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Evaluation of the Benefits of Bilateral Fitting in Bone-Anchored Hearing System Users: Spatial Resolution and Memory for Speech. Ear Hear 2022; 44:530-543. [PMID: 36378104 PMCID: PMC10097484 DOI: 10.1097/aud.0000000000001297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the benefits of bilateral implantation for bone-anchored hearing system (BAHS) users in terms of spatial resolution abilities and auditory memory for speech. DESIGN This is a prospective, single-center, comparative, single-blinded study where the listeners served as their own control. Twenty-four experienced bone-anchored users with a bilateral conductive or mixed hearing loss participated in the study. After fitting the listeners unilaterally and bilaterally with BAHS sound processor(s) (Ponto 3 SuperPower), spatial resolution was estimated by measuring the minimum audible angle (MAA) to achieve an 80% correct response via a two-alternative-forced choice task (right-left discrimination of noise bursts) in two conditions: both sound processors active (bilateral condition) and only one sound processor active (unilateral condition). In addition, a memory recall test, the Sentence-final Word Identification and Recall (SWIR) test was performed with five lists of seven sentences for each of the two conditions (unilateral and bilateral). Self-reported performance in everyday life with the listener's own sound processors was also evaluated via a questionnaire (the abbreviated version of the Speech, Spatial and Qualities of Hearing scale). RESULTS The MAA to discriminate noise bursts improved significantly from 75.04° in the unilateral condition to 3.61° in the bilateral condition ( p < 0.0001). The average improvement in performance was 54.28°. The SWIR test results showed that the listeners could recall, on average, 55.03% of the last words in a list of seven sentences in the unilateral condition and 57.23% in the bilateral condition. While the main effect of condition was not significant, there was a significant interaction between condition and repetition (list), revealing a significantly higher recall performance in the bilateral condition than in the unilateral condition for the second repetition/list out of five (10.2% difference; p = 0.022). Self-reported performance with bilateral BAHS obtained via the Speech, Spatial and Qualities of Hearing scale questionnaire was, on average, 4.4 for speech, 3.7 for spatial, and 5.1 for qualities of hearing. There was no correlation between self-reported performance in everyday life and bilateral performance in the MAA test, while significant correlations were obtained between self-reported performance and recall performance in the SWIR test. CONCLUSIONS These results showed a large benefit in spatial resolution for users with symmetric BC thresholds when being fitted with two BAHS, although their self-reported performance with bilateral BAHS in everyday life was rather low. In addition, there was no overall benefit of bilateral fitting on memory for speech, despite observing a benefit in one out of five repetitions of the SWIR test. Performance in the SWIR test was correlated with the users' self-reported performance in everyday life, such that users with higher recall ability reported to achieve better performance in real life. These findings highlight the advantages of bilateral fitting on spatial resolution, although bilaterally fitted BAHS users continue to experience some difficulties in their daily lives, especially when locating sounds, judging distance and movement. More research is needed to support a higher penetration of bilateral BAHS treatment for bilateral conductive and mixed hearing losses.
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Ueda CHY, Soares RM, Jardim I, Bento RF. Assessment Protocol for Candidates for Bone-Anchored Hearing Devices. Int Arch Otorhinolaryngol 2022; 26:e718-e724. [DOI: 10.1055/s-0042-1745734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/18/2022] [Indexed: 10/18/2022] Open
Abstract
Abstract
Introduction The technology regarding bone-anchored hearing devices has been advancing. Nevertheless, complications are still often reported, which can impair treatment adherence and lead to discontinuation of use. There is a lack of studies conducted in tropical countries, where complications can be even greater, as well as standardized protocols for selection, indication and evaluation.
Objective To characterize implanted patients from a Brazilian public institution and describe the medical and audiological assessment protocols to which they were submitted during the selection process and in the follow-up after surgery.
Method An observational, cross-sectional study evaluating the medical records of patients with hearing loss and ear malformations and describing the care protocol through which they were treated.
Results The medical records of 15 patients were reviewed: 6 received transcutaneous implants, and 9, percutaneous implants; 9 patients reported some type of skin lesion, 2 reported pain on the follow-up visit, and 3 had osseointegration failure. The time between surgery and activation ranged from 2 to 9 months. The median scores on the sentences, Sentences in Noise and Monosyllable tests were 100%, 60% and 80%, respectively.
Conclusion It was possible to characterize the patients who received implants at the institution. The patients performed well in silence and had greater difficulty in noise. Even patients who had complications did not complain about the audibility and sound quality. It is essential to develop a model and to standardize the assessment and follow-up methods aimed at the benefit of users of bone-anchored hearing devices, as well as to enable the technico-scientific development in this field.
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Affiliation(s)
- Cynthia Harumi Yokoyama Ueda
- Department of Otorhinolaryngology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Renata Marcial Soares
- Department of Otorhinolaryngology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Isabela Jardim
- Department of Otorhinolaryngology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Ricardo Ferreira Bento
- Department of Otorhinolaryngology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
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Heath E, Dawoud MM, Stavrakas M, Ray J. The outcomes of bilateral bone conduction hearing devices (BCHD) implantation in the treatment of hearing loss: A systematic review. Cochlear Implants Int 2021; 23:95-108. [PMID: 34852723 DOI: 10.1080/14670100.2021.2001926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Bone Conduction Hearing Devices (BCHDs) are a means of improving hearing ability in those that do not receive full benefit from conventional hearing aids. In 2016, the NHS started commissioning bilateral BCHDs. This review aims to evaluate the current literature and identify areas for further research. METHODS This review was conducted in line with the PRISMA guidelines and registered on the PROSPERO database (registration CRD42020191956). MEDLINE, CINAHL and The Cochrane Library were systematically searched. The full text of relevant titles and abstracts was then reviewed before data extraction was undertaken. Risk of bias was assessed using the ROBINS-1 tool. RESULTS Searches identified 125 studies. After removing duplicates, 28 full texts were screened. 14 studies were included in the final review. Amongst the audiological outcomes, greater improvements for bilateral compared to unilateral BCHDs were seen in hearing thresholds, understanding speech in quiet, localization, and restoration of binaural hearing. Thus, supporting the addition of a second implant. For speech in noise however, bilateral BCHDs were less effective when the noise was presented from one side. Increases in measures of Quality of Life, including the Glasgow Benefit Index, were seen across all included studies. No studies included complication rates. CONCLUSION Overall, bilateral BCHDs offer benefits to the recipient's audiological capabilities and QoL. However, more research is required on the complications and the cost of bilateral BCHDs. Further to this, future research should aim to use uniform tests to measure outcomes.
