The Bonebridge BCI 602 Active Transcutaneous Bone Conduction Implant in Children: Objective and Subjective Benefits

MED-EL Bonebridge implantation in pediatric patients age 11 Years and younger: Is it safe and effective?

OBJECTIVE

To present our experience with off-label MED-EL Bonebridge implantation in pediatric patients younger than 12 years of age and compare outcomes to pediatric patients 12 years and older.

METHODS

Pediatric patients who underwent Bonebridge implantation were included in a retrospective cohort study and were categorized by off-label use (<12 years) and ≥12 years at time of bone conduction implantation (BCI). Hearing outcomes were collected after implant activation, which was typically 4-8 weeks post-implantation. Mann-Whitney U tests were performed to assess for differences between audiometric outcomes. Significance was set at p < 0.05.

RESULTS

Twenty patients (25 implants) < 12 years of age and 17 patients (23 implants) ≥12 years of age underwent BCI. Pre-BCI speech recognition threshold (SRT) was better for the older patient group (median 50 dB) than the younger patient group (median 60 dB). Post-BCI SRT, however, was significantly lower in the younger patient group (median 22.5 dB) as compared to the older patient group (median 35 dB), (p < 0.001, Z = 3.1). The two groups performed similarly on age-appropriate wordlists presented at 50 dB HL in aided conditions (p > 0.05, -1

CONCLUSION

Pediatric patients younger than 12 years showed similar or better audiometric benefit from off-label Bonebridge implantation when compared to older patients. Pediatric patients younger than 12 years can be considered Bonebridge implant candidates if clinically indicated; Bonebridge implantation in this age group appears safe and technically feasible.

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Key Words

• Active transcutaneous bone conduction device
• Bone conduction hearing device
• MED-EL bonebridge
• Off-label
• Pediatric

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MESH Headings

• Humans
• Child
• Retrospective Studies
• Female
• Male
• Bone Conduction
• Adolescent
• Treatment Outcome
• Child, Preschool
• Age Factors
• Hearing Loss, Conductive/surgery
• Bone-Anchored Prosthesis
• Cohort Studies
• Hearing Aids
• Speech Perception
• Prosthesis Implantation/adverse effects
• Prosthesis Implantation/methods

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Affiliation(s)

Kaitlyn A Brooks Department of Otolaryngology- Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA; Division of Otolaryngology, Children's Healthcare of Atlanta, Atlanta, GA, USA.
Anastasia Kolousek Morehouse School of Medicine, Atlanta, GA, USA
Erin K Holman Children's Healthcare of Atlanta, Department of Audiology, Atlanta, GA, USA
Sean S Evans Department of Otolaryngology- Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA; Division of Otolaryngology, Children's Healthcare of Atlanta, Atlanta, GA, USA
Nandini Govil Department of Otolaryngology- Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA; Division of Otolaryngology, Children's Healthcare of Atlanta, Atlanta, GA, USA
Kristan P Alfonso Department of Otolaryngology- Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA; Division of Otolaryngology, Children's Healthcare of Atlanta, Atlanta, GA, USA

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Long-term follow-up of Bonebridge BCI 601 implantation in microtia patients with aural atresia: Acoustic and subjective benefits

BACKGROUND

This study evaluated the long-term acoustic and subjective outcomes of Bonebridge bone conduction implant (BCI) 601 implantation in Taiwanese patients with microtia and aural atresia (AA).

METHODS

A total of 41 microtia patients (28 males and 13 females; 26 with bilateral AA and 15 with unilateral AA) who received Bonebridge BCI 601 implantation between December 2014 and March 2021 at Chang Gung Memorial Hospital, Linkou, Taiwan, were included in this retrospective study. Acoustic outcomes assessed included functional hearing gain (FHG), speech reception threshold (SRT), and word recognition score (WRS), were assessed. Subjective outcomes were assessed using the Chinese versions of four questionnaires: the Abbreviated Profile of Hearing Aid Benefit (APHAB); the Speech, Spatial and Qualities of Hearing Scale; the International Outcome Inventory for Hearing Aids; and the Satisfaction with Amplification in Daily Living.

