The bone-anchored hearing aid in the rehabilitation of single-sided deafness: experience with 58 patients

Comparison of Quality of Life Outcomes for Percutaneous Versus Transcutaneous Implantable Hearing Devices: A Systematic Review and Meta-analysis

OBJECTIVE

To compare quality of life (QOL) outcomes of percutaneous and transcutaneous bone conduction devices (pBCD and tBCD, respectively).

DATABASES REVIEWED

Pubmed, Scopus, CINAHL.

METHODS

A systematic review was performed searching for English language articles from inception to March 15, 2023. Studies reporting QOL outcomes measured using a validated tool following implantation of either pBCDs or tBCDs were considered for inclusion. QOL outcomes included scores for Glasgow Benefit Inventory, Glasgow Children's Benefit Inventory, Abbreviated Profile of Hearing Aid Benefit, and the Speech, Spatial, and Qualities of Hearing Scale. A meta-analysis of continuous measures was performed.

RESULTS

A total of 52 articles with 1,469 patients were included. Six hundred eighty-nine patients were implanted with pBCDs, and the remaining 780 were implanted with tBCDs. Average Glasgow Benefit Inventory scores for the tBCD group (33.0, 95% confidence interval [22.7-43.3]) were significantly higher than the pBCD group (30.9 [25.2-36.6]) (Δ2.1 [1.4-2.8], p < 0.0001). Mean Glasgow Children's Benefit Inventory scores (Δ3.9 [2.0-5.8], p = 0.0001) and mean gain in Abbreviated Profile of Hearing Aid Benefit scores (Δ5.6 [4.8-6.4], p < 0.0001) were significantly higher among patients implanted with tBCDs than those implanted with pBCDs. Patients implanted with tBCDs also had significantly higher gains on the Speech (Δ1.1 [0.9-1.3], p < 0.0001), Spatial (Δ0.8 [0.7-0.9], p < 0.0001), and Qualities of Hearing (Δ1.2 [1.1-1.3], p < 0.0001) portions of the Speech, Spatial, and Qualities of Hearing Scale than those implanted with pBCDs.

CONCLUSIONS

Patients implanted with transcutaneous devices had better QOL outcomes than those implanted with percutaneous devices.

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.

Patient reported outcome measures in unilateral aural atresia treated using a transcutaneous bone conduction implant (The Cochlear Baha Attract®)

OBJECTIVES

Unilateral aural atresia (UAA) is a congenital condition that is associated with maximal conductive hearing loss. The primary objective of this study was to assess the long-term compliance, complications, and quality of life of pediatric patients with UAA who had transcutaneous bone conduction hearing implants (TCBI).

METHODS

Retrospective consecutive case series at a single centre between 2014 and 2018. Inclusion criteria consisted of UAA patients between 5 to 17 years-old receiving the Cochlear Baha Attract ® device. Demographic and audiologic data was extracted from charts. A prospective telephone survey was done, with patients and their families completing the Glasgow Children's Benefit Inventory (GCBI). Basic descriptive statistics, paired t-tests, and a univariate analysis were completed.

RESULTS

Data was successfully collected from all 9 eligible children who received the Cochlear Baha Attract ® device for UAA (100%). The mean follow-up duration was 33 months after TBCI (9-60 months). The mean daily use was 7.7 h/day. Pure tone average and mean speech in noise scores were both significantly improved when comparing the unaided condition to the aided condition with TCBI (p < 0.001). The majority (89%) of patients had an improvement in GCBI; the median GCBI score was +14.6, indicating overall positive benefit. A linear regression showed no demographic variables were significant for mean daily use or GCBI scores.

CONCLUSION

This preliminary study showed that patients with a TCBI for UAA had high long-term compliance and daily usage rates. TCBI improved the quality of life for the majority of patients and significantly improved hearing measures.

Cochlear Implantation in Adults With Single-Sided Deafness: A Systematic Review and Meta-analysis

OBJECTIVE

To determine the clinical outcomes of adult patients with single-sided deafness (SSD) undergoing ipsilateral cochlear implantation.

DATA SOURCE

An electronic search of Medline and Embase articles.

REVIEW METHODS

A systematic review was performed with a search strategy developed by a licensed librarian to identify studies of adult patients with SSD who underwent ipsilateral cochlear implantation. Articles were managed in Covidence and evaluated by 2 independent reviewers. Risk of bias was assessed and data were extracted, including patient demographics, etiology of deafness, duration of deafness, and postoperative change in speech recognition, tinnitus, sound localization, and quality of life (QoL). A meta-analysis was performed, and pooled mean differences were calculated for each outcome of interest via random effects models by each outcome, as well as subgroup analyses by the individual clinical score used.

RESULTS

Of 2309 studies identified, 185 full texts were evaluated, and 50 were ultimately included involving 674 patients. Speech perception scores in quiet and noise, tinnitus control, sound localization, and QoL all significantly improved after implantation. Pooled outcomes demonstrated score improvements in speech perception (standardized mean difference [SMD], 2.8 [95% CI, 2.16-3.43]), QoL (SMD, 0.68 [95% CI, 0.45-0.91]), sound localization (SMD, -1.13 [95% CI, -1.68 to -0.57]), and tinnitus score reduction (SMD, -1.32 [95% CI, -1.85 to -0.80]).

CONCLUSIONS

Cochlear implantation in adults with SSD results in significant improvements in speech perception, tinnitus control, sound localization, and QoL.

