Audiometric Results of Bilateral Bone-Anchored Hearing Aid Application in Patients With Bilateral Congenital Aural Atresia

The effect of bilateral application of bone-anchored hearing aids (BAHAs) was examined in terms of directional hearing and speech recognition in quiet and in noise in four patients with bilateral congenital atresia who, out of pure necessity, had been using a unilateral bone-conduction hearing aid since early life. This study comprised a prospective clinical evaluation in a single subject design; four patients with bilateral congenital atresia originating from the Nijmegen BAHA series participated. Three patients had Treacher Collins syndrome. All four patients had conductive, most probably, symmetrical, hearing loss. Recently these patients had applied for a second BAHA and were subsequently fitted bilaterally. With two BAHAs, all four patients showed significant improvement in sound localization. Also, speech perception in quiet showed significant improvement with bilateral application, and a significant improvement was found in speech perception in noise in three patients. These results suggest that patients with congenital conductive, symmetrical hearing loss will benefit from bilateral BAHAs.     

Bilateral bone-anchored hearing aids (BAHAs): an audiometric evaluation

OBJECTIVES: Since the technique to implant bone-anchored hearing aids (BAHAs) with the use of osseointegrated implants was developed in 1977, more than 15,000 patients have been fitted with BAHAs worldwide. Although the majority have bilateral hearing loss, they are primarily fitted unilaterally. The main objective of this study was to reveal benefits and drawbacks of bilateral fitting of BAHAs in patients with symmetric or slight asymmetric bone-conduction thresholds. The possible effects were divided into three categories: hearing thresholds, directional hearing, and binaural hearing. STUDY DESIGN: Prospective study of 12 patients with bilateral BAHAs. METHODS: Baseline audiometry, directional hearing, speech reception thresholds in quiet and in noise, and binaural masking level difference were tested when BAHAs were fitted unilaterally and bilaterally. RESULTS: Eleven of the 12 patients used bilateral BAHAs on a daily basis. Tests performed in the study show a significant improvement in sound localization with bilateral BAHAs; the results with unilateral fitting were close to the chance level. Furthermore, with bilateral application, the improvement of the speech reception threshold in quiet was 5.4 dB. An improvement with bilateral fitting was also found for speech reception in noise. CONCLUSIONS: Overall, the results with bilateral fitted BAHAs were better than with unilaterally fitted BAHA; the benefit is not only caused simply by bilateral stimulation but also, to some extent, by binaural hearing. Bilateral BAHAs should be considered for patients with bilateral hearing loss otherwise suitable for BAHAs.     

Audiometric evaluation of bilaterally fitted bone-anchored hearing aids

Bilateral fittings of bone-anchored hearing aids (BAHA) were evaluated in 25 patients with at least 3 months experience with using two BAHAs. For all patients, air conduction hearing aids were contraindicated due to either recurrent otorrhoea or otitis externa (19 cases) or to congenital aural atresia (six cases). Candidacy for bilateral fitting was primarily based on symmetry of bone conduction thresholds. For all patients, measurements comprised sound localisation, speech recognition in quiet and in noise. In addition, in a subgroup of nine patients, release from masking for pure-tone stimuli in noise with interaural phase differences (binaural masking level difference. BMLD) was measured. The percentage of correct localisation judgments with 500-Hz and 2-kHz noise bursts increased significantly (p<0.01) from 22.2 per cent and 24.3 per cent for unilateral fittings to 41.8 per cent and 45.3 per cent for bilateral fittings, respectively. With unilateral fittings sound localisation judgments appeared to be strongly biased to the ipsilateral BAHA side. whereas with bilateral fittings, judgments were far more symmetrical. The speech reception threshold for sentences in quiet was significantly (p<0.01) better for the bilateral fittings compared to the unilateral fittings: 37.5 dBA versus 41.7 dBA. Speech recognition in noise was measured with the speech signal presented in front of the listener and a 65-dBA masking noise at either +90 degrees or -90 degrees azimuth. For noise presented at the ipsilateral side of the first fitted BAHA, the signal-to-noise ratio was significantly reduced (p<0.01) from -0.7 dB for the unilateral fitting to -4.0 dB for the bilateral fitting. The speech reception threshold in noise was not significantly different (p>0.05) for unilateral and bilateral fittings when the noise was presented at the contralateral side of the first fitted BAHA. The results for the six patients with congenital atresia are comparable with those for the other patients. So, directional hearing and speech recognition in noise improve significantly with a second BAHA. The BMLD measurements showed a significant (p<0.01) release from masking of 6.1, 6.0 and 6.6 dB for 125-Hz, 250-Hz and 500-Hz stimuli, respectively. The BMLD effect of 4.1 dB at 1,000 Hz was not significant at the 5 per cent level. The positive results with the bilateral fittings in quiet can be ascribed to increased stimulus levels due to diotic summation of signals from either side. The results for localisation, speech recognition in noise and BMLD measurements indicate that bilaterally fitted BAHAs do indeed (to some extent) result in binaural hearing.     

