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Simpson ES, Salgado CD, Rohani SA, Agrawal SK, Ladak HM. Development and validation of a surgical planning tool for bone-conduction implants. Heliyon 2024; 10:e27436. [PMID: 38495182 PMCID: PMC10943392 DOI: 10.1016/j.heliyon.2024.e27436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 02/21/2024] [Accepted: 02/28/2024] [Indexed: 03/19/2024] Open
Abstract
Background The BONEBRIDGE® (Med-El GmbH) is a bone-conduction device comprising an external audio processor and an internal Bone Conduction-Floating Mass Transducer (BC-FMT) surgically anchored to the temporal bone. Due to the implant's size, its placement may be challenging in certain anatomies, necessitating thorough surgical planning. Manual planning methods are laborious, time-intensive, and prone to errors. This study aimed to develop and validate an automated algorithm for determining skull thickness, aiding in the surgical planning of the BONEBRIDGE and other devices requiring similar bone thickness estimations. Materials and methods Twelve cadaveric temporal bones underwent clinical computed tomography (CT). A custom Python algorithm was developed to automatically segment bone from soft tissue, generate 3D models, and perform ray-tracing to estimate bone thickness. Two thickness colormaps were generated for each sample: the cortical thickness to the first air cell and the total thickness down to the dura. The algorithm was validated against expert manual measurements to achieve consensus interpretation. Results The algorithm estimated bone-to-air thicknesses (mean = 4.7 mm, 95% Confidence Interval [CI] of 4.3-5.0 mm) that closely matched the expert measurements (mean = 4.7 mm, CI of 4.4-5.0 mm), with a mean absolute difference (MAD) of 0.3 mm. Similarly, the algorithm's estimations to the dura (6.0 mm, CI of 5.4-6.5 mm) were comparable to the expert markings (5.9 mm, CI of 5.4-6.5 mm), with a MAD of 0.3 mm. Conclusions The first automated algorithm to calculate skull thickness to both the air cells and dura in the temporal bone was developed. Colormaps were optimized to aid with the surgical planning of BONEBRIDGE implantation, however the tool can be generalized to aid in the surgical planning of any bone thickness application. The tool was published as a freely available extension to the open-source 3D Slicer software program (www.slicer.org).
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Affiliation(s)
- Evan S. Simpson
- Department of Electrical and Computer Engineering, Western University, London, ON, Canada
| | - Carlos D. Salgado
- Department of Electrical and Computer Engineering, Western University, London, ON, Canada
| | - Seyed Alireza Rohani
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Sumit K. Agrawal
- Department of Electrical and Computer Engineering, Western University, London, ON, Canada
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
- Department of Medical Biophysics, Western University, London, ON, Canada
- School of Biomedical Engineering, Western University, London, ON, Canada
| | - Hanif M. Ladak
- Department of Electrical and Computer Engineering, Western University, London, ON, Canada
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
- Department of Medical Biophysics, Western University, London, ON, Canada
- School of Biomedical Engineering, Western University, London, ON, Canada
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Wimmer W, Zbinden M, Gawliczek T, Huber A, Caversaccio M, Kompis M. Performance with a new bone conduction implant audio processor in patients with single-sided deafness. Eur Arch Otorhinolaryngol 2023; 280:3585-3591. [PMID: 36692617 PMCID: PMC10313841 DOI: 10.1007/s00405-023-07852-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/18/2023] [Indexed: 01/25/2023]
Abstract
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.
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Affiliation(s)
- Wilhelm Wimmer
- Department of ENT, Head and Neck Surgery, Bern University Hospital, University of Bern, Bern, Switzerland.
- Hearing Research Laboratory, ARTORG Center, University of Bern, Bern, Switzerland.
