Estimation of the benefit of bone-anchored hearing aids

Cartilage Conduction Hearing Aids for Severe Conduction Hearing Loss

OBJECTIVE

To assess the benefits of a new type of hearing aid using cartilage conduction (CC) in patients with severe conduction hearing loss and evaluate its potential for practical use.

STUDY DESIGN

Consecutive, prospective case series.

PATIENTS

Forty-one subjects (21 with bilateral aural atresia; 15 with unilateral aural atresia; and 5 others) participated in this study.

INTERVENTION

Fitting and gain adjustments of the CC hearing aids were performed to the ear(s) with conduction hearing loss.

MAIN OUTCOME MEASURES

The function gains were measured. Evaluation of the measurements of speech performance-intensity functions, speech recognition scores, tolerance of environmental noise, and subject questionnaires were also performed, and judged according to the "Guidelines for the evaluation of hearing aid fitting" established by the Japan Audiological Society.

RESULTS

The thresholds were significantly improved by CC hearing aids. The functional gains for CC hearing aids were nearly equivalent to that for their previously used hearing aids. The style of the transducer fixation and the type of aural atresia had no significant influence on the functional gains. Most of the assessment results were judged to be sufficient. Before the trial, bone conduction hearing aids had been used most frequently by bilateral aural atresia subjects. However, after the trial, most subjects continued to use CC hearing aids instead of reverting back to their original device. Overall, 39 subjects continued use of the CC hearing aids. No severe adverse effects were noted in the trial.

CONCLUSION

Cartilage conduction hearing aids could be an additional and beneficial option for severe conduction hearing loss from aural atresia.

[Epidemiological and demographic analysis of indications for Baha® surgery in Poland--multicenter study]

AIM OF THE STUDY

To collect and analyze epidemiological and demographical data of patients qualified for and implanted with the Baha® system in Poland.

MATERIAL AND METHOD

17 out of 28 otolaryngology departments performing Baha® implantation in Poland participated in the study. Up to date there were 286 patients registered in database. Data were obtained from the preoperative questionnaires including information such as age and gender, indications for the implantation, previous hearing aid use as well as data regarding the surgical technique.

RESULTS

The most frequent indication for the Baha® system was bilateral mixed hearing loss (51%), followed by SSD (18%), bilateral conductive hearing loss (17%), unilateral mixed (8%) and conductive (6%) hearing loss. In 11% of subjects hearing impairment was congenital versus 89% cases of acquired. The mean age was 44 years with the slight prevalence of women (52%). 63% of patients did not have previous experience with hearing aids. The most frequent surgical technique was classic dermatome single stage procedure performed under general anesthesia (65%).

CONCLUSIONS

Data gather in this multicentre research serve as a valuable source of information on qualifications for the Baha®, shows demographic spectrum of adult recipients in Poland. It also presents the preferences of surgical procedures. Outcomes of the study may constitute a reference for each centre participating in this research as well as for new centers starting the Baha® procedure.

[Audiological analysis and peri-and postoperative complications in bone-anchored hearing aid surgery]

The bone-anchored hearing aid (BAHA) has advantages over conventional hearing aids in sound quality and speech reception in silence, but requires surgery and may have peri-and postoperative complications. We evaluated audiological findings and complications in 12 subjects (13 ears)-8 men and 4 women aged 20-71--undergoing BAHA surgery from September 2001 to October 2005. Surgery was for single-sided deafness in one subject. Mean warble tone thresholds with BAHA were 29.9dB and 65.2dB without. Functional gains ranged from 16 to 52dB (mean: 35.3dB). Dural exposure or venous hemorrhage was seen in 4 ears, and mastoid cells opened and a skin flap was damaged in 1 ear each. No severe complications occurred perioperatively. Skin reactions categorized into grade 1 or more were recognized in nearly 70% of ears during the first postoperative year but most were a grade 1 reaction and skin reactions decreased with time. Skin overgrowth occurred in 1 ear immediately after an abutment separated accidentally from the fixture. All complications were treated in outpatient clinics. No fixture extrusion occurred. The decision to proceed with BAHA surgery thus required fully informed consent based on knowledge of peri-and postoperative complications.

Patient quality of life with bone-anchored hearing aid: 10-year experience in Glasgow, Scotland

OBJECTIVES

This study aimed to ascertain the usefulness of the bone-anchored hearing aid and its impact on the quality of life of patients fitted in Glasgow between 1996 and 2006.