Does the bone-anchored hearing aid have a complementary effect on audiological and subjective outcomes in patients with unilateral conductive hearing loss?

OBJECTIVES: To study the effect of a bone-anchored hearing aid (BAHA) in patients with unilateral conductive hearing loss. STUDY DESIGN: Prospective evaluation on 18 subjects. METHODS: Aided and unaided binaural hearing was assessed in the sound field using a sound localization test and a speech recognition in noise test with spatially separated sound and noise sources. The patients also filled out a disability-specific questionnaire. PATIENTS: 13 out of the 18 subjects had normal hearing on one side and acquired conductive hearing loss in the other ear. The remaining 5 patients had a unilateral air-bone gap and mild symmetrical sensorineural hearing loss. RESULTS: Sound localization with the BAHA improved significantly. Speech recognition in noise with spatially separated speech and noise sources also improved with the BAHA. Fitting a BAHA to patients with unilateral conductive hearing loss had a complementary effect on hearing. Questionnaire results showed that the BAHA was of obvious benefit in daily life. CONCLUSIONS: The BAHA proved to be a beneficial means to optimize binaural hearing in patients with severe (40-60 dB) unilateral conductive hearing loss according to audiometric data and patient outcome measures.     

Audiological effect of bone-anchored hearing aid

The bone-anchored hearing aid (BAHA) has proved to be a valuable alternative to conventional air and bone conduction hearing aids for patients suffering from chronic otitis media or bilateral aural atresia. The BAHA gave better sound quality and greater comfort than conventional hearing aids (HAs), but only 1 study has been done in Japan. We implanted BAHAs in 6 hard-of-hearing patients in the last 2 years. One patient suffered skin problems around the abutment and used the BAHA only briefly. Free-field audiometry, the speech discrimination test (SDT), and the speech recognition test (SRT) were conducted in all subjects. They were evaluated either with the HA or BAHA. The SDT and SRT showed better hearing results in quiet for the BAHA than the conventional HA, but there was a minimum difference in SDT and SRT in noise. Subjects assessed the HA and BAHA using questionnaires. Subjects reported that the BAHA offers a number of important advantages, including greater cosmetic acceptability, improved speech intelligibility, and better sound quality.     

Speech intelligibility with bilateral bone-anchored hearing aids: the Birmingham experience

The Birmingham bone-anchored hearing aid (BAHA) programme, since its inception in 1988, has fitted more than 300 patients with unilateral bone-anchored hearing aids. Recently, some of the patients who benefited extremely well with unilateral aids applied for bilateral amplification. To date, 15 patients have been fitted with bilateral BAHAs. The benefits of bilateral amplification have been compared to unilateral amplification in 11 of these patients who have used their second BAHA for 12 months or longer. Following a subjective analysis in the form of comprehensive questionnaires, objective testing was undertaken to assess specific issues such as 'speech recognition in quiet', 'speech recognition in noise' and a modified 'speech-in-simulated-party-noise' (Plomp) test. 'Speech in quiet' testing revealed a 100 per cent score with both unilateral and bilateral BAHAs. With 'speech in noise' all 11 patients scored marginally better with bilateral aids compared to best unilateral responses. The modified Plomp test demonstrated that bilateral BAHAs provided maximum flexibility when the origin of noise cannot be controlled as in day-to-day situations. In this small case series the results are positive and are comparable to the experience of the Nijmegen BAHA group.     

