Hearing performance benefits of a programmable power baha® sound processor with a directional microphone for patients with a mixed hearing loss

Exploring the impact of force direction and phase on bone conduction hearing with bone conduction actuator

A comprehensive understanding of the effects of bone conduction (BC) input force is essential for elucidating BC hearing mechanisms. However, this area remains underexplored due to the inherent difficulties in controlling input forces when BC transducers are anchored to the bone. In this study, the effects of both unilateral and bilateral BC input forces were investigated using a three-dimensional finite element (FE) model of the human head, which allows precise manipulation of input forces. For unilateral input, 16 distinct directions were created by combining eight in-plane vectors with two tilt angles based on the normal direction of the input force location, and the resulting promontory velocities were compared. Although the magnitude differences between input directions remained within 10 dB, anti-resonance shifts were observed between 1 and 3 kHz. In the bilateral case, phase differences of 0°, 90°, and 180° were applied between input forces at the right and left mastoid positions, and basilar membrane velocities were compared to examine the complex interactions between input forces. These findings provide deeper insights into the effects of input force direction and phase on BC hearing, advancing the understanding of BC hearing mechanisms.

Auditory and Speech Outcomes Following Transcutaneous Bone Conduction Hearing Implantation

OBJECTIVES

Implantable bone conduction hearing devices offer excellent auditory rehabilitation. Transcutaneous devices, which use an implanted magnet, are gaining popularity due to higher skin complications associated with traditional percutaneous devices. The CochlearTM Baha® Attract System (Cochlear Corporation, Sydney, Australia) is a transcutaneous device and is regarded as a passive transcutaneous implant. This study, encompassing children and adults, aims to evaluate audiological and speech outcomes, as well as postoperative complications after the implantation of the CochlearTM Baha® Attract System.

METHODS

This is a retrospective cohort analysis of patients who underwent the CochlearTM Baha® Attract procedure from January 2017 to December 2020. Demographics, pre-and postoperative hearing thresholds, speech discrimination testing, hearing-aided thresholds, and complications were assessed.

RESULTS

A total of 13 patients underwent the CochlearTM Baha® Attract surgery. The most common cause of implantation was microtia and aural atresia. Seven patients had mixed hearing loss (MHL), four had conductive hearing loss (CHL), and two patients had single-sided sensorineural deafness (SSD). A statistically significant improvement in hearing and speech understanding was observed with the device compared to preoperative unaided hearing (p-value = 0.00001). The overall mean for the gain at frequencies 0.5 to 4 kilohertz (kHz) was 31 decibels (dB). On average, speech discrimination scores improved by 36% after surgery. Postoperative wound healing and skin condition remained stable, with no major soft tissue-related complications. A patient developed a skin reaction at the implant site and was treated conservatively. All patients were satisfied and maintained device usage.

CONCLUSIONS

The CochlearTM Baha® Attract System, classified as a passive transcutaneous bone conduction hearing implant, provides excellent auditory outcomes in patients with conductive, mixed, or single-sided sensorineural hearing loss, with minimal soft tissue complications in both children and adults. More research is necessary to directly compare passive and active transcutaneous bone conduction devices.

Speech understanding in noise for cochlear implant recipients using a spatial noise reduction setting in an off the ear sound processor with directional microphones

PURPOSE

Cochlear implant (CI) recipients struggle to hear in competing background noise. ForwardFocus is a spatial noise reduction setting from Cochlear Ltd. (Sydney) that can simultaneously attenuate noise from multiple sources behind the listener. This study assessed hearing performance with ForwardFocus in an off-the-ear (OTE) sound processor.

METHOD

Twenty-two experienced adult CI recipients participated. Speech reception data was collected in fixed noise acutely in the clinic. After three to five weeks take home experience, subjective impressions were recorded, and evaluations were conducted for speech reception in quiet and roving noise.