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Affiliation(s)
- Ella Heath
- The Department of Neuroscience, University of Sheffield Medical School, Sheffield, UK
| | - Moustafa Mohamed Dawoud
- Regional Department of Neurotology, ENT Directorate, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK.,Oto-Rhino-Laryngology Department, Menoufia Faculty of Medicine, General Hospital Santah, El Santa, Egypt
| | - Marios Stavrakas
- Regional Department of Neurotology, ENT Directorate, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Jaydip Ray
- Regional Department of Neurotology, ENT Directorate, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
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Asp F, Stokroos RJ, Agterberg MJH. Toward Optimal Care for Children With Congenital Unilateral Aural Atresia. Front Neurol 2021; 12:687070. [PMID: 34305795 PMCID: PMC8298319 DOI: 10.3389/fneur.2021.687070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/14/2021] [Indexed: 11/21/2022] Open
Affiliation(s)
- Filip Asp
- Scientific Center for Advanced Pediatric Audiology, Division of Ear, Nose, and Throat Diseases, Department of Clinical Science, Intervention and Technology Karolinska Institute, Stockholm, Sweden
| | - Robert J Stokroos
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands.,University Medical Center (UMC) Utrecht Brain Center, Utrecht, Netherlands
| | - Martijn J H Agterberg
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre Nijmegen, Nijmegen, Netherlands.,Department of Biophysics, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Nijmegen, Nijmegen, Netherlands
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Sound localization with bilateral bone conduction devices. Eur Arch Otorhinolaryngol 2021; 279:1751-1764. [PMID: 33956208 PMCID: PMC8930961 DOI: 10.1007/s00405-021-06842-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 04/20/2021] [Indexed: 11/04/2022]
Abstract
Purpose To investigate sound localization in patients bilaterally fitted with bone conduction devices (BCDs). Additionally, clinically applicable methods to improve localization accuracy were explored. Methods Fifteen adults with bilaterally fitted percutaneous BCDs were included. At baseline, sound localization, (un)aided pure-tone thresholds, device use, speech, spatial and qualities of hearing scale (SSQ) and York hearing-related quality of life (YHRQL) questionnaire were measured. Settings to optimize sound localizing were added to the BCDs. At 1 month, sound localization was assessed again and localization was practiced with a series of sounds with visual feedback. At 3 months¸ localization performance, device use and questionnaire scores were determined again. Results At baseline, one patient with congenital hearing loss demonstrated near excellent localization performance and four other patients (three with congenital hearing loss) localized sounds (quite) accurately. Seven patients with acquired hearing loss were able to lateralize sounds, i.e. identify whether sounds were coming from the left or right side, but could not localize sounds accurately. Three patients (one with congenital hearing loss) could not even lateralize sounds correctly. SSQ scores were significantly higher at 3 months. Localization performance, device use and YHRQL scores were not significantly different between visits. Conclusion In this study, the majority of experienced bilateral BCD users could lateralize sounds and one third was able to localize sounds (quite) accurately. The localization performance was robust and stable over time. Although SSQ scores were increased at the last visit, optimizing device settings and a short practice session did not improve sound localization.
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Hearing in Noise With Unilateral Versus Bilateral Bone Conduction Hearing Aids in Adults With Pseudo-conductive Hearing Loss. Otol Neurotol 2021; 41:379-385. [PMID: 31917768 DOI: 10.1097/mao.0000000000002550] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The role of bilateral bone conduction amplification in patients with bilateral conductive hearing loss is unclear because cranial attenuation is usually considered negligible, and both cochleae can be stimulated with similar efficacy by each device. The aim of the study was to determine if bilateral bone-conduction hearing aids can improve hearing in noise in a homogeneous group of normal-hearing subjects with bilateral pseudo-conductive hearing loss. STUDY DESIGN Prospective, comparative. SETTING Department of Communication Sciences and Disorders in University of Haifa, Israel. SUBJECTS Department of Communication Sciences and Disorders in University of Haifa, Israel. INTERVENTIONS Induction of bilateral pseudo-conductive hearing loss of more than 35 dB using earplugs and earmuffs. MAIN OUTCOME MEASURES Hearing quality on blinded comparison of unilateral versus bilateral amplification with bone-conduction hearing aids under different locations of noise. RESULTS Unilateral and bilateral amplification had similar efficacy when both signal and noise were presented from the front. However, bilateral amplification was significantly better when signals were presented from the front and noise was presented from both sides (SNR -10: 92% vs. 84%, p = 0.001; SNR -15: 84% vs. 78%, p = 0.005). Analysis of subject responses on blinded questionnaires revealed that 81% found hearing easier with bilateral amplification. Noise was reported to be more disturbing with unilateral amplification by 55% of the subjects and with bilateral amplification, by 9%. CONCLUSIONS Bilateral amplification with bone conduction devices can improve understanding in noise in the binaural squelch setting. Subjective improvements with bilateral bone-conduction aids included better sound quality and reduced noise disturbance. These findings are consistent with the binaural mechanism of spectral release from masking.