METHOD

The Entific Medical Systems questionnaire and the Glasgow Benefit Inventory were posted to patients in order to assess their satisfaction and quality of life changes.

RESULTS

Sixty adult patients were identified, with a questionnaire response rate of 63 per cent. Thirty-two respondents (85 per cent) reported using their bone-anchored hearing aid for more than eight hours per day. Twenty-nine respondents (75 per cent) found their bone-anchored hearing aid to be generally better than their previous, conventional aid. Twenty-seven respondents (71 per cent) reported that their bone-anchored hearing aid improved their quality of life. The median total Glasgow Benefit Inventory score was +33.3.

CONCLUSIONS

Bone-anchored hearing aid usage rates and satisfaction levels were high amongst patients in Glasgow. Glasgow Benefit Inventory indices were comparable to published findings from other centres. Despite this, bone-anchored hearing aid funding is still not universally available within the National Health Service in Scotland.

Bone anchored hearing aids: a preliminary assessment of the impact on outpatients and cost when rehabilitating hearing in chronic suppurative otitis media

OBJECTIVES

To compare the difference in ENT and Audiology visits, treatments dispensed and potential savings pre- and post-bone anchored hearing aid (BAHA) insertion in patients with chronic suppurative otitis media exacerbated by behind the ear hearing aids.

DESIGN

A retrospective pilot study.

SETTING

District General Hospital.

PARTICIPANTS

All patients who had BAHA inserted from January 2001 to January 2006.

PARAMETERS

Age, gender, number of visits per month, treatments per month dispensed from the ENT and Audiology Departments and direct and limited indirect medical costs pre- and post-BAHA insertion.

RESULTS

Twelve of 26 (46%) adult patients had BAHA inserted over the 5-year period for CSOM. The male to female ratio was 1 : 3 with a median age of 61 (range 29-81). The number of visits and treatments dispensed per month in the ENT Department fell from a mean of 0.42-0.33 (P < 0.08) and 0.22-0.14 (P < 0.02) respectfully. When the difference in medical cost was taken into account BAHA offered a potential saving of pound 627.80 per patient.

CONCLUSION

Although the initial acquisition of surgical equipment and BAHA sound processors is expensive, there is a reduction in the number of treatments and visits required for patients with chronic suppurative otitis media after BAHA is inserted leading to a reduction in average costs.

Comparison of the audiologic results obtained with the bone-anchored hearing aid attached to the headband, the testband, and to the "snap" abutment

OBJECTIVES

1) To quantify the audiometric differences between the preoperative tests with the Bone-Anchored Hearing Aid (BAHA) attached to the headband or the testband and the final postoperative result with the BAHA positioned at the implanted abutment. 2) To compare the results obtained with the headband and the testband. 3) To quantify the magnitude of the damping through the skin for the BAHA placed at the testband (important for comparison with the implantable hearing aids).

STUDY DESIGN

Prospective.

SETTING

Tertiary otological referral centre.

PATIENTS

Ten adult (> or = 14 yr old) BAHA patients (6 male and 4 female subjects) with bilateral air-bone gaps of minimum 40-dB hearing loss and with more than 6 months of BAHA experience with the BAHA "Compact."

METHODS

Audiometric free-field thresholds and speech audiometry scores (Consonant-Vowel-Consonant lists, phonemic score) have been evaluated for 3 conditions: BAHA attached to the implanted "Snap" abutment, to the headband, or to the testband.

RESULTS

For frequencies 1 to 4 kHz, significant differences in the range of 5 to 20 dB were found between the BAHA coupled with the Snap abutment and the preoperative testing conditions with the BAHA positioned at the headband or the testband. These differences were also reflected in the speech audiometry with a difference in speech reception threshold of approximately 4 to 7 dB.

CONCLUSION

1) Significant differences in the audiometric thresholds and the speech understanding scores were found between the preoperative test conditions and the final postoperative result. 2) Audiometric results obtained with the headband and the testband are comparable; therefore, the more comfortable headband is also suitable for the preoperative audiologic evaluation. 3) The magnitude of the skin damping must be accounted for when referring to the audiometric results obtained with the BAHA attached to the testband or headband.

A Systematic Review of the Nonacoustic Benefits of Bone-Anchored Hearing Aids

OBJECTIVE

This study completed an evidence-based practice systematic review of the nonacoustic benefits for adult patients receiving bone-anchored hearing aid(s) (BAHAs) relative to other forms of amplification (i.e., none, bone-conduction hearing aids [BCHAs], or air-conduction hearing aids [ACHAs]).

