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.     

Bone-anchored hearing aids (Baha) in congenital aural atresia: personal experience

Aims

Aural atresia is a congenital disease constituted by partial or complete lack of development of the external auditory canal, which is generally associated with malformations of the auricle and middle ear.Reconstruction of the auditory canal and correction of any deformities of the middle ear have yielded unpredictable results and variable functional outcomes, and there is a high rate of complications. Therefore, the use of bone-conduction hearing aids, such as the Baha, may represent a valid alternative for subjects who have conductive hearing loss with cochlear reserve that, as a rule, is fully conserved.The aim of this work is to reexamine our experience with the management of conductive and mixed hearing loss using the Baha system in children with bilateral aural atresia.

Methods

We examined 31 patients with bilateral congenital aural atresia in whom a Baha system had been implanted. The patients, 16 males and 15 females, were between 5 and 14 years of age (mean 8.7).The following parameters were assessed for each patient: mean preoperative air and bone conduction for frequencies between 0.5 and 4 kHz; mean preoperative threshold with conventional bone-conduction hearing aids; mean postoperative threshold with the Baha system; improvement in quality of life evaluated with the Glasgow Children's Benefit Inventory; rate and type of surgical complications.

Results

The mean preoperative air- and bone-conduction thresholds were 51.2 ± 12.5 and 14.1 ± 6.3 dB HL, respectively. The mean preoperative threshold with a conventional bone-conduction hearing aid was 29.3 ± 7.2 dB HL, and the mean postoperative threshold with the Baha system was 18.1 ± 7.5 dB HL. Quality of life improved for all operated patients.

Conclusions

The results of our study of the Baha system to treat patients with bilateral aural atresia were extremely satisfactory compared both with those of surgical reconstruction of the auditory canal and those of traditional bone-conduction hearing aids. Furthermore, great improvement was noted in quality of life, while the rate of complications was very low.Therefore, we are convinced that the Baha system is the treatment of choice for hearing loss due to bilateral congenital aural atresia.     

Results of the bone-anchored hearing aid in unilateral hearing loss

OBJECTIVES: The advantages of binaural hearing are well established and universally accepted. However, a tendency remains to withhold the benefits of binaural hearing to adults and children with one normal ear. The purpose of this study is to demonstrate the benefit of the bone-anchored hearing aid (BAHA) in a group of patients with unilateral conductive or mixed hearing loss. STUDY DESIGN: This is a prospective study of nine patients (five males and four female patients) with conductive or mixed hearing loss who met the criteria for BAHA except for having normal hearing in the other ear. They had congenital aural atresia or mastoidectomies secondary to chronic ear infections with or without cholesteatoma or had a temporal bone tumor excised METHODS: Patients had evaluations before and after implantation, including audiological testing and responses to a standardized hearing handicap questionnaire. Statistical analyses of the data were made using the Wilcoxon signed rank test and the paired Student t test for repeated measures. RESULTS: All patients had tonal and spondee threshold improvement with BAHA when compared with thresholds before treatment. Speech recognition performance in BAHA-aided conditions was comparable to the patient's best score in unaided condition. Patients reported a significant improvement in their hearing handicap scores with the BAHA. CONCLUSIONS: The use of BAHA has significantly improved the hearing handicap scores in patients with unilateral conductive or mixed hearing loss. The proven safety and efficacy of the device promote its use in unilateral cases that traditionally had been left unaided.     

An alternate approach for surgical dressing of bone-anchored hearing aid abutment sites

OBJECTIVE: To present an alternative surgical dressing for bone-anchored hearing aid (BAHA) abutment sites, comparing it with the manufacturer's recommended "healing cap" in terms of split thickness skin graft (STSG) survival. STUDY DESIGN AND SETTING: A retrospective review of 30 patients who underwent unilateral BAHA implantation at a tertiary referral center. Patients were divided into two groups on the basis of the surgical dressing for the BAHA abutment site. Group 1 had a "healing cap" dressing, and group 2 had a bolster dressing. STSG survival was evaluated. RESULTS: Between May 2002 and July 2006, 30 patients underwent BAHA implantation. Seven patients received the "healing cap" dressing, and 23 patients received the bolster dressing. There was 100% STSG survival in the bolster dressing group and 71% skin graft survival in the healing cap group (P = .048). CONCLUSION: A traditional bolster dressing had improved STSG survival as compared with the manufacturer's recommended "healing cap." Additional benefits of a bolster are that it is maintenance free, well suited for noncompliant patients, and inexpensive.     