Bilateral fitting of BAHAs and BAHA fitted in unilateral deaf persons: acoustical aspects

The benefit of a bone-anchored hearing aid (BAHA) to a patient fitted bilaterally; and the benefit of a BAHA to a unilaterally deaf person was estimated by four acoustical measurements: directional sensitivity of a BAHA placed at the skull, vibration transmission in the skull, gain, and estimated transcranial attenuation of bone conducted sound. Provided a patient has a similar bone conduction hearing ability at both cochlea, it was found that a patient should, theoretically, benefit from bilateral fitting of BAHAs in terms of better hearing thresholds from the front, and better overall hearing ability from the surround. The data indicates further, that bilateral fitting facilitates extraction of interaural cues, which should lead to greater ability to determine the direction of a sound source, as well as better hearing in noise. However, due to the cross-hearing of bone conducted sound, the binaural processing for the patient fitted bilaterally with BAHAs is less than for normal binaural air conduction hearing. Finally, the data showed that the benefit of fitting a BAHA in a unilaterally deaf person, depends on that person's transcranial attenuation.     

The Bone-Anchored Hearing Aid for children: Recent developments

In 1984 the Bone-Anchored Hearing Aid, or BAHA, system was introduced. Its transducer is coupled directly to the skull percutaneously to form a highly effective bone-conduction hearing device. Clinical studies on adults with conductive hearing loss have shown that the BAHA system outperforms conventional bone-conduction hearing aids. Therefore, the next step was to apply the BAHA system in children with congenital or acquired conductive hearing loss. Reviewed data showed that, on average, such children benefited significantly more from the BAHA than from reconstructive surgery. Thus, BAHA application appears to be the best option to achieve normal communication and speech and language development in children with bilateral conductive hearing loss. However, in children under the age of three to four years, a conventional solution must be applied, e.g. a bone conductor with a transcutaneous coupling, because they are too young to undergo BAHA implant surgery. In the case of unilateral congenital conductive hearing loss, there is no convincing evidence in the clinical literature for early intervention.

In summary, the BAHA system can be considered a new, indispensable tool for children with bilateral conductive hearing loss.     

The bone-anchored hearing aid for children: recent developments

In 1984 the Bone-Anchored Hearing Aid, or BAHA, system was introduced. Its transducer is coupled directly to the skull percutaneously to form a highly effective bone-conduction hearing device. Clinical studies on adults with conductive hearing loss have shown that the BAHA system outperforms conventional bone-conduction hearing aids. Therefore, the next step was to apply the BAHA system in children with congenital or acquired conductive hearing loss. Reviewed data showed that, on average, such children benefited significantly more from the BAHA than from reconstructive surgery. Thus, BAHA application appears to be the best option to achieve normal communication and speech and language development in children with bilateral conductive hearing loss. However, in children under the age of three to four years, a conventional solution must be applied, e.g. a bone conductor with a transcutaneous coupling, because they are too young to undergo BAHA implant surgery. In the case of unilateral congenital conductive hearing loss, there is no convincing evidence in the clinical literature for early intervention. In summary, the BAHA system can be considered a new, indispensable tool for children with bilateral conductive hearing loss.     

The BAHA Softband. A new treatment for young children with bilateral congenital aural atresia

OBJECTIVE: To evaluate the validity of a bone-anchored hearing aid (BAHA) Softband (fitted unilaterally and bilaterally) in young children with bilateral congenital aural atresia. SUBJECTS: Two children with severe bilateral congenital conductive hearing loss, who had been fitted with a transcutaneous BAHA Softband at the age of 3 and 28 months, respectively. The latter child had been fitted with a conventional bone-conduction hearing aid at the age of 3 months; at 28 months, this child had received the BAHA Softband and after 5 months of unilateral application, the BAHA Softband was fitted bilaterally. Follow-up in the two children was 31 and 17 months, respectively. METHODS: Using the artificial mastoid, gain and maximum output were studied in this new transcutaneous application of the BAHA, with the BAHA Classic and the BAHA Compact as sound processor. Results were compared to those obtained with a conventional bone-conduction device (Oticon E 300 P). Aided thresholds and sound lateralization scores were assessed with double visual reinforcement audiometry (VRA). To test the validity of the BAHA Softband, the speech and language development of the children was assessed by means of age-appropriate tests (the preverbal Symbolic play test and the Dutch non-speech test for receptive and expressive language and the Dutch version of the Reynell language test). RESULTS: The electro-acoustic measurements showed minor differences in gain between the three devices. At a reduced volume setting, the mean input level at which the output levelled off was largely comparable between the BAHA Classic and the conventional device, but somewhat poorer with the BAHA Compact. Both children showed speech and language development that was in accordance with their cognitive development. CONCLUSIONS: The BAHA Softband was a valid intervention in children with congenital bilateral aural atresia who were too young for percutaneous BAHA application.     

