Bone-anchored hearing aids in unilateral inner ear deafness: an evaluation of audiometric and patient outcome measurements.

OBJECTIVE: To evaluate the benefit of a bone-anchored hearing aid contralateral routing of sound hearing aid (BAHA CROS hearing aid) in 29 patients with unilateral inner ear deafness. STUDY DESIGN: Prospective clinical follow-up study. SETTING: Tertiary referral center. PATIENTS: Thirty patients were recruited. There were 19 patients with a history of acoustic neuroma surgery and 11 patients with unilateral inner ear deafness due to other causes; 1 patient was excluded. The first 21 patients had also participated in a previous evaluation. INTERVENTION: Audiometric measurements were taken before intervention, when fitted with a conventional CROS, and after BAHA implementation. Patients' subjective benefit was quantified with four different hearing aid-specific instruments: the Abbreviated Profile of Hearing Aid Benefit, the Glasgow Hearing Aid Benefit Profile, the International Outcome Inventory for Hearing Aids, and the Single-Sided Deafness questionnaire. MAIN OUTCOME MEASURES: The same instruments were used at a mean long-term follow-up of 1 year after BAHA implantation. RESULTS: Sound localization in an audiologic test setting was no different from chance level. The main effect of the BAHA CROS that was found was the "lift the head shadow" effect in the speech-in-noise measurements. All instruments also showed positive results in favor of the BAHA CROS at long-term follow-up. CONCLUSIONS: The poor sound-localization results in an audiologic test setting illustrated the inability of patients with unilateral inner ear deafness to localize sounds. The speech-in-noise measurements demonstrated the efficacy of the BAHA CROS to lift the head shadow. Patients were still satisfied at 1-year follow-up, according to the four instruments.     

Subjective measures of hearing aid benefit and satisfaction in the NIDCD/VA follow-up study

Perceived benefit, satisfaction, and hearing aid use patterns were measured in a follow-up study to a large-scale multi-site clinical trial conducted in 1996-97. Measures included the Hearing Aid Status Questionnaire, the Profile of Hearing Aid Benefit, the Glasgow Hearing Aid Benefit Profile, the Satisfaction with Amplification in Daily Life, and the International Outcome Inventory for Hearing Aids. On the Profile of Hearing Aid Benefit, hearing aid users indicated more unaided difficulty in easy listening situations and less aided benefit in more difficult listening situations compared to the original study. Subjects who no longer used hearing aids indicated less difficulty in unaided situations. All measures indicated significant long-term subjective benefit and satisfaction with hearing aids. Although understanding speech in noise or in group situations continues to be problematic, subjects reported wearing their hearing aids almost all of the time in both easy and difficult listening situations.     

The benefits of using bluetooth accessories with hearing aids

Abstract

Objective: To investigate the benefits in reported outcomes after providing bluetooth accessories for established hearing aid users. Design: Prospective observational study using validated quantitative outcome measures and detailed patient narrative before and two months after patients were provided with bluetooth accessories. Study sample: Twelve patients with bilateral NHS hearing aids participated. They had a wide range of ages and hearing loss. Results: After two months, 10 patients reported substantial additional benefit and kept the accessories; two returned them for various reasons. Statistically significant changes were seen in two validated outcome measures: the Glasgow Hearing Aid Benefit Profile and the International Outcome Inventory – Hearing Aids, but not in the Speech, Spatial and Qualities of Hearing Scale. Two notable benefits were reported: some described hearing the emotion and mood in a voice for the first time; others were amazed to report an improved ability to hear film or to hold conversations over the telephone. Conclusions: The provision of bluetooth accessories can give additional reported benefit for some patients – we need better knowledge about who benefits, and whether further support/training to individuals would make a difference.     

Bone-anchored Hearing Aids in Unilateral Inner Ear Deafness

In nine patients with unilateral deafness and normal hearing in the contralateral ear, measurements of sound localization and speech perception were obtained before intervention, with a conventional contralateral routing of sound (CROS) hearing aid and later with a bone-anchored hearing aid (BAHA) implanted in the deaf ear. Sound localization did not show any differences between the three conditions. Speech perception using short, everyday sentences showed a reduction in the head-shadow effect of 2 dB for both the conventional CROS hearing aid and the BAHA in comparison to the unaided condition. Patients' real-life experiences of the three conditions were evaluated using the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire. The results showed a significant benefit with the BAHA in situations involving background noise and reverberation and a reduced aversion to loud sounds in comparison to the unaided and conventional CROS conditions.     

