Rehabilitation der Hochtoninnenohrschwerhörigkeit

Background

In spite of modern technology conventional hearing aids are only helpful in a limited number of patients with sensorineural hearing loss. In particular, patients presenting with moderate to severe high frequency hearing loss but only mild hearing loss in the low frequencies suffer from problems associated with conventional hearing aids such as occlusion of the ear canal and feedback.The aim of the study was the evaluation of rehabilitation of patients with high frequency hearing loss with the active middle ear implant Vibrant Soundbridge®.

Patients and methods

The Vibrant Soundbridge® was surgically implanted into 30 patients, and the floating mass transducer was clipped onto the long process of the incus. Out of the 30 patients 9 presented with a ski slope audiogram of high frequency hearing loss of 25 dB within 1 octave in the frequency range 1000–8000 Hz. Main outcome measures were pure tone audiometry, speech audiometry in quiet and in noise.

Results

Residual hearing was preserved in all cases. Functional hearing gain was in proportion to the individual hearing losses and was remarkably high in the high frequencies up to 8000 Hz. Mean functional gain was 34 dB in the frequencies between 2000–8000 Hz. Speech recognition scores in quiet and in noise were significantly higher with the implant compared to the unaided situation.

Conclusion

The middle ear implant Vibrant Soundbridge® has been shown to be perform extremely well especially in the high frequencies. It offers a new solution for rehabilitation of high frequency hearing loss.     

Esteem® middle ear device versus conventional hearing aids for rehabilitation of bilateral sensorineural hearing loss

This retrospective study aimed to evaluate the efficacy of the Esteem^® middle ear implant in sensorineural hearing loss (SNHL) of different degree as well as to compare it with that obtained with conventional hearing aids. Fifteen out of 30 adults patients who received an Esteem^® middle ear device for rehabilitation of sensorineural hearing loss met the primary eligibility criterion of prior, continuous use of conventional hearing aids. Study population included moderate-to-severe SNHL (8 patients) and severe-to-profound SNHL (7 patients). Audiometric measurements included free-field pure-tone and speech audiometry in Esteem^®-aided, HA-aided, and baseline threshold. For speech audiometry, speech reception threshold (SRT) and word recognition score (WRS) were assessed. Subjective benefit was evaluated by Client Oriented Scale of Improvement (COSI) questionnaire. In all the subjects, SRT and WRS showed improvement both with conventional HA and Esteem^® in respect to the unaided situation. Although not statistically significant, a slight prevalence of the Esteem^® performances was recorded both audiometrically and as subjective satisfaction score. The Esteem^® middle ear device demonstrated appreciable benefit for rehabilitation of SNHL of different degree, comparable to what can be achieved by conventional hearing aids. In addition, this rehabilitative process may enable also individuals presenting with severe-to-profound SNHL to achieve remarkable functional outcomes.     

Binaurality in middle ear implant recipients using contralateral digital hearing AIDS.

OBJECTIVE: For some patients, conventional hearing aids might have disadvantages that clearly limit the benefit of using them. The middle ear implant, Vibrant Soundbridge hearing prosthesis offers an approach to help such patients. Our study's objective was to identify the binaurality in a well-fitted digital hearing aid worn in the contralateral ear in recipients experienced with use of the Vibrant Soundbridge middle ear implant device. STUDY DESIGN: In a prospective study, warble-tone thresholds and stereophony were evaluated for the following conditions: (1) binaural unaided-with the middle ear implant inactive and the behind-the-ear hearing aid removed; (2) middle ear implant alone-middle ear implant active, behind-the-ear hearing aid removed; (3) middle ear implant plus behind-the-ear omnidirectional-middle ear implant active, behind-the-ear active; and (4) behind-the-ear omnidirectional alone-middle ear implant inactive, behind-the-ear omnidirectional active. Behind-the-ear omnidirectional and behind-the-ear is defined as the behind-the-ear active in the omnidirectional or directional response, respectively. Behind-the-ear is a contralateral digital hearing aid to the middle ear implant. Benefits such as improved sound detection, speech perception in quiet and in noise, and sound quality were investigated. The evaluation of subjective hearing benefit was based on the Abbreviated Profile of Hearing Aid Benefit (APHAB) test. Paired t tests (subject) were used to analyze the differences between mean thresholds for the different test conditions. SETTING: Tertiary referral center. PATIENTS: Eight adults (aged 45-68 yr) had undergone implantation with a single Vibrant Soundbridge at least 12 months before starting the study. These eight subjects presented no contraindication for contralateral hearing aid use. Patients were fitted 5 weeks before testing with a Siemens Signia digital behind-the-ear hearing aid in the side contralateral to the Vibrant Soundbridge. RESULTS: Five weeks after use of the contralateral hearing aid together with the middle ear implant, mean differences in warble-tone thresholds between Conditions 2 and 3 and between Conditions 3 and 4 were both statistically significant. The mean differences in speech reception thresholds were in line with the mean differences in average warble-tone thresholds. The mean speech reception threshold for the middle ear implant plus behind-the-ear omnidirectional condition was slightly worse (3 dB) than that for the middle ear implant alone condition; however, this difference was not statistically significant. Whereas speech reception threshold difference between Condition 1 and Condition 4 was not statistically significant (60 dB and 61 dB, respectively). The mean difference for the 0-degree azimuth alone was statistically significant (p < 0.05) for the conditions middle ear implant alone and middle ear implant plus behind-the-ear omnidirectional. The middle ear implant alone appears to give good sensitivity at 2 kHz for any direction. Increasing scores indicate greater percentages of problems. Percentages of problems were on average lower for the middle ear implant when used with the contralateral digital hearing aid based on the global score. CONCLUSION: The use of a middle ear implant Vibrant Soundbridge together with a contralateral digital hearing aid improved functional gain and speech perception thresholds in quiet, especially for the sound coming from the front of the patient. The use of a middle ear implant together with a contralateral digital hearing did not significantly improve hearing in noise.     