LEVEL OF EVIDENCE: 2

Functional consequences of extended high frequency hearing impairment: Evidence from the speech, spatial, and qualities of hearing scale

Hearing loss in the extended high frequencies, despite a normal audiogram, could affect speech-in-noise recognition. However, it is not known if extended high frequency (EHF) hearing loss is associated with everyday listening and communication deficits. The present study aimed to determine the functional effects of impaired EHF hearing among adults using the Speech, Spatial, and Qualities of Hearing Scale (SSQ). A secondary objective was to evaluate the relationship between objective (speech-in-noise recognition) and subjective (SSQ) measures of hearing function. Listeners with EHF hearing loss provided lower SSQ ratings compared with their EHF-normal counterparts. The lower ratings could not be attributed to the age or standard audiogram of the listeners. Ratings from more than 50% of EHF-impaired listeners were below the 2 SD cutoff point obtained from EHF-normal listeners. The mean speech recognition threshold was poorer for EHF-impaired listeners, and a poorer speech recognition threshold was associated with lower SSQ ratings, i.e., poorer self-reported hearing ability. For some listeners, EHF hearing loss could be the missing link between self-reported hearing difficulty in the presence of a normal audiogram. These findings provide evidence for the functional deficits associated with EHF hearing loss and invoke the need for future investigations into the management of EHF loss.

Hearing outcomes in children with single sided deafness: Our experience at a tertiary paediatric otorhinolaryngology unit

INTRODUCTION

Hearing rehabilitation options for single sided deafness (SSD) include contralateral routing of sound (CROS) aids and bone conduction devices (BCDs). This study aimed to review the management of children with SSD at our tertiary paediatric otolaryngology unit over the last 15 years.

MATERIAL AND METHODS

A retrospective cohort study was performed. Primary hearing outcomes were measured using the Children's Home Inventory for Listening Difficulties (CHILD) questionnaire score and secondary hearing outcomes were measured using hearing thresholds for speech in noise. Outcomes were measured pre and post bone conduction device (BCD) trial.

RESULTS

49 patients with SSD were identified. 20 children had trial of a BCD. 16 patients had pre- and post- BCD trial CHILD scores available for analysis. There was a statistically significant improvement in CHILD scores and speech in noise testing at +5 dB and +0 dB following amplification with a BCD. The mean use of BCD was 1.3 h per day.

DISCUSSION

We have described the management of children with SSD in our unit. This study demonstrated a statistically significant benefit of BCD use on hearing outcomes. However, device compliance is low suggesting hearing advice choice in the population is complex and further research is warranted.

Hearing-Related Quality of Life in 75 Patients With a Percutaneous Bone Conduction Device

OBJECTIVE

To evaluate long-term hearing-related quality of life (HRQoL) and device use in bone conduction (BCD) users. Furthermore, to assess differences between indications and changes in HRQoL over time.

STUDY DESIGN

Prospective questionnaire survey.

SETTING

Tertiary referral center.

PATIENTS

Seventy-five patients with a percutaneous BCD.

MAIN OUTCOME MEASURES

Glasgow Benefit Inventory (GBI) at 3 and 12 months postoperatively, Glasgow Health Status Inventory (GHSI) preoperatively, and 6 and 36 months postoperatively, device use at 6, 12, and 36 months. Changes over time were assessed and outcomes were compared between indications.

RESULTS

After implantation, 97% of all patients reported a positive benefit on the GBI total. The GHSI total had improved with median 15 points (Interquartile range [IQR] 12). At 36 months, median device use was 15 hours/day (IQR 10) and one nonuser was reported. Patients with bilateral hearing loss (BHL) showed greater improvement on the GHSI total (median 18 vs 14, p < 0.0001) and used their devices more frequently (median 16 vs 8 h/day, p < 0.0001) than patients with unilateral HL (UHL). Postoperative GHSI and GBI scores were consistent over time, in the entire patient population and for every indication. Between 6 and 36 months, device use was stable over time, except for patients with single-sided deafness (SSD; median -6.4 h/day, p = 0.009).

CONCLUSION

The BCD improves HRQoL in patients with BHL, in patients with unilateral conductive/mixed hearing loss and in patients with SSD. Patients with BHL experienced a greater improvement in hearing status compared to patients with UHL. Although use decreased over time in SSD patients, device use was high for every indication.

Multicenter Results With an Active Transcutaneous Bone Conduction Implant in Patients With Single-sided Deafness

OBJECTIVE

To evaluate the audiological and subjective benefit from hearing rehabilitation with an active bone conduction implant in subjects with single-sided sensorineural deafness (SSD).

STUDY DESIGN

Prospective, multicenter, single-subject repeated measures.

SETTING

Tertiary referral center, five clinics in Germany and Switzerland.

PATIENTS

Seventeen subjects aged 18 years and older with severe to profound unilateral sensorineural hearing loss and contralateral normal hearing were followed up for 24 months.

INTERVENTION

Active bone conduction implant.

MAIN OUTCOME MEASURES

Speech understanding in noise was assessed in three situations: with signal from front, deaf, or normal hearing side (with noise from front in all set-ups). Subjective benefit was evaluated using the Speech, Spatial, and Qualities of Hearing (SSQ-B) and Bern Benefit in Single-Sided Deafness (BBSS) questionnaire.

