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Sun L, Ping L, Fan X, Wang J, Chen X. Simulator Verification Is Potentially Beneficial for the Fitting of Softband Bone Conduction Hearing Devices in Young Children. Otol Neurotol 2024; 45:e500-e508. [PMID: 38924037 DOI: 10.1097/mao.0000000000004245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
HYPOTHESIS The current study employed a skull-simulator verification method to assess whether the output of softband bone conduction hearing devices (BCHDs) at the manufacturer's default settings deviated widely from the target determined by the fitting formula. BACKGROUND Real ear analysis is utilized for the verification of the fitting of air conduction hearing devices (ACHDs) in a variety of institutions. This procedure, however, has not been used in the fitting of BCHDs, largely due to the difficulty of testing the output of these devices to temporal bones. Despite the availability of skull simulators, they have not been utilized clinically to measure BCHD output. MATERIALS AND METHODS This prospective, single-center study enrolled 42 subjects, aged 3 months to 10 years, with microtia-atresia-associated mild-to-severe bilateral conductive hearing loss. Hearing sensitivity was evaluated behaviorally by pure tone audiometry (PTA) in 22 subjects 4 years or older (the PTA group), and by auditory brainstem response (ABR) in 20 subjects younger than 4 years (the ABR group). Following 6 months of subjects wearing the prescribed softband BCHDs, their dial level (DL) thresholds were reassessed while using their own BCHDs, configured with zero gain across all frequencies, functioning solely as a bone vibrator. These DL thresholds were inputted into the fitting formula, desired sensation level-bone conduction devices (DSL-BCD) for children, to obtain the target values of BCHD output. The simulator output of the BCHD programmed at the manufacturer's default setting was measured in response to speech presented at 55, 65, and 80 dB SPL, followed by gain adjustment based on the differences between the simulator output and the target. Aided speech intelligibility index (SII) was measured before and after the gain adjustment. RESULTS The softband BCHDs at the manufacturer's settings generally had lower output than the prescribed target values. This difference was larger at low frequencies and low levels. Across the 12 points tested (four frequencies from 500 to 4000 Hz multiplied by three levels), 22 (52.3%) and 42 (100%) BCHDs had deviations of +7 and +5 dB, respectively, at one point or more. The gain adjustments reduced the deviation and improved the SII values at the two lower levels of speech presented. CONCLUSION The simulator output of softband bone conduction hearing devices (BCHDs) with the manufacturer's settings may exhibit significant deviations from the formula. Objective output verification should be considered a beneficial step in BCHD fitting and is recommended when applicable.
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Affiliation(s)
- Le Sun
- Department of Otolaryngology
| | - Lu Ping
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | - Jian Wang
- School of Communication Science and Disorders, Dalhousie University, Halifax, Canada
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Sun Y, Yilala MH, Musumano LB, Yang J, Sanna M. Surgical management of chondrosarcomas of the skull-base and temporal bone. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08864-x. [PMID: 39085472 DOI: 10.1007/s00405-024-08864-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024]
Abstract
OBJECTIVES To analyze the overall long-term outcome of surgically treated skull base and temporal bone chondrosarcomas. METHODS The medical records of patients with surgically treated skull base and temporal bone chondrosarcomas between 1983 and 2024 were thoroughly evaluated. RESULTS Out of a total of over 5000 skull base surgeries performed at our center, only 29 patients had histopathologically confirmed chondrosarcomas of the skull base and temporal bone. The mean of patients age was 45.6, and the male-to-female ratio was 1.9:1. The most common symptoms included hearing loss (58.6%), tinnitus (41.4%), diplopia (31%), dysphonia (24.1%), dysphagia (20.7%), vertigo (10.3%), and dizziness (10.3%). The most frequent locations of lesions among the 29 patients are as follows: petroclival region (34.5%), jugular foramen (27.6%), petrous apex (17.2%), middle ear (13.8%), others (3.4%). TO, IFTA, IFTB, IFTC, POTS, and combined surgical approaches were commonly used. The rate of gross total removal and recurrence was 82.6% and 13.8% respectively. The follow-up duration of 6 patients was more than five years and less than ten years whereas ten patients had more than ten years of follow-up. CONCLUSIONS Chondrosarcoma of the skull base and temporal bone is a very rare pathology. Due to its multiple potential sites of origin and histological specificity, it presents us with significant challenges. Gross total removal is the primary treatment for chondrosarcoma of the skull base and temporal bone. Personalized decision-making should be considered based on the following aspects: tumor, patient, and surgeon's factors. Postoperative radiation therapy is complementary to surgical treatment in grades II and III lesions to achieve long-term survival.
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Affiliation(s)
- Yi Sun
- Department of Otorhinolaryngology, Head and Neck Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Melcol Hailu Yilala
- Department of ORL-HNS, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lucia Belen Musumano
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University of Ferrara, 44121, Ferrara, Italy
| | - Jianming Yang
- Department of Otorhinolaryngology, Head and Neck Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.
| | - Mario Sanna
- Department of Otology and Skull Base Surgery, Gruppo Otologico, 29121, Piacenza, Italy
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Yilala MH, Fancello G, Fancello V, Lauda L, Sanna M. Long-Term Surgical Outcome of Class A and B Tympanomastoid Paragangliomas. Cancers (Basel) 2024; 16:1466. [PMID: 38672548 PMCID: PMC11048109 DOI: 10.3390/cancers16081466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/05/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVE To analyze the long-term facial function as well as overall postoperative condition in surgically treated tympanomastoid PGL patients. STUDY DESIGN Retrospective study. METHOD The medical records of patients with surgically managed class A and B tympanomastoid PGLs between 1983 and 2023 were thoroughly evaluated. RESULT Our center has treated a total of 213 cases of tympanomastoid PGL surgically. The mean age of patients was 54, and the male-to-female ratio was 1:6. The most common symptoms at presentation were hearing loss (80%), pulsatile tinnitus (77%), and vertigo (15%). According to the modified Fisch classification, 45% of the cases were classified as class A (A1 and A2), while 55% were classified as class B (B1, B2, and B3). All class A and most class B1 and B2 tumors were removed either with transcanal or retroauricular-transcanal approaches. However, more advanced class B3 lesions were removed with subtotal petrosectomy (SP) along with middle ear obliteration. Facial nerve outcome was excellent in all class A and B cases, while chances of postoperative paresis slightly increased with the size and extent of the tumor (p < 0.05). The hearing outcome is excellent for class A1, A2, B1, and B2 tumors, whereas more advanced class B3 cases have a loss of air conduction (AC) and increased bone conduction (BC) threshold (p < 0.05). Complete surgical removal was achieved in 97% of our cases. The most common late complication was permanent TM perforation (7%), and the recurrence rate was 3%. CONCLUSIONS Tympanomastoid PGL represents the most common neoplasm of the middle ear space. The most frequent presenting symptoms include pulsatile tinnitus and hearing loss, whereas the presence of retrotympanic mass was evident in all cases at the time of initial otoscopic evaluation. Proper documentation of facial function and audiometric evaluation are crucial elements of preoperative workup. The most preferred preoperative radiologic examination is high-resolution computer tomography (HRCT), whereas magnetic resonance imaging (MRI) with or without gadolinium enhancement is reserved for cases with a dilemma of carotid artery or jugular bulb involvement. The main goal of tympanomastoid PGL treatment is complete disease removal with preservation of hearing and facial functions. Surgical treatment remains the preferred treatment modality with the benefits of complete disease removal, lower rate of recurrence and complication, and acceptable postoperative hearing level. Here, we present our 40 years of experience, which, to the very best of our knowledge, is the largest series of tympanomastoid PGL in the English literature.
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Affiliation(s)
- Melcol Hailu Yilala
- Department of Otology and Skull Base Surgery, Gruppo Otologico, 29121 Piacenza, Italy
- Department of Otorhinolaryngology, College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 1176, Ethiopia
| | - Giuseppe Fancello
- Department of Otorhinolaryngology, Careggi University Hospital, 50134 Florence, Italy
| | - Virginia Fancello
- Department of Otology and Skull Base Surgery, Gruppo Otologico, 29121 Piacenza, Italy
| | - Lorenzo Lauda
- Department of Otology and Skull Base Surgery, Gruppo Otologico, 29121 Piacenza, Italy
| | - Mario Sanna
- Department of Otology and Skull Base Surgery, Gruppo Otologico, 29121 Piacenza, Italy
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Bradley M, Shields C, Sabourn R, Whittle E, Boyd R, Bruce IA, Nichani J. Paediatric percutaneous bone anchored hearing aid implant failures: Comparing the experience of a tertiary centre with a systematic review of the literature and meta-analysis. Cochlear Implants Int 2024:1-13. [PMID: 38591756 DOI: 10.1080/14670100.2024.2332036] [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: 04/10/2024]
Abstract
BACKGROUND Despite the proven audiological benefits of Percutaneous Bone Anchored Hearing Aids (BAHAs) in paediatric patients with conductive or mixed hearing loss, their adoption has been limited due to concerns over implant failure and associated complications. This paper conducts a systematic review and meta-analysis to assess the prevalence of implant failure in paediatric populations, combined with a case series from our tertiary referral centre. METHODS A comprehensive literature search identified 562 articles, from which 34 were included in the review, covering 1599 implants in 1285 patients. Our retrospective case series included consecutive patients from our tertiary referral centre who underwent percutaneous BAHA implantation from 2003-2019. RESULTS Meta-analysis revealed an overall implant failure rate of 11%, predominantly attributed to traumatic extrusion. Our retrospective case series comprised 104 implantations in 76 patients, with a 4.8% failure rate. DISCUSSION Factors contributing to the lower-than-expected failure rates in the case series likely included consistent use of 4 mm fixtures from a single manufacturer and older age at implantation. The study underscores the need for standardised reporting formats in bone conduction implants research, given the systematic review's limitations in study design heterogeneity, especially with the expected rise in the adoption of novel active devices.