Bone-anchored hearing aids in unilateral inner ear deafness

In nine patients with unilateral deafness and normal hearing in the contralateral ear, measurements of sound localization and speech perception were obtained before intervention, with a conventional contralateral routing of sound (CROS) hearing aid and later with a bone-anchored hearing aid (BAHA) implanted in the deaf ear. Sound localization did not show any differences between the three conditions. Speech perception using short, everyday sentences showed a reduction in the head-shadow effect of 2 dB for both the conventional CROS hearing aid and the BAHA in comparison to the unaided condition. Patients' real-life experiences of the three conditions were evaluated using the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire. The results showed a significant benefit with the BAHA in situations involving background noise and reverberation and a reduced aversion to loud sounds in comparison to the unaided and conventional CROS conditions.     

Relative benefits of linear analogue and advanced digital hearing aids

Speech recognition performance and self-reported benefit from linear analogue and advanced (digital) hearing aids were compared in 100 first-time hearing aid users with mild-to-moderate sensorineural hearing loss fitted monaurally with a behind-the-ear (BTE) hearing aid in a single-blind randomized crossover trial. Subjects used each aid for 5 weeks in turn, with aid order balanced across subjects. Three alternative models of digital hearing aid were assigned to subjects according to a balanced design. Aid type was disguised to keep subjects blind within practical limitations. Aided speech recognition performance in noise was measured at speech levels of 65 and 75dB at a speech-to-noise ratio (SNR) of +2dB for closed sets of single words. Self-rated benefit was measured using the Abbreviated Profile of Hearing Aid Benefit (APHAB) and the Glasgow Hearing Aid Benefit Profile (GHABP). Quality of life, hearing aid use and user preferences were also assessed. Speech recognition scores with the digital aids were significantly better at 75dB than with the analogue aids Self-reported benefit (APHAB, GHABP) and improvement in quality of life were generally not significantly different between analogue and digital aids, although aversiveness measured with the APHAB was significantly lower with digital aids, and satisfaction measured with the GHABP was greater. The digital aids were preferred significantly more often than the analogue aids, with 61 subjects choosing their digital aid, 26 choosing the analogue aid, and nine being equivocal. Overall, this study shows advantages for advanced digital over simple linear analogue aids in terms of both objective and subjective outcomes, although average differences are not large.     

Relative benefits of linear analogue and advanced digital hearing aids

Speech recognition performance and self-reported benefitfrom linear analogue and advanced (digital) hearing aidswere compared in 100 first-time hearing aid users withmild-to-moderate sensorineural hearing loss fitted monaurally with a behind-the-ear (BTE) hearing aid in a single-blind randomized crossover trial. Subjects usedeach aid for 5 weeks in turn, with aid order balancedacross subjects. Three alternative models of digital hearing aid were assigned to subjects according to a balanceddesign. Aid type was disguised to keep subjects blind within practical limitations. Aided speech recognition performance in noise was measured at speech levels of 65 and 75 dB at a speech-to-noise ratio (SNR) of _2 dB forclosed sets of single words. Self-rated benefit was measured using the Abbreviated Profile of Hearing Aid Benefit (APHAB) and the Glasgow Hearing Aid Benefit Profile (GHABP). Quality of life, hearing aid use and user preferences were also assessed. Speech recognition scores with the digital aids were significantly better at 75 dB than with the analogue aids. Self-reported benefit (APHAB, GHABP) and improvement in quality of life were generally not significantly different between analogue and digital aids, although aversiveness measured with the APHAB was significantly lower with digital aids,and satisfaction measured with the GHABP was greater. The digital aids were preferred significantly more often than the analogue aids, with 61 subjects choosing their digital aid, 26 choosing the analogue aid, and nine being equivocal. Overall, this study shows advantages for advanced digital over simple linear analogue aids interms of both objective and subjective outcomes, although average differences are not large.     