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Nishimura T, Hosoi H, Saito O, Shimokura R, Yamanaka T, Kitahara T. Sound localisation ability using cartilage conduction hearing aids in bilateral aural atresia. Int J Audiol 2020; 59:891-896. [DOI: 10.1080/14992027.2020.1802671] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Tadashi Nishimura
- Department of Otolaryngology-Head and Neck surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Hiroshi Hosoi
- President’s Office, Nara Medical University, Kashihara, Nara, Japan
| | - Osamu Saito
- Department of Otolaryngology-Head and Neck surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Ryota Shimokura
- Graduate School of Engineering Science, Osaka University, Toyonaka, Osaka, Japan
| | - Toshiaki Yamanaka
- Department of Otolaryngology-Head and Neck surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Tadashi Kitahara
- Department of Otolaryngology-Head and Neck surgery, Nara Medical University, Kashihara, Nara, Japan
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Lippmann E, Pritchett C, Ittner C, Hoff SR. Transcutaneous Osseointegrated Implants for Pediatric Patients With Aural Atresia. JAMA Otolaryngol Head Neck Surg 2019; 144:704-709. [PMID: 29978214 DOI: 10.1001/jamaoto.2018.0911] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Importance Patients with aural atresia typically have maximal conductive hearing loss, which can have negative academic and social consequences. Transcutaneous osseointegrated implants (TOIs) can potentially restore hearing on the affected side. Objectives To review the demographic, audiological, and surgical outcomes of TOI placement in pediatric patients with aural atresia and to describe a modification in incision technique in anticipation of later auricular reconstruction. Design, Setting, and Participants This retrospective case series reviewed 41 cases of TOI placement in pediatric patients between January 1, 2014, and September 30, 2016, at Lurie Children's Microtia and Aural Atresia Clinic. Patients, all younger than 18 years and with atresia or microtia, received at least 6 months of follow-up and underwent testing before and after surgery. Main Outcomes and Measures Patient age, indication for procedure, ear sidedness, case length, incision type, complications, and other postoperative events. Audiological outcomes before and after implantation were measured using pure-tone averages and the Hearing In Noise Test for Children, presented in variable signal to noise ratios. Results In total, 46 TOIs were performed in 38 pediatric patients, but only 41 implantations in 34 patients were included in this study. Of the 34 patients, 13 (38%) were males and 21 (62%) were females, with a mean age of 8.9 (range, 5-17) years at the time of TOI placement. Microtia on the implanted side was present in 39 cases (95%). A modified posterior-superior scalp incision technique was used in 30 (73%) of 41 ears, all in cases of microtia. One perioperative surgical complication occurred: a seroma requiring drainage. Two patients developed minor skin irritation and erythema at the magnet site related to the overnight use of the processor, which resolved when removed while sleeping. The mean (SD; range) score for the Speech In Noise test at 5 dB signal to noise ratio improved from 75.3% (14.4%; range, 50%-92%) correct in unaided/preoperative condition to 93.6% (6.95%; range, 80%-100%) correct in the aided/postoperative condition. The mean improvement in score was 18.3% (95% CI, 10.8%-25.9%), with an effect size of 1.62 (95% CI, 0.95-2.29). The mean pure-tone averages (SD; range) similarly improved from 63.7 (13.2; range, 25-11) dB to 9.6 (4.9; range, 5-15) dB. Conclusions and Relevance Transcutaneous osseointegrated implantation has a low complication rate among pediatric patients with atresia or microtia and can provide excellent audiological results. It should be included as a treatment option for this population of patients who meet audiological criteria.
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Affiliation(s)
- Elise Lippmann
- Department of Otolaryngology-Head and Neck Surgery, University of Illinois Hospital and Health Sciences System, Chicago
| | - Cedric Pritchett
- Division of Otolaryngology-Head and Neck Surgery, Nemours Children's Hospital, Orlando, Florida
| | - Colleen Ittner
- Department of Pediatric Audiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Stephen R Hoff
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Unilateral and Bilateral Audiological Benefit With an Adhesively Attached, Noninvasive Bone Conduction Hearing System. Otol Neurotol 2018; 39:1025-1030. [DOI: 10.1097/mao.0000000000001924] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Reabilitação auditiva na Síndrome de Treacher Collins por meio de prótese auditiva ancorada no osso. REVISTA PAULISTA DE PEDIATRIA 2015; 33:483-7. [PMID: 26298651 PMCID: PMC4685570 DOI: 10.1016/j.rpped.2015.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 12/22/2014] [Accepted: 01/18/2015] [Indexed: 12/02/2022]
Abstract
Objective: To describe a case of hearing rehabilitation with bone anchored hearing aid in a
patient with Treacher Collins syndrome. Case description: 3 years old patient, male, with Treacher Collins syndrome and severe complications
due to the syndrome, mostly related to the upper airway and hearing. He had
bilateral atresia of external auditory canals, and malformation of the pinna. The
initial hearing rehabilitation was with bone vibration arch, but there was poor
acceptance due the discomfort caused by skull compression. It was prescribed a
model of bone-anchored hearing aid, in soft band format. The results were
evaluated through behavioral hearing tests and questionnaires Meaningful Use of
Speech Scale (MUSS) and Infant-Toddler Meaningful Auditory Integration Scale
(IT-MAIS). Comments: The patient had a higher acceptance of the bone-anchored hearing aid compared to
the traditional bone vibration arch. Audiological tests and the speech and
auditory skills assessments also showed better communication and hearing outcomes.
The bone-anchored hearing aid is a good option in hearing rehabilitation in this
syndrome.