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Affiliation(s)
- Matthew Bradley
- Department of Paediatric Otolaryngology, Royal Manchester Children's Hospital, Manchester, UK
| | - Callum Shields
- Department of Paediatric Otolaryngology, Royal Manchester Children's Hospital, Manchester, UK
- Department of Health Sciences, University of Manchester, Manchester, UK
| | - Robert Sabourn
- Department of Health Sciences, University of Manchester, Manchester, UK
| | | | - Rachel Boyd
- Audiology, Royal Manchester Children's Hospital, Manchester, UK
| | - Iain Alexander Bruce
- Department of Paediatric Otolaryngology, Royal Manchester Children's Hospital, Manchester, UK
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Jaya Nichani
- Department of Paediatric Otolaryngology, Royal Manchester Children's Hospital, Manchester, UK
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Gutierrez JA, Shannon CM, Nguyen SA, Meyer TA, Lambert PR. Comparison of Transcutaneous and Percutaneous Implantable Hearing Devices for the Management of Congenital Aural Atresia: A Systematic Review and Meta-Analysis. Otol Neurotol 2024; 45:1-10. [PMID: 38085758 DOI: 10.1097/mao.0000000000004061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
OBJECTIVE To compare audiometric outcomes, complications, and revisions required for percutaneous (pBCD) versus transcutaneous (tBCD) implantable bone-conduction devices for the treatment of hearing loss associated with congenital aural atresia (CAA).Databases Reviewed.PubMed, Scopus, CINAHL. METHODS A systematic review was performed searching for English language articles from inception to December 14, 2022. Studies reporting audiometric outcomes or complications for either pBCDs or tBCDs for the treatment of CAA were selected for inclusion. A meta-analysis of single means and meta-analysis of proportions with comparison (Δ) of weighted proportions was conducted. RESULTS A total of 56 articles with 756 patients were selected for inclusion. One hundred ninety patients were implanted with pBCDs, whereas the remaining 566 were implanted with tBCDs. Mean pure-tone audiometry improvement in the pBCD group (39.1 ± 1.1 dB) was significantly higher than in the tBCD group (34.6 ± 1.6 dB; Δ4.5 dB; 95% confidence interval, 4.2-4.7 dB; p < 0.0001). The average improvement in speech reception threshold was 38.6 ± 2.5 dB in the percutaneous group as compared with 32.7 ± 1.6 dB in the transcutaneous group (Δ5.9 dB [5.3-6.5 dB], p < 0.0001). Overall complication rates for patients implanted with pBCDs and tBCDs were 29.0% (15.7-44.4%) and 9.4% (6.5%-13.0%), respectively (Δ19.6% [12.0-27.7%], p < 0.0001). CONCLUSIONS Patients with CAA implanted with pBCDs had significantly better audiometric outcomes than those implanted with tBCDs. However, complication rates were significantly higher among the pBCD group.
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Affiliation(s)
- Jorge A Gutierrez
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
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Shannon CM, Gutierrez JA, Nguyen SA, Meyer TA, Lambert PR. Comparison of Outcomes of Surgery Versus Implantable Device for the Treatment of Hearing Loss Associated With Congenital Aural Atresia: A Systematic Review and Meta-Analysis. Otol Neurotol 2023; 44:758-766. [PMID: 37464461 DOI: 10.1097/mao.0000000000003950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
OBJECTIVE To compare audiometric outcomes, complications, and revisions required for implantable bone-conduction devices (BCDs) versus atresia surgery for the treatment of hearing loss associated with congenital aural atresia. DATABASES REVIEWED PubMed, Scopus, CINAHL. METHODS Databases were searched for English articles from inception to July 1, 2022, for studies reporting audiometric outcomes or complications for either BCDs or atresia surgery for the treatment of congenital aural atresia. Main outcome measures included pure-tone audiometry, air-bone gap, speech reception threshold, associated complications, and rates of revision for each treatment option. RESULTS We identified 973 abstracts, of which 89 were selected for data extraction and analysis. A total of 2,611 patients were included, 1,901 in the atresia surgery group and 710 in the BCDs group. A meta-analysis of single means was conducted for age and audiometric outcomes, and a meta-analysis of proportions was conducted for complications and revisions. The average short-term improvement in pure-tone audiometry for the BCDs group was 34.4 ± 1.6 dB compared with 22.4 ± 1.5 dB for the atresia surgery group, representing a significant difference (12.0 dB; 95% confidence interval, 11.9-12.2; p < 0.0001). A smaller proportion of complications were reported in the devices group (16.9%) compared with the atresia surgery group (45.7%). In addition, a smaller proportion of cases in the devices group required some degree of revision (17.8%) compared with the atresia surgery group (23.0%). CONCLUSIONS This study demonstrates that implantable BCDs have significantly better audiometric outcomes as well as a lower rate of complications and revisions required compared with atresia surgery.
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Affiliation(s)
- Christian M Shannon
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
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Costa JR, Costa S, Soares T, Feliciano T, Almeida e Sousa C, Coutinho MB. Skin and soft tissue complications of bone-anchored hearing aids: Introducing a new classification system. ACTA OTORRINOLARINGOLOGICA (ENGLISH EDITION) 2023; 74:85-92. [PMID: 37005042 DOI: 10.1016/j.otoeng.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 01/24/2022] [Indexed: 04/03/2023]
Abstract
OBJECTIVES There have been significant surgical and technological advances in bone-anchored hearing aid (BAHA) design, function, and implantation technique, but peri-implant skin complications remain the most frequent complication. The most important aspect in dealing with cutaneous complications is to identify the type of cutaneous lesion. Although Holger's Classification has been an extremely useful clinical tool, this grading system has been shown to be unsuitable for some cases. We therefore propose a new consistent and easy assessment classification of cutaneous complications associated with BAHA. METHODS A retrospective clinical study was carried out at a tertiary centre, between January 2008 and December 2014. All patients under 18 years old with a unilateral BAHA were included in the study. RESULTS A total of 53 children, with a BAHA, were included in the study. Post-operative skin complications were observed in 49.1% of the patients. Of the children, 28.3% presented with soft tissue hypertrophy, the most frequently reported skin complication, and grading according to the Holger's classification was not considered feasible. To overcome the difficulties we face in clinical practice, a new classification was developed and presented. CONCLUSION The new proposed classification - Coutinho Classification - aims to fill the gaps in the one used currently by introducing new clinical features, most importantly the presence/absence of tissue overgrowth, and by providing a better description of what each category encompasses. This is an inclusive and objective new classification system, maintaining applicability, and useful in guiding the treatment.
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Shapiro SB, Llerena PA, Mowery TM, Miele EA, Wackym PA. Subtemporalis Muscle Middle Cranial Fossa Bone-Island Craniotomy Technique for Placement of an Active Transcutaneous Bone-Conduction Implant. Otol Neurotol 2023; 44:54-60. [PMID: 36509440 PMCID: PMC9762702 DOI: 10.1097/mao.0000000000003760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Placement of an active transcutaneous bone-conduction implant (BCI) requires drilling of a precise bone bed to accommodate the device and allow for fixation points to make appropriate contact with bone, which can be difficult even when lifts are used. We describe a subtemporalis muscle middle cranial fossa bone-island craniotomy technique that simplifies the procedure and obviates the need for lifts in securing the device. STUDY DESIGN Prospective case series. SETTING Tertiary academic medical center. PATIENTS Seventeen patients underwent surgery for placement of 18 transcutaneous BCIs, 14 for conductive or mixed hearing loss, and 4 for single-sided deafness. INTERVENTIONS Surgical placement of a transcutaneous BCI with a bone-island craniotomy technique. MAIN OUTCOME MEASURES Functional gain in air-conduction thresholds, aided air-bone gap, frequency of need for lifts, and minor and major complications. RESULTS For the conductive or mixed hearing loss cohort, with the transcutaneous BCI in place, there was a highly statistically significant mean functional gain of 35.4 dB hearing level (HL) (range, 16.7-50.25 dB HL; standard deviation, 12.4 dB HL) compared with the unaided condition (p < 0.0001; 95% confidence interval, 36.6-51.6 dB HL). Lifts were not needed in any case. There was one minor complication requiring a second procedure in a patient who had previously received radiation and no major complications. There was no device loss or failure. CONCLUSIONS A subtemporalis muscle middle cranial fossa bone-island craniotomy technique eliminates the need for lifts and is a safe and effective method for placement of a transcutaneous BCI.