DESIGN

Systematic review.

METHODS

ComDisDome and PubMed were used to perform a comprehensive search for studies that were of at least level III of evidence. Three independent reviewers completed the search, quality assessment, and data extraction.

RESULTS

Out of 28 studies, seven studies were identified, three of which were prospective and four of which were retrospective within-subject comparison designs. Nearly all of the studies were of small sample size and/or limited methodological quality, primarily because of logistics (e.g., heterogeneity of subject samples and prior experience with amplification).

CONCLUSIONS

The evidence identified in this review is limited regarding the nonacoustic benefits of BAHAs compared with unaided conditions or other types of amplification. Professionals should use caution when counseling patients about the quality of life (QOL) benefits of these devices. Routine use of QOL outcome measures and standardized methods for reporting findings are critical in demonstrating the nonacoustic benefits of BAHAs.

Long-term Results of Bone-Anchored Hearing Aid Recipients Who Had Previously Used Air-Conduction Hearing Aids

OBJECTIVE

To study the long-term results (use, care, satisfaction, ear infections, and audiometry) of the application of a bone-anchored hearing aid (BAHA) to patients with conventional indications who had previously used air-conduction hearing aids.

DESIGN

Follow-up study (mean duration, 9 years).

SETTING

Tertiary referral center.

PATIENTS

The study population comprised 27 patients with conductive or mixed hearing loss and who had participated in a previous study (N = 34). Seven could not be included anymore as a result of death, Alzheimer disease, or problems related to the implant. Everyone filled out the questionnaire, and 23 patients underwent audiometric evaluation.

MAIN OUTCOME MEASURES

The patients filled out the adapted Nijmegen questionnaire. Aided free-field thresholds were measured as well as scores for speech in noise and in quiet. Results were compared with those obtained in the initial study.

RESULTS

All 27 patients were still using their BAHA and appreciated it with regard to speech recognition in quiet, sound comfort, and improvements in ear infections. The audiometric results showed that most patients tested had stable bone-conduction thresholds over the years (after correction for age). Despite the treatment with BAHA, a significant deterioration in the cochlear hearing was observed in the other patients in the ear under study (their best hearing ear).

CONCLUSIONS

Positive patient outcome measures emphasized the importance of BAHA application to patients with conventional indications. The audiometric data showed fairly stable cochlear function but not for all patients. This underlines that conservative treatment should be chosen (fitting of bone-conduction devices).

Early amplification options

Children with permanent hearing loss have been remediated with hearing amplification devices for decades. The influx of young infants identified with hearing loss through successful newborn hearing screening programs has established a need for amplification resources for infants within the first six months of life. For the approximately two of every 1000 infants born who are identified with bilateral hearing loss [Mehl and Thomson, 1998, Pediatrics 101, p. e4], the use of amplification is commonly the first step in treating the sequella of their loss. The use of hearing aids, combined with early intervention, has been shown to significantly improve the speech and language skills of young children with hearing loss [Yoshinaga-Itano, 2000, Seminars in Hearing 21, p. 309]. Speech and language delays have contributed to compromised academic performance of school aged children with hearing loss [Johnson et al., 1997, Educational Audiology Handbook, Singular Publishing, San Diego]. Most hard-of-hearing and deaf children use hearing aids and other assistive listening devices every day throughout their lifetime and the life expectancy of a hearing aid is only five to eight years. The current challenge for pediatric audiologists is selecting and evaluating the available amplification to provide the best options for children and their families. Amplification technology has seen an explosion in growth the past few years and the options continue to expand rapidly. This article examines currently available amplification technology and reviews the selection criteria that may be used for infants and young children. Issues such as style, type, amplification features, signal processing strategies, and verification and validation tools are also discussed.

Bone-Anchored Hearing Aid: Comparison of Benefit by Patient Subgroups

OBJECTIVES/HYPOTHESIS

The osseointegrated bone-anchored hearing aid, using the Branemark system, is well established and has proven benefit. The aim was to study quality of life benefits within patient subgroups using the validated Glasgow Benefit Inventory (GBI).

STUDY DESIGN

Retrospective questionnaire study.

METHODS

Ninety-four consecutive patients were enrolled into the study. Mean patient age was 49 years, with a female-to-male ratio of 1.1:1. Patient subgroups were discharging mastoid cavities, chronic active otitis media, congenital ear problems, otosclerosis, and acoustic neuroma and other unilateral hearing losses.