RESULTS

The mean age at the time of implantation was 18.9 years (range, 6.3-54.9), and the mean follow-up duration was 6.3 years (range, 2.8-9.1). The mean unaided air conduction pure tone average (PTA4) was 65.3 ± 8.8 decibels (dB) hearing level (HL) and the mean aided sound field PTA4 was 31.1 ± 9.1 dB HL, resulting in a FHG of 34.2 ± 11.7 dB HL ( p < 0.05). After Bonebridge implantation, improvements ( p < 0.05) in the mean SRT in quiet (from 58.3 ± 7.4 dB HL to 29.4 ± 7.0 dB HL), SRT in noise (from -1.4 ± 7.3 dB signal-to-noise ratio (SNR) to -9.6 ± 5.4 dB SNR), WRS in quiet (from 46.4 ± 26.9% to 93.8 ± 3.1%), and WRS in noise (from 46.7 ± 21.8% to 72.7 ± 19.3%) were found. Additionally, the bilateral AA group exhibited greater SRT and WRS improvements compared to the unilateral AA group ( p < 0.05). All mean subscale scores in the four questionnaires showed improvement after Bonebridge implantation, except for the mean aversiveness to sounds subscale score in the APHAB questionnaire.

CONCLUSION

Bonebridge BCI 601 implantation provided long-term acoustic and subjective benefits for patients with microtia and AA, particularly those with bilateral AA.

Bone-conduction Hearing Aids: A Scoping Review

Aim of this paper is to present a literature review among bone conduction hearing aids particularly focusing on their surgical and functional outcomes.

METHODS

A detailed review of the English literature to date on bone conduction hearing aids and outcomes have been performed using Pubmed, Scopus, Google Scholar and Medline databases. The literature review was performed using the guidelines proposed by the study "Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA)" for scoping review.

RESULTS

a total of 30 full text articles were included in this review, collecting 660 patients. All the studies examined reported an improvement, in terms of PTA and speech audiometry, following the implantation of bone-conduction devices. The subjective outcome of patients was also evaluated, which was positive in terms of improved quality of life perception.

CONCLUSIONS

Bone conduction devices represent an excellent rehabilitative solution allowing adequate functional gain. Nowadays, the variability of devices consents an appropriate customization of the surgical indication based on the functional and general needs of the patient, to achieve a tailored approach.

Audiological and Subjective Benefits in a Child with Microtia and Atresia After Sequential Bilateral Implantation with Active Bone Conduction Devices: A Case Study

BACKGROUND

With bilateral hearing loss, the main problems for the patient are speech understanding in noise and, especially in asymmetrical hearing loss, an inability to correctly localize sound sources. There are multiple methods of treatment and rehabilitation for people with conductive hearing loss, and one of them is to use an active bone conduction implant. This case study is designed to evaluate the auditory benefits and sound localization accuracy with active bilateral bone conduction implants-in comparison to unilateral ones-in a patient with congenital bilateral conductive hearing loss caused by a congenital malformation. We assess subjective and audiological benefits (functional, directional hearing, speech comprehension in quiet and noise).

CASE REPORT

This study describes the results in a 15-year-old patient with bilateral congenital malformation of the outer ears and associated conductive hearing loss who was treated with two Bonebridge active bone conduction implants. Speech recognition ability, hearing thresholds, and sound localization were tested under three conditions: unaided, unilateral on the right-side, and bilateral on both sides. The patient filled in an Abbreviated Profile of Hearing Aid Benefit questionnaire (APHAB) to evaluate limitations in daily life caused by hearing impairment. The results show an improvement in free-field hearing thresholds and the ability to discriminate speech, both in quiet and in noise after implantation. Subjectively, the patient had significantly fewer problems with two implants than with one (or with no implant) in terms of hearing in everyday situations.

CONCLUSIONS

Unilateral use of the Bonebridge device in a patient with congenital bilateral conductive hearing loss did not provide full benefits. However, bilateral implantation improved speech understanding in noise and sound localization.