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Siegel L, Araslanova R, Stepniak C, Zimmerman K, Agrawal SK. Achondroplasia and severe sensorineural hearing loss: The role of active bone conduction implants. Cochlear Implants Int 2022; 23:291-299. [DOI: 10.1080/14670100.2022.2045073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Lauren Siegel
- Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Rakhna Araslanova
- Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada
- Department of Otolaryngology-Head and Neck Surgery, Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Camilla Stepniak
- Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Kim Zimmerman
- Cochlear Implant Program, London Health Sciences Centre, London, Canada
| | - Sumit K. Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada
- Cochlear Implant Program, London Health Sciences Centre, London, Canada
- National Centre for Audiology, University of Western Ontario, London, Canada
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Abstract
OBJECTIVE Compare surgical and audiological outcomes of patients with congenital aural stenosis (CAS) with cholesteatoma to patients with CAS without cholesteatoma and patients with complete congenital aural atresia (CCAA). STUDY DESIGN Retrospective case series. SETTING Tertiary care hospital. PATIENTS Patients with CAS (with and without cholesteatoma) and CCAA. INTERVENTION Surgery for CAS/CAA. MAIN OUTCOME MEASURES Patients with CAS and CAA undergoing surgical repair from June 2004 to July 2020 were identified from an institutional database. Included patients were divided by presence of a canal cholesteatoma. Clinical history, pre- and postoperative audiometric data, and clinical outcomes were compared. RESULTS Of the 283 patients (300 ears), 18 (19 ears) had a canal cholesteatoma. When compared to ears without cholesteatoma (CCAA ears plus CAS ears without cholesteatoma), ears with cholesteatoma were more likely to be younger (9.2 ± 6.6 vs. 11.5 ± 9.2; p = 0.015), female (66.7% vs. 38.1%; p = 0.02; OR 3.2, 95% CI 1.18-8.9), and have normal/Grade I microtia (47.4% vs. 9.6%; p < 0.0001; OR 0.12, 95% CI 0.044-0.32), but not a history of draining ear (5.3% vs. 0%; p = 0.05; OR 0.06, 95% CI 0.004-0.999). Preoperative audiometric data demonstrated a lower mean air-bone gap (45.8 dB vs. 52.3 dB; p = 0.009) and better speech reception threshold (48.7 dB vs. 57.4 dB; p = 0.0004) in cholesteatoma ears. Postoperatively, ears with cholesteatoma were more likely to close the ABG within 20 dB (p = 0.001; OR 0.19, 95% CI 0.072-0.52). No patient in the cholesteatoma group developed post-operative bony/soft-tissue stenosis (0% vs. 9.7%; p = 0.65; OR 1.61; 0.21-12.6) or required revision surgery (0% vs. 11%; p = 0.38; OR 2.46, 0.32-19). CONCLUSIONS Patients with CAS and cholesteatoma have better audiometric outcomes and likely a more durable repair with a decreased need for revision possibly secondary to greater embryologic development of the meatus, ear canal, and middle ear space despite the cholesteatoma.
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Affiliation(s)
- Geoffrey C Casazza
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia, Charlottesville, Virginia
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Costa JR, Costa S, Soares T, Feliciano T, Almeida e Sousa C, Coutinho MB. Skin and soft tissue complications of bone-anchored hearing aids: Introducing a new classification system. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022. [DOI: 10.1016/j.otorri.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Holmes S, Hamiter M, Berry C, Mankekar G. Tissue Preservation Techniques for Bone-Anchored Hearing Aid Surgery. Otol Neurotol 2021; 42:1044-1050. [PMID: 34260508 DOI: 10.1097/mao.0000000000003157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Compare outcomes of surgical techniques in percutaneous bone-anchored hearing implant surgery. STUDY DESIGN Matched retrospective cohort study. SETTING Tertiary referral center. PATIENTS Electronic review of adult and pediatric patients who underwent bone conduction device surgery by either the Minimally-invasive Ponto Surgery (MIPS) technique or the linear incision with no soft tissue removal (LnSTR) technique or between August 2015 and April 2018 at our facility. INTERVENTION Patients in MIPS group underwent Minimally invasive Ponto Surgery (MIPS) technique, while those in LnSTR group underwent LnSTR technique. MAIN OUTCOME MEASURE Major outcome was presence/severity of localized skin reaction. Secondary outcomes included cosmetic outcome, revision surgery, minor adverse events, device utilization, and postoperative aided speech recognition thresholds (SRTs) across 250 to 4000 Hertz (Hz). RESULTS Fifty patients met inclusion criteria. There was a significantly lower rate of localized cutaneous reactions for the MIPS group (4.5%) compared with LnSTR group (33.3%; p = 0.026). Rate of revision surgery was significantly less for MIPS (13.6%) compared with LnSTR (20.8%; p = 0.008). Occurrence of poor cosmetic outcome was noted significantly less for the MIPS group (9.1%) compared with LnSTR patients (20.8%; p = 0.005). Minor adverse events and aided SRTs were comparable between groups. CONCLUSIONS MIPS leads to a statistically significant decrease in localized cutaneous reaction compared with LnSTR. Both the LnSTR and MIPS techniques are safe and effective in the treatment of hearing loss, however MIPS may be superior in certain cases by offering improved healing, decreasing needs for wound care, and possibly decreasing need for frequent follow up.
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Affiliation(s)
- Sean Holmes
- Department of Otolaryngology, Ochsner Health Louisiana State University Shreveport, Shreveport, Louisiana
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Goldstein MR, Bourn S, Jacob A. Early Osia® 2 bone conduction hearing implant experience: Nationwide controlled-market release data and single-center outcomes. Am J Otolaryngol 2021; 42:102818. [PMID: 33166860 DOI: 10.1016/j.amjoto.2020.102818] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/23/2020] [Accepted: 10/25/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE Bone conduction hearing devices are a well-established treatment option for conductive or mixed hearing losses as well as single-sided deafness. The Osia® 2 System is an active osseointegrated device where a surgically implanted titanium fixture supports a newly developed piezoelectric actuator that is placed under the skin. METHODS Nationwide data collected during a controlled-market release (CMR) of the Cochlear™ Osia® 2 System as well as outcomes at single, tertiary-level private practice Otology/Neurotology center were retrospectively reviewed. Key learnings from surgeons and audiologists are discussed. RESULTS During the CMR period, 23 surgeons performed 44 operations on 43 recipients. The mean age of recipients was 44 years and mean surgery duration was 52 min. The most commonly used incision was postauricular but anterior to the device (78%). Five complications were observed during the CMR, none of which were device related. Twenty-one audiologists performed 33 Osia® 2 activations during the CMR. The mean age of this group was 47 years, and the mean duration of each activation appointment was 55 min. Single-center data at the authors' institution demonstrated an average additional PTA4 gain with the Osia® 2 patients of 9.6 dB compared to Baha Attract and 10.2 dB compared to Baha Connect. CONCLUSION The Cochlear™ Osia® 2 System represents a significant advance in auditory osseointegrated implant technology. Digital piezoelectric stimulation delivers high power outputs, improves high frequency gain for optimal speech perception, and maintains safety while providing excellent patient satisfaction.
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Affiliation(s)
- Mary Rose Goldstein
- Ear & Hearing, Center for Neurosciences, Tucson, AZ, United States of America.
| | - Stephanie Bourn
- Ear & Hearing, Center for Neurosciences, Tucson, AZ, United States of America.
| | - Abraham Jacob
- Ear & Hearing, Center for Neurosciences, Tucson, AZ, United States of America.
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Zhao Y, Liu W, Liu H, Yang J, Zhou L, Huang X. Numerical analysis of the effects of ossicular chain malformations on bone conduction stimulation. Comput Methods Biomech Biomed Engin 2020; 24:817-830. [PMID: 33252263 DOI: 10.1080/10255842.2020.1853107] [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: 10/22/2022]
Abstract
To assess the effects of ossicular chain malformations on the performance of bone conduction hearing aids, a human ear finite-element model that includes an ear canal, a middle ear, and a spiral cochlea incorporating the third windows was established. This finite element model was built based on micro-computed tomography scanning and reverse modelling techniques, and the reliability of the finite element model was verified by comparison with reported experimental data. Based on this model, two main types of ossicular chain malformations, i.e., the incudostapedial disconnection and the ossicles fixation, were simulated, and their influences on bone conduction were analyzed by comparing the trans-cochlear-partition differential pressures. The results indicate that the incudostapedial disconnection mainly deteriorates the bone conduction response at mid frequencies. The stapes fixation has the largest effect among the ossicles fixation with the bone conduction stimulation, which also mainly decreases the mid-frequency response of the bone conduction, especially at 2 kHz. As the speech intelligibility has the most important frequency range at the range between 1 kHz and 2.5 kHz, the mid-frequency deterioration caused by ossicular chain malformations should be compensated in optimizing the design of the bone conduction hearing aids. For treating patients with the ossicular chain malformations, especially for the patients who suffer from the stapes fixation, the output of bone conduction hearing aids' actuator in the middle frequency band should be improved.