Bone‐anchored hearing aids for people with bilateral hearing impairment: a systematic review

Clin. Otolaryngol. 2011, 36 , 419–441 Background: Bone‐anchored hearing aids (BAHAs) are indicated for people with conductive or mixed hearing loss who can benefit from amplification of sound. In resource limited health care systems, it is important that evidence regarding the benefit of BAHAs is critically appraised to aid decision‐making. Objective of review: To assess the clinical effectiveness of BAHAs for people with bilateral hearing impairment. Type of review: Systematic review. Search strategy: Nineteen electronic resources were searched from inception to November 2009. Additional studies were sought from reference lists, clinical experts and BAHA manufacturers. Evaluation method: Inclusion criteria were applied by two reviewers independently. Data extraction and quality assessment of full papers were undertaken by one reviewer and checked by a second. Studies were synthesised through narrative review with tabulation of results. Results: Twelve studies were included. Studies suggested audiological benefits of BAHAs when compared with bone‐conduction hearing aids or no aiding. A mixed pattern of results was seen when BAHAs were compared to air‐conduction hearing aids. Improvements in quality of life with BAHAs were found by a hearing‐specific instrument but not generic quality of life measures. Issues such as improvement of discharging ears and length of time the aid can be worn were not adequately addressed by the studies. Studies demonstrated some benefits of bilateral BAHAs. Adverse events data were limited. The quality of the studies was low. Conclusions: The available evidence is weak. As such, caution is indicated in the interpretation of presently available data. However, based on the available evidence, BAHAs appear to be a reasonable treatment option for people with bilateral conductive or mixed hearing loss. Further research into the benefits of BAHAs, including quality of life, is required to reduce the uncertainty.     

Bone-anchored hearing aid system application for unilateral congenital conductive hearing impairment: audiometric results.

OBJECTIVE: To study the audiologic outcome of bone-anchored hearing aid (BAHA) application in patients with congenital unilateral conductive hearing impairment. STUDY DESIGN: Prospective audiometric evaluation on 20 patients. SETTING: Tertiary referral center. PATIENTS: The experimental group comprised 20 consecutive patients with congenital unilateral conductive hearing impairment, with a mean air-bone gap of 50 dB. METHODS: Aided and unaided hearing was assessed using sound localization and speech recognition-in-noise tests. RESULTS: Aided hearing thresholds and aided speech perception thresholds were measured to verify the effect of the BAHA system on the hearing acuity. All patients fulfilled the criteria that the aided speech reception thresholds or the mean aided sound field thresholds were 25 dB or better in the aided situation. Most patients were still using the BAHA almost every day. Sound localization scores varied widely in the unaided and aided situations. Many patients showed unexpectedly good unaided performance. However, nonsignificant improvements of 3.0 (500 Hz) and 6.9 degrees (3,000 Hz) were observed in favor of the BAHA. Speech recognition in noise with spatially separated speech and noise sources also improved after BAHA implantation, but not significantly. CONCLUSION: Some patients with congenital unilateral conductive hearing impairment had such good directional hearing and speech-in-noise scores in the unaided situation that no overall significant improvement occurred after BAHA fitting in our setup. Of the 18 patients with a complete data set, 6 did not show any significant improvement at all. However, compliance with BAHA use in this patient group was remarkably high. Observations of consistent use of the device are highly suggestive of patient benefit. Further research is recommended to get more insight into these findings.     

Bilateral fitting of BAHAs and BAHA® fitted in unilateral deaf persons: Acoustical aspects Adaptación bilateral de BAHA y adaptación de BAHA en sorderas unilaterales: Aspectos acústicos

The benefit of a bone-anchored hearing aid (BAHA) to a patient fitted bilaterally; and the benefit of a BAHA®to a unilaterally deaf person was estimated by four acoustical measurements: directional sensitivity of a BAHA® placed at the skull, vibration transmission in the skull, gain, and estimated transcranial attenuation of bone conducted sound. Provided a patient has a similar bone conduction hearing ability at both cochlea, it was found that a patient should, theoretically, benefit from bilateral fitting of BAHAs in terms of better hearing thresholds from the front, and better overall hearing ability from the surround. The data indicates further, that bilateral fitting facilitates extraction of interaural cues, which should lead to greater ability to determine the direction of a sound source, as well as better hearing in noise. However, due to the cross-hearing of bone conducted sound, the binaural processing for the patient fitted bilaterally with BAHAs is less than for normal binaural air conduction hearing. Finally, the data showed that the benefit of fitting a BAHA® in a unilaterally deaf person, depends on that person's transcranial attenuation.     