Bone anchored hearing aid in children--prevention of complications

To report results with the bone anchored hearing aid (BAHA) in children. Retrospective medical record review. Tertiary care children's hospital. Fourteen children with microtia/aural atresia underwent BAHA surgery. Mean age was 5.8 years. Data were collected concerning age, diagnoses, surgery, success of implantation, hearing, complications use of BAHA, speech reception thresholds (SRT), complications BAHA surgeries and revisions. Fifteen implants were placed by the author in 13 children. Eleven of 13 (84.6%) children are successfully using BAHAs (one bilateral) with a mean post operative SRT of 18.5dB (range 14-25dB). Mean interval between first and second stages was 7.3 months (n=12). Three unilateral implants were placed by a different surgeon in a child with severe hemifacial microsomia who developed complications treated by the author. Complications included poor healing requiring removal of three implants in one child, recurrent cellulitis of flap requiring revision (n=4), loss of implant (n=2), tearing of flap with dermatome due to tenting by healing screw (n=1), thin skull necessitating multiple drilling sites (n=1). BAHA surgery has a high success rate in children. The following recommendations may decrease complications: (1) 6-month period between stages in children with thin skulls, (2) thin flap with scalpel when it is tented by healing screw or infiltrate flap with local anesthetic to balloon it prior to using the dermatome for second stage cases, and (3) create extremely thin flap to prevent cellulitis.     

Quality of life in elderly adults before and after hearing aid fitting

Presbycusis is a common disorder in the elderly, which causes hearing loss and may contribute to the development of some psychiatric disorders, leading to isolation due to communication difficulties in the social environment.ObjectiveTo identify through the WHOQOL (World Health Organization Quality of Life Questionnaire), the quality of life of hearing impaired individuals before and after hearing aid fittings.MethodWe had 30 individuals with hearing loss, all over 60 years of age - patients from a Speech Therapy Clinic. The patients answered the WHOQOL questions without the use of hearing aids; and after the effective use of a sound amplification device for a period of three months they answered it again. The WHOQOL - Bref consists of 26 questions, two general quality-of-life questions and 24 associated with four aspects: physical, psychological, environmental and social relations.ResultsThere was a significant improvement in quality of life in general, as far as leisure activities were concerned, there were no major changes regarding the frequency of negative feelings; even after the hearing aid fitting, the patients continue to have such feelings.ConclusionThe use of hearing aids favored the overall quality of life of the individuals evaluated.     

Health-related quality of life in adults with hearing impairment before and after hearing-aid rehabilitation in Finland

Objective: The aim of this study was to evaluate health-related quality of life (HRQoL) in adults with hearing impairment in Finland before and after hearing rehabilitation. Design: The study was prospective with hearing-aid rehabilitation as the intervention. The data was collected, using the 15D instrument, before and six months after hearing-aid rehabilitation. The data was analysed using t-tests and multiple linear regression methods. Study sample: The study sample included 949 adults with hearing impairment, and the control group included a sample of age- and gender-standardized general population. Results: The study population had significantly poorer HRQoL on most dimensions of the 15D when compared to the control group both before and after hearing-aid rehabilitation. Hearing-aid rehabilitation resulted in improved mean scores on the dimensions of hearing and in the overall 15D score that were statistically significant, although the mean improvement in the overall score was marginal. Self-reported hearing ability can better predict the change in HRQoL, as a result of a hearing aid, when compared with measured hearing sensitivity. Conclusions: The study supports the hypothesis that on average, use of a unilateral hearing aid results in improved subjective hearing and marginal improvement in HRQoL in adults with hearing impairment.     

The role of bone anchored hearing aids in children with Down syndrome

OBJECTIVES: To evaluate complication rates and outcomes of children with Down syndrome fitted with a Bone Anchored Hearing Aid (Baha). To evaluate whether the Bone Anchored Hearing Aid is a successful form of aural rehabilitation in children with Down syndrome from a patients' perspective. STUDY DESIGN: Retrospective case analysis and postal questionnaire study. SETTING: The Birmingham Children's Hospital, UK. METHODS: A total of 15 children were fitted with a Baha between February 1992 and February 2007. The age range was 2-15 years. A postal questionnaire was sent to each family. The Glasgow Children's Benefit Inventory (GCBI) was used in this study. OUTCOME MEASURES: Implantation results, skin reactions and other complications were recorded. Quality of life after receiving a Baha was assessed with the GCBI. RESULTS: All 15 patients are using their Baha 7 days a week for more than 8h a day after a follow-up of 14 months with continuing audiological benefit. No fixtures were lost, and skin problems were encountered in 3 (20%). Regarding quality of life, all 15 patients had improved social and physical functioning as a result of better hearing. CONCLUSIONS: Baha has an important role in the overall management of individuals with Down syndrome after conventional hearing aids and/or ventilation tubes have been considered or already failed. This study has shown a 20% rate of soft tissue reaction and there were no fixture losses in this group. No significant increase in complication rates was identified in children with Down syndrome. Finally, there was a significantly improved quality of life in children with Down syndrome after receiving their Baha. There was a high patient/carer satisfaction with Baha. Two of our series had bilateral two stage fixture procedures without any complications. More consideration should be given to bilateral bone anchored hearing aids in this group.     