RESULTS

When the signal was coming from the deaf side the mean improvement of the speech reception threshold in noise ranged from 1.5 up to 2.2 dB with the device and was statistically and clinically significant at all tested timepoints. No significant difference between the aided and unaided situation was found when signal and noise were coming from the front. With the signal from the normal hearing side no clinically significant difference, that is, greater than 1 dB between the aided and unaided situation was found. The SSQ-B and BBSS questionnaire showed an overall improvement with no significant difference between time points.

CONCLUSIONS

The study demonstrates long-term efficacy and benefit of the device in adults with SSD. Patients reported substantial and persistent subjective benefit from the active bone conduction implant.

Usefulness of cochlear implantation in children with single sided deafness

OBJECTIVES

Children with single sided deafness (SSD) show a poorer performance at school, which is attributable to reduced speech discrimination in noise, to reduced localization ability, and to a decreased power of concentration due to faster hearing exhaustion. Therefore, it is important to provide children with SSD with adequate hearing amplification to restore binaural hearing. This can only be achieved by provision with a cochlear implant (CI). But these treatment option in children with SSD is still under discussion. The aim of the present study is to evaluate audiological and clinical results in children with SSD following cochlear implantation. A special focus was placed on the duration of deafness before implantation and on the frequency of CI-use in everyday life.

METHODS

Seven children with SSD of different etiologies who were provided with a CI between 3 and 16 years of age were evaluated. Every child underwent multiple audiological tests before and after cochlear implantation. After cochlear implantation speech recognition tests in noise using the HSM (Hochmair, Schulz and Moser 1997) test and localization tests were performed. Furthermore, the frequency of implant use was evaluated.

RESULTS

Speech recognition in noise with CI compared to the unaided condition significantly improved in all children in different settings. Improvement of the localization ability measured by the root mean square error (RMSE) was shown in all children. All children are very satisfied with the decision to have undergone cochlear implantation and are all full-time users.

CONCLUSIONS

Cochlear implantation benefits speech recognition in noise and sound localization ability in children with SSD at different ages. All implanted children are full-time users regardless of age or duration of deafness before implantation.

Outcomes after Application of Active Bone Conducting Implants

BACKGROUND

A bone conducting implant is a treatment option for individuals with conductive or mixed hearing loss (CHL, MHL) who do not tolerate regular hearing aids, and for individuals with single-sided deafness (SSD). An active bone conducting implant (ABCI) was introduced in 2012 with indication in CHL, MHL, and SSD, and it is still the only ABCI available. With complete implantation of the active transducer and consequent intact skin, a decrease in infections, skin overgrowth, and implant losses, all common disadvantages with earlier passive bone conducting implants, could be expected. Our Ear, Nose and Throat Department, a secondary care center for otosurgery that covers a population of approximately 365,000 inhabitants, was approved to implant ABCIs in 2012.

OBJECTIVES

Our aim was to conduct an evaluation of audiological and subjective outcomes after ABCIs.

METHOD

A cohort study with retrospective and prospective data collection was performed.The first 20 consecutive patients operated with an ABCI were asked for informed consent. The main outcome measures werepure tone and speech audiometry and the Glasgow Benefit Inventory (GBI).

RESULTS

Seventeen patients accepted to participate and 15 were able to complete all parts. Six patients had CHL or MHL. In this group the pure tone audiometry tests are comparable with an average functional hearing gain of 29.8 dB HL. With bilateral hearing, the mean Word Recognition Score (WRS) in noise was 35.7% unaided and 62.7% aided. Ten patients had the indication SSD. With the hearing ear blocked, the pure tone average was >101 dB HL, compared to 29.3 dB HL in sound field aided. With bilateral hearing, the mean WRS in noise was 59.7% unaided and 72.8% aided. The mean of the total GBI score was 42.1 in the group with CHL or MHL and 20.6 in the group with SSD.

CONCLUSIONS

The patients benefit from their implants in terms of quality of life, and there is a substantial hearing gain from the implant for patients with conductive or MHL. Patients with SSD benefit less from the implant than other diagnoses but the positive outcomes are comparable to other options for this group.

Effect of Tinnitus and Duration of Deafness on Sound Localization and Speech Recognition in Noise in Patients With Single-Sided Deafness

Patients with single-sided deafness (SSD) often experience poor sound localization, reduced speech understanding in noise, reduced quality of life, and tinnitus. The present study aims to evaluate effects of tinnitus and duration of deafness on sound localization and speech recognition in noise by SSD subjects. Sound localization and speech recognition in noise were measured in 26 SSD and 10 normal-hearing (NH) subjects. Speech was always presented directly in front of the listener. Noise was presented to the deaf ear, in front of the listener, or to the better hearing ear. Tinnitus severity was measured using visual analog scale and Tinnitus Handicap Inventory. Relative to NH subjects, SSD subjects had significant deficits in sound localization and speech recognition in all listening conditions (p < .001). For SSD subjects, speech recognition in noise was correlated with mean hearing thresholds in the better hearing ear (p < .001) but not in the deaf ear. SSD subjects with tinnitus performed poorer in sound localization and speech recognition in noise than those without tinnitus. Shorter duration of deafness was associated with greater tinnitus and sound localization difficulty. Tinnitus visual analog scale and Tinnitus Handicap Inventory were highly correlated; the degree of tinnitus was negatively correlated with sound localization and speech recognition in noise. Those experiencing noticeable tinnitus may benefit more from cochlear implantation than those without; subjective tinnitus reduction may be correlated with improved sound localization and speech recognition in noise. Subjects with longer duration of deafness demonstrated better sound localization, suggesting long-term compensation for loss of binaural cues.