Practice guidelines for bone-anchored hearing aids in children

After more than 20 years of clinical experience in children, bone-anchored hearing aids, essentially BAHA(?), have become the standard treatment for conductive or mixed hearing loss. Based on a general review of the literature and the authors' own experience, this article reviews the use of bone-anchored hearing aids in children. The main indications for bone-anchored hearing aids are a minimum age of 5 years at the time of implantation and/or cortical bone thickness ≥ 3 mm. Fixture loss is observed in 40% of children under the age of 5 years versus 8% for children aged 5 to 10 years and 1% for children over the age of 10 years, i.e. identical to the rate observed in adults. Skin complications are similar to those observed in adults and must be prevented by parental education and regular follow-up. Surgery is generally performed in two stages or as a one-stage procedure for fixtures ≥ 4 mm. The functional success rate, correlated with medium- and long-term use of BAHA(?) is about 96%. BAHA(?) may be indicated in children with profound unilateral hearing loss following a trial period wearing a BAHA(?) headband for several weeks with the child's active participation. Sequential bilateral implantation requires complementary investigations and appears to provide improved perception in noise. This type of hearing aid provides an improvement of the quality of life of children with bilateral conductive and/or mixed hearing loss which should be further improved as a result of recent technical developments.     

Patient satisfaction with bilateral bone-anchored hearing aids: the Birmingham experience

The Birmingham bone-anchored hearing aid (BAHA) programme has fitted more than 300 patients with unilateral bone-anchored hearing aids since 1988. Some of the patients who benefited well with unilateral aids and who had used bilateral conventional aids previously applied for bilateral amplification. To date, 15 patients have been fitted with bilateral BAHAs. The benefits of bilateral amplification have been compared to unilateral amplification in 11 of these patients. Subjective analysis in the form of validated comprehensive questionnaires was undertaken. The Glasgow benefit inventory (GBI), which is a subjective patient orientated post-interventional questionnaire developed to evaluate any otorhinolaryngological surgery and therapy was administered. The results revealed that the use of bilateral bone-anchored hearing aids significantly enhanced general well being (patient benefit) and improved the patient's state of health (quality of life). The Chung and Stephens questionnaire which addresses specific issues related to binaural hearing was used. Our preliminary results are encouraging and are comparable to the experience of the Nijmegen BAHA group.     

Bone-anchored hearing aids in infants and children younger than 5 years

OBJECTIVE: While bone-anchored hearing aids (BAHAs) are currently indicated for rehabilitation in children older than 5 years with bilateral maximal conductive hearing loss, our objective was to capitalize on potentially important stages of auditory and speech-language development by providing BAHAs to children younger than 5 years. DESIGN: A retrospective review of surgical data of children receiving BAHA implants over a 10-year period. SETTING: The Hospital for Sick Children, Toronto, Ontario. PATIENTS: Twenty children 5 years or younger (mean +/- SD age, 3.21 +/- 1.65 years) served as the study group, while 20 older children (mean +/- SD age, 7.63 +/- 1.55 years) served as the comparison group. INTERVENTIONS: All patients received BAHA implants. Children with cortical bone thickness less than 2.5 mm underwent a 2-stage procedure; children with cortical bone thickness greater than 4 mm underwent a single-stage procedure. MAIN OUTCOME MEASURES: Traumatic and skin revision complication rates and implantation interstage intervals were compared between groups. RESULTS: The mean +/- SD interstage interval was 7.72 +/- 3.81 months for the younger children, which was significantly longer than for the older children (4.41 +/- 2.51 months) (P<.003). Two traumatic fixture losses occurred in the younger children, while 4 occurred in the older children. Skin site revision was required in 3 younger children. All children are currently wearing their BAHAs. CONCLUSION: Two-stage BAHA implantation with a prolonged interval between stages yields surgical success in younger children comparable to that routinely observed in older children.     