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Graham ME, Haworth R, Chorney J, Bance M, Hong P. Decisional Conflict in Parents Considering Bone-Anchored Hearing Devices in Children With Unilateral Aural Atresia. Ann Otol Rhinol Laryngol 2015; 124:925-30. [PMID: 26082472 DOI: 10.1177/0003489415592000] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The benefits of bone-anchored hearing devices (BAHD) in children with unilateral aural atresia are controversial. We sought to determine whether there is parental decisional conflict surrounding elective placement of BAHD for this indication. METHODS Caregivers of pediatric patients with unilateral aural atresia and normal contralateral ear undergoing percutaneous BAHD consultation were enrolled. All consultations were carried out by one pediatric otolaryngologist in a consistent manner. After consultation, the participants completed a demographics form and the Decisional Conflict Scale (DCS) questionnaire. RESULTS Twenty-three caregivers of 15 male (65.2%) and 8 female (34.8%) children (mean age 5.65 years) participated. The overall median DCS score was 15.63 (standard error = 4.21). Significant decisional conflict (DCS score ≥ 25) was found in 10 participants (43.5%). The median DCS score in the group choosing surgery was 5.47, and it was 23.44 in those who did not choose surgery (Mann-Whitney U = 39, Z = -1.391, P = .164). The median DCS score for mothers and fathers was 25 and 3.91, respectively. CONCLUSION Many parents experienced significant decisional conflict when considering percutaneous BAHD surgery in children with unilateral aural atresia in our study population. Future research should explore the impact of decisional conflict on health outcomes.
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Affiliation(s)
- M Elise Graham
- IWK Health Centre, Halifax, Nova Scotia, Canada Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Jill Chorney
- IWK Health Centre, Halifax, Nova Scotia, Canada Dalhousie University, Halifax, Nova Scotia, Canada
| | - Manohar Bance
- IWK Health Centre, Halifax, Nova Scotia, Canada Dalhousie University, Halifax, Nova Scotia, Canada
| | - Paul Hong
- IWK Health Centre, Halifax, Nova Scotia, Canada Dalhousie University, Halifax, Nova Scotia, Canada
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Nicholas BD, Kesser BW. Unilateral Aural Atresia: Current Management Issues and Results. CURRENT OTORHINOLARYNGOLOGY REPORTS 2013. [DOI: 10.1007/s40136-013-0014-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Janssen RM, Hong P, Chadha NK. Bilateral Bone-Anchored Hearing Aids for Bilateral Permanent Conductive Hearing Loss. Otolaryngol Head Neck Surg 2012; 147:412-22. [DOI: 10.1177/0194599812451569] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To systematically review the outcomes of bilateral versus unilateral bone-anchored hearing aids (BAHA) for individuals with bilateral permanent conductive hearing loss (CHL) with the goal of (1) deriving clinically oriented insights into the advantages and disadvantages of bilateral fitting and (2) identifying gaps in knowledge to stimulate future research. Data Sources Medline, EMBASE, and Cochrane databases were searched for studies of all languages published between 1977 and July 2011. Review Methods Studies were included if subjects of any age had permanent bilateral CHL and bilateral implanted BAHAs. Outcome measures of interest were any subjective or objective audiologic measures, quality of life indicators, or reports of adverse events. Results In all, 628 abstracts were generated from the literature searches; 11 studies met the criteria for data extraction and analysis. All 11 studies were observational. In most studies, comparisons between unilateral and bilateral BAHA were intra-subject. Bilateral BAHA provided audiologic benefit compared to unilateral BAHA (improved thresholds for tones [2 studies], speech in quiet [5 studies] and in noise [3 studies], and improved localization/lateralization [3 studies]) and patients’ perceived subjective benefit from bilateral BAHA (3 studies). Disadvantages of bilateral BAHAs included listening in noise in some conditions (3 studies), presumed additional cost, and presumed increase in adverse event risk. Conclusion Bilateral BAHA provided additional objective and subjective benefit compared to unilateral BAHA; however, there was a limited number of studies available with good quality evidence. Aspects of bilateral BAHA that would benefit from further investigation are described, and recommendations for bilateral BAHA candidacy criteria are provided.
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Affiliation(s)
- Renée M. Janssen
- University of British Columbia Faculty of Medicine, Vancouver, Canada
| | - Paul Hong
- Division of Otolaryngology–Head and Neck Surgery, IWK Health Centre, Dalhousie University, Halifax, Canada
| | - Neil K. Chadha
- Division of Pediatric Otolaryngology–Head and Neck Surgery, BC Children’s Hospital, University of British Columbia, Vancouver, Canada
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Colquitt J, Loveman E, Baguley D, Mitchell T, Sheehan P, Harris P, Proops D, Jones J, Clegg A, Welch K. Bone-anchored hearing aids for people with bilateral hearing impairment: a systematic review. Clin Otolaryngol 2011; 36:419-41. [DOI: 10.1111/j.1749-4486.2011.02376.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Skin reactions following BAHA surgery using the skin flap dermatome technique. Eur Arch Otorhinolaryngol 2010; 268:373-6. [DOI: 10.1007/s00405-010-1366-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 08/12/2010] [Indexed: 11/27/2022]
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Deas RW, Adamson RBA, Curran LL, Makki FM, Bance M, Brown JA. Audiometric thresholds measured with single and dual BAHA transducers: The effect of phase inversion. Int J Audiol 2010; 49:933-9. [PMID: 20874054 DOI: 10.3109/14992027.2010.515621] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The bone-anchored-hearing-aid (BAHA) transduces airborne sound into skull vibration. Current bilateral BAHA configurations, for sounds directly facing listeners, will apply forces that are in-phase with each other and directed roughly towards the center of the head. Below approximately 1000 Hz the two cochleae respond in approximately the same direction and with approximately the same phase to each BAHA, thus it may be preferable to drive bilateral BAHAs such that when one pushes, the other pulls. This can be achieved by adjusting the relative phase offset of the BAHAs, and doing so results in greater vibration and improved hearing threshold. In this paper we compare performance of bilateral BAHAs driven in this configuration to the standard configuration. In twelve normal participants we show significant improvements in low-frequency (≤750 Hz) hearing thresholds using out-of-phase BAHAs. The threshold measurements are further supported by velocimetric measurements taken at the cochlear promontory in a cadaveric head. Comparing vibration arising from each configuration confirms that out-of-phase driving results in greater vibration. Neither dataset shows either improved or reduced threshold at high frequencies.