A MAUDE database analysis on the new generation of active bone conduction hearing implants

Objective

To analyze medical device reports (MDR) submitted to the Food and Drug Administration's (FDA) Manufacturer and User Device Facility Experience (MAUDE) database to identify adverse events (AEs) in patients implanted with novel active bone conduction hearing implants (BCIs).

Methods

We conducted a search of the FDA MAUDE database on the newest generation of BCIs. Data were collected concerning device malfunctions, patient injuries, factors triggering these incidents, and the subsequent actions taken.

Results

In total, 93 (16.7%) device malfunctions and 465 (83.3%) patient injuries with 358 subsequent interventions were identified, resulting in 558 AEs. Although the absolute AE number per device cannot be identified, the following trends were detected: Among the 494 AEs associated with OSI200, 55 (11.1%) reported device malfunctions and 454 (88.9%) cited patient injuries. Out of the 64 AEs linked to BCI602, 28 (59.4%) were associated with malfunctions, whereas 26 (40.6%) involved patient injuries. The most frequently reported particular AEs for the OSI200 were infection (n = 171, 34.6%), extrusion of the device (n = 107, 21.7%), and pain (n = 51, 10.3%). Conversely, no device output (n = 20, 31.3%) and loss of osseointegration (n = 7, 10.9%) were the most reported AEs for the BCI602. Various AEs led to 214 explanations and 77 revision surgeries. Sixty-seven AEs reported conservative treatment.

Conclusion

The current study provides an overview of the most commonly reported complications with new active BCIs. Although providing an overview, given the limitations of the FDA MAUDE database, our results have to be interpreted with caution.

Level of Evidence

4.

Staged implantation of active transcutaneous bone conduction hearing devices (BCHD) after explantation of older generation bone anchored hearing aids (BAHAs): Surgical outcomes and approach to management

PURPOSE

To evaluate outcomes following explantation of percutaneous or transcutaneous bone conduction implants (pBCIs or tBCIs) and subsequent implantation of transcutaneous active bone conduction hearing devices (BCHDs); to provide guidance regarding staging of surgery and adjunctive procedures.

MATERIALS AND METHODS

Retrospective chart review of eight adult subjects (ten ears) with pBCIs or tBCIs who underwent explantation of their device and subsequent implantation with a BCHD [MED-EL BONEBRIDGE™ (n = 7, 70 %) or Cochlear™ Osia® (n = 3, 30 %)].

RESULTS

Reasons for pBCI or tBCI explantation were pain (60 %, 6/10), infection (60 %, 6/10), skin overgrowth (50 %, 5/10), and inability to obtain new processors (20 %, 2/10). Median time between pBCI or tBCI removal and BCHD staged implant was 4.7 (IQR 2.2-8.1) months. Two subjects developed complications following BCHD implantation. One had a persistent wound overlying the osseointegrated screw after removal of the pBCI abutment, requiring removal and temporalis rotational flap. Staged Osia® implantation was performed, but ultimately wound dehiscence developed over the device. The second subject experienced an infection after BONEBRIDGE™ implantation (32 days after pBCI explant), necessitating washout and treatment with intravenous antibiotics. There was subsequent device failure.

CONCLUSION

The transition from a pBCI or tBCI to a novel transcutaneous device is nuanced. Staged pBCI or tBCI explantation and novel BCHD implantation with sufficient time for wound healing is vital. Adjunctive procedures to augment soft tissue in cases of prior attenuation may be required to avoid complications with larger internal devices.

Early Results With the New Active Bone-Conduction Hearing Implant: A Systematic Review and Meta-Analysis

OBJECTIVE

The bone conduction implant (BCI) 602 is a new transcutaneous BCI with smaller dimensions. However, limited patient numbers restrict the statistical power and generalizability of the current studies. The present systematic review and meta-analysis summarize early audiological and medical outcomes of adult and pediatric patients implanted with the BCI 602 due to mixed or conductive hearing loss.

DATA SOURCE

Following the Preferred Reporting items for Systematic Reviews and Meta-analyses guidelines, 108 studies were reviewed, and 6 (5.6%) were included in the meta-analysis.