| | - Michael Zbinden
- Department of ENT, Head and Neck Surgery, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tom Gawliczek
- Department of ENT, Head and Neck Surgery, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alexander Huber
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Marco Caversaccio
- Department of ENT, Head and Neck Surgery, Bern University Hospital, University of Bern, Bern, Switzerland
- Hearing Research Laboratory, ARTORG Center, University of Bern, Bern, Switzerland
| | - Martin Kompis
- Department of ENT, Head and Neck Surgery, Bern University Hospital, University of Bern, Bern, Switzerland
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Lassaletta L, Calvino M, Sanchez-Cuadrado I, Skarzynski PH, Cywka KB, Czajka N, Kutyba J, Tavora-Vieira D, van de Heyning P, Mertens G, Staecker H, Humphrey B, Zernotti M, Zernotti M, Magele A, Ploder M, Zabeu JS. Using Generic and Disease-Specific Measures to Assess Quality of Life before and after 12 Months of Hearing Implant Use: A Prospective, Longitudinal, Multicenter, Observational Clinical Study. Int J Environ Res Public Health 2022; 19:2503. [PMID: 35270201 DOI: 10.3390/ijerph19052503] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/18/2022] [Accepted: 02/20/2022] [Indexed: 12/04/2022]
Abstract
The primary objectives of this study were to evaluate the effect of hearing implant (HI) use on quality of life (QoL) and to determine which QoL measure(s) quantify QoL with greater sensitivity in users of different types of HIs. Participants were adult cochlear implant (CI), active middle ear implant (VIBRANT SOUNDBRIDGE (VSB)), or active transcutaneous bone conduction implant (the BONEBRIDGE (BB)) recipients. Generic QoL and disease-specific QoL were assessed at three intervals: pre-activation, 6 months of device use, and 12 months of device use. 169 participants completed the study (110 CI, 18VSB, and 41BB). CI users' QoL significantly increased from 0-6 m device use on both the generic- and the disease-specific measures. On some device-specific measures, their QoL also significantly increased between 6 and 12 m device use. VSB users' QoL significantly increased between all tested intervals with the disease-specific measure but not the generic measure. BB users' QoL significantly increased from 0-6 m device use on both the generic- and the disease-specific measures. In sum, HI users experienced significant postoperative increases in QoL within their first 12 m of device use, especially when disease-specific measures were used. Disease-specific QoL measures appeared to be more sensitive than their generic counterparts.
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Rohani SA, Bartling ML, Ladak HM, Agrawal SK. The BONEBRIDGE active transcutaneous bone conduction implant: effects of location, lifts and screws on sound transmission. J Otolaryngol Head Neck Surg 2020; 49:58. [PMID: 32778163 PMCID: PMC7418375 DOI: 10.1186/s40463-020-00454-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The BONEBRIDGE (MED-EL, Innsbruck, Austria) is a bone-conduction implant used in the treatment of conductive and mixed hearing loss. The BONEBRIDGE consists of an external audio processor and a bone-conduction floating mass transducer that is surgically implanted into the skull in either the transmastoid, retrosigmoid or middle fossa regions. The manufacturer includes self-tapping screws to secure the transducer; however, self-drilling screws have also been used with success. In cases where the skull is not thick enough to house the transducer, lifts are available in a variety of sizes to elevate the transducer away from the skull. The objective of the present study was to investigate the effects of screw type, lift thickness, and implant location on the sound transmission of the BONEBRIDGE. METHOD Six cadaveric temporal bones were embalmed and dried for use in this study. In each sample, a hole was drilled in each of the three implant locations to house the implant transducer. At the middle fossa, six pairs of screw holes were pre-drilled; four pairs to be used with self-tapping screws and lifts (1, 2, 3, and 4 mm thick lifts, respectively), one pair with self-tapping screws and no lifts, and one pair with self-drilling screws and no lifts. At the transmastoid and retrosigmoid locations, one pair of screw holes were pre-drilled in each for the use of the self-tapping screws. The vibration of transmitted sound to the cochlea was measured using a laser Doppler vibrometry technique. The measurements were performed on the cochlear promontory at eight discrete frequencies (0.5, 0.75, 1, 1.5, 2, 3, 4 and 6 kHz). Vibration velocity of the cochlear wall was measured in all samples. Measurements were analyzed using a single-factor ANOVA to investigate the effect of each modification. RESULTS No significant differences were found related to either screw type, lift thickness, or implant location. CONCLUSIONS This is the first known study to evaluate the effect of screw type, lift thickness, and implant location on the sound transmission produced by the BONEBRIDGE bone-conduction implant. Further studies may benefit from analysis using fresh cadaveric samples or in-vivo measurements.
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Affiliation(s)
- Seyed Alireza Rohani
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Canada
| | | | - Hanif M Ladak
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Canada
- Department of Medical Biophysics, Western University, London, Canada
- Department of Electrical and Computer Engineering, Western University, London, Canada
- National Centre for Audiology, Western University, London, Canada
| | - Sumit K Agrawal
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Canada.
- National Centre for Audiology, Western University, London, Canada.
- Cochlear Implant Program, London Health Sciences Centre, London, Canada.