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Affiliation(s)
- Ross W Deas
- SENSE Laboratory, Division of Otolaryngology, Dept of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
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Middle Ear Dimensions in Congenital Aural Atresia and Hearing Outcomes After Atresiaplasty. Otol Neurotol 2010; 31:946-53. [DOI: 10.1097/mao.0b013e3181e8f997] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Skarzyński H, Porowski M, Podskarbi-Fayette R. Treatment of otological features of the oculoauriculovertebral dysplasia (Goldenhar syndrome). Int J Pediatr Otorhinolaryngol 2009; 73:915-21. [PMID: 19203801 DOI: 10.1016/j.ijporl.2009.01.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Revised: 01/12/2009] [Accepted: 01/13/2009] [Indexed: 10/21/2022]
Abstract
The oculoauriculovertebral dysplasia is a rare congenital malformation that is characterized by a hemifacial microsomia with ocular abnormalities and coexisting disorders in the spinal column and other organs. Characteristic features of the disease were first described by Maurice Goldenhar in 1952. A broad spectrum of hearing impairment is a result of complex malformations of the external ear, the middle ear and in some cases-the inner ear. The degree of hearing loss can range from mild to moderate conductive type in cases of chronic otitis media with effusion and severe to profound sensorineural hearing impairment with malformations of the inner ear in various forms of cochlear hypoplasia. This study focuses on surgical methods of hearing improvement in patients with the oculoauriculovertebral dysplasia (OAVD). We present 11 patients diagnosed with OAVD who are under supervision of the Institute of Physiology and Pathology of Hearing in Warsaw. It is, to our knowledge, one of the largest groups of patients reported by a single ORL medical center. The degree of hearing impairment was thoroughly described in all patients and individual treatment was introduced. The aim of this report was to present algorithm for diagnostics and treatment of symptoms of Goldenhar syndrome (GS) based upon methodology used in modern otosurgery.
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Affiliation(s)
- Henryk Skarzyński
- International Center of Hearing and Speech of the Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland
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Abstract
OBJECTIVE To evaluate the clinical outcome of a simplified surgical technique for BAHA implantation, in terms of implant failure and its causes. DESIGN Retrospective analysis. METHODS Analysis of a consecutive cohort of 142 patients (150 loaded implants) fitted with the BAHA implant between January 1, 1997, and December 31, 1999. The simplified surgical Nijmegen technique comprises a longitudinal postauricular incision, extensive subcutaneous tissue reduction, and removal of the periosteum. Clinical outcomes were the rate of implant failures, its causes for this, and skin reactions around the percutaneous implants classified according to Holgers. Clinical results were compared with other BAHA series. RESULTS Mean follow-up was 5.6 +/- 2.7 years (range, 0-10.5 yr). Holgers grade 2 or more severe skin reactions were seen in 6.5% of the 1,038 follow-up visits. Extrusion of the implants occurred as a result of failed osseointegration (n = 3), trauma (n = 5), infection (n = 1), and (other) medical reasons (n = 5 explanations). Total extrusion rate was 9.3%. Only 3% (1 and 3) were due to failed osseointegration or infection around the percutaneous implant. CONCLUSION The modified Nijmegen surgical technique is a simple straightforward surgical procedure without the use of a pedicled skin flap. Surgery takes approximately 20 minutes. Meticulous performance of the procedure is considered important to achieve optimal results in the long-term. Particularly the soft tissue reduction has to be done with great care. In terms of the low rates of implant failure and adverse tissue reactions, the Nijmegen surgical technique proved to be a good alternative to other techniques.
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An approach to bilateral bone-anchored hearing aid surgery in children: contralateral placement of sleeper fixture. The Journal of Laryngology & Otology 2008; 123:555-7. [DOI: 10.1017/s0022215108003952] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:Bone-anchored hearing aid surgery in younger children is a two-stage procedure, with a titanium fixture being allowed to osseointegrate for several months before an abutment is fitted through a skin graft. In the first procedure, it has been usual to place a reserve or sleeper fixture approximately 5 mm from the primary fixture as a backup in case the primary fixture fails to osseointegrate. This ipsilateral sleeper fixture is expensive, is often not used, and is placed in thinner calvarial bone where it is less likely to osseointegrate successfully. The authors have implanted the sleeper fixture on the contralateral side, with the additional objective of reducing the number of procedures for bilateral bone-anchored hearing aid implantation, providing a cost-effective use for the sleeper.Methods:The authors implanted the bone-anchored hearing aid sleeper fixture in the contralateral temporal bone instead of on the ipsilateral side in seven successive paediatric cases with bilateral conductive hearing loss requiring two-stage bone-anchored hearing aids, treated at the Royal Manchester Children's Hospital, UK.Results:The seven patients ranged in age from five to 15 years, with a mean age of 10 years; in addition, a 20-year-old with learning disability was also treated. In each case, the contralateral sleeper fixture was not needed as a backup fixture, but was used in four patients (57 per cent) as the basis for a second-side bone-anchored hearing aid.Conclusions:In children with bilateral conductive hearing loss, in whom a bilateral bone-anchored hearing aid is being considered and the second side is to be operated upon at a later date, we recommend placing the sleeper fixture on the contralateral side at the time of primary first-side surgery. Our technique provides a sleeper fixture located in an optimal position, where it also offers the option of use for a second-side bone-anchored hearing aid and reduces the number of procedures needed.