REVIEW METHOD

The data on study and patient characteristics, surgical outcomes, and audiological test results were extracted from each article. Meta-analysis employed the fixed-effect and random-effects models to analyze the mean differences (MDs) between pre- and postoperative performances.

RESULTS

In total, 116 patients were evaluated, including 64 (55%) adult and 52 (45%) pediatric patients. No intraoperative adverse events were reported, while postoperative complications were reported in 2 (3.1%) adult and 2 (3.8%) pediatric patients. Studies consistently showed significant improvements in audiological outcomes, quality of life, and sound localization in the aided condition. In the meta-analysis, we observed a significant difference in the unaided compared to the aided condition in sound field thresholds (n = 112; MD, -27.05 dB; P < 0.01), signal-to-noise ratio (n = 96; MD, -6.35 dB; P < 0.01), and word recognition scores (n = 96; MD, 68.89%; P < 0.01).

CONCLUSION

The implantation of the BCI 602 was associated with minimal surgical complications and excellent audiological outcomes for both the pediatric and the adult cohort. Therefore, our analysis indicates a high level of safety and reliability. Further research should focus on direct comparisons with other BCIs and long-term functional outcomes.

Role of early hearing aid experience in speech recognition in patients with bilateral congenital microtia following Bonebridge implantation: a retrospective cohort study

PURPOSE

To identify audiological and demographic variables that predict speech recognition abilities in patients with bilateral microtia who underwent Bonebridge (BB) implantation.

METHODS

Fifty patients with bilateral microtia and bilateral conductive hearing loss (CHL) who underwent BB implantation were included. Demographic data, preoperative hearing aid use experience, and audiological outcomes (including pure-tone hearing threshold, sound field hearing threshold [SFHT], and speech recognition ability) for each participant were obtained. The Chinese-Mandarin Speech Test Materials were used to test speech recognition ability. The word recognition score (WRS) of disyllabic words at 65 dB SPL signals was measured before and after BB implantation in quiet and noisy conditions.

RESULTS

The mean preoperative WRS under quiet and noisy conditions was 10.44 ± 12.73% and 5.90 ± 8.76%, which was significantly improved to 86.38 ± 9.03% and 80.70 ± 11.34%, respectively, following BB fitting. Multiple linear regression analysis revealed that lower preoperative SFHT suggested higher preoperative WRS under both quiet and noisy conditions. Higher age at implantation predicted higher preoperative WRS under quiet conditions. Furthermore, patients with more preoperative hearing aid experience and lower postoperative SFHT were more likely to have higher postoperative WRS under both quiet and noisy testing conditions.

CONCLUSIONS

This study represents the first attempt to identify predictors of preoperative and postoperative speech recognition abilities in patients with bilateral microtia with BB implantation. These findings emphasize that early hearing intervention before implantation surgery, combined with appropriate postoperative fitting, contributes to optimal benefits in terms of postoperative speech recognition ability.

Efficacy of the Bonebridge BCI602 for Adult Patients with Single-sided Deafness: A Prospective Multicenter Study

OBJECTIVE

To investigate the safety and efficacy of a novel active transcutaneous bone conduction implant (BCI) device for patients with single-sided deafness (SSD).

STUDY DESIGN

Prospective cohort study.

SETTING

Tertiary referral hospitals.

METHODS

This prospective multicenter study was conducted at 15 institutions nationwide. Thirty adult (aged ≥19 years) SSD patients were recruited. They underwent implantation of an active transcutaneous BCI device (Bonebridge BCI602). Objective outcomes included aided pure-tone thresholds, aided speech discrimination scores (SDSs), and the Hearing in Noise Test (HINT) and sound localization test results. The Bern Benefit in Single-Sided Deafness (BBSS) questionnaire, the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire, and the Tinnitus Handicap Inventory (THI) were used to measure subjective benefits.

