged from 39 to 58%. Mean benefit scores of the Glasgow Benefit Inventory were positive in 112 of the 134 patients (84%). The APHAB showed clinically significantly more benefit with the BAHA than with the previous aided or unaided situation. A trend could be seen-the higher the pure-tone average at frequencies of 500, 1,000, 2,000, and 4,000 Hz for bone conduction, the smaller the mean benefit scores on the questionnaires. Bone-anchored hearing aid users aged 60 years or older were able to place and handle the device very adequately and clean the skin around the implant. Most patients reported comparable or increased general benefit and good quality of life with the BAHA.

Update on Bone-Anchored Hearing Aids in Pediatric Patients With Profound Unilateral Sensorineural Hearing Loss

To evaluate the use of bone-anchored hearing aids (Bahas) in children with single-sided deafness. Retrospective 3-year chart review. Arkansas Children's Hospital, Little Rock, pediatric hospital serving children from birth to 21 years of age. The study included 23 children (14 girls and 9 boys) with single-sided deafness (mean age, 12.6 years; age range, 6-19 years). Two-stage Baha surgery with 6-month osseointegration was performed on children 5 years and older at a single institution. The Baha processor was placed 2 weeks after the second-stage surgery. Results of the Hearing in Noise Test (HINT) and the Children's Home Inventory for Listening Difficulties (CHILD) questionnaires were compared before and after Baha activation in children with profound unilateral sensorineural hearing loss. Preimplant mean HINT scores at speech-noise ratios of 0, +5, and +10 dB were 42%, 76%, and 95%, respectively. Postimplant mean HINT scores improved to mean speech-noise ratios of 82%, 97%, and 99% at 0, 5, and 10 dB, respectively. The CHILD scores also improved from mean preimplant ratings of 4.49 and 4.60 for patients and parents, respectively, to postimplant ratings of 6.90 and 7.10. Both teenagers (n = 15) and children younger than 13 years (n = 7) demonstrated improved HINT and CHILD scores. The complication rate was 17%. Bone-anchored hearing aids are a durable treatment option that can achieve noticeable improvements in hearing in noise and in listening difficulties in children with profound unilateral sensorineural hearing loss.

Bone‐anchored hearing aid subjective benefit for unilateral deafness

Determine the benefit of the bone-anchored hearing aid (BAHA) in patients with unilateral deafness. Retrospective case series and prospective questionnaire study at a tertiary referral center. Patients with unilateral deafness of various etiologies who were implanted with a BAHA (n = 126) or not implanted with a BAHA after a translabyrinthine craniotomy (n = 126) were mailed questionnaires. A total of 139 patients (55%) responded to the questionnaires. Patients who were implanted with a BAHA received a general questionnaire concerning BAHA usage, the Abbreviated Profile of Hearing Aid Benefit (APHAB), and the Speech, Spatial, and Qualities of Hearing Questionnaire (SSQ). Patients not implanted with a BAHA received only the SSQ hearing questionnaire. Patients with unilateral deafness demonstrated a benefit with BAHA use on the APHAB. Most improvement with the BAHA was seen in the Background Noise subscale, with a 17.4% improvement. Ease of Communication and Reverberation subscales also demonstrated an 11.6% and 13.2% benefit, respectively. Patients with a BAHA demonstrated better scores in the SSQ Speech subscale when compared to unilaterally deaf patients who did not have a BAHA, although this difference was not significant. The APHAB demonstrated significant benefit with the use of a BAHA in patients with unilateral deafness. Although the SSQ speech subscale showed overall improvement in auditory disability with the use of a BAHA, this difference was not significant. However, the SSQ hearing questionnaire demonstrated specific situations were the BAHA is most useful.

The BAHA Hearing System for Hearing-Impaired Postirradiated Nasopharyngeal Cancer Patients