Hearing Rehabilitation through Bone-Conducted Sound Stimulation: Preliminary Results

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.

Current concepts in the management of idiopathic sudden sensorineural hearing loss

PURPOSE OF REVIEW

The purpose of this manuscript is to review the initial management strategies for idiopathic sudden sensorineural hearing loss, with an emphasis on the role that steroids play in treatment of this condition, and discuss options for auditory rehabilitation of persistent unilateral hearing loss.

RECENT FINDINGS

Recent data suggest that hearing improvement may be greater for patients initially treated with both systemic and intratympanic steroid when compared with those treated with systemic steroids alone. Salvage intratympanic steroids have been shown to confer hearing benefit if initial management fails. The ideal dosing regimen for intratympanic steroids has not been established, but evidence supports that higher dosing strategies are advantageous. Cochlear implantation has emerged as a strategy for auditory rehabilitation of persistent unilateral hearing loss. Recent studies have demonstrated high patient satisfaction, subjective improvement in tinnitus, and objective performance benefit after cochlear implantation for single-sided deafness.

SUMMARY

Patients can be offered steroid therapy in the initial management of idiopathic sudden sensorineural hearing loss, but should be counseled that the efficacy of steroids remains unclear. If patients fail to improve with initial management, salvage intratympanic steroid administration should be considered. If hearing loss persists long term, options for auditory rehabilitation should be discussed.

Hearing Instruments for Unilateral Severe-to-Profound Sensorineural Hearing Loss in Adults: A Systematic Review and Meta-Analysis

Objectives:

A systematic review of the literature and meta-analysis was conducted to assess the nature and quality of the evidence for the use of hearing instruments in adults with a unilateral severe to profound sensorineural hearing loss.

Design:

The PubMed, EMBASE, MEDLINE, Cochrane, CINAHL, and DARE databases were searched with no restrictions on language. The search included articles from the start of each database until February 11, 2015. Studies were included that (a) assessed the impact of any form of hearing instrument, including devices that reroute signals between the ears or restore aspects of hearing to a deaf ear, in adults with a sensorineural severe to profound loss in one ear and normal or near-normal hearing in the other ear; (b) compared different devices or compared a device with placebo or the unaided condition; (c) measured outcomes in terms of speech perception, spatial listening, or quality of life; (d) were prospective controlled or observational studies. Studies that met prospectively defined criteria were subjected to random effects meta-analyses.

Results:

Twenty-seven studies reported in 30 articles were included. The evidence was graded as low-to-moderate quality having been obtained primarily from observational before-after comparisons. The meta-analysis identified statistically significant benefits to speech perception in noise for devices that rerouted the speech signals of interest from the worse ear to the better ear using either air or bone conduction (mean benefit, 2.5 dB). However, these devices also degraded speech understanding significantly and to a similar extent (mean deficit, 3.1 dB) when noise was rerouted to the better ear. Data on the effects of cochlear implantation on speech perception could not be pooled as the prospectively defined criteria for meta-analysis were not met. Inconsistency in the assessment of outcomes relating to sound localization also precluded the synthesis of evidence across studies. Evidence for the relative efficacy of different devices was sparse but a statistically significant advantage was observed for rerouting speech signals using abutment-mounted bone conduction devices when compared with outcomes after preoperative trials of air conduction devices when speech and noise were colocated (mean benefit, 1.5 dB). Patients reported significant improvements in hearing-related quality of life with both rerouting devices and following cochlear implantation. Only two studies measured health-related quality of life and findings were inconclusive.

Conclusions:

Devices that reroute sounds from an ear with a severe to profound hearing loss to an ear with minimal hearing loss may improve speech perception in noise when signals of interest are located toward the impaired ear. However, the same device may also degrade speech perception as all signals are rerouted indiscriminately, including noise. Although the restoration of functional hearing in both ears through cochlear implantation could be expected to provide benefits to speech perception, the inability to synthesize evidence across existing studies means that such a conclusion cannot yet be made. For the same reason, it remains unclear whether cochlear implantation can improve the ability to localize sounds despite restoring bilateral input. Prospective controlled studies that measure outcomes consistently and control for selection and observation biases are required to improve the quality of the evidence for the provision of hearing instruments to patients with unilateral deafness and to support any future recommendations for the clinical management of these patients.

Adults with a unilateral severe-to-profound sensorineural hearing loss report difficulties with listening in many everyday situations. Current hearing instruments attempt to alleviate these difficulties either by rerouting sounds from the impaired ear to the non-impaired ear or by restoring hearing in the impaired ear. A systematic review and meta-analysis evaluated the evidence for their use. The evidence was of low-to-moderate quality. Meta-analyses found benefits to speech perception in noise and reductions in listening difficulty. Controlled trials are needed to provide higher-quality evidence for hearing instrument use in unilateral deafness and to support recommendations for the clinical management of these patients.

Supplemental Digital Content is available in the text.

Long term benefit of bone anchored hearing systems in single sided deafness

CONCLUSION

Bone Anchored Hearing Systems (BAHS) can be expected to still be used by ∼85% of patients with single sided deafness (SSD) 5 years after implantation, and by ∼50% after 10 years.

OBJECTIVES

To investigate the long-term use of BAHS and the reasons to stop.

METHOD

This was a retrospective chart review of all 33 German speaking adults with SSD who had been implanted with a BAHS at one center and of whom the implant status and use of the BAHS were known.