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Curca IA, Parsa V, Macpherson EA, Scollie S, Vansevenant K, Zimmerman K, Lewis-Teeter J, Allen P, Parnes L, Agrawal S. Audiological outcome measures with the BONEBRIDGE transcutaneous bone conduction hearing implant: impact of noise, reverberation and signal processing features. Int J Audiol 2020; 59:556-565. [PMID: 32069128 DOI: 10.1080/14992027.2020.1728400] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To assess the performance of an active transcutaneous implantable-bone conduction device (TI-BCD), and to evaluate the benefit of device digital signal processing (DSP) features in challenging listening environments.Design: Participants were tested at 1- and 3-month post-activation of the TI-BCD. At each session, aided and unaided phoneme perception was assessed using the Ling-6 test. Speech reception thresholds (SRTs) and quality ratings of speech and music samples were collected in noisy and reverberant environments, with and without the DSP features. Self-assessment of the device performance was obtained using the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire.Study sample: Six adults with conductive or mixed hearing loss.Results: Average SRTs were 2.9 and 12.3 dB in low and high reverberation environments, respectively, which improved to -1.7 and 8.7 dB, respectively with the DSP features. In addition, speech quality ratings improved by 23 points with the DSP features when averaged across all environmental conditions. Improvement scores on APHAB scales revealed a statistically significant aided benefit.Conclusions: Noise and reverberation significantly impacted speech recognition performance and perceived sound quality. DSP features (directional microphone processing and adaptive noise reduction) significantly enhanced subjects' performance in these challenging listening environments.
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Affiliation(s)
- Ioan A Curca
- School of Communication Sciences and Disorders, Western University, London, Ontario, Canada.,National Centre for Audiology, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
| | - Vijay Parsa
- School of Communication Sciences and Disorders, Western University, London, Ontario, Canada.,National Centre for Audiology, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
| | - Ewan A Macpherson
- School of Communication Sciences and Disorders, Western University, London, Ontario, Canada.,National Centre for Audiology, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
| | - Susan Scollie
- School of Communication Sciences and Disorders, Western University, London, Ontario, Canada.,National Centre for Audiology, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
| | | | - Kim Zimmerman
- Cochlear Implant Program, London Health Sciences Centre, London, ON, Canada
| | - Jamie Lewis-Teeter
- Cochlear Implant Program, London Health Sciences Centre, London, ON, Canada
| | - Prudence Allen
- School of Communication Sciences and Disorders, Western University, London, Ontario, Canada.,National Centre for Audiology, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
| | - Lorne Parnes
- Cochlear Implant Program, London Health Sciences Centre, London, ON, Canada.,Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine, University of Western Ontario, London, ON, Canada
| | - Sumit Agrawal
- Cochlear Implant Program, London Health Sciences Centre, London, ON, Canada.,Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine, University of Western Ontario, London, ON, Canada
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You P, Siegel LH, Kassam Z, Hebb M, Parnes L, Ladak H, Agrawal SK. Response to commentary on "the middle fossa approach with self-drilling screws: a novel technique for BONEBRIDGE implantation". J Otolaryngol Head Neck Surg 2019; 48:57. [PMID: 31690345 PMCID: PMC6833272 DOI: 10.1186/s40463-019-0375-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 09/21/2019] [Indexed: 11/18/2022] Open
Abstract
The aim of this letter is to respond to a commentary on a published article on the middle fossa approach to BONEBRIDGE implantation with self-drilling screws published by the senior authors.
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Affiliation(s)
- Peng You
- Department of Otolaryngology-Head and Neck Surgery, London Health Science Centre, Schulich School of Medicine & Dentistry, Western University, Room B1-333, London Health Sciences Centre - University Hospital 339 Windermere Road, London, Ontario, N6A 5A5, Canada
| | - Lauren H Siegel
- Department of Otolaryngology-Head and Neck Surgery, London Health Science Centre, Schulich School of Medicine & Dentistry, Western University, Room B1-333, London Health Sciences Centre - University Hospital 339 Windermere Road, London, Ontario, N6A 5A5, Canada
| | - Zahra Kassam
- Department of Medical Imaging, St. Joseph's Health Care London, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Matthew Hebb
- Department of Clinical Neurological Sciences, London Health Science Centre, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Lorne Parnes
- Department of Otolaryngology-Head and Neck Surgery, London Health Science Centre, Schulich School of Medicine & Dentistry, Western University, Room B1-333, London Health Sciences Centre - University Hospital 339 Windermere Road, London, Ontario, N6A 5A5, Canada
| | - Hanif Ladak
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Sumit Kishore Agrawal
- Department of Otolaryngology-Head and Neck Surgery, London Health Science Centre, Schulich School of Medicine & Dentistry, Western University, Room B1-333, London Health Sciences Centre - University Hospital 339 Windermere Road, London, Ontario, N6A 5A5, Canada.