Radiation for patients who have nasopharyngeal cancer (NPC) often renders them hearing challenged and facing difficulties from treatment sequelae such as chronic suppurative otitis media and osteoradionecrosis. Conventional hearing aids aggravate otorrhea, and ear moulds traumatize osteoradionecrosis ulcers in the ear canal. The bone-anchored hearing aid (BAHA) hearing system might represent an excellent hearing solution. To investigate the BAHA benefit and osseointegration results for hearing-impaired postirradiated NPC patients. A prospective longitudinal study. Tertiary university center. Eleven hearing-impaired postirradiated NPC patients were studied from October 2002 to October 2006. Two-stage BAHA surgeries were performed. Assessments include pure-tone and speech audiometry, implant integrity, periabutment audit, and patient satisfaction analysis during a 24-month period. Radiation dosimetric analysis and bone sampling at the fixture implant sites were studied. No implant fixtures were lost (follow-up, 13-58 mo). Average patient satisfaction scores were 84.4%, with 80% using their BAHA everyday and 90% using their devices for more than 8 hours. Dosimetric analysis of the implant site revealed that all fixtures were outside the irradiated field. There was a reduction in otorrhea rates after BAHA use over the course of the study. Successful osseointegration was demonstrated in postirradiated NPC patients. Improved subjective hearing clarity, reduced ear discharge rates, and extended BAHA usage times accounted for high patient satisfaction with the BAHA hearing system. This is the first study to demonstrate long-term osseointegration and hearing benefit in postirradiated NPC patients. We recommend the BAHA hearing system for the treatment of chronic suppurative otitis media-related hearing problems in NPC patients.

Efficacy of the bone‐anchored hearing aid for single‐sided deafness

The aim was to examine short- and long-term efficacy of the bone-anchored hearing aid (BAHA) on adults with single-sided deafness. Prospective investigation. The outcome measures included the Hearing in Noise Test (HINT), Abbreviated Profile of Hearing Aid Benefit (APHAB), and Single-Sided Deafness Questionnaire (SSD). The BAHA group comprised seven adults with single-sided deafness and the control group comprised 20 adults with essentially normal-hearing sensitivity, bilaterally. The outcome measures were administered in the unaided, directional BAHA, and omnidirectional BAHA conditions after 1 month, 6 months, and 12 months of BAHA use. A repeated measures analysis of variance (ANOVA) model was used to evaluate the data (for the SSD, a nonparametric analog of ANOVA was employed). None of the factors (time, HINT condition, amplification status) or their interactions were significant predictors of change in signal-to-noise ratio (SNR) from baseline over time on the HINT. The mean SNR (non-baseline-subtracted) was significantly lower in the directional BAHA versus the unaided status and in the omnidirectional BAHA versus the unaided status, but only under the noise in front, speech lateralized to the bad ear HINT condition. Significant short- and long-term BAHA benefit was observed on the APHAB (all subscales except Aversiveness) and SSD (all questionnaire items). Our results show short- and long-term efficacy for the BAHA in adults with single-sided deafness for recognition of speech in noise (noise in front, speech lateralized to the bad ear) and on subjective measures of benefit.

Bone-anchored hearing aid abutment skin overgrowth reduction with clobetasol

The bone-anchored hearing aid (BAHA) osseointegrated cochlear stimulator can treat hearing loss in a variety of clinical situations. Occasionally skin/scar overgrowth may cover the abutment. This overgrowth interferes with affixing the BAHA to the abutment. Surgical scar revision/excision has been used to treat this problem. Clobetasol (0.05%), a steroid gel, can reduce skin overgrowth. Experience with skin overgrowth and the efficacy of clobetasol to treat this problem was reviewed. The authors conducted a retrospective analysis of patients who underwent BAHA abutment implantation from January 2003 through December 2006. Eighty-eight patients (2 patients received bilateral BAHAs) were reviewed. Twenty (22%) of 90 sites developed overgrowth. Thirteen of 20 sites were treated with clobetasol. The overgrowth resolved in 11 (85%) of 13 sites after treatment. Patients with incomplete skin graft survival were significantly more likely to develop skin overgrowth (P = 0.0017). Clobetasol is an effective treatment for abutment skin/scar overgrowth. Clobetasol allows patients to resume BAHA use and obviates the need for scar revision.

Bone-anchored hearing aid in unilateral inner ear deafness: electrophysiological results in patients following vestibular schwannoma removal

Conclusions. The results show that the healthy cochlea perceives one auditory stimulus from two auditory signals: the first through normal air conduction and the second provided by the bone-anchored hearing aid (BAHA). This artificial acoustic difference could partly explain ‘pseudo’ binaural hearing. Functional cerebral imaging using the same experimental procedure is now necessary. Objectives. The aim of this study was to evaluate electrophysiological phenomena induced by BAHA on brainstem and long-latency auditory evoked potentials (AEPs) to understand how patients recover a ‘pseudo’ binaural sensation with only one functional cochlea. Patients and methods. This prospective study included 10 patients operated via the translabyrinthine approach and who received implants on the deaf side. Electrophysiological recordings were performed at least 2 months after BAHA use. Brainstem and long-latency (N1, P2, N2, P300) AEPs were studied in free field according to four conditions: 1, without BAHA; 2, with BAHA; 3, with BAHA and normal ear occluded; 4, without BAHA and normal ear occluded. Results. For brainstem AEPs, we found significantly longer latencies of waves III and V in condition 3 compared with condition 1. For long-latency AEPs, comparison between conditions showed no significant differences.