RESULTS

Ranging from 2.6-12.3 years after BAHS implantation, 21 implantees (63.6%) were still using their device (average use = 7.9 years). Seven (21.2%) had stopped using their BAHS because of insufficient benefit (audiologic reasons). The subjective assessment of the benefit of the BAHS differs significantly from the users. Five former users (15.2%) became non-users for reasons unrelated to their hearing performance, namely infections, implant loss, difficulties with the handling, or aesthetic reasons.

Baha implant as a hearing solution for single-sided deafness after retrosigmoid approach for the vestibular schwannoma: surgical results

Skull base tumors and, in particular, vestibular schwannoma (VS) are among the etiological reasons for single-sided deafness (SSD). Patients with SSD have problems in understanding speech in a noisy environment and cannot localize the direction of sounds. Baha is one of the most frequently used systems for SSD compensation. Out of 38 patients with SSD after retrosigmoid removal of VS who underwent testing with Baha softband, 16 were satisfied and were indicated for Baha implantation. Two surgical approaches have been used-the Nijmegen linear incision technique with subdermal thinning (Group I, implant BI300) and fast surgery technique without subdermal thinning (Group II, implant BIA400). The duration of the surgery, the implant stability measured by Ostell, and skin or soft tissue reactions in long range follow-up were evaluated and compared between Group I and II. There was a difference in duration of surgery, in Group II procedures averaged significantly faster (p > 0.001). In both groups, there was a similar trend of the gradual increase of implant stability. In the Group I and II, there was comparable rate of the skin or soft tissue reactions grade 0, I, II, or III. We have proved Baha to be a suitable possibility for SSD patients after the removal of VS, regardless of the approach. After the retrosigmoid approach to the VS, the key step of Baha implantation must be to reach intact healthy bone to avoid implantation into scar tissue.

[Validation of the Russian language version of the SSQ questionnaire]

The Speech, Spatial and Qualities of Hearing Scale (SSQ) is applied worldwide as a highly reliable tool for the characteristic of the quality of life and subjective sensations of the patients presenting with hearing impairment as well as for the estimation of the efficiency of hearing aids. The objective of the present study was to validate and adapt the Russian language version of the SSQ questionnaire (SSQrus) for its application in the audiological practice under conditions of this country. After the cultural and language adaptation of SSQrus, it was validated by means of repeat interviewing of three groups of the respondents (a total of 93 subjects with normal, moderately and severely impaired hearing). The results of the validation give evidence of the high reliability of the modified questionnaire. Specifically, high reproducibility of the data estimated from the results of the second interview has been demonstrated (r=0.85--0.99). High sensitivity of SSQruswas confirmed by the agreement between the results of the estimation (in scores) and the degree of the observed loss of hearing. The estimates obtained by the application of the SSQrus questionnaire are comparable with those reported by the foreign authors. It is concluded that the SSQrus questionnaire can be used in routine audiological practice as an additional diagnostic instrument for the estimation of hearing problems experienced by a patient, monitoring efficiency of therapy and surgical treatment of hearing impairment, improvement of hearing aids, and hearing dysfunction research.

Audiological Results and Quality of Life of Sophono Alpha 2 Transcutaneous Bone-Anchored Implant Users in Single-Sided Deafness

Single-sided deafness (SSD) represents one of the most difficult audiological conditions to rehabilitate. The aim of this prospective study was to evaluate the audiological benefits and quality of life of patients affected by SSD who had previously been users of the Alpha 1® when upgrading them to the Sophono Alpha 2® external processor (Boulder, Colo., USA). Nine patients were included in the study. They underwent physical examination, free-field speech audiometry at 40 and 60 dB, a hearing-in-noise test (Hirsch's test and the squelch test), the Glasgow Benefit Inventory (GBI) questionnaire, and a specific questionnaire on patient satisfaction with Alpha 1. Afterwards, the Alpha 2 external processor was delivered to all patients, and the above-mentioned protocol was repeated after 1 month with the Alpha 2. A statistically significant improvement was found in the speech discrimination score at 40 dB and in the squelch test when using the Alpha 2 external processor compared to the Alpha 1. Alpha 2 had a good clinical tolerance and gave similar results in the specific questionnaire and the GBI to Alpha 1. In conclusion, the new Alpha 2 external processor represents a safe and effective device for the rehabilitation of SSD, and there is an audiological benefit to upgrading to the Alpha 2 external processor for patients who had previously been users of the Alpha 1. The improvement in quality of life is similar to that with other bone-anchored hearing devices.

The Glasgow Benefit Inventory: a systematic review of the use and value of an otorhinolaryngological generic patient-recorded outcome measure

BACKGROUND

The Glasgow Benefit Inventory (GBI) is a validated, generic patient-recorded outcome measure widely used in otolaryngology to report change in quality of life post-intervention.

OBJECTIVES OF REVIEW

To date, no systematic review has made (i) a quality assessment of reporting of Glasgow Benefit Inventory outcomes; (ii) a comparison between Glasgow Benefit Inventory outcomes for different interventions and objectives; (iii) an evaluation of subscales in describing the area of benefit; (iv) commented on its value in clinical practice and research.

TYPE OF REVIEW

Systematic review.

SEARCH STRATEGY

'Glasgow Benefit Inventory' and 'GBI' were used as keywords to search for published, unpublished and ongoing trials in PubMed, EMBASE, CINAHL and Google in addition to an ISI citation search for the original validating Glasgow Benefit Inventory paper between 1996 and January 2015.