人工耳蜗与助听器对听障儿童嗓音音质的影响研究

目的：探讨人工耳蜗与助听器对聋儿嗓音音质的影响机制。方法：随机选择昕障儿童组成健听组、助听器组、人工耳蜗组以及裸耳听障组,其中健听组与裸耳听障组作为对照控制组。采用“嗓音疾病评估仪”（TigerDRS）进行嗓音音质评估,要求儿童发／越／音,持续3s。测试的声学参数为：F0、SDF0、Jitter、Shimmer、NNE、HNR、SNR。结果：人工耳蜗组的嗓音F0显著小于其他各组（均P〈0．05）,助听器组、健听组、裸耳听障组之间的嗓音F0无显著性差异（P〉0．05）;人工耳蜗组与助听器组的SDF0显著大于健听组和裸耳听障组（P〈0．05）,助听器及人工耳蜗对听障女性患儿嗓音SDFo的影响大于昕障男性患儿,其交互作用达显著临界水平（P〉0．05）;各组之间的嗓音音质参数（Jitter、Shimmer、NNE、HNR、SNR）差异无统计学意义（P〉0．05）。结论：人工耳蜗与助听器主要影响的是嗓音F0及SDF0,而对其他音质参数影响不大。     

Congenital aural atresia: bone-anchored hearing aid vs. external auditory canal reconstruction

Objective

To compare the audiologic outcome and feasibility of bone-anchored hearing aid (BAHA) and external auditory canal reconstruction (EACR) surgeries in pediatric patients presenting a congenital aural atresia (CAA).

Methods

A retrospective chart review of 40 patients operated in our tertiary pediatric care center between 2002 and 2010 was performed. 20 patients underwent EACR, whereas another 20 patients were implanted with a BAHA device. Air conduction (AC), bone conduction (BC), pure tone average (PTA) and speech discrimination score (SDS) were compared preoperatively, and hearing gain (HG) postoperatively at 6 and at 12 months at frequencies of 500, 1000, 2000 and 4000 Hz. Operative time, complications and associated microtia were documented as well. EACR patients were graded retrospectively upon Jahrsdoerfer's classification.

Results

Preoperative AC were significantly different between groups, at 500, 1000 and 2000 Hz but not at 4000 Hz. BAHA group compared postoperatively to EACR group showed significantly a superior HG of 46.9 ± 7.0 dB (p < 0.001) and of 39.8(7) ± 7.2(6.9) dB (p < 0.001) at 6 months and at 1 year, respectively.Moreover, aided air thresholds from the EACR group revealed an audiologic status similar to those of the BAHA group patients, at 6 months and one year postoperatively. Both groups had a similar evolution of their BC, as well as of the incidence of complications. We report one case of transient facial paralysis in the EACR group. Total operative time is significantly lower (p < 0.001) for a BAHA implantation (56 ± 21 min) than for EACR surgery (216 ± 174 min). No preoperative or postoperative correlation (Pearson correlation test; p > 0.05) was found between patient's Jahrsdoerfer's score and their audiologic outcome. HG does not seem to be influenced by the presence of microtia.

Conclusion

EACR, although constituting an attractive option, does not give acceptable results alone. It can however, when combined to conventional air conduction hearing aids, provide excellent audiologic outcomes comparable to BAHA. BAHA implantation is a reliable, safe and efficient therapeutic option that allows a significantly better audiologic outcome when compared to unaided EACR for patients with CAA.     

Advantages of a new miniature hearing aid for mild to moderate hearing loss

OBJECTIVES/HYPOTHESIS: To evaluate the performance of a new, miniature, behind-the-ear hearing aid designed for individuals with mild to moderate high-frequency hearing loss who need an aid but are reluctant to try one. The aid is essentially invisible, leaves the ear canal open, and can be fit in less than 30 minutes without an ear impression. The cost is less than $500. STUDY DESIGN: A 4-week trial of the aid in 63 ears (62 subjects) with mild to moderate bilateral hearing loss. METHODS: A questionnaire was completed at the end of the study by each subject asking them to evaluate several features of the aid (cosmesis, comfort, understanding speech, amplification, and so forth) and to compare their unaided performance in quiet and in noise with the test hearing aid. A rating scale of 1 to 10 was used, with 10 being excellent and 1 poor. RESULTS: Subjective improvement in understanding speech in both quiet (5.8-->7.3) and noise (4.6-->5.9) occurred with the aid. Cosmesis, comfort, and appearance were highly rated (mean scores, > 8). CONCLUSIONS: This aid appears to have several features (comfort, cost, performance, and cosmesis) that make it ideal as a first aid for patients with mild to moderate losses.