Bone-anchored hearing aid in unilateral inner ear deafness: a study of 20 patients

OBJECTIVE: To evaluate the benefit of a bone-anchored hearing aid (BAHA) contralateral routing of sound (CROS) in 20 patients with unilateral inner ear deafness. SUBJECTS: 21 patients were recruited; 15 had undergone acoustic neuroma surgery and 6 patients had unilateral profound hearing loss due to other causes; 1 patient was excluded. Only patients with thresholds of better than 25 dB HL (500-2000 Hz) and an air-bone gap of less than 10 dB in the best ear were included. METHODS: Evaluation involved audiometric measurements before intervention, when fitted with a conventional CROS and after implementation and quantification of the patients' subjective benefit with a hearing aid-specific instrument: the Abbreviated Profile of Hearing Aid Benefit (APHAB). RESULTS: Lateralization scores were not significantly different from chance (50%) in any of the three conditions. Measurements of speech perception in noise showed an increase in the signal to noise ratio (S/N ratio) with the conventional CROS (p = 0.001) and with the BAHA CROS compared to the unaided condition when speech was presented at the front with noise on the poor hearing side. On the other hand, a lower S/N ratio was seen with the BAHA CROS (p = 0.003) compared to the unaided situation when noise was presented at the front with speech on the poor hearing side. The patient outcome measure (APHAB) showed improvement, particularly with the BAHA CROS. CONCLUSIONS: The poor sound localization results illustrate the inability of patients with unilateral inner ear deafness to localize sounds. The speech-in-noise measurements reflect the benefit of a BAHA CROS in lifting the head shadow while avoiding some of the disadvantages of a conventional CROS. The benefit of the BAHA CROS was most clearly reflected in the patients' opinion measured with the APHAB.     

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.     

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

Clin. Otolaryngol. 2011, 36 , 114–120 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.     

Patient's quality of life and hearing outcomes after stapes surgery

Objectives: To determine the quality of life (QOL) after stapes surgery and whether audiological parameters for hearing correlate with specific QOL factors. Design: A retrospective cross‐sectional study. Setting: A tertiary referral centre. Participants: A series of 35 patients who underwent stapes surgery of which three were excluded because they were <18 years of age, chronically or mentally ill, or in a dependant relationship. Response rate was 93% (30/32). Nine were further excluded because they had revision or bilateral surgery, or missing data. Twenty‐one patients were included in this study. Main outcome measures: The Glasgow Benefit Inventory (GBI) was used to evaluate general QOL and the Hearing Disability and Handicap Scale (HDHS) was used as a disease‐specific measure. The Belfast Rule of Thumb and Glasgow Benefit Plot assessed hearing outcomes. Results: Operative success was 86% using the Belfast Rule of Thumb and 95% had closure of the air–bone gap to within 20 dB. 81.8% of patients reported a better overall QOL as surgery. Glasgow Benefit Inventory Social and GBI Physical scores correlated positively with the HDHS speech component (P < 0.05). The duration of hearing loss correlated inversely with the average HDHS score (P < 0.05). Conclusion: The majority of patients report a better QOL as undergoing stapes surgery. Speech impacts on people's physical and social QOL of patients. Quality of life tools, in addition to objective audiologic measurements can provide clinicians with patients’ subjective perspective that helps guide clinical decision‐making and counselling.     

Good speech recognition and quality-of-life scores after cochlear implantation in patients with DFNA9.

OBJECTIVE: To compare audiometric and quality-of-life results in DFNA 9 patients who received a cochlear implant with cochlear implant patients with adult-onset progressive sensorineural hearing loss. STUDY DESIGN: Prospective comparative design; results were collected cross-sectionally. SETTING: Tertiary referral center. PATIENTS: Eleven DFNA 9 patients were included in the study as well as a comparative group of 39 post-lingually deafened cochlear implant subjects with adult-onset progressive sensorineural hearing loss. INTERVENTIONS: All patients received a cochlear implant. Subjects were implanted with either the Nucleus 24 M/RCS or Med-el Combi 40+ cochlear implant systems implementing the SPEAK, ACE, or CIS+ coding strategies. MEAN OUTCOME MEASURES: Speech recognition was determined by means of phonetically balanced monosyllabic word lists. The Hearing Handicap Inventory for Adults, the Glasgow Benefit Inventory, and the Scale for the Prediction of Hearing Disability in Sensorineural Hearing Loss were used to quantify the quality of life. RESULTS: The results show that the speech perception and the quality of life of the DFNA 9 patients do not differ significantly from the control group (p=0.179; p=0.56). CONCLUSION: In spite of the fact that DFNA 9 is a disease that is known to involve cochlear dendrites, cochlear implantation is a good option for treatment of deafness in DFNA 9.     