EVALUATION METHOD

Papers were assessed for study type and quality graded by a predesigned scale, by two authors independently. Papers with sufficient quality Glasgow Benefit Inventory data were identified for statistical comparisons. Papers with <50% follow-up were excluded.

RESULTS

A total of 118 eligible papers were identified for inclusion. A national audit paper (n = 4325) showed that the Glasgow Benefit Inventory gave a range of scores across the specialty, being greater for surgical intervention than medical intervention or 'reassurance'. Fourteen papers compared one form of surgery versus another form of surgery. In all but one study, there was no difference between the Glasgow Benefit Inventory scores (or of any other outcome). The most likely reason was lack of power. Two papers took an epidemiological approach and used the Glasgow Benefit Inventory scores to predict benefit. One was for tonsillectomy where duration of sore throat episodes and days with fever were identified on multivariate analysis to predict benefit albeit the precision was low. However, the traditional factor of number of episodes of sore throat was not predictive. The other was surgery for chronic rhinosinusitis where those with polyps on univariate analysis had greater benefit than those without. Forty-three papers had a response rate of >50% and gave sufficient Glasgow Benefit Inventory total and subscales for meta-analysis. For five of the 11 operation categories (vestibular schwannoma, tonsillectomy, cochlear implant, middle ear implant and stapes surgery) that were most likely to have a single clear clinical objective, score data had low-to-moderate heterogeneity. The value in the Glasgow Benefit Inventory having both positive and negative scores was shown by an overall negative score for the management of vestibular schwannoma. The other six operations gave considerable heterogeneity with rhinoplasty and septoplasty giving the greatest percentages (98% and 99%) most likely because of the considerable variations in patient selection. The data from these operations should not be used for comparative purposes. Five papers also reported the number of patients that had no or negative benefit, a potentially a more clinically useful outcome to report. Glasgow Benefit Inventory subscores for tonsillectomy were significantly different from ear surgery suggesting different areas of benefit

CONCLUSIONS

The Glasgow Benefit Inventory has been shown to differentiate the benefit between surgical and medical otolaryngology interventions as well as 'reassurance'. Reporting benefit as percentages with negative, no and positive benefit would enable better comparisons between different interventions with varying objectives and pathology. This could also allow easier evaluation of factors that predict benefit. Meta-analysis data are now available for comparison purposes for vestibular schwannoma, tonsillectomy, cochlear implant, middle ear implant and stapes surgery. Fuller report of the Glasgow Benefit Inventory outcomes for non-surgical otolaryngology interventions is encouraged.

Long-term subjective benefit with a bone conduction implant sound processor in 44 patients with single-sided deafness

INTRODUCTION

Studies that investigate the subjective benefit from a bone conduction implant (BCI) sound processor in patients with single-sided sensorineural deafness (SSD) have been limited to examining short- and mid-term benefit. In the current study, we performed a survey among 44 SSD BCI users with a median follow-up time of 50 months.

MATERIALS AND METHODS

Forty-four experienced SSD BCI users participated in the survey, which consisted of the Abbreviated Profile of Hearing Aid Benefit, the Single-Sided Deafness Questionnaire, the Short Hearing Handicap Inventory for Adults, and a self-made user questionnaire. For patients with tinnitus, the Tinnitus Questionnaire was also completed. The results of the survey were correlated with contralateral hearing loss, age at implantation, duration of the hearing loss at the time of implantation, duration of BCI use, and the presence and burden of tinnitus.

RESULTS

In total, 86% of the patients still used their sound processor. The Abbreviated Profile of Hearing Aid Benefit and the Short Hearing Handicap Inventory for Adults show a statistically significant overall improvement with the BCI. The Single-Sided Deafness Questionnaire and the user questionnaire showed that almost 40% of the patients reported daily use of the sound processor. However, the survey of daily use reveals benefit only in certain circumstances. Speech understanding in noisy situations is rated rather low, and 58% of all patients reported that their BCI benefit was less than expected.

CONCLUSION

The majority of the patients reported an overall improvement from using their BCI. However, the number of users decreases during a longer follow-up time and patients get less enthusiastic about the device after an extended period of use, especially in noisy situations. However, diminished satisfaction because of time-related reductions in processor function could not be ruled out.

A new bone conduction implant: surgical technique and results

OBJECTIVE

To describe the surgical technique under local or general anesthesia of 5 cases that have undergone this procedure and the audiologic results obtained with this new device.

PATIENTS

Four patients with mixed hearing loss and 1 patient with single-sided deafness.

INTERVENTION

Therapeutic.

MAIN OUTCOME MEASURES

The surgery was planned beforehand with a 3D reconstruction of a CT scan. The procedure was documented and timed in every case. Air and bone conductive pure tone audiometry and disyllabic words discrimination were tested after and before the procedure. Results were statistically analyzed.

RESULTS

All patients tolerated well the procedure. Four patients were intervened under local anesthesia and 1 under general anesthesia because of an associated procedure. All patients showed statistically significant difference between the presurgery and postsurgery audiologic tests.

CONCLUSION

Implantation of the Bonebridge with local or general anesthesia is a safe and feasible procedure, with audiometric results that can come close with the ones provided by BAHD users.

Comparison of speech discrimination in noise and directional hearing with 2 different sound processors of a bone-anchored hearing system in adults with unilateral severe or profound sensorineural hearing loss

OBJECTIVE

To evaluate and compare the benefit of a bone-anchored hearing implant with 2 different sound processors in adult patients with unilateral severe to profound sensorineural hearing loss (UHL).