RESULTS

The mean aided pure-tone threshold was 34.2 (11.3), mean (SD), dB HL at 500 to 4000 Hz. The mean total BBSS score was 27.5 (13.8). All APHAB questionnaire domain scores showed significant improvements: ease of communication, 33.6 (23.2) versus 22.6 (21.3), P = .025; reverberation, 44.8 (16.6) versus 32.8 (15.9), P = .002; background noise, 55.5 (23.6) versus 35.2 (18.1), P < .001; and aversiveness, 36.7 (22.8) versus 25.8 (21.4), P = .028. Moreover, the THI scores were significantly reduced [47.4 (30.1) versus 31.1 (27.0), P = .003]. Congenital SSD was a significant factor of subjective benefit (-11.643; 95% confidence interval: -21.946 to -1.340).

CONCLUSION

The BCI602 active transcutaneous BCI device can provide functional hearing gain without any adverse effects and is a feasible option for acquired SSD patients with long-term deafness.

Implantable hearing devices in clinical practice. Systematic review and consensus statements

Objective

Implantable hearing devices represent a modern and innovative solution for hearing restoration. Over the years, these high-tech devices have increasingly evolved but their use in clinical practice is not universally agreed in the scientific literature. Congresses, meetings, conferences, and consensus statements to achieve international agreement have been made. This work follows this line and aims to answer unsolved questions regarding examinations, selection criteria and surgery for implantable hearing devices.

Materials and methods

A Consensus Working Group was established by the Italian Society of Otorhinolaryngology. A method group performed a systematic review for each single question to identify the current best evidence on the topic and to guide a multidisciplinary panel in developing the statements.

Results

Twenty-nine consensus statements were approved by the Italian Society of Otorhinolaryngology. These were associated with 4 key area subtopics regarding pre-operative tests, otological, audiological and surgical indications.

Conclusions

This consensus can be considered a further step forward to establish realistic guidelines on the debated topic of implantable hearing devices.

Surgical and audiological outcomes with a new transcutaneous bone conduction device with reduced transducer thickness in children

PURPOSE

Due to smaller bone thickness, young children with conductive or mixed hearing loss or single-sided deafness were previously most commonly treated with a percutaneous osseointegrated bone-anchored hearing aid (BAHA) or an active middle-ear implant. While the BAHA increases the risk of implant infections, skin infection, overgrowth of the screw or involvement of the implant in head trauma, middle-ear implant surgery involves manipulation of the ossicles with possible risk of surgical trauma. These complications can be omitted with transcutaneous bone conduction implant systems like the MED-EL Bonebridge system. The purpose of this study was to analyze whether the second generation of the Bonebridge (BCI 602) that features a decreased implant thickness with a reduced surgical drilling depth can be implanted safely in young children with good postoperative hearing performance.

METHODS

In this study, 14 patients under 12 years were implanted with the second generation of the Bonebridge. Preoperative workup comprised a CT scan, an MRI scan, pure tone audiometry, or alternatively a BERA (bone conduction, air conduction). Since children under 12 years often have a lower bone thickness, the CT was performed to determine the suitability of the temporal bone for optimal implant placement using the Otoplan software.

RESULTS

All patients (including three under the age of five) were successfully implanted and showed a good postoperative hearing performance.

CONCLUSION

With adequate preoperative workup, this device can be safely implanted in children and even children under 5 years of age and allows for an extension of indication criteria toward younger children.

Experience With the New Active Transcutaneous Bone-Conduction Implant With Smaller Dimensions

OBJECTIVE

Recently, the Bonebridge 602 implant was introduced. Its smaller dimensions facilitate implantation even in surgically demanding cases. However, in extreme anatomical conditions, implant lifts are still required. We intended to report on the medical and audiological outcomes of all patients implanted with the implant with a secondary focus on the safety, efficacy, and feasibility of the use of 1-mm lifts.

STUDY DESIGN

Retrospective cohort study.

SETTING

Tertiary academic center.

METHODS

We retrospectively analyzed all patients implanted with the Bonebridge 602. Patient demographics and surgically-specific data were collected from the medical charts. Furthermore, audiological results were assessed. Outcomes were compared between implantations with versus without lifts.