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Affiliation(s)
- Yu Zhao
- School of Mechatronic Engineering, China University of Mining and Technology, Xuzhou, PR China
| | - Wen Liu
- Department of Otolaryngology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, PR China
| | - Houguang Liu
- School of Mechatronic Engineering, China University of Mining and Technology, Xuzhou, PR China
| | - Jianhua Yang
- School of Mechatronic Engineering, China University of Mining and Technology, Xuzhou, PR China
| | - Lei Zhou
- Department of Otorhinolaryngology-Head and Neck Surgery, Shanghai Zhongshan Hospital affiliated to Fudan University, Shanghai, PR China
| | - Xinsheng Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, Shanghai Zhongshan Hospital affiliated to Fudan University, Shanghai, PR China
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Patients’ Experiences of Deciding Whether or Not to Accept Bone Conduction Hearing Implants: A Qualitative Investigation. Ear Hear 2020; 42:456-464. [DOI: 10.1097/aud.0000000000000952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Active Transcutaneous Bone Conduction Implant: Audiometric Outcomes Following a Novel Middle Fossa Approach With Self-Drilling Screws. Otol Neurotol 2020; 41:605-613. [PMID: 32080031 DOI: 10.1097/mao.0000000000002597] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To present surgical and audiometric outcomes of patients implanted with an active transcutaneous bone conduction implant following the novel middle fossa surgical approach with self-drilling screws. STUDY DESIGN Retrospective review. SETTING Tertiary care center. PATIENTS Thirty-seven adults with either conductive or mixed hearing loss that met indications for an active transcutaneous bone conduction implant were consecutively implanted from April, 2013 to May, 2018. INTERVENTION Unilateral middle fossa implantation of an active transcutaneous bone conduction implant. MAIN OUTCOME MEASURES Patient charts were reviewed for surgical outcomes and complications over the 6-year period. Preoperative air conduction, preoperative bone conduction, and 3-month postoperative aided thresholds were recorded. Speech perception was assessed using CNC words and AzBio sentences. Pure-tone averages (PTAs; measured at 0.5, 1.0, 2.0 and 3.0 kHz), air-bone gap, and functional gain were calculated. RESULTS Mean air conduction and bone conduction PTAs (±standard deviation) of the implanted ear were 66.8 dB (±14.9 dB) and 21.9 dB (±14.0 dB), respectively. Mean aided PTA was 26.5 dB (± 8.5 dB). The average functional gain was 40.3 dB (±19.0 dB). Favorable speech perception outcomes were observed. No complications or instances of revision surgery were reported, with a mean follow-up time of 32 months (range, 9-71 mo). CONCLUSIONS This is the first paper to describe outcomes of patients implanted with an active transcutaneous bone conduction implant via the middle fossa with self-drilling screws. Favorable surgical outcomes were observed with a follow-up of up to 6 years.
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Abstract
Supplemental Digital Content is available in the text To evaluate the long-term outcomes of three different types of bone conduction hearing implants (BCHI)—BAHA, Ponto, and Bonebridge—in Mandarin-speaking patients with bilateral microtia-atresia.
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Bezdjian A, Verzani Z, Thomeer HGXM, Willie B, Daniel SJ. Smoking as a risk factor for spontaneous bone anchored hearing implant extrusion: A case report and review of literature. OTOLARYNGOLOGY CASE REPORTS 2020. [DOI: 10.1016/j.xocr.2019.100140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Cochlear Implantation in Chronic Otitis Media: Investigation of Long-term Speech Comprehension and Rate of Complications. Otol Neurotol 2019; 39:e979-e984. [PMID: 30289846 DOI: 10.1097/mao.0000000000002026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyze the long-term speech comprehension and rate of complications of cochlear implantation in chronic otitis media. STUDY DESIGN Retrospective data analysis. SETTING Tertiary referral center with a large cochlear implant program. MAIN OUTCOME MEASURE Speech perception scores in quiet and background noise and rate of complications. PATIENTS Forty ears from a total of 38 patients with a mean age of 63.28 ± 2.16 years at the time of implantation were included. RESULTS Patients with a history of multiple ear surgeries, with no alternative option for hearing restoration than a cochlear implant, were implanted with satisfactory results in regard to speech comprehension. Preoperative bone conduction PTA4 correlated to postoperative speech comprehension scores in background noise. The rate of complications was low, but higher than in cases of cochlear implantation in normal middle ears. CONCLUSION Cochlear implantation in chronic otitis media can be a satisfactory and safe procedure, if the surgery technique and aftercare is appropriate to the altered anatomy.
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Svrakic M, Vambutas A. Medical and Audiological Indications for Implantable Auditory Devices. Otolaryngol Clin North Am 2019; 52:195-210. [DOI: 10.1016/j.otc.2018.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Bahmad F, Cardoso CC, Caldas FF, Barreto MADSC, Hilgenberg AMDS, Teixeira MS, Serra LSM. Hearing Rehabilitation through Bone-Conducted Sound Stimulation: Preliminary Results. Int Arch Otorhinolaryngol 2018; 23:12-17. [PMID: 30647778 PMCID: PMC6331313 DOI: 10.1055/s-0038-1670694] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 06/20/2018] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Fayez Bahmad
- Department of Otorhinolaryngology, Faculdade de Ciências da Saúde, Universidade de Brasília, Brasília, DF, Brazil.,Instituto Brasiliense de Otorrinolaringologia, Brasília, DF, Brazil
| | - Carolina Costa Cardoso
- Secretaria de Saúde do Distrito Federal, Brasília, DF, Brazil.,Instituto Brasiliense de Otorrinolaringologia, Brasília, DF, Brazil
| | - Fernanda Ferreira Caldas
- Secretaria de Saúde do Distrito Federal, Brasília, DF, Brazil.,Instituto Brasiliense de Otorrinolaringologia, Brasília, DF, Brazil
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Pellinen J, Vasama JP, Kivekäs I. Long-term results of atresiaplasty in patients with congenital aural atresia. Acta Otolaryngol 2018; 138:621-624. [PMID: 29426271 DOI: 10.1080/00016489.2018.1431402] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To evaluate long-term benefits of atresiaplasty on hearing and the impact of surgery on quality of life (QoL) in congenital aural atresia (CAA) patients. METHODS We evaluated the long-term hearing results, the impact of atresiaplasty on QoL, the meatal diameter of the operated ear canal, and the cumulative number of post-operative hospital visits in 14 CAA patients, on average, 12 years (range: 4-17 years) post-operatively. RESULTS The mean preoperative pure tone average (PTA) was 61 dB HL. The postoperative short-term PTA was 36 dB HL and the long-term PTA was 51 dB HL. The mean total Glasgow Benefit Inventory (GBI) score was 16 (range: -11-39), showing the positive benefit of atresiaplasty on QoL. The mean postoperative diameter of the auditory meatus was 6 mm. The average number of hospital outpatient visits during the first postoperative year was 10. CONCLUSION Surgery for CAA is a demanding operation with variable anatomical and hearing outcomes. Atresiaplasty operations should be centralized to hospitals with large numbers of such patients to ensure sufficient levels of surgical experience. Bone-anchored hearing devices or middle-ear implants should be considered as a first-line option because they offer good hearing predictability.
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Affiliation(s)
- Juuso Pellinen
- Department of Otorhinolaryngology, Tampere University Hospital, and School of Medicine, University of Tampere, Tampere, Finland
| | - Juha-Pekka Vasama
- Department of Otorhinolaryngology, Tampere University Hospital, Tampere, Finland
| | - Ilkka Kivekäs
- Department of Otorhinolaryngology, Tampere University Hospital, and School of Medicine, University of Tampere, Tampere, Finland
- Department of Otorhinolaryngology, Tampere University Hospital, Tampere, Finland
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Comparison Study of Percutaneous Osseointegrated Bone Conduction Device Complications When Using the 9 mm Abutment Versus 6 mm Abutment at Initial Implantation. Otol Neurotol 2018; 39:451-457. [PMID: 29494471 DOI: 10.1097/mao.0000000000001736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To assess differences in the incidence, type, and management of complications encountered with implantation of percutaneous osseointegrated bone conduction devices when using a 9 mm abutment versus 6 mm abutment at initial implantation. STUDY DESIGN Retrospective cohort study. METHODS One hundred thirty consecutive patients between January 2010 and December 2011 underwent single-stage percutaneous osseointegrated bone conduction device implantation using a 9 or 6 mm abutment. Clinical outcomes assessed for the two groups included the incidence, type, and management of postoperative complications. Abutment size, age, sex, indication for surgery, implant device type, duration of follow-up, and patient comorbidities were evaluated as potential factors affecting outcomes. RESULTS Average duration of follow-up was 16 months (range 6-29 mo). Postoperative complications occurred in 38 (29.2%) patients. Twenty-four (18.4%) patients experienced minor complications requiring simple, local care; eight (6.1%) patients required in-office procedural intervention; and six (4.6%) patients required revision surgery in the operating room. Implant extrusion occurred in three (2.3%) patients. Eleven (8.5%) patients required placement of a longer abutment. Patients receiving the 6 mm abutment at initial surgery were significantly more likely to encounter a complication requiring in-office procedural intervention or revision surgery (p = 0.001). CONCLUSION Minor complications after implantation of percutaneous osseointegrated bone conduction devices are common. The vast majority of these complications are due to localized skin reactions, most of which are readily addressed through local care. Patients receiving the 9 mm abutment during initial implantation are significantly less likely to require in-office procedural intervention or revision surgery postoperatively as compared with those receiving the shorter, 6 mm abutment.