Expanding the indications for the bone anchored hearing system (BAHS) in patients with single sided deafness

PurposeProvide data to support expansion of FDA indications for the Bone anchored hearing system (BAHS).Materials and methodsThis retrospective study in a tertiary otologic referral center included106 consecutive subjects who were implanted with a Bone Anchored Hearing System (BAHS) between January 2009 and January 2015 for single sided deafness. Subjects were divided into three groups by bone conduction pure tone average (PTA) of the better hearing ear: 0–20 dB (group 1), 21–40 dB (group 2) and 41–55 dB (group 3). All patients underwent BAHS implantation. Speech perception data (Hearing In Noise Test and Consonant-Nucleus-Consonant testing) was collected before and after surgical intervention. Patient-reported quality of life measures were obtained at least 6 months after activation. These included the Abbreviated Profile of Hearing Aid Benefit and Glasgow Benefit Inventory.ResultsAll three groups of subjects demonstrated statistically significant improvement in outcome measures following BAHS. Subject reported quality of life outcome measures demonstrated significant improvement in disability from hearing loss and in quality of life.ConclusionsPatients with single sided deafness who have bone conduction thresholds worse than 20 dB in their contralateral ear are still able to benefit significantly from BAHS.     

Einseitige Taubheit und Cochlear-implant-Versorgung

Cochlear implantation (CI) is a new form of treatment in the rehabilitation of single-sided deafness. The patient requires thorough initial examination and a full explanation of alternative treatment options prior to determining the indication for CI treatment. To date, we have treated 28 patients with CI, of whom data are available for 11 after 12 months. We examined speech comprehension in background noise and localisation ability 12 months after CI implantation compared to conventional CROS (contralateral routing of signal) hearing aids, BAHA (bone-anchored hearing aid) and hearing in untreated patients. In addition, we determined the subjective handicap (HHIE, hearing handicap inventory for the elderly) and the subjective success (IOI-HA, international outcome inventory for hearing aids; SSQ, spatial and qualities of hearing scale) of each treatment option. After 12 months' experience, the results show a significantly better localisation ability and an improvement in speech comprehension in background noise with CI than with the other treatment options. Subjective results also show a clear benefit with CI. Careful patient selection is a decisive factor for successful treatment of this patient group. Under these conditions, CI is a treatment option with which significant improvement in speech comprehension and localization ability in single-sided deafness is possible.     

Speech understanding in quiet and noise,with and without hearing aids

Speech recognition and cognitive functions important for speech understanding were evaluated by objective measures and by scores of perceived effort, with and without hearing aids. The tests were performed in silence, and with background conditions of speech spectrum random noise and ordinary speech. One young and one elderly group of twelve hearing-impaired subjects each participated. Hearing aid use improved speech recognition in silence (7 dB) and in the condition with speech as background (2.5 dB S/N), but did not change the perceived effort scores. In the cognitive tests no hearing aid benefit was seen in objective measures, while there was an effect of hearing aid use in scores of perceived effort, subjects reported less effort. There were no age effects on hearing aid benefit. In conclusion, hearing aid use may result in reduced effort in listening tasks that is not associated with improvement in objective scores.     

Gebrauchsnutzen moderner Hörsysteme

Background

In the face of the rapid development of hearing aid system technology it is helpful to regularly study the user benefit of the current generation.

Test persons and methods

To contribute to the question on how the user benefit of current hearing aids compares with the benefit of the previous generation of hearing aids, a multicentre study was carried out in cooperation with 79 hearing aid acoustics companies in Germany. The user benefit of modern hearing aids in everyday life was assessed by asking end users to participate in a survey by completing a questionnaire. The questionnaire consisted of 20 items, 10 of which were taken from validated international inventories (SSQ: Speech, Spatial and Qualities of Hearing scale, IOI-HA: International Outcome Inventory for Hearing Aids) and the other 10 were formulated particularly for this purpose.

Results

A total of 664 usable questionnaires were returned whereby 421 responders were first time users and 243 responders were previous hearing aid users. The results of the present study showed that modern hearing aid system technology provides significant extra benefits at the 5 % level relative to the previous generation of hearing aids for all variables tested in this study.