RESULTS

The response rate was 73%. The score for total benefit of bone-anchored hearing aid fitting for the entire group was +33.3 (95% confidence interval [CI], 25-42). Glasgow Benefit Inventory scores for each subgroup were all greater than +20. The congenital atresia group scored highest with +45 (95% CI, 28-61). Variation in benefit across the subgroups has been demonstrated. Fitting of BAHA following acoustic neuroma surgery was shown to be of benefit with a score of +22.2. General benefits scored highest in all subgroups compared with physical and social benefits.

CONCLUSION

The study demonstrated the differences in benefit within patient subgroups. Its results can be used to give patients a predictive value at the time of preoperative counseling. The study identified congenital ear disorders as the group likely to obtain maximal benefit. Notably, for the first time, the study demonstrated the documented benefit of restoring stereo hearing to patients who have acquired unilateral hearing loss following acoustic neuroma surgery using a BAHA.

A comparison of the audiometric performance of bone anchored hearing aids and air conduction hearing aids

OBJECTIVE

To compare the function of bone anchored hearing aids (BAHA) with conventional air conduction hearing aids (ACHA) by means of objective audiometric tests focusing on temporal acuity and consonant discrimination in quiet and noise, as well as subjective quality-of-life questionnaires.

SETTING

Tertiary referral center.

STUDY DESIGN

Prospective.

SUBJECTS

Patients using BAHAs because of profuse drainage from chronic suppurative otitis media, and a comparison group of healthy volunteers.

MAIN OUTCOME MEASURES

Objective measures: sound field audiograms, duration discrimination, gap discrimination, and final and initial consonant discrimination in quiet and in noise. Subjective measures: Sanders' Profiles, MOS SF-36 questionnaire.

RESULTS

Normal-hearing subjects always performed better than hearing-impaired patients in all tests. When the BAHA was compared with the ACHA, there were no significant differences in any of the measures.

CONCLUSIONS

The BAHA and the ACHA provided similar audiometric functioning in audiometric tests. The BAHA, although using a nonphysiologic sound conduction route, did not sacrifice temporal processing ability or speech perception in noise, and should be considered for patients with profuse ear drainage.

Bone-anchored hearing aid quality of life assessed by Glasgow Benefit Inventory

OBJECTIVE/HYPOTHESIS

The bone-anchored hearing aid (BAHA) is a well established mode of treatment and many studies show the audiological benefit, but none has assessed the benefit to the quality of life of patients. This study uses the validated Glasgow Benefit Inventory to quantify the changes in quality of life.

STUDY DESIGN

Retrospective questionnaire study.

METHODS

Sixty consecutive patients receiving treatment with BAHA were enrolled in the study. The male/female ratio was 1.26 to 1; mean patient age was 45 years. The most common indication was hearing loss secondary to mastoid disease and surgery followed by congenital atresia and chronic discharge from the ear.

RESULTS

The response rate was 85%, which is high and adds weight to the results. The general benefit score was +34 (range, +27-+48), which is comparable to middle ear surgery but just below benefit from cochlear implantation. The social benefit was +21 (range, +12-+37) with only +10 (range, +2-+26) for the physical score. This pattern mirrors that reported for other ear interventions. Maximum benefit was noted in patients with congenital atresias followed by discharging mastoid cavities.

CONCLUSION

This study is the first to demonstrate significant quality of life benefit from BAHA surgical intervention as measured by the Glasgow Benefit Inventory.

The bone-anchored hearing aid: a solution for previously unresolved otologic problems

A major challenge for otologists treating middle ear infection is to obtain a dry ear and optimal hearing. If the patient needs amplification and uses an air conduction hearing aid, the ear mold, occluding the ear canal, may provoke or aggravate the infection in the middle ear and thus cause otorrhoea. Continuous otorrhoea may cause cochlear damage in the long run. Bone conduction hearing aids offer an alternative for such patients.