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Subjective Benefit After BAHA System Application in Patients With Congenital Unilateral Conductive Hearing Impairment. Otol Neurotol 2008; 29:353-58. [DOI: 10.1097/mao.0b013e318162f1d9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Abstract
PURPOSE OF REVIEW To discuss recent controversies regarding the management of aural atresia. RECENT FINDINGS Management of unilateral atresia is less controversial. Candidacy for successful repair is based on high-resolution computed tomography findings and atresia grading. The bone-anchored hearing aid is a viable alternative strategy for hearing improvement. Stability of hearing results following atresia repair improves with the number of atresiaplasties performed. Development of image-guided surgery may provide benefit in atresia surgery. New unrecognized rare complications of aural atresia and atresia repair including salivary fistula and middle ear cholesteatoma are now being recognized and are manageable. SUMMARY Management of aural atresia continues to be difficult and surrounded by controversy. New studies and cases series may shed light on these management issues.
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Affiliation(s)
- Alessandro de Alarcon
- Center for Hearing and Deafness Research, Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA
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26
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Wollenberg B, Beltrame M, Schönweiler R, Gehrking E, Nitsch S, Steffen A, Frenzel H. Integration des aktiven Mittelohrimplantates in die plastische Ohrmuschelrekonstruktion. HNO 2007; 55:349-56. [PMID: 17356875 DOI: 10.1007/s00106-007-1540-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patients with high-grade microtia and atresia require a sophisticated and specific treatment. Apart from the plastic reconstruction of the auricle, in some cases hearing rehabilitation is medically indicated or is desired by the patients. The long-term results of simultaneous middle ear reconstruction with tympanoplasty are often inadequate owing to a persisting air-bone gap, and new techniques in hearing rehabilitation are needed for these patients. METHODS We present three cases of unilateral atresia to illustrate a combined approach integrating hearing rehabilitation using the active middle ear implant Vibrant Soundbridge (VSB) into plastic auricular reconstruction. The VSB was attached to the stapes suprastructure via the titanium clip in two of these cases and in the third case a subfacial approach was used to attach it directly to the membrane of the round window. RESULTS The air-bone gap was reduced to 17 dB, 14 dB and 0.25 dB HL. In free-field speech recognition tests at 65 dB SPL the patients achieved 100%, 90% and 100% recognition with the activated implant. No postoperative complications such as facial nerve paresis, vertigo or inner ear damage were found. CONCLUSIONS The integration of active middle ear implants in auricular reconstruction opens up a new approach in complete hearing rehabilitation. The additional implantation of the VSB does not have any negative effect on the healing process or the cosmetic outcome of the auricular reconstruction.
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Affiliation(s)
- B Wollenberg
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde & Plastische Operationen, Universitätsklinikum Schleswig-Holstein-Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck,.
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27
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Yellon RF. Bone anchored hearing aid in children--prevention of complications. Int J Pediatr Otorhinolaryngol 2007; 71:823-6. [PMID: 17316833 DOI: 10.1016/j.ijporl.2007.01.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2006] [Revised: 01/03/2007] [Accepted: 01/06/2007] [Indexed: 10/23/2022]
Abstract
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.
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Affiliation(s)
- Robert F Yellon
- Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, Pittsburgh, PA 15213, United States.
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28
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Johnson CE, Danhauer JL, Reith AC, Latiolais LN. A Systematic Review of the Nonacoustic Benefits of Bone-Anchored Hearing Aids. Ear Hear 2006; 27:703-13. [PMID: 17086080 DOI: 10.1097/01.aud.0000240635.70277.3f] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study completed an evidence-based practice systematic review of the nonacoustic benefits for adult patients receiving bone-anchored hearing aid(s) (BAHAs) relative to other forms of amplification (i.e., none, bone-conduction hearing aids [BCHAs], or air-conduction hearing aids [ACHAs]). DESIGN Systematic review. METHODS ComDisDome and PubMed were used to perform a comprehensive search for studies that were of at least level III of evidence. Three independent reviewers completed the search, quality assessment, and data extraction. RESULTS Out of 28 studies, seven studies were identified, three of which were prospective and four of which were retrospective within-subject comparison designs. Nearly all of the studies were of small sample size and/or limited methodological quality, primarily because of logistics (e.g., heterogeneity of subject samples and prior experience with amplification). CONCLUSIONS The evidence identified in this review is limited regarding the nonacoustic benefits of BAHAs compared with unaided conditions or other types of amplification. Professionals should use caution when counseling patients about the quality of life (QOL) benefits of these devices. Routine use of QOL outcome measures and standardized methods for reporting findings are critical in demonstrating the nonacoustic benefits of BAHAs.
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Affiliation(s)
- Carole E Johnson
- Department of Communication Disorders, Auburn University, Auburn, Alabama 36849-5232, USA.