Conclusions

Even though the amount of gain in terms of user benefit may be overestimated due to well-known placebo effects, an obvious net effect was evident. Correlations between the level of hearing aid benefit and possible influencing factors, such as age, gender, subjects own hearing aid, duration of use or hearing loss, could not be identified.     

Retrospective analysis of skin complications related to bone-anchored hearing aid implant: association with surgical technique,quality of life,and audiological benefit

Introduction

The bone-anchored hearing aid is an effective form of auditory rehabilitation. Due to the nature of the implant, the most common complications are skin related. A number of alternative surgical implantation techniques have been used to reduce the frequency and severity of skin complications, including the U-shaped graft and the linear incision.

Speech understanding in quiet and noise, with and without hearing aids

Speech recognition and cognitive functions important for speech understanding were evaluated by objective measures and by scores of perceived effort, with and without hearing aids. The tests were performed in silence, and with background conditions of speech spectrum random noise and ordinary speech. One young and one elderly group of twelve hearing-impaired subjects each participated. Hearing aid use improved speech recognition in silence (7 dB) and in the condition with speech as background (2.5 dB S/N), but did not change the perceived effort scores. In the cognitive tests no hearing aid benefit was seen in objective measures, while there was an effect of hearing aid use in scores of perceived effort, subjects reported less effort. There were no age effects on hearing aid benefit. In conclusion, hearing aid use may result in reduced effort in listening tasks that is not associated with improvement in objective scores.     

Effects of bilateral versus unilateral hearing aid fitting on abilities measured by the Speech, Spatial, and Qualities of Hearing Scale (SSQ)

The Speech, Spatial and Qualities of Hearing Scale (Gatehouse & Noble, 2004) was applied to three independent clinical groups: 144 people prior to being fitted with amplification; 118 people with six months experience with unilateral amplification; and 42 people with six months experience with bilateral amplification. For traditional speech hearing contexts (one-on-one, in groups, in quiet, in noise) there was benefit with one aid, and no further benefit with two. By contrast, hearing speech in demanding contexts (divided or rapidly switching attention) showed benefit with one aid and further benefit with two. In the spatial domain, directional hearing showed some benefit with one hearing aid, and particular further benefit in distance and movement discrimination from fitting with two. There was some benefit from unilateral fitting for elements of the qualities domains (clarity, naturalness, recognisability, segregation of sounds), with no consistent sign of further benefit from two. Bilateral fitting added benefit with respect to listening effort. Two hearing aids offer advantage in demanding and dynamic contexts; these contexts are argued as significant in the maintenance of social competence and emotional wellbeing. The present results go toward establishing the real-world advantages of bilateral hearing aid fitting and suggest that previous, inconclusive clinical findings reflect inquiry limited to more traditional areas of hearing function.     

Subjective benefit after BAHA system application in patients with congenital unilateral conductive hearing impairment.

OBJECTIVE: To study whether unilateral Bone-anchored Hearing Aid (BAHA) fitting led to subjective hearing benefit in patients with congenital unilateral conductive hearing impairment. STUDY DESIGN: Prospective evaluation on 20 patients. SETTING: Tertiary referral center. PATIENTS: Ten adults and 10 children with congenital unilateral conductive hearing impairment, with a mean air-bone gap of 50 dB, were included. METHODS: Subjective bilateral hearing benefit after BAHA fitting was measured using 2 disability-specific questionnaires: Chung and Stephens and the Speech, Spatial and Qualities of hearing profile (children's version in the patients aged <18 yr). The Glasgow children's benefit inventory was also used to measure patient's health benefit after BAHA fitting. RESULTS: Chung and Stephens' questionnaire showed an overall preference for the BAHA in several specific hearing situations. The Glasgow children's benefit inventory demonstrated an overall mean improvement of +34, which was the most prominent in the learning domain. The 10 adults showed an already good score on the Speech, Spatial and Qualities of hearing scale in the unaided situation. CONCLUSION: The BAHA was well accepted by most of the patients with congenital unilateral conductive hearing impairment. A preoperative trial of the BAHA system with the BAHA on a headband is part of the preoperative procedure. In children with unilateral conductive hearing loss, with regard to possible childs' development and communication difficulties, intervention with BAHA can be considered as an option.