RESULTS

Twenty-one devices were implanted during the study period. Satisfactory audiological results were observed, while no intra- or postoperative adverse events occurred. The majority of patients were daily users at the end of the observation period (n = 20/21, 95.2%), and one patient (n = 1/21, 4.8%) was a nonuser after 6 months of use because of subjective dissatisfaction. Due to anatomical considerations, 1-mm lifts were used in 4 implantations (19.0%). The application of lifts did not result in prolonged surgical times, complications, or shorter time of use, nor did it negatively affect audiometric results.

CONCLUSION

Implantations with the new and smaller Bonebridge were associated with gratifying medical and audiological outcomes. Still, in extreme anatomical conditions, 1-mm lifts are necessary. Nonetheless, surgical placement with the help of lifts seems safe, effective, and feasible, and is a viable option in cases with challenging anatomies due to previous surgeries or anomalies.

Performance with a new bone conduction implant audio processor in patients with single-sided deafness

PURPOSE

The SAMBA 2 BB audio processor for the BONEBRIDGE bone conduction implant features a new automatic listening environment detection to focus on target speech and to reduce interfering speech and background noises. The aim of this study was to evaluate the audiological benefit of the SAMBA 2 BB (AP2) and to compare it with its predecessor SAMBA BB (AP1).

METHODS

Prospective within-subject comparison study. We compared the aided sound field hearing thresholds, speech understanding in quiet (Freiburg monosyllables), and speech understanding in noise (Oldenburg sentence test) with the AP1 and AP2. Each audio processor was worn for 2 weeks before assessment and seven users with single-sided sensorineural deafness (SSD) participated in the study. For speech understanding in noise, two complex noise scenarios with multiple noise sources including single talker interfering speech were used. The first scenario included speech presented from the front (S0NMIX), while in the second scenario speech was presented from the side of the implanted ear (SIPSINMIX). In addition, subjective evaluation using the SSQ12, APSQ, and the BBSS questionnaires was performed.

RESULTS

We found improved speech understanding in quiet with the AP2 compared to the AP1 aided condition (on average + 17%, p = 0.007). In both noise scenarios, the AP2 lead to improved speech reception thresholds by 1.2 dB (S0NMIX, p = 0.032) and 2.1 dB (SIPSINMIX, p = 0.048) compared to the AP1. The questionnaires revealed no statistically significant differences, except an improved APSQ usability score with the AP2.

CONCLUSION

Clinicians can expect that patients with SSD will benefit from the SAMBA 2 BB by improved speech understanding in both quiet and in complex noise scenarios, when compared to the older SAMBA BB.

Bonebridge® bone conduction implant. Hearing outcomes and quality of life in patients with conductive/mixed hearing loss

PURPOSE

The aim of this study was to analyze the hearing outcomes and quality of life in a series of 52 patients affected by conductive or mixed hearing loss and treated with Bonebridge^®.

METHODS

52 of 71 patients implanted with Bonebridge^® between October 2012 and January 2022, were included in the study. We compared the air conduction thresholds at the frequencies 500, 1000, 2000, 3000, 4000 Hz, the SRT50% and the World Recognition Score at an intensity of 50 dB with and without the implant. The Abbreviated Profile of Hearing Aid Benefit (APHAB) was employed to assess the quality of life of patients.

RESULTS

The liminal tone audiometry (free field) pure tone average for air conduction after 6 months with the implant was 35.12 dB, obtaining a mean gain of 31.83 dB. With Bonebridge^®, the mean SRT was 34.17 dB, whereas before the surgery no patient achieved 50% of correct answers at a sound intensity of 50 dB. The world recognition score at 50 dB changed from 11% without the implant to 85% with it. We observed one case of implant failure and one case of implant exposure. The APHAB questionnaire showed an improvement after implantation in practically all the subscales.

CONCLUSIONS

The hearing outcomes and the subjective benefits reported by patients obtained in our study are similar to those published in the literature. Bonebridge^® represents an excellent method for the rehabilitation of patients with conductive and mixed hearing loss, showing a low rate of complications.

Subtemporalis Muscle Middle Cranial Fossa Bone-Island Craniotomy Technique for Placement of an Active Transcutaneous Bone-Conduction Implant

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.