Individual computer-assisted 3D planning for placement of auricular prosthesis anchors in combination with an implantable transcutaneous bone conduction hearing device in patients with aural atresia

Fabrication of Implant-Supported Auricular Prosthesis Using Artificial Intelligence

The absence of any organ of the facial region causes an asymmetrical appearance. This asymmetrical appearance can cause social dilemmas for the patient. The maxillofacial technician, the prosthodontist, and the patient must work closely together to fabricate an epithesis. On the implants, a superstructure is first constructed. Most of it is made up of rings and a bar that joins the implants. The firm acrylic resin base of the epithesis is equipped with clips that serve as the epithesis's retention mechanism. The actual epithesis is made of silicone rubber. The epithesis has to be shaped and colored with extreme caution. An appropriate substitute is an auricular prosthesis that is implant-retained. Microtia, deformity, malformation, and loss of the external ear, either partially or completely, can result from a variety of inherited genetic conditions. To evaluate the symmetry of both ears, artificial intelligence (AI) software is used. An Instagram lens Gridset by crystalwavesxx was used to correct and verify the bilateral symmetry of the patient. This case report primarily focuses on the fabrication of implant-supported auricular prostheses using AI.

Evaluating temporal bone column density for optimized bone conduction implant placement

Introduction

An optimal placement of bone conduction implants can provide more efficient mechanical transmission to the cochlea if placed in regions with greater bone column density. The aim of this study was to test this hypothesis and to determine the clinical potential of preoperative bone column density assessment for optimal implant placement.

Methods

Five complete cadaver heads were scanned with quantitative computed tomography imaging to create topographic maps of bone density based on the column density index (CODI). Laser Doppler vibrometry was used to measure cochlear promontory acceleration under bone conduction stimulation in different locations on the temporal bone, using a bone-anchored hearing aid transducer at frequencies ranging from 355 Hz to 10 kHz.

Results

We found a statistically significant association between CODI levels and the accelerance of the cochlear promontory throughout the frequency spectrum, with an average increase of 0.6 dB per unit of CODI. The distance between the transducer and the cochlear promontory had no statistically significant effect on the overall spectrum.

Discussion

We highlight the importance of bone column density in relation to the mechanical transmission efficiency of bone conduction implants. It may be worthwhile to consider column density in preoperative planning in clinical practice.

Multicentric study on surgical information and early safety and performance results with the Bonebridge BCI 602: an active transcutaneous bone conduction hearing implant

AIM

This European multicentric study aimed to prove safety and performance of the Bonebridge BCI 602 in children and adults suffering from either conductive hearing loss (CHL), mixed hearing loss (MHL), or single-sided sensorineural deafness (SSD).

METHODS

33 patients (13 adults and 10 children with either CHL or MHL and 10 patients with SSD) in three study groups were included. Patients were their own controls (single-subject repeated measures), comparing the unaided or pre-operative to the 3-month post-operative outcomes. Performance was evaluated by sound field thresholds (SF), word recognition scores (WRS) and/or speech reception thresholds in quiet (SRT) and in noise (SNR). Safety was demonstrated with a device-specific surgical questionnaire, adverse event reporting and stable pure-tone measurements.

RESULTS

The Bonebridge BCI 602 significantly improved SF thresholds (+ 25.5 dB CHL/MHL/SSD), speech intelligibility in WRS (+ 68.0% CHL/MHL) and SRT in quiet (- 16.5 dB C/MHL) and in noise (- 3.51 dB SNR SSD). Air conduction (AC) and bone conduction (BC) thresholds remained stable over time. All adverse events were resolved, with none unanticipated. Mean audio processor wearing times in hours [h] per day for the CHL/MHL group were ~ 13 h for adults, ~ 11 h for paediatrics and ~ 6 h for the SSD group. The average surgical length was 57 min for the CHL/MHL group and 42 min for the SSD group. The versatility of the BCI 602 (reduced drilling depth and ability to bend the transition for optimal placement) allows for treatment of normal, pre-operated and malformed anatomies. All audiological endpoints were reached.

CONCLUSIONS

The Bonebridge BCI 602 significantly improved hearing thresholds and speech understanding. Since implant placement follows the patient's anatomy instead of the shape of the device and the duration of surgery is shorter than with its predecessor, implantation is easier with the BCI 602. Performance and safety were proven for adults and children as well as for the CHL/MHL and SSD indications 3 months post-operatively.