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Sardiwalla Y, Jufas N, Morris DP. Direct cost comparison of minimally invasive punch technique versus traditional approaches for percutaneous bone anchored hearing devices. J Otolaryngol Head Neck Surg 2017; 46:46. [PMID: 28606168 PMCID: PMC5468937 DOI: 10.1186/s40463-017-0222-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/26/2017] [Indexed: 12/02/2022] Open
Abstract
Background Minimally Invasive Ponto Surgery (MIPS) was recently described as a new technique to facilitate the placement of percutaneous bone anchored hearing devices. The procedure has resulted in a simplification of the surgical steps and a dramatic reduction in surgical time while maintaining excellent patient outcomes. Given these developments, our group sought to move the procedure from the main operating suite where they have traditionally been performed. This study aims to test the null hypothesis that MIPS and open approaches have the same direct costs for the implantation of percutaneous bone anchored hearing devices in a Canadian public hospital setting. Methods A retrospective direct cost comparison of MIPS and open approaches for the implantation of bone conduction implants was conducted. Indirect and future costs were not included in the fiscal analysis. A simple cost comparison of the two approaches was made considering time, staff and equipment needs. All 12 operations were performed on adult patients from 2013 to 2016 by the same surgeon at a single hospital site. Results MIPS has a total mean reduction in cost of CAD$456.83 per operation from the hospital perspective when compared to open approaches. The average duration of the MIPS operation was 7 min, which is on average 61 min shorter compared with open approaches. Conclusion The MIPS technique was more cost effective than traditional open approaches. This primarily reflects a direct consequence of a reduction in surgical time, with further contributions from reduced staffing and equipment costs. This simple, quick intervention proved to be feasible when performed outside the main operating room. A blister pack of required equipment could prove convenient and further reduce costs.
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Affiliation(s)
| | - Nicholas Jufas
- Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, Halifax, NS, Canada.,Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, Australia
| | - David P Morris
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada. .,Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, Halifax, NS, Canada. .,QEII Health Science Center - VG Site Otolaryngology, 5820 University Ave - Rm 3037, Halifax, NS, B3H 2Y9, Canada.
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25
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Patel SH, Halpern CH, Shepherd TM, Timpone VM. Electrical stimulation and monitoring devices of the CNS: An imaging review. J Neuroradiol 2017; 44:175-184. [DOI: 10.1016/j.neurad.2016.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 10/12/2016] [Accepted: 12/21/2016] [Indexed: 10/20/2022]
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26
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Complications and parent satisfaction in pediatric osseointegrated bone-conduction hearing implants. Laryngoscope 2017; 127:2165-2170. [DOI: 10.1002/lary.26469] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 10/26/2016] [Accepted: 11/21/2016] [Indexed: 11/07/2022]
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Snik AFM, Mylanus EAM, Proops DW, Wolfaardt JF, Hodgetts WE, Somers T, Niparko JK, Wazen JJ, Sterkers O, Cremers CWRJ, Tjellström A. Consensus Statements on the BAHA System: Where Do We Stand at Present? Ann Otol Rhinol Laryngol 2016; 195:2-12. [PMID: 16619473 DOI: 10.1177/0003489405114s1201] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
After more than 25 years of clinical experience, the BAHA (bone-anchored hearing aid) system is a well-established treatment for hearing-impaired patients with conductive or mixed hearing loss. Owing to its success, the use of the BAHA system has spread and the indications for application have gradually become broader. New indications, as well as clinical applications, were discussed during scientific roundtable meetings in 2004 by experts in the field, and the outcomes of these discussions are presented in the form of statements. The issues that were discussed concerned BAHA surgery, the fitting range of the BAHA system, the BAHA system compared to conventional devices, bilateral application, the BAHA system in children, the BAHA system in patients with single-sided deafness, and, finally, the BAHA system in patients with unilateral conductive hearing loss.
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Affiliation(s)
- Ad F M Snik
- Department of Otorhinolaryngology, University Hospital St Radboud, Nijmegen, the Netherlands
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Ihler F, Blum J, Berger MU, Weiss BG, Welz C, Canis M. The Prediction of Speech Recognition in Noise With a Semi-Implantable Bone Conduction Hearing System by External Bone Conduction Stimulation With Headband: A Prospective Study. Trends Hear 2016; 20:2331216516669330. [PMID: 27698259 PMCID: PMC5051673 DOI: 10.1177/2331216516669330] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 08/24/2016] [Accepted: 08/24/2016] [Indexed: 02/05/2023] Open
Abstract
Semi-implantable transcutaneous bone conduction devices are treatment options for conductive and mixed hearing loss (CHL/MHL). For counseling of patients, realistic simulation of the functional result is desirable. This study compared speech recognition in noise with a semi-implantable transcutaneous bone conduction device to external stimulation with a bone conduction device fixed by a headband. Eight German-language adult patients were enrolled after a semi-implantable transcutaneous bone conduction device (Bonebridge, Med-El) was implanted and fitted. Patients received a bone conduction device for external stimulation (Baha BP110, Cochlear) fixed by a headband for comparison. The main outcome measure was speech recognition in noise (Oldenburg Sentence Test). Pure-tone audiometry was performed and subjective benefit was assessed using the Glasgow Benefit Inventory and Abbreviated Profile of Hearing Aid Benefit questionnaires. Unaided, patients showed a mean signal-to-noise ratio threshold of 4.6 ± 4.2 dB S/N for speech recognition. The aided results were -3.3 ± 7.2 dB S/N by external bone conduction stimulation and -1.2 ± 4.0 dB S/N by the semi-implantable bone conduction device. The difference between the two devices was not statistically significant, while the difference was significant between unaided and aided situation for both devices. Both questionnaires for subjective benefit favored the semi-implantable device over external stimulation. We conclude that it is possible to simulate the result of speech recognition in noise with a semi-implantable transcutaneous bone conduction device by external stimulation. This should be part of preoperative counseling of patients with CHL/MHL before implantation of a bone conduction device.
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Affiliation(s)
- Friedrich Ihler
- Department of Otorhinolaryngology, University Medical Center Göttingen, Georg-August-University Göttingen, Germany
| | - Jenny Blum
- Department of Otorhinolaryngology, University Medical Center Göttingen, Georg-August-University Göttingen, Germany
| | - Max-Ulrich Berger
- Department of Otorhinolaryngology, University Medical Center Göttingen, Georg-August-University Göttingen, Germany Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Hamburg-Eppendorf (UKE), University of Hamburg, Germany
| | - Bernhard G Weiss
- Department of Otorhinolaryngology, University Medical Center Göttingen, Georg-August-University Göttingen, Germany
| | - Christian Welz
- Department of Otorhinolaryngology, University Medical Center Göttingen, Georg-August-University Göttingen, Germany
| | - Martin Canis
- Department of Otorhinolaryngology, University Medical Center Göttingen, Georg-August-University Göttingen, Germany
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Caruso A, Giannuzzi AL, Sozzi V, Sanna M. Bone anchored hearing implants without skin thinning: the Gruppo Otologico surgical and audiological experience. Eur Arch Otorhinolaryngol 2016; 274:695-700. [PMID: 27637751 DOI: 10.1007/s00405-016-4305-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 09/09/2016] [Indexed: 11/28/2022]
Abstract
To investigate the surgical and audiological outcomes of an installation of a bone-anchored hearing system (BAHS) procedure without tissue reduction using Ponto implants and abutments. Retrospective consecutive case series. Forty-nine patients, 18 years or older and eligible for treatment with a bone-anchored hearing system with tissue preservation surgery, were included in the study. Following a systematic scheme for medical outcomes, we collected the data regarding surgical intervention, quality of life (GBI), skin and soft tissue reactions (Holgers grading system), pain and numbness (VAS). Hearing performance (aided thresholds and speech recognition in noise) was recorded in 20 patients. No implants were lost, skin, and soft tissue reactions were mild in 96 % of the all visits. Quality of life (GBI) generally improved in the aided condition compared to prior to implantation. Audiologically, 100 % of the 20 patients examined showed improvement of speech reception and sound field thresholds comparing aided to unaided. An average improvement of 33 dB on PTA was recorded. The study, presenting data on a large population, treated with tissue preservation and modern titanium implants, shows that this treatment is a viable solution that results in fewer complications, high degree of predictability and good audiological results.