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29
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Abstract
Morphology, genetic conditioning, terminology, and the principles of treatment of Treacher Collins syndrome have been presented on the basis of our own material, as well as review of literature. Fifty patients (27 males, 23 females) were operated on at the Hospital of Plastic Surgery in Polanica Zdrój from 1976 to 2005. The patients were first seen when they were from 1 to 32 years of age (mean, 7). The disease was hereditary in 17 patients, while the remaining subjects did not reveal any genetic conditioning. The lifesaving surgical treatment was undertaken in 4 children with the most severe form of the disease who presented with dyspnea and paroxysmal apnea. In those cases, the treatment aimed at improving the respiratory function by restoring patency of the nostrils and distraction of the mandible. Twelve patients were operated on for cleft palate between 1 and 2 years of age. Twelve patients had eyelid correction with the use of musculocutaneous flap transposition from the upper eyelid (Z-plasty). The zygomatic bone and lateral wall of the orbit were reconstructed by means of iliac bone grafts in 26 patients. The auricular reconstruction was usually undertaken after 10 years of age. Nine patients underwent bilateral auricular reconstruction by means of a modified Brent method. Fifteen patients aged 12-14 had chin osteotomy according to the Obwegeser method. Nasal osteotomy was performed in 10 patients with characteristic broad, long, and hooked noses, who were operated on after 16 years of age and after completion of orthognathic treatment. In total, 258 surgical procedures were performed in 50 patients, an average of 5.2 operations per every patient. Apart from a multistage surgical treatment, the patients required a combined multidisciplinary approach, mainly due to hearing impairment and occlusal disturbances. The obtained outcome of treatment, although far from being perfect, but still beneficial, confirmed the correctness of applied approach but at the same time pointed to the necessity of introducing new methods of treatment aiming, among others, at compensating for the tissue deficiency by means of tissue engineering.
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Affiliation(s)
- Kazimierz Kobus
- Plastic Surgery Hospital in Polanica Zdrój and Department of Plastic Surgery in Polanica Zdrój, Medical University, Wrocław, Wrocław, Poland
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30
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Hol MKS, Snik AFM, Mylanus EAM, Cremers CWRJ. Does the Bone-Anchored Hearing Aid Have a Complementary Effect on Audiological and Subjective Outcomes in Patients with Unilateral Conductive Hearing Loss? Audiol Neurootol 2005; 10:159-68. [PMID: 15724087 DOI: 10.1159/000084026] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2004] [Accepted: 11/10/2004] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To study the effect of a bone-anchored hearing aid (BAHA) in patients with unilateral conductive hearing loss. STUDY DESIGN Prospective evaluation on 18 subjects. METHODS Aided and unaided binaural hearing was assessed in the sound field using a sound localization test and a speech recognition in noise test with spatially separated sound and noise sources. The patients also filled out a disability-specific questionnaire. PATIENTS 13 out of the 18 subjects had normal hearing on one side and acquired conductive hearing loss in the other ear. The remaining 5 patients had a unilateral air-bone gap and mild symmetrical sensorineural hearing loss. RESULTS Sound localization with the BAHA improved significantly. Speech recognition in noise with spatially separated speech and noise sources also improved with the BAHA. Fitting a BAHA to patients with unilateral conductive hearing loss had a complementary effect on hearing. Questionnaire results showed that the BAHA was of obvious benefit in daily life. CONCLUSIONS The BAHA proved to be a beneficial means to optimize binaural hearing in patients with severe (40-60 dB) unilateral conductive hearing loss according to audiometric data and patient outcome measures.
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Affiliation(s)
- Myrthe K S Hol
- Department of Otorhinolaryngology, University Medical Centre St. Radboud, Nijmegen, The Netherlands.
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31
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Schmerber S, Sheykholeslami K, Kermany MH, Hotta S, Kaga K. Time–intensity trading in bilateral congenital aural atresia patients. Hear Res 2005; 202:248-57. [PMID: 15811716 DOI: 10.1016/j.heares.2004.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2004] [Accepted: 11/19/2004] [Indexed: 10/26/2022]
Abstract
In an effort to examine the rules by which information of bilaterally applied bone-conducted signals arising from interaural time differences (ITD) and interaural intensity differences (IID) is combined, data were measured for continuous 500 Hz narrow band noise at 65-70 dB HL in 11 patients with bilateral congenital aural atresia. Time-intensity trading functions were obtained by shifting the sound image towards one side using ITD, and shifting back to a centered sound image by varying the IID in the same ear (auditory midline task). ITD values were varied from -600 to +600 micros at 200 micros steps, where negative values indicate delays to the right ear. The results indicate that time-intensity trading is present in patients with bilateral aural atresia. The gross response properties of time-intensity trading in response to bone-conducted signals were comparable in patients with bilateral aural atresia and normal-hearing subjects, though there was a larger inter-subject variability and higher discrimination thresholds across IIDs in the atresia group. These results suggest that the mature auditory brainstem has a potential to employ binaural cues later in life, although to a restricted degree. A binaural fitting of a bone-conducted hearing aid might optimize binaural hearing and improve sound lateralization, and we recommend now systematically bilateral fitting in aural atresia patients.
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Affiliation(s)
- Sébastien Schmerber
- Department of Otolaryngology, University Hospital, Service O.R.L C.H.U de Grenoble, France.
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32
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Abstract
Patients with congenital conductive hearing loss present a surgical challenge. Surgeons must be aware of the potential altered anatomy, in particular the potential risks to the facial nerve and inner ear structures; however, meticulous attention to detail in the preoperative evaluation and in the operating room can minimize these risks. If surgery poses too high a risk to these structures, the chances of success are low, or there is a contraindication to surgery, traditional air-conduction hearing aids or bone-anchored hearing aids should be considered.
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Affiliation(s)
- Yael Raz
- Division of Otology, Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, JHOC 6th Floor, Baltimore, MD 21287, USA
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33
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Beahm EK, Walton RL. Auricular reconstruction for microtia: part I. Anatomy, embryology, and clinical evaluation. Plast Reconstr Surg 2002; 109:2473-82; quiz following 2482. [PMID: 12045579 DOI: 10.1097/00006534-200206000-00046] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Elisabeth K Beahm
- Department of Plastic Surgery, M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Box 443, Houston, Texas 77030, USA.