RESULTS

Group mean speech reception thresholds (SRT) were below 0 dB in two spatially-separated noise test conditions when using ForwardFocus in the OTE sound processor. SRT were -8.5 dB (SD 2.9) in 4-talker babble roving in a rear hemi-field (S0Nrearhemi) and -3.9 dB (SD 3.3) in 12-talker babble presented laterally and behind (S0N3). Results in S0N3 were significantly better with ForwardFocus On (p = 0.0018). Subjective ratings with the OTE were comparable to, or better than, with their walk-in BTE or OTE sound processor.

CONCLUSIONS

ForwardFocus provides significant benefits for speech recognition in competing background noise in an OTE sound processor. These results support clinicians in counselling CI recipients on potential sound processor options to consider.

Efficacy of Auditory Implants for Patients With Conductive and Mixed Hearing Loss Depends on Implant Center

INTRODUCTION

Although from a technological point of view, progress is impressive, most implantable hearing devices for conductive or mixed hearing loss have a limited capacity. These devices all bypass the impaired middle ear; therefore, the desired amplification (gain) should be based on the cochlear hearing loss (component) only. The aim of the study is to review the literature with regard to accomplished gain with current implantable devices.

METHOD

Thirty-one articles could be included. Aided thresholds were compared with prescribed values, based on cochlear hearing loss (bone-conduction thresholds), according to the well-validated NAL rule.

RESULTS

For the majority of the studies, NAL targets were not met. Variation in accomplished gain between implant teams was unacceptably large, largely independent of the type of device that was used. NAL targets were best met at 2 kHz, with worse results at the other frequencies.

CONCLUSION

Large variations in reported results were found, which primarily depended on implant center. Based on the analyses, a pragmatic fitting procedure is proposed which should minimize the differences between implant centres.

Audiological outcome measures with the BONEBRIDGE transcutaneous bone conduction hearing implant: impact of noise, reverberation and signal processing features

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.

Hearing Rehabilitation Implementing a Transcutaneous Bone Conduction Device: Single-Center Experience

Bone conduction implants based on percutaneous abutment acoustic transmission have been implemented in patients with satisfactory outcomes. However, adverse soft tissue outcomes present a limitation. Transcutaneous bone conduction devices (t-BCDs) are an alternative that may mitigate these complications. A retrospective review was performed of patients who underwent implantation of a t-BCD from 2013 to 2017. Surgical outcomes were reviewed including wound complications, frequency of device use, patient concerns regarding the device, and reported patient satisfaction. A total of 37 patients were implanted with the bone-anchored hearing aids, BAHA Attract (Cochlear™ Baha® Implant System). Average follow-up time was 271.8 days. Postoperatively, 7 (18.9%) patients complained of soft tissue changes or issues with wound healing. Twelve (32.4%) patients requested adjustment of their devices. The t-BCD is an excellent option for hearing rehabilitation. Overall, the complication rate is low, patient satisfaction is high, and successful conversion from a percutaneous device is possible with minimal risk.

Comparison of Satisfaction Between Patients Using Percutaneous and Transcutaneous Bone Conduction Devices

BACKGROUND

Bone conduction devices are widely used to treat conductive and mixed hearing loss as well as single-sided deafness (SSD). A transcutaneous system was introduced recently with the clear advantage of fewer local reactions. Our goal was to evaluate and compare the satisfaction of patients with percutaneous and transcutaneous bone conduction devices.

METHODS

We divided a cohort of 72 patients into groups by type of hearing loss and their relation to the use of the percutaneous or transcutaneous system. The Glasgow Benefit Inventory (GBI) questionnaire, adapted for hearing aids, was employed to assess patient satisfaction, along with an additional questionnaire covering the general usefulness of the devices.

RESULTS

Overall median daily wearing time was 12 hours for the percutaneous and seven for the transcutaneous groups (p < 0.001). We found no correlation between the bone conduction level at any frequency and the GBI satisfaction score. The median total GBI score of the entire patient cohort was 30.1; median values for general, social support, and physical health subscales were 0, 37.5, and 16.7, respectively. People suffering from SSD had the lowest satisfaction rates, and these were significantly lower for the patients who used transcutaneous aids than for those with percutaneous devices (p = 0.033). Similarly, the percutaneous system brought more satisfaction to combined hearing loss patients than did the transcutaneous (p = 0.010).