Behavioural performance and self-report measures in children with unilateral hearing loss due to congenital aural atresia

ObjectiveTo explore the behavioural and functional performance of a group of children with conductive unilateral hearing loss (UHL) due to congenital aural atresia.MethodTwelve children aged 7 to 16 years (M_age 10.0, SD 3.1 years) formed the UHL group and 15 age-matched children (M_age 9.5, SD 3.6 years) with normal hearing formed the control group. Auditory skills were assessed using tests of sound localisation, spatial speech perception in noise, and self-ratings of auditory abilities (Listening Inventory for Education; LIFE and Speech, Spatial and Qualities of Hearing scale; SSQ).ResultsWhen speech was directed to the good ear, performance was poorer than for normal hearing controls. Sound localisation abilities were impaired in children with UHL. Children with UHL reported higher levels of difficulties in classroom settings compared to children with normal hearing, particularly for activities involving listening in noise and focused listening activities. Older children self-report and parents report difficulties for their children across all SSQ scales.ConclusionsChildren with UHL showed a wide range of auditory difficulties. As expected, speech recognition in noise differed from controls. Sound localisation abilities were variable; greater variability was seen for right ear hearing losses suggesting that some of these children may have developed compensatory mechanisms. Younger children identified listening difficulties for school situations where focussed auditory attention was needed. Older children and parents reported greatest difficulty for activities requiring perception of the direction, distance, and movement of sound. Higher levels of effort and inability to ignore sounds were reported as major difficulties.     

Amplification in the rehabilitation of unilateral deafness: speech in noise and directional hearing effects with bone-anchored hearing and contralateral routing of signal amplification.

OBJECTIVE: Vibromechanical stimulation with a semi-implantable bone conductor (Entific BAHA device) overcomes some of the head-shadow effects in unilateral deafness. What specific rehabilitative benefits are observed when the functional ear exhibits normal hearing versus moderate sensorineural hearing loss (SNHL)? DESIGN: The authors conducted a prospective trial of subjects with unilateral deafness in a tertiary care center. PATIENTS: This study comprised adults with unilateral deafness (pure-tone average [PTA] > 90 dB; Sp.D. < 20%) and either normal monaural hearing (n = 18) or moderate SNHL (PTA = 25-50 dB: Sp.D. > 75%) in the contralateral functional ear (n = 5). INTERVENTIONS: Subjects were fit with contralateral routing of signal (CROS) devices for 1 month and tested before (mastoid) implantation, fitting, and testing with a bone-anchored hearing aid (BAHA). OUTCOME MEASURES: Outcome measures were: 1) subjective benefit; 2) source localization tests (Source Azimuth Identification in Noise Test [SAINT]); 3) speech discrimination in quiet and in noise assessed with Hearing In Noise Test (HINT) protocols. RESULTS: There was consistent satisfaction with BAHA amplification and poor acceptance of CROS amplification. General directional hearing decreased with CROS use and was unchanged by BAHA and directional microphone aids. Relative to baseline and CROS, BAHA produced significantly better speech recognition in noise. Twenty-two of 23 subjects followed up in this study continue to use their BAHA device over an average follow-up period of 30.24 months (range, 51-12 months). CONCLUSION: BAHA amplification on the side of a deaf ear yields greater benefit in subjects with monaural hearing than does CROS amplification. Advantages likely related to averting the interference of speech signals delivered to the better ear, as occurs with conventional CROS amplification, while alleviating the negative head-shadow effects of unilateral deafness. The advantages of head-shadow reduction in enhancing speech recognition with noise in the hearing ear outweigh disadvantages inherent in head-shadow reduction that can occur by introducing noise from the deaf side. The level of hearing impairment correlates with incremental benefit provided by the BAHA. Patients with a moderate SNHL in the functioning ear perceived greater increments in benefit, especially in background noise, and demonstrated greater improvements in speech understanding with BAHA amplification.     

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.     

A bone-anchored hearing aid for patients with pure sensorineural hearing impairment: a pilot study

This pilot study assesses the potential benefits of an optimized bone-anchored hearing aid (BAHA) for patients with a mild to moderate pure sensorineural high frequency hearing impairment. The evaluation was conducted with eight first-time hearing aid users by means of psycho-acoustic sound field measurements and a questionnaire on subjective experience; all of the patients benefited from the BAHA. On average, the eight patients showed improvement in PTA threshold of 3.4 dB and in speech intelligibility in noise of 14%. Seven of the subjects, also fitted with present standard air conduction hearing aids (ACHA) found the ACHA thresholds to be improved more than the BAHA ones. In speech tests, the ACHA was only slightly better; these patients chose between their different hearing aids according to the sound environment. Although the BAHA was preferred for wearing and sound comfort, it cannot be used as the sole aid for patients with pure sensorineural impairment.