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Snik AFM, Mylanus EAM, Cremers CWRJ. The bone-anchored hearing aid in patients with a unilateral air-bone gap. Otol Neurotol 2002; 23:61-6. [PMID: 11773849 DOI: 10.1097/00129492-200201000-00015] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To study the benefit of the application of a bone-anchored hearing aid in patients with a unilateral air-bone gap. STUDY DESIGN Prospective evaluation in eight patients. METHODS Binaural hearing was assessed in the sound field by comparing aided and unaided scores obtained with a sound localization test and a speech recognition in noise test with spatially separated sound and noise sources. SETTING Tertiary referral center. PATIENTS The patients had subnormal hearing and unilateral conductive hearing loss. RESULTS Sound localization improved significantly in the six patients with acquired hearing loss. The binaural advantage, studied with speech-in-noise tests with spatially separated speech and noise sources, proved to be comparable with that in a control group of subjects with normal hearing when they were listening monaurally versus binaurally. For one of the two patients with unilateral congenital conductive hearing loss, the results were ambiguous. This patient's age at the time of surgery was high: 40 years (the other patient was 19 years old at the time of surgery). This might have played a role. CONCLUSION If reconstructive surgery is not possible (e.g., in a patient with a chronically draining ear or a severe congenital malformation), a bone-anchored hearing aid is an option to reestablish binaural hearing. The results reported herein suggest that, at least for patients with acquired hearing loss, the bone-anchored hearing aid is an effective treatment of unilateral conductive hearing loss.
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Affiliation(s)
- Ad F M Snik
- Department of Otorhinolaryngology, University Hospital Nijmegen, Nijmegen, The Netherlands
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35
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Snik AF, Mylanus EA, Cremers CW. The bone-anchored hearing aid: a solution for previously unresolved otologic problems. Otolaryngol Clin North Am 2001; 34:365-72. [PMID: 11382575 DOI: 10.1016/s0030-6665(05)70336-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A major challenge for otologists treating middle ear infection is to obtain a dry ear and optimal hearing. If the patient needs amplification and uses an air conduction hearing aid, the ear mold, occluding the ear canal, may provoke or aggravate the infection in the middle ear and thus cause otorrhoea. Continuous otorrhoea may cause cochlear damage in the long run. Bone conduction hearing aids offer an alternative for such patients.
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Affiliation(s)
- A F Snik
- Department of Otolaryngology, University Hospital Nijmegen, Nijmegen, The Netherlands
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36
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Stenfelt S, Håkansson B, Jönsson R, Granström G. A bone-anchored hearing aid for patients with pure sensorineural hearing impairment: a pilot study. SCANDINAVIAN AUDIOLOGY 2001; 29:175-85. [PMID: 10990016 DOI: 10.1080/010503900750042743] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This pilot study assesses the potential benefits of an optimized bone-anchored hearing aid (BAHA) for patients with a mild to moderate pure sensorineural high frequency hearing impairment. The evaluation was conducted with eight first-time hearing aid users by means of psycho-acoustic sound field measurements and a questionnaire on subjective experience; all of the patients benefited from the BAHA. On average, the eight patients showed improvement in PTA threshold of 3.4 dB and in speech intelligibility in noise of 14%. Seven of the subjects, also fitted with present standard air conduction hearing aids (ACHA) found the ACHA thresholds to be improved more than the BAHA ones. In speech tests, the ACHA was only slightly better; these patients chose between their different hearing aids according to the sound environment. Although the BAHA was preferred for wearing and sound comfort, it cannot be used as the sole aid for patients with pure sensorineural impairment.
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Affiliation(s)
- S Stenfelt
- Department of Signals and Systems, Chalmers University of Technology, Göteborg, Sweden
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Bosman AJ, Snik AM, van der Pouw CTM, Mylanus EAM, Cremers CW. Audiometric Evaluation of Bilaterally Fitted Bone-anchored Hearing Aids: Evaluatión audíométrica de auxiliares auditivos tipo vibrador óseo bilateral. Int J Audiol 2001. [DOI: 10.3109/00206090109073111] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Declau F, Cremers C, Van de Heyning P. Diagnosis and management strategies in congenital atresia of the external auditory canal. Study Group on Otological Malformations and Hearing Impairment. BRITISH JOURNAL OF AUDIOLOGY 1999; 33:313-27. [PMID: 10890146 DOI: 10.3109/03005369909090115] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This consensus report represents a distillation of current opinion regarding diagnosis and management of congenital aural atresia. It also takes into account the philosophical differences which exist in Europe. Congenital aural atresia requires prompt diagnosis, genetic counselling and an early assessment of hearing. In bilateral atresia, early amplification with a bone conduction hearing aid is essential for proper speech development. Further rehabilitation in bilateral cases is managed with surgical reconstruction in selected patients or by implantation of a bone-anchored hearing aid. Atresia repair surgery is worthwhile if proper patient selection is made by use of stringent audiological and radiological criteria and state of the art surgery is performed. The divergent views concerning indications, ideal age for surgery and surgical approach to achieve better hearing are discussed. Review of the literature demonstrated that even in the hands of the best surgeons a mean hearing gain of only 20-25 dB is achieved in atresia Type II, with 30-35 dB in Type I. Therefore, surgical reconstruction should only be done in the more favourable cases where post-operative hearing of <25-30 dB is attainable. Less favoured patients should be helped with bone-anchored hearing aids, as this type of surgery does not interfere with the future use of new techniques.
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Affiliation(s)
- F Declau
- Department of Otorhinolaryngology, Head and Neck Surgery and Communication Disorders, University of Antwerp, Edegem, Belgium
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