Diagnosis and management strategies in congenital atresia of the external auditory canal. Study Group on Otological Malformations and Hearing Impairment

This consensus report represents a distillation of current opinion regarding diagnosis and management of congenital aural atresia. It also takes into account the philosophical differences which exist in Europe. Congenital aural atresia requires prompt diagnosis, genetic counselling and an early assessment of hearing. In bilateral atresia, early amplification with a bone conduction hearing aid is essential for proper speech development. Further rehabilitation in bilateral cases is managed with surgical reconstruction in selected patients or by implantation of a bone-anchored hearing aid. Atresia repair surgery is worthwhile if proper patient selection is made by use of stringent audiological and radiological criteria and state of the art surgery is performed. The divergent views concerning indications, ideal age for surgery and surgical approach to achieve better hearing are discussed. Review of the literature demonstrated that even in the hands of the best surgeons a mean hearing gain of only 20-25 dB is achieved in atresia Type II, with 30-35 dB in Type I. Therefore, surgical reconstruction should only be done in the more favourable cases where post-operative hearing of <25-30 dB is attainable. Less favoured patients should be helped with bone-anchored hearing aids, as this type of surgery does not interfere with the future use of new techniques.

The BAHA HC200/300 in comparison with conventional bone conduction hearing aids

A retrospective study was performed on 89 patients from a consecutive series who received a BAHA HC200/300 after having previously used conventional bone conduction hearing aids. The patients' performance with the BAHA HC 200/300 was compared to their performance with conventional bone conduction hearing aids. The patients were divided into two groups, depending on the time of implantation (before or after May 1992). The patients in group 1 (long-term users) were asked to fill in a questionnaire, the same one as they had filled in at the initial BAHA fitting more than 5 years previously. The answers were compared to their original opinions and difference scores were calculated. The long-term clinical results from group 1 are also presented. Although they are encouraging, the patients' opinion about the BAHA deteriorated somewhat over time. The audiometric results of group 2 were highly comparable with those of group 1. This confirms the positive results with the BAHA found in previous studies.

Reported benefits and problems experienced with bone-anchored hearing aids

Within this study we have examined the self-reported benefits and shortcomings experienced by patients fitted with bone-anchored hearing aids using an open-ended approach developed for hearing aid users. Reports were obtained from 39 patients who, between them, listed 165 benefits and 105 shortcomings. Benefits and shortcomings could be sub-divided into four main groups: practical, acoustical, psychological and medical, in that order of frequency. The most commonly reported benefits included hearing better and clearer, ease of use, inconspicuousness, and the fact that it made the individual more confident. The main shortcomings were difficulties with the telephone, wind noise and hearing speech in noise.

The bone anchored hearing aid (BAHA) in chronic suppurative otitis media (CSOM)

Bone anchored hearing aids are gaining wide acceptability in the treatment of patients with congenital ear problems, chronic suppurative otitis media (CSOM) and in some cases otosclerosis. To date little information on the effect of the bone anchored hearing aid on the symptoms of chronic suppurative otitis is available. This retrospective study based on notes review and telephone interviews was to assess the outcome of bone anchored hearing aid surgery in patients with CSOM in terms of: ear discharge; surgical techniques and complications; the number of hours the aid is worn compared with the previous aid. One hundred and forty-two patients were fitted with bone anchored hearing aids without additional prostheses in Birmingham between 1989 and 1995. Sixty-nine (48.5 per cent) of these were for chronic suppurative otitis media, 45 of these were female and 24 were male with a mean age of 58 years. Most (85 per cent) had undergone previous ear surgery with 65 per cent having mastoid surgery. Ninety-eight per cent of this patient group had undergone single stage surgery and 65 per cent under local anaesthetic as a day case. A variety of techniques for soft tissue reduction were employed. The mean follow-up time for these patients was 24 months (range one month to seven years). No patients experienced worse discharge following their BAHA and 84 per cent had significantly reduced discharge, 16 per cent had no change. Complications included skin reactions, 15; failure to integrate, one; late loss of fixture, three. Seventy-three per cent wore their bone anchored hearing aid more than eight hours per day and 58 per cent were more satisfied with their bone anchored hearing aid than their previous aid.

Paired comparisons between the Classic 300 bone-anchored and conventional bone-conduction hearing aids in terms of sound quality and speech intelligibility

Fourteen experienced users of bone-anchored hearing aids conducted paired comparisons of sound quality and speech intelligibility for 6 and 4 different stimuli respectively in the Classic 300 and a bone-conduction hearing aid with a steel clip. Ten paired comparisons were made for each stimulus. The patient selected the best hearing aid and rated the chosen hearing aid on a scale of 'somewhat better', 'better' and 'much better'. The Classic 300 obtained a positive assessment in terms of sound quality and speech intelligibility far more frequently. All the patients chose the Classic 300 as the best hearing aid when they assessed the sound quality of the classical music stimulus.