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Affiliation(s)
- Antonio Caruso
- Gruppo Otologico, Casa di Cura Piacenza, Via Morigi, 41, 29121, Piacenza, Italy.
| | - Anna Lisa Giannuzzi
- Gruppo Otologico, Casa di Cura Piacenza, Via Morigi, 41, 29121, Piacenza, Italy
| | - Valerio Sozzi
- Gruppo Otologico, Casa di Cura Piacenza, Via Morigi, 41, 29121, Piacenza, Italy
| | - Mario Sanna
- Gruppo Otologico, Casa di Cura Piacenza, Via Morigi, 41, 29121, Piacenza, Italy
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Comparison of Audiological Results Between a Transcutaneous and a Percutaneous Bone Conduction Instrument in Conductive Hearing Loss. Otol Neurotol 2016; 37:685-91. [DOI: 10.1097/mao.0000000000001010] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Challenges During Baha Surgery: Our Experience. Indian J Otolaryngol Head Neck Surg 2016; 68:317-21. [PMID: 27508133 DOI: 10.1007/s12070-016-1002-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 06/03/2016] [Indexed: 10/21/2022] Open
Abstract
Baha has proven performance and advantages for patients with aural atresia or chronic ear drainage. Being a per cutaneous osseo integrated implant the skin around the fixture is in contact with a foreign body that leads to chronic inflammatory reaction and complications such as skin irritation and overgrowth occur frequently. Challenges that are faced during Baha surgery include those during candidate selection, work up, anesthesia related as well as intra-operative and post operative complications. Ours was a retrospective and observational study where case records of 10 patients who underwent Baha surgery in the Department of E.N.T during the time period from January 2010 to June 2013 were reviewed. Here, the candidates were advised Baha either for congenital external ear deformity or single sided deafness. Out of 10 patients, who underwent Baha implantation, 8 underwent single staged Baha implant and two patients had two staged implant owing to bone thickness <3 mm behind temporo-parietal suture line on HRCT Temporal bone. The complications observed were skin infection (Holgers grade 2) around the site of implant in two patients, skin overgrowth due to more thickness of scalp (Holgers grade 4) in one of the patient. The patient had to undergo revision surgery to replace the abutment. And one of the patients underwent failure of osseointegration and was re-implanted later. Proper surgical technique and post operative wound care play an important role in avoiding complications.
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Predisposing factors for adverse skin reactions with percutaneous bone anchored hearing devices implanted with skin reduction techniques. Eur Arch Otorhinolaryngol 2016; 273:4185-4192. [PMID: 27250841 DOI: 10.1007/s00405-016-4106-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 05/17/2016] [Indexed: 10/21/2022]
Abstract
We present an analysis of adverse events after implantation of bone anchored hearing device in our patient population with focus on individual risk factors for peri-implant skin reactions. The investigation involved a chart review of adult Baha patients (n = 179) with 203 Bahas implanted with skin reduction techniques between 1993 and 2009, a questionnaire (n = 97) and a free clinical examination (n = 47). Skin reactions were graded by severity from 0 (no skin reaction) to 4 (implant loss resulting from infection) according to Holgers. We analyzed the skin reaction rate (SRR) defined as the number of skin reactions per year and the worst Holgers grade (WHG), which indicates the grade of the worst skin reaction per implant. We defined 20 parameters including the demographic characteristics, surgery details, subjective benefits, handling and individual factors. The most frequent adverse events (85 %) were skin reactions. The average SRR was 0.426 per Baha year. Six parameters showed an association with the SRR or the WHG. The clinically most relevant factors are an elevated Body Mass Index (BMI, p = 0.02) and darker skin type (p = 0.03). The SRR increased with the distance between the tragus and the implant (p = 0.02). Regarding the identified risk factors, the SRR might be reduced by selecting a location for the implant near the pinna and by specific counseling regarding post-operative care for patients with darker skin type or an elevated Body Mass Index (BMI). Few of the factors analyzed were found to influence the SRR and WHG. Since most adverse skin reactions could be treated easily with local therapy, our results suggest that in adult patients, individual risk factors for skin reactions are not a contraindication for Baha implantation. Thus, patients can be selected purely on audiological criteria.
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Sound location modulation of electrocochleographic responses in chinchilla with single-sided deafness and fitted with an osseointegrated bone-conducting hearing prosthesis. Otol Neurotol 2015; 36:678-86. [PMID: 25275868 DOI: 10.1097/mao.0000000000000595] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HYPOTHESIS Bone-anchored hearing systems (BAHSs) provide sound location-dependent input to the normal ear for reducing the head shadow effect in the case of single-sided deafness (SSD). BACKGROUND Patients with SSD can be fit with a BAHS positioned on the impaired side. Despite successful outcomes and some reports of spatial hearing capabilities, little data are available regarding the physiologic performance of BAHSs in response to free-field sounds. METHODS Cochlear microphonics (CMs) were recorded from five chinchillas before and after destruction of one cochlea. A BAHS (Cochlear Baha) was fitted on the deafened side. CM measurements were made in response to tones, with and without the BAHS, to free-field sounds presented ipsilateral to the SSD, on the side of the normal ear, and along the midline. Stimuli were also presented directly through the BAHS and an earphone to generate sounds with interaural time and level differences approximating free-field sounds. RESULTS With the BAHS, CM thresholds were decreased (re: no BAHS) by approximately 10 dB for sources ipsilateral to the SSD, approximately 14 dB for midline sources, and approximately 5 dB for sources contralateral to the SSD. Changes in CM amplitudes and thresholds were sound location dependent. CM amplitudes were modulated by interaural time and level differences generated by the linear interaction of BAHS and acoustic signals. CONCLUSION This study suggests that BAHS can provide input to the normal ear that is modulated by sound location, which serves to reduce the head shadow effect and may also offer cues to sound location.
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Jovankovičová A, Staník R, Kunzo S, Majáková L, Profant M. Surgery or implantable hearing devices in children with congenital aural atresia: 25 years of our experience. Int J Pediatr Otorhinolaryngol 2015; 79:975-9. [PMID: 25930173 DOI: 10.1016/j.ijporl.2015.03.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 03/30/2015] [Accepted: 03/31/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Congenital aural atresia and ear deformities have been the subject of serious discussions for centuries. These malformations are associated with significant aesthetic and functional problems. Outcome of the surgical solution is rarely optimal. Despite the gradual improvement of surgical techniques the surgery still remains associated with very limited short-term and mainly long-term functional outcome. Therefore, the priority treatment in modern otology becomes implantable devices--BAHA, Bonebridge and active middle ear implants. METHODS The functional and aesthetic outcomes of aural atresia reconstruction performed at Pediatric ENT Department of Children's University Hospital were retrospectively evaluated and compared with the results prospectively obtained from implantable hearing devices (BAHA, Vibrant Soundbridge, Bonebridge), which have been implanted in patients with aural atresia at Department of ORL HNS, University Hospital Bratislava. RESULTS Aural atresia reconstruction has been performed in 34 patients during last 25 years. Results of the surgery could be viewed as excellent only in three patients (gain above 30 dB). Air conduction threshold has decreased after the surgery in seven patients, and in two cases total deafness occurred after the surgery. Patients gain on average 12 dB in auditory threshold after surgery. Hearing devices were implanted to the group of 11 children in order to improve their hearing. All of them were the patients with bilateral aural atresia. After implantation a significant improvement in hearing threshold occurred in all children (30-35 dB on average). Together with results of air conduction threshold in patient with aural atresia before and after surgery and implantation we also present a standard deviation. CONCLUSION The functional outcome of implantable hearing devices in patients with bilateral aural atresia clearly dominates over the traditional reconstructive surgery. Aesthetic results in pinna deformity management remain a major concern for patients and parents. Implantable epithesis bring promising results. Since there is no universal solution to this disorder, the final selection of the treatment is upon the patient. Patients should opt for the most suitable solution through consultation with the surgeon, after clarifying the advantages and disadvantages of each option.