CONCLUSION

Both types of bone conduction devices provide a safe and efficient way to improve hearing for candidates within correct indications. Our study revealed that patients wore the transcutaneous device less than they did the percutaneous. Satisfaction was the lowest among SSD patients who used the transcutaneous device; hence it is especially important to carry out preoperative counseling for such patients.

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.

Outcomes of Bone Anchored Hearing Aid Implant at Universiti Kebangsaan Malaysia Medical Centre (UKMMC)

The cross sectional study was conducted in Universiti Kebangsaan Malaysia Medical Center (UKMMC), Malaysia from August 2012 to December 2013. All patients implanted with in UKMMC from December 2001 until December 2012 was included. Glasgow Benefit Inventory (GBI) questionnaires and UKMMC questionnaires were used as part of the assessment tool. The GBI is a scoring which measures the change in health status produced by surgical interventions. UKMMC questionnaires was invented by our department to assess questions related to social and life style of patients and also the cosmetic perspective Baha implant and other daily related activities. The audiological assessment was assessed using hearing aid gain threshold. Complication with regards to skin reaction was graded using Holger Skin Classification. A total of 40 patients underwent Baha implant were recruited but only 35 patients fulfilled the criteria and included in this study for analysis. Age of patients ranged from 5 year old to 38 year old, with median of 13 years old. There were 22 patients (62.8%) were male and 13 patients (37.1%) were females. Almost all cases were canal atresia except one adult patient was a case of bilateral chronic discharging ear with chronic irritation with ear mould. Majority of patients 21 (60%) have hearing level of moderate to severe hearing loss (40-89 dB) and 14 patients (40%) have mild to moderate hearing loss (20-39 dB). The level of hearing was retested post operatively. All of the patients have improvement in their aided hearing with the range of 10-25 dBL which is statistically significant at p value of <0.05. The GBI was scored positively in all subscales. Majority of patients (91.4%) used BAHA more than 4 h per day and 88.6% agreed that BAHA is cosmetically acceptable. All patients experienced some form of skin irritation (Holger grade 1-2) however only 20% required surgical intervention. All our patients have range of 10-25 dB improvement of their aided hearing which is statistically significant at p value of <0.05. BAHA has been proven to show significant benefit in audiological improvement and quality of life.

Surgical, functional and audiological evaluation of new Baha(®) Attract system implantations

Bone-anchored hearing aids are well-established solutions for treatment of hearing-impaired patients. However, classical systems with percutaneous abutments have disadvantages concerning aesthetics, hygiene and adverse soft tissue reactions. The study aimed to evaluate surgical, functional and audiological results of a new Baha(®) Attract system, in which the sound processor is attached by magnetic force. Twenty patients implanted with a Baha(®) Attract system were divided into two groups: A-bilateral mixed and conductive hearing loss, B-single-sided deafness, and evaluated during a 6-month follow-up. Parameters analysed comprised: (1) surgery and wound healing, (2) postoperative functional results (GBI, APHAB and BAHU questionnaires), (3) audiological results (free field speech in noise audiometry in two situations: with signal from implant side and from contralateral side). Obtained results revealed: mean time of surgery-44 min, soft tissue reduction-30 %, bone polishing-20 %, haematoma-10 %. Functional results showed: GBI total score-29.6 points, APHAB global score mean gain-23.5 %, BAHU 'good or very good' score for: aesthetic-85 %, hygiene-100 %, ease of placing the processor-100 %, stability of attraction-75 %. Audiological results-mean gain for the two analysed situations: 32.9 % (group A-36.5 %, group B-27.5 %). To conclude, the data obtained prove the safety and effectiveness of the Baha(®) Attract system in patients with conductive and mixed hearing loss as well as in patients with single-sided deafness. Cosmetic aspects are highly acceptable and the idea of Attract itself is important for patients with limited manual dexterity.