STUDY DESIGN

Prospective crossover design.

SETTING

Tertiary referral center.

PATIENTS

Eleven adults with UHL and normal hearing in the contralateral ear were assigned to 2 groups.

INTERVENTION

All subjects were unilaterally implanted with a bone-anchored hearing implant and were initially fitted with 2 different sound processors (SP-1 and SP-2). SP-1 is a multichannel device equipped with an omnidirectional microphone and relatively simple digital signal-processing technology and provides a user-adjustable overall gain and tone control with compression limiting. SP-2 is a fully channel-by-channel programmable device, which can be set with nonlinear dynamic range compression or linear amplification. In addition, SP-2 features automatic noise management, an automatic multichannel directional microphone, microphone position compensation, and an implementation of prescription rules for different types of hearing losses, one of them unilateral deafness. After at least 1-month use of the initial processor, both groups were fitted with the alternative processor.

MAIN OUTCOME MEASURES

Speech discrimination in noise and localization tests were performed at baseline visit before surgery, after at least 1-month use of the initial processor, and after at least 2-week use of the alternative processor.

RESULTS

Relative to unaided baseline, SP-2 enabled significantly better overall speech discrimination results, whereas there was no overall improvement with SP-1. There was no difference in speech discrimination between SP-1 and SP-2 in all spatial settings. Sound localization was comparably poor at baseline and with both processors but significantly better than chance level for all 3 conditions.

CONCLUSION

Patients with UHL have an overall objective benefit for speech discrimination in noise using a bone-anchored hearing implant with SP-2. In contrast, there is no overall objective benefit from SP-1. Depending on the speech-in-noise presentation setting, the difference between objective benefit from SP-2 and SP-1 might be mainly attributed to the new technological features in SP-2 unavailable in SP-1 such as 1) automatic noise management reducing the noise in the speech signal and thus improving the signal-to-noise ratio of the resulting signal on the better ear, 2) programmable multichannel sound-processing and nonlinear dynamic range compression offering considerably greater control over signal amplification compared to SP-1, and 3) implementation of a prescription rule for unilateral deafness addressing the specific amplification needs of patients with UHL by reducing amplification in the low frequencies and applying additional gain in the high frequencies. Sound localization is poor but better than chance level in the unaided condition as well as in both bone-anchored hearing system-aided conditions.

A factor analysis of the SSQ (Speech, Spatial, and Qualities of Hearing Scale)

OBJECTIVE

The speech, spatial, and qualities of hearing questionnaire (SSQ) is a self-report test of auditory disability. The 49 items ask how well a listener would do in many complex listening situations illustrative of real life. The scores on the items are often combined into the three main sections or into 10 pragmatic subscales. We report here a factor analysis of the SSQ that we conducted to further investigate its statistical properties and to determine its structure.

DESIGN

Statistical factor analysis of questionnaire data, using parallel analysis to determine the number of factors to retain, oblique rotation of factors, and a bootstrap method to estimate the confidence intervals.

STUDY SAMPLE

1220 people who have attended MRC IHR over the last decade.

RESULTS

We found three clear factors, essentially corresponding to the three main sections of the SSQ. They are termed "speech understanding", "spatial perception", and "clarity, separation, and identification". Thirty-five of the SSQ questions were included in the three factors. There was partial evidence for a fourth factor, "effort and concentration", representing two more questions.

CONCLUSIONS

These results aid in the interpretation and application of the SSQ and indicate potential methods for generating average scores.

Can audiometric results predict qualitative hearing improvements in bone-anchored hearing aid recipients?

Introduction:

Patients receiving a bone-anchored hearing aid have well-documented improvements in their quality of life and audiometric performance. However, the relationship between audiometric measurements and subjective improvement is not well understood.

Methods:

Adult patients enrolled in the Nova Scotia bone-anchored hearing aid programme were identified. The pure tone average for fitting the sound-field threshold, as well as the better and worse hearing ear bone conduction and air conduction levels, were collected pre-operatively. Recipients were asked to complete the Speech, Spatial and Qualities of Hearing questionnaire; their partners were asked to complete a pre- and post-bone anchored hearing aid fitting Hearing Handicap Inventory for Adults questionnaire.

Results:

Forty-eight patients who completed and returned the Speech, Spatial and Qualities of Hearing questionnaire had partners who completed the Hearing Handicap Inventory for Adults questionnaire. The results from the Speech, Spatial and Qualities of Hearing questionnaire correlated with the sound-field hearing threshold post-bone-anchored hearing aid fitting and the pure tone average of the better hearing ear bone conduction (total Speech, Spatial and Qualities of Hearing Scale to the pre-operative better hearing ear air curve (r = 0.3); worse hearing ear air curve (r = 0.27); post-operative, bone-anchored hearing aid-aided sound-field thresholds (r = 0.35)). An improvement in sound-field threshold correlated only with spatial abilities. In the Hearing Handicap Inventory for Adults questionnaire, there was no correlation between the subjective evaluation of each patient and their partner.

Conclusion:

The subjective impressions of hearing aid recipients with regards to speech reception and the spatial qualities of hearing correlate well with pre-operative audiometric results. However, the overall magnitude of sound-field improvement predicts an improvement of spatial perception, but not other aspects of hearing, resulting in hearing aid recipients having strongly disparate subjective impressions when compared to those of their partners.