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Affiliation(s)
- Andrea Jovankovičová
- Pediatric ENT Department, Children's Univ. Hospital, Limbova 1, 833 40 Bratislava, Slovak Republic.
| | - Roman Staník
- Pediatric ENT Department, Children's Univ. Hospital, Limbova 1, 833 40 Bratislava, Slovak Republic
| | - Samuel Kunzo
- Pediatric ENT Department, Children's Univ. Hospital, Limbova 1, 833 40 Bratislava, Slovak Republic
| | - Lucia Majáková
- Pediatric ENT Department, Children's Univ. Hospital, Limbova 1, 833 40 Bratislava, Slovak Republic
| | - Milan Profant
- Department of ORL HNS, University Hospital Bratislava, Antolská 11, 851 07 Bratislava, Slovak Republic
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Littlefield PD, Tolisano AM, Sabol JV, Herberg ME, Coppit GL. Total Auricular Rehabilitation: Combined Cosmetic and Functional Lateral Temporal Bone Reconstruction. J Craniofac Surg 2015; 26:1467-70. [PMID: 26114506 DOI: 10.1097/scs.0000000000001770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The aim of the study was to describe 3 cases of total auricular rehabilitation, including the novel use of iliac crest bone grafts to support bone-anchored auricular prostheses. STUDY DESIGN This study is a retrospective case series from a single institution. RESULTS Three cases with large lateral temporal bone and soft tissue defects were successfully treated with total auricular rehabilitation. Rehabilitation included the following: soft tissue coverage with an anterolateral thigh microvascular free flap, iliac crest-free bone graft with staged placement of a bone-anchored auricular prosthesis into the bone graft, and audiologic rehabilitation with a bone-anchored hearing aid (BAHA). All of the cases with grafts and flaps survived and were without significant donor site morbidity. Bone-anchored hearing aid abutment skin overgrowth was seen in 2 cases and was revised under local anesthesia. All of the patients had expected functional recovery on postoperative audiologic testing. Each patient continues to consistently wear his/her auricular prosthesis and BAHA during 3 years of follow-up. CONCLUSIONS Total auricular rehabilitation is a complex task involving reconstruction of extensive soft tissue defects, bony defects, and the hearing apparatus. Acceptable cosmetic and functional outcomes and high patient satisfaction is possible in committed patients.
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Affiliation(s)
- Philip D Littlefield
- *Department of Otolaryngology, Tripler Army Medical Center, Honolulu, HI †Department of Otolaryngology ‡Department of Maxillofacial Prosthetics, Walter Reed National Military Medical Center, Bethesda, MD
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Bento RF, Kiesewetter A, Ikari LS, Brito R. Bone-anchored hearing aid (BAHA): indications, functional results, and comparison with reconstructive surgery of the ear. Int Arch Otorhinolaryngol 2015; 16:400-5. [PMID: 25991965 PMCID: PMC4399697 DOI: 10.7162/s1809-97772012000300017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Accepted: 03/18/2012] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION The bone-anchored hearing aid (BAHA) is a bone conduction hearing device that transmits sound directly into the inner ear. It is mainly used in patients with conductive hearing loss associated with aural atresia, but it is also used in those with mixed and sensorineural hearing loss. GOALS To review the main indications for BAHA, to analyze the audiometric results and its benefits for patients and compare them with other treatment modalities, and to compare the literature data with our sample of 13 patients. METHOD The research was performed using a database covering works in English, Spanish, and Portuguese, with no limitations in the years when the procedures were performed. We compared the literature data with our results for the 13 patients who underwent BAHA implantation between the years 2000 and 2009. RESULTS Most of the studies showed that BAHA has great advantages over reconstructive surgery in terms of hearing results, complications, and disease recurrence. The postoperative results for our 13 patients were satisfactory and comparable with the results from the literature, with closure of the air-bone gap in 7 patients and achieving an air-bone gap of 10 dB in 6 patients. No postoperative complications were observed. CONCLUSION BAHA is a better treatment option than reconstructive surgery for patients with bilateral deafness. It is a relatively simple surgical procedure with few complications and good hearing results. Recent studies have examined its use in conductive and unilateral sensorineural hearing loss.
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Affiliation(s)
- Ricardo Ferreira Bento
- Professor in Charge of Otorhinolaryngology, Medical School of the University of São Paulo. Chief of the Department of Ophthalmology and Otorhinolaryngology at the Medical School of the University of São Paulo
| | - Alessandra Kiesewetter
- Medical Specialist in Otorhinolaryngology, Fellow in Ear Surgery and Base of Skull at the Medical School of the University of São Paulo. Medical Specialist in Otorhinolaryngology, Fellow in Ear Surgery and Base of Skull at the Medical School of the University of São Paulo
| | - Liliane Satomi Ikari
- Medical Specialist in Otorhinolaryngology, Fellow in Ear Surgery and Base of Skull at the Medical School of the University of São Paulo. Medical Specialist in Otorhinolaryngology, Fellow in Ear Surgery and Base of Skull at the Medical School of the University of São Paulo
| | - Rubens Brito
- Associate Professor of Otorhinolaryngology, Medical School of the University of São Paulo. Associate Professor of Otorhinolaryngology, Medical School of the University of São Paulo
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Gordon SA, Coelho DH. Minimally Invasive Surgery for Osseointegrated Auditory Implants: A Comparison of Linear versus Punch Techniques. Otolaryngol Head Neck Surg 2015; 152:1089-93. [PMID: 25715352 DOI: 10.1177/0194599815571532] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 01/16/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES (1) To describe the benefits of the minimally invasive punch technique without soft tissue reduction (PT) for the placement of percutaneous osseointegrated auditory implants. (2) To compare and contrast techniques and outcomes from PT with the linear technique with soft tissue reduction (LT). STUDY DESIGN Case series with chart review SETTING Performed at a tertiary otology practice at an academic medical center. SUBJECTS AND METHODS LT was used until 2012 when a switch was made for all patients to PT. Preoperative variables recorded included age, sex, BMI, smoking status, indication, device selected, and abutment length. Outcomes measures included surgical time, skin reaction grading by Holgers score at 1 week and at most recent follow-up, and any other complications. Two-sample t test and χ(2) was used to compare. RESULTS A total of 51 patients (34 LT, 17 PT) were identified. Surgical time was found to be significantly shorter for the PT group (LT, 49.2 min; PT, 13.4 min; P < .001). There were no statistically significant differences between LT and PT for mean Holgers at first (LT, 0.24; PT, 0.47; P = .87) or final follow-up (LT, 0.62; PT, 0.41; P = .22). CONCLUSIONS The punch technique offers several potential surgical and cosmetic advantages over the linear technique without compromising skin-reactivity outcomes. This study supports a growing trend toward minimally invasive percutaneous auditory implant surgery.
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Affiliation(s)
- Steven A Gordon
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Daniel H Coelho
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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Friedland DR, Runge CL, Kerschner JA. Surgical implantation of the Sophono transcutaneous bone conduction system. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.otot.2014.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Outcomes after cochlear implantation for patients with single-sided deafness, including those with recalcitrant Ménière's disease. Otol Neurotol 2014; 34:1681-7. [PMID: 24232066 DOI: 10.1097/mao.0000000000000102] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Compare preoperative and postoperative performance in patients undergoing cochlear implantation (CI) for unilateral severe-to-profound sensorineural hearing loss (single-sided deafness, SSD). STUDY DESIGN IRB-approved, prospective SETTING Tertiary center PATIENTS Twenty-nine patients have undergone CI for SSD. SSD was due to Ménière's disease (MD) in 10 subjects; these also suffered from recalcitrant vertigo spells and in these 10 patients along with 2 others the CI was placed simultaneous with a labyrinthectomy. INTERVENTION(S) CI with or without labyrinthectomy. MAIN OUTCOME MEASURE(S) CNC word and AzBio sentences in quiet were administered to the implanted ear. A multiple-loudspeaker sound localization test was administered in the bilateral listening condition. All data were collected preoperatively and 3, 6, and 12 months postoperatively with postoperative data available for 19 subjects. Additionally, a tinnitus handicap questionnaire is administered pre- and 12-months post-operatively. RESULTS CNC word and AzBio sentence scores showed improvement in the implanted ear. Sound localization appeared to improve in an experience-dependent fashion in some patients. Most patients reported diminished tinnitus after cochlear implantation. All patients undergoing labyrinthectomy experienced resolution of vertigo attacks. CONCLUSION CI restores auditory function to the deafened ear. Additionally, the binaural input appears to improve sound localization for most patients. In patients with severe hearing loss and recalcitrant vertigo attacks because of MD, simultaneous labyrinthectomy and CI effectively relieves vertigo attacks and improves auditory function.
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Favorable Prognostic Factors for Long-term Postoperative Hearing Results After Canal Tympanoplasty for Congenital Aural Stenosis. Otol Neurotol 2014; 35:966-71. [DOI: 10.1097/mao.0000000000000335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Contemporary hearing rehabilitation options in patients with aural atresia. BIOMED RESEARCH INTERNATIONAL 2014; 2014:761579. [PMID: 24883324 PMCID: PMC4022278 DOI: 10.1155/2014/761579] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 03/26/2014] [Indexed: 12/04/2022]
Abstract
Congenital aural atresia is the failure of development of the external auditory canal. It usually occurs in conjunction with microtia, which is the malformation of the auricle due to a failure of development of the external ear. Aural atresia, with or without microtia, may significantly affect the hearing and social life of the patients. It is important for every medical practitioner to be aware of the possible treatment options for hearing rehabilitation in this group of patients. In the era of modern technology, new choices, including Bone-Anchored Hearing Aid (BAHA) (Cochlear Ltd. and Oticon Medical), Vibrant Soundbridge (VSB) (MED-EL, Innsbruck, Austria), and Bonebridge system (BB) (MED-EL, Innsbruck, Austria), provide high-end alternatives to traditional Bone Conduction Hearing Aid and Auditory Canal Reconstruction. All these options have advantages and disadvantages, and they are appropriate for different patients and/or at different ages. This paper aims to provide an overview of the management of hearing rehabilitation in congenital aural atresia patients and a discussion of each treatment option.