Bone-Anchored Hearing Aid System Application for Unilateral Congenital Conductive Hearing Impairment

To study the audiologic outcome of bone-anchored hearing aid (BAHA) application in patients with congenital unilateral conductive hearing impairment. Prospective audiometric evaluation on 20 patients. Tertiary referral center. The experimental group comprised 20 consecutive patients with congenital unilateral conductive hearing impairment, with a mean air-bone gap of 50 dB. Aided and unaided hearing was assessed using sound localization and speech recognition-in-noise tests. Aided hearing thresholds and aided speech perception thresholds were measured to verify the effect of the BAHA system on the hearing acuity. All patients fulfilled the criteria that the aided speech reception thresholds or the mean aided sound field thresholds were 25 dB or better in the aided situation. Most patients were still using the BAHA almost every day. Sound localization scores varied widely in the unaided and aided situations. Many patients showed unexpectedly good unaided performance. However, nonsignificant improvements of 3.0 (500 Hz) and 6.9 degrees (3,000 Hz) were observed in favor of the BAHA. Speech recognition in noise with spatially separated speech and noise sources also improved after BAHA implantation, but not significantly. Some patients with congenital unilateral conductive hearing impairment had such good directional hearing and speech-in-noise scores in the unaided situation that no overall significant improvement occurred after BAHA fitting in our setup. Of the 18 patients with a complete data set, 6 did not show any significant improvement at all. However, compliance with BAHA use in this patient group was remarkably high. Observations of consistent use of the device are highly suggestive of patient benefit. Further research is recommended to get more insight into these findings.

Bone-Anchored Hearing Aid in Patients With Moderate Mental Retardation

To assess the impact and the subjective benefit of Bone-anchored Hearing Aid (BAHA) implementation in patients with hearing impairment combined with moderate mental retardation. Case control study using two validated patient-oriented instruments. Tertiary referral center. Twenty-two patients with moderate mental retardation and conductive or mixed hearing loss. Rehabilitative. Subjective benefit, listening and learning capabilities. BAHA implementation in patients with moderate mental retardation, by using the Glasgow Children's Benefit Inventory and the Listening Inventory for Education, showed a subjective benefit, which was comparable with that of the control group and was consistent with the results of earlier studies. The use of BAHA proved beneficial in most patients with hearing impairment and moderate mental retardation. Extending the indications for BAHA application to this special patient group shows to be a very valuable option.

P131: Bone-Anchored Hearing Aid Abutment Skin Overgrowth Reduction

P131: Bone-Anchored Hearing Aid Abutment Skin Overgrowth Reduction

Bone anchored hearing aid in children—Prevention of complications

To report results with the bone anchored hearing aid (BAHA) in children. Retrospective medical record review. Tertiary care children's hospital. Fourteen children with microtia/aural atresia underwent BAHA surgery. Mean age was 5.8 years. Data were collected concerning age, diagnoses, surgery, success of implantation, hearing, complications use of BAHA, speech reception thresholds (SRT), complications BAHA surgeries and revisions. Fifteen implants were placed by the author in 13 children. Eleven of 13 (84.6%) children are successfully using BAHAs (one bilateral) with a mean post operative SRT of 18.5dB (range 14-25dB). Mean interval between first and second stages was 7.3 months (n=12). Three unilateral implants were placed by a different surgeon in a child with severe hemifacial microsomia who developed complications treated by the author. Complications included poor healing requiring removal of three implants in one child, recurrent cellulitis of flap requiring revision (n=4), loss of implant (n=2), tearing of flap with dermatome due to tenting by healing screw (n=1), thin skull necessitating multiple drilling sites (n=1). BAHA surgery has a high success rate in children. The following recommendations may decrease complications: (1) 6-month period between stages in children with thin skulls, (2) thin flap with scalpel when it is tented by healing screw or infiltrate flap with local anesthetic to balloon it prior to using the dermatome for second stage cases, and (3) create extremely thin flap to prevent cellulitis.