Bone-Anchored Hearing Devices in Children with Unilateral Conductive Hearing Loss: A Patient-Carer Perspective

Objectives:

We sought to determine the outcome of implantation of a bone-anchored hearing device in children with unilateral conductive hearing loss.

Methods:

A retrospective case note analysis was used in a tertiary referral pediatric hospital to study 17 consecutive cases of pediatric patients with unilateral conductive hearing loss who were fitted with a bone-anchored hearing device between 2005 and 2010.

Results:

The average age of the patients at the time of bone-anchored hearing device fitting was 10 years 6 months (range, 6 years 3 months to 16 years). Qualitative subjective outcome measures demonstrated benefit. The vast majority of patients reported improved social and physical functioning and improved quality of life. All 17 patients are currently using their bone-anchored hearing device on a daily basis after a follow-up of 6 months.

Conclusions:

This study has shown improved quality of life in children with unilateral hearing loss after implantation of their bone-anchored hearing device. There was a high degree of patient satisfaction and improvement in health status reported by children and/or carers. Bone-anchored hearing devices have an important role in the management of children with symptomatic unilateral hearing loss. Perhaps earlier consideration of a bone-anchored hearing device would be appropriate in selected cases.

Adult bone anchored hearing aid services in the United Kingdom: building a consensus for development

AIMS AND OBJECTIVES

In October 2009, a multi-disciplinary group of UK clinicians met to review issues relating to bone-anchored hearing-aid (BAHA) development. The aim was to help define a model for BAHA services and service development via a process of widespread consultation with UK BAHA professionals.

METHODS

A modified Delphi technique was used. Statements were proposed by the lead group and sent out for consultation. Those with ≥90% agreement were approved without further discussion. Statements with 50-89% agreement were discussed by the lead group to determine whether they should be included in the final document. Any statement with <50% agreement was removed without discussion. A second consultation was then made, and the process repeated. This led to a final set of consensus statements.

RESULTS

The final consensus comprises 33 statements validated by the modified Delphi process. All of these statements achieved >75% agreement, with only six statements having <90% agreement. When these statements were presented to the UK BAHA Professionals group at their annual conference there was 89% agreement from the group for the consensus statements to be accepted.

DISCUSSION

The levels of agreement for the final questionnaire show that the mandate for the consensus statements was exceptionally high. Implementation of the consensus is discussed, as are each of the key areas of the consensus, such as funding and minimum assessment standards.

Outcome of bone-anchored hearing aids for single-sided deafness: a prospective study

CONCLUSION

The bone-anchored hearing aid (BAHA) system can offer significant benefits to patients with single-sided deafness (SSD), primarily by lifting the head shadow effect.

OBJECTIVE

To evaluate the efficacy of BAHA for SSD by comparing pre- and postoperative speech, spatial and qualities of hearing scale (SSQ) scores.

METHODS

This was a prospective study conducted within a tertiary auditory implant department. The inclusion criteria were unilateral profound hearing loss with normal or mild high frequency hearing loss in the hearing ear (pure tone average better than or equal to 25 dBHL measured at 0.5, 1, 2 and 3 kHz) and subjective benefits reported by patients following a home trial with a BAHA Softband. Patients who met the above criteria and opted for surgery were asked to complete the SSQ questionnaire. The postoperative SSQ response was collected after at least 6 months of consistent BAHA usage.

RESULTS

This study included 25 adult patients (mean age at implantation 57.5 years). There was a statistically significant improvement in the average SSQ score in all three sections of the questionnaire with the use of the BAHA. Our patients experienced most marked benefits in speech hearing in challenging listening situations. All patients remain consistent users and there has been no explantation to date.

Functional benefit of the bone-anchored hearing aid with different auditory profiles: objective and subjective measures

OBJECTIVES

To examine sentence recognition and self-report outcomes in hearing-impaired persons with different auditory profiles and who were fitted unilaterally with a bone-anchored hearing aid.

STUDY-DESIGN

Prospective cohort study.

SETTING

Tertiary referral unit.

PATIENTS

Data were collected of six patients with single-sided deafness (SSD), seven with a mild to severe hearing loss at the bone-anchored hearing aid side and (near-)normal hearing at the other side and six with a severe bilateral hearing loss.

MAIN OUTCOME MEASUREMENTS

Sound field thresholds, and sentence recognition in noise (presented from different angles) with bone-anchored hearing aid, without bone-anchored hearing aid and with bone-anchored hearing aid and other ear occluded. In addition, the Speech, Spatial and Qualities of hearing scale and the Abbreviated Profile of Hearing Aid Benefit questionnaire were administered as self-report measures.

RESULTS

Patients with single-sided deafness listened mainly with their non-bone-anchored hearing aid ear, although the bone-anchored hearing aid lifted the head shadow effect. Patients with mild to severe hearing loss at the bone-anchored hearing aid side and (near-)normal hearing at the other side performed significantly differently in aided and unaided conditions and even regained limited binaural sensitivity with the device. The latter was also true for the patients with severe bilateral hearing loss. However, their hearing loss at the non-bone-anchored hearing aid side was too great to contribute to hearing and they listened predominantly with their bone-anchored hearing aid. Self-report outcomes provided useful information on hearing disability, although this information was not significantly differently for the 3 groups of patients.

CONCLUSIONS

The bone-anchored hearing aid enhanced performance in different hearing configurations, albeit to different extents.