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Preliminary Functional Results and Quality of Life After Implantation of a New Bone Conduction Hearing Device in Patients With Conductive and Mixed Hearing Loss. Otol Neurotol 2014; 35:211-5. [DOI: 10.1097/mao.0000000000000208] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Audiologic and Surgical Outcomes of a Novel, Nonpercutaneous, Bone Conducting Hearing Implant. Otol Neurotol 2013; 34:922-6. [DOI: 10.1097/mao.0b013e31827e60bd] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Asma A, Ubaidah MA, Hasan SS, Wan Fazlina WH, Lim BY, Saim L, Goh BS. Surgical outcome of bone anchored hearing aid (baha) implant surgery: a 10 years experience. Indian J Otolaryngol Head Neck Surg 2013; 65:251-4. [PMID: 24427576 DOI: 10.1007/s12070-013-0621-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Accepted: 01/21/2013] [Indexed: 11/29/2022] Open
Abstract
Bone anchored hearing aid (Baha) implant is an option for patient with canal atresia, single sided deafness(SSD) and chronically discharging ears despite treatments. This retrospective study was conducted from 2001 to 2011 to evaluate the surgical outcome of Baha implant surgery. Thirty-three patients were identified during this study period. Their age at implantation ranged from 5 to 40 years. Of 33 patients, 29 (87.9 %) patients had bilateral microtia and canal atresia, 3 (9.1 %) patients had unilateral microtia and canal atresia and 1 (3.0 %) patients have SSD following labyrinthitis. One patient (3.2 %) had major complication which is lost of implant due to failure of osseointegration. Soft tissue reactions were seen 7 patients (21.1 %). Of these 7 patients, 4 patients required 3-4 procedures as day care operation for excision of the skin overgrowth surrounding the abutment. Recurrent antibiotic treatment was required in 3 patients (9.7 %). None of our patient had history of intraoperative or peri-operative complication following Baha surgery. The commonest complications are local infection and inflammation at the implant site. None of our patient had history of intraoperative or peri-operative complication following Baha implant surgery.
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Affiliation(s)
- A Asma
- Department of Otorhinolaryngology Head & Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaakub Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - M A Ubaidah
- Department of Otorhinolaryngology Head & Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaakub Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Siti Salbiah Hasan
- Department of Otorhinolaryngology Head & Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaakub Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - W H Wan Fazlina
- Department of Medical Rehabilitation Services, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaakub Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - B Y Lim
- Department of Medical Rehabilitation Services, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaakub Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - L Saim
- Department of Otorhinolaryngology Head & Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaakub Latif, 56000 Cheras, Kuala Lumpur, Malaysia
| | - B S Goh
- Department of Otorhinolaryngology Head & Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaakub Latif, 56000 Cheras, Kuala Lumpur, Malaysia
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Zeitler DM, Herman BS, Snapp HA, Telischi FF, Angeli SI. Ethnic disparity in skin complications following bone-anchored hearing aid implantation. Ann Otol Rhinol Laryngol 2012; 121:549-54. [PMID: 22953662 DOI: 10.1177/000348941212100809] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Sound processor loading after implantation of a bone-anchored hearing aid is often delayed by skin-site complications. This study examined the frequency of skin-site complications in various ethnic groups and determined factors that may lead to higher rates of skin-site complications resulting in delayed processor loading. METHODS Adult, English-speaking patients who underwent implantation of a bone-anchored hearing aid between 2007 and 2010 were reviewed. Demographic data including ethnicity, tobacco use, diabetes mellitus, immunosuppression, and long-term steroid use were determined. Major and minor skin-site complications and the time to processor loading were recorded. RESULTS The mean time to processor loading was 9.5 weeks, and the mean follow-up time was 23 months. There were no cases of osseointegration failure. African American patients had a significantly higher rate of major skin-site complications (p < 0.005) and a longer time to processor loading (mean, 17.6 weeks; p < 0.05) than the other ethnic groups. There was no significant difference in minor skin complication rates. There was no correlation between diabetes mellitus, long-term immunosuppression, or tobacco use and skin-site complications. CONCLUSIONS Skin complications can delay processor loading following implantation of a bone-anchored hearing aid. There is a higher rate of major skin-site complications in African American patients, and these often delay processor loading. The risk of skin-site complications is not correlated with smoking, diabetes mellitus, or immunosuppression. An increased risk of skin-site complications is an important consideration for preoperative counseling.
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Affiliation(s)
- Daniel M Zeitler
- University of Miami Ear Institute, Department of Otolaryngology, Miami, Florida, USA
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D'Eredità R, Caroncini M, Saetti R. The new Baha implant: a prospective osseointegration study. Otolaryngol Head Neck Surg 2012; 146:979-83. [PMID: 22344291 DOI: 10.1177/0194599812438042] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To assess stability of a new-design titanium implant (Cochlear Baha BAI300) in bone-anchored hearing aid (Baha) recipients over time. STUDY DESIGN AND SETTING Prospective case series with planned data collection at a tertiary care institution. Twelve patients who underwent Baha surgery over 12 months were analyzed. SUBJECTS All patients (3 children, age range 6-10 years, mean 7.7 years, median 7.3 years; 9 adults, age range 34-73 years, mean 52.8 years, median 48 years) underwent the 1-stage procedure following the standard Brånemark technique. In all procedures, the single-skin incision was applied. METHODS The stability of the implant was measured with implant stability quotient (ISQ) measurement tests. All patients were tested at surgery and every week after for 1 year. Wound-healing time, degree of soft tissue reactions around the abutment, and need for revision surgery were examined. Two-tailed Student t test and χ(2) for all comparisons were calculated; P < .05 values were considered significant. RESULTS The new implant showed a steep increase of ISQ values over the first 2 weeks and reached stable ISQ values 3 weeks after surgery. Complete skin healing time was obtained in 8 days on average (range, 7-12 days; median 7.6 days). Neither implant extrusion nor skin revision surgery was observed in our patients during the first year of follow-up. CONCLUSIONS This new implant revealed stability and fast integration. The data from the present study suggest the new implant may be suitable for early loading protocols.
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Affiliation(s)
- Riccardo D'Eredità
- Department of Otorhinolaryngology, Head and Neck Surgery, Vicenza Civil Hospital, Vicenza, Padova, Italy.
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Treatment of the atretic ear with round window vibrant soundbridge implantation in infants and children: electrocochleography and audiologic outcomes. Otol Neurotol 2012; 32:1250-5. [PMID: 21897320 DOI: 10.1097/mao.0b013e31822e9513] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the long-term outcomes of the first 5 infants and 9 children with congenital aural atresia (CAA) who had undergone hearing rehabilitation using the MED-EL Vibrant Soundbridge with intraoperative assistance of electrocochleography (ECoG) for optimal fitting of the floating mass transducer (FMT) on the round window (RW) membrane. STUDY DESIGN Tertiary referral medical center; retrospective case series. PATIENTS Infants and children ranging in age from 2 months to 16 years with a moderate-to-severe conductive or mixed hearing loss with CAA. For comparison, the study population was divided into 2 groups: older children (≥5 yr of age; 5 patients) and younger children/infants (<5 yr of age; 9 subjects) who were submitted to different audiologic tests appropriate for their age and general condition. INTERVENTION RW implantation. MAIN OUTCOME MEASURES Compound action potential threshold and amplitude were assessed as a function of different methods for stabilizing the FMT on the RW. Pure tone audiogram at 0.5, 1, 2, and 4 kHz, free-field speech testing (older children), bone conduction and free-field auditory brainstem response (ABR; younger children and infants), intraoperative and postoperative complications, and FMT displacement or extrusion rate. RESULTS Statistically significant differences were observed with ECoG recordings between pre- and post-FMT-RW membrane optimization with fascia and cartilage (p < 0.001). Significant improvements were observed in speech perception and pure-tone and ABR threshold, immediately after surgery and at follow-up intervals (12-65 mo) in children and infants (p < 0.01). No complications or instances of device extrusion were observed. CONCLUSION Infants and children with moderate-to-severe conductive or mixed hearing loss, not suitable or unwilling to accept Bone-Anchored Hearing Aids and who would not tolerate traditional bone and air conduction hearing aids, obtain substantial benefit with the FMT-RW implantation procedure. Intraoperative ECoG is of significant help in achieving the best FMT-RW fitting.
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