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You P, Siegel LH, Kassam Z, Hebb M, Parnes L, Ladak HM, Agrawal SK. The middle fossa approach with self-drilling screws: a novel technique for BONEBRIDGE implantation. J Otolaryngol Head Neck Surg 2019; 48:35. [PMID: 31358057 PMCID: PMC6664741 DOI: 10.1186/s40463-019-0354-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 06/25/2019] [Indexed: 12/05/2022] Open
Abstract
Background Bone conduction implants can be used in the treatment of conductive or mixed hearing loss. The BONEBRIDGE bone conduction implant (BB-BCI) is an active, transcutaneous device. BB-BCI implantation can be performed through either the transmastoid or retrosigmoid approach with their respective limitations. Here, we present a third, novel approach for BB-BCI implantation. Objective Describe the detailed surgical technique of BB-BCI implantation through a middle fossa approach with self-drilling screws and present preliminary audiometric outcome data following this approach. Methods A single institution, retrospective chart review was completed for patients implanted with the BB-BCI via the middle fossa approach. Preoperative planning and modelling were performed using 3D Slicer. Audiological testing was performed pre- and post-operatively following standard audiometric techniques. Results Forty patients underwent BB-BCI implantation using the middle fossa approach. Modelling techniques allowed for implantation through the use of external landmarks, obviating the need for intraoperative image guidance. The surgical technique was refined over time through experience and adaptation. Mean follow-up was 29 months (range 3–71 months) with no surgical complications, favourable cosmesis, and expected audiometric outcomes. An average functional gain of 39.6 dB (± 14.7 SD) was found. Conclusion The middle fossa technique with self-drilling screws is a safe and effective option for BONEBRIDGE implantation. As a reference for other groups considering this approach, an annotated video has been included as a supplement to the study. Electronic supplementary material The online version of this article (10.1186/s40463-019-0354-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Peng You
- Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Lauren H Siegel
- Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Zahra Kassam
- Department of Medical Imaging, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Matthew Hebb
- Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Lorne Parnes
- Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Hanif M Ladak
- Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, Canada.,Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, Canada.,Department of Electrical & Computer Engineering, Faculty of Engineering, Western University, London, Canada
| | - Sumit Kishore Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, Canada. .,University Hospital, Room B1-333, London Health Sciences Centre - University Hospital, 339 Windermere Road, London, Ontario, N6A 5A5, Canada. .,Department of Electrical & Computer Engineering, Faculty of Engineering, Western University, London, Canada.
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Zernotti ME, Chiaraviglio MM, Mauricio SB, Tabernero PA, Zernotti M, Di Gregorio MF. Audiological outcomes in patients with congenital aural atresia implanted with transcutaneous active bone conduction hearing implant. Int J Pediatr Otorhinolaryngol 2019; 119:54-58. [PMID: 30665177 DOI: 10.1016/j.ijporl.2019.01.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The objective of this study is to evaluate the safety and efficacy of the transcutaneous Bone Conduction Implant, the Bonebridge, in patients with congenital aural atresia. METHODS Audiometry, speech recognition test and free field audiometry were performed. Word recognition scores and speech perception was evaluated using Spanish phonetically-balanced disyllables word list. RESULTS Fourteen subjects were implanted with the Bonebridge (seven bilateral placements). The study cohort comprised seven males and seven females aged from 3 to 17 years (mean age 9.76yrs). All patients accepted and benefited from the implanted Bonebridge system. The pre-operative PTA4 was 66.4 dB (64.2-68.6, 95-%CI) and improved after activation to 19.2 dB (16.9-21.5, 95%CI), resulting in a mean functional gain of 47,2 dB. Regarding speech discrimination, the pre-operative outcomes of the disyllabic measurements were 34.3% and for monosyllables 27.4%. Following activation the speech discrimination improved to 98.6% and 97.9%, respectively. No infections or adverse device related effects occurred in patient group. CONCLUSION We have concluded that the Bonebridge implant is an innovative solution for patients with conductive or mixed hearing loss and unilateral loss suffering from congenital atresia. Different surgical techniques may be used for implant placement, based on the patient's anatomy. Studies show improved functional gain, better speech perception, and lower rates of percutaneous complications associated with this implant.
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