Our auditory results using the Vibrant Soundbridge on the long process of the incus: 20 years of data

Objective

After 20 years of experience with different types of middle ear implants, we analyzed our database about the Vibrant Soundbridge (VSB) to know the rate of complications, the effect on the residual hearing and the audiometric gain in our center.

Vibrant sound bridge application to middle ear windows versus conventional hearing aids: a comparative study based on international outcome inventory for hearing aids

In this study, we aimed to compare the outcomes of satisfaction of the patients who used hearing aids preceding the vibrant sound bridge (VSB) application on middle ear windows (14 oval window and 5 round window). Nineteen adult patients with conductive or mixed hearing loss were included in the study. All patients used behind the ear hearing aids on the site which was selected for VSB application. The patients used hearing aids for at least 3 months before the VSB operation. The floating mass transducer (FMT) was placed on one of the middle ear windows (oval or round) in VSB operation. The patients were evaluated with International Outcome Inventory for Hearing Aids (IOI-HA) preoperatively after at least 3 months trial of conventional hearing aid and postoperatively after 3 months use of VSB. No perioperative problem was encountered. The total score of IOI-HA was significantly higher with VSB compared with conventional hearing aids (p < 0.05). No statistically significant difference was found between the daily use, residual activity limitations, satisfaction, impact on others, quality of life between middle ear implant and hearing aid (p > 0.05). The IOI-HA scores were significantly higher with the middle ear implant than the conventional hearing aid regarding benefit and residual participation restrictions (p < 0.05). Although the scores for quality of life assessment was similar between VSB and hearing aid use, there was a superiority of VSB in terms of benefit and residual participation restrictions as well as overall IOI-HA scores as the FMT was placed on one of the middle ear windows.     

Vibrant Sound Bridge System. A new kind hearing prosthesis for patients with sensorineural hearing loss. 2. Audiological results

OBJECTIVE: Implantable hearing aids present a new treatment modality for patients suffering from sensorineural hearing loss. The functional gain obtained with the partially implantable Symphonix soundbridge system was evaluated in a clinical study. The audiological results achieved with n = 34 patients over a period of up to three years are presented in this second part of the publication. PATIENTS AND METHODS: 34 patients have received the Symphonix Vibrant soundbridge system since February 1997. The average age at implantation was 47.2 years (minimum: 18.9 years; maximum: 80.3 years). All patients have had several years of experience with hearing aids, which, however, provided insufficient functional gain or could not be fitted with a conventional hearing aid for medical reasons (such as auditory ear canal problems). All patients fulfilled the audiological selection criteria as they had bilateral moderate to severe sensorineural hearing loss. As a rule, the ear with poorer performance was implanted. All patients were fitted with the audio processor eight weeks after the implantation. The pure tone thresholds, the functional gain, the monosyllable and sentence understanding (G?ttinger Sentence Test in quiet and noise) were preoperatively and postoperatively assessed. Standardized self-assessment questionnaires were used to evaluate the subjective benefit (PHAB) and the quality of hearing (HDSS) as compared to the preoperative situation. Further hearing tests were performed after four weeks, three, six, nine, twelve, eighteen, twenty-four and thirty-six months postoperatively. During the observation period of up to three years the audioprocessor was updated several times, most recently with the fully digital three-channel-system Vibrant D. The results obtained were documented. RESULTS: Postoperatively, the pure tone threshold with the soundbridge system switched off did not change significantly in the implanted ear. All patients had a functional gain that was either comparable to the gain achieved with hearing aids or better. In particular speech-related frequencies showed improved amplification. The free field speech recognition tests revealed higher scores in quiet and in noise. The patients commended the natural sound quality, the lack of feedback, the absence of occlusion and distortion, the improved speech understanding in noise and the favourable cosmetic appeal. Only two patients failed to achieve better results as compared to their performance with conventional hearing aids. No complications, such as a deterioration of hearing due to inner ear damage or a conductive hearing loss, were observed in the long-term. CONCLUSIONS: The Symphonix Vibrant Soundbridge is a new and promising treatment modality for patients suffering from moderate to severe sensorineural hearing loss. Further improvement of the good results can be expected with improved coupling of the transducer to the ossicular chain and further development of signal processing.     

Ten years of active middle ear implantation for sensorineural hearing loss

Objectives: To evaluate long-term benefits of a totally implantable active middle ear implant (AMEI) that has been used in a single implanting center for over 10 years.

Methods: Forty-one subjects who underwent implantation with an Esteem^® AMEI during a 10-years period were evaluated on the auditory benefits, as derived from pure tone and speech audiometry tests. The analysis included a comparison with a conventional hearing aid, the problematics related to the battery duration and surgical replacement and, finally, the complication rate.

Results: Over 80% of the implanted subjects maintained over time a satisfactory auditory gain, ranging from 10 to over 30?dB in respect to the unaided situation, as mean at 0.5, 1, 2 and 4?kHz. In more than 60% of them, an improvement has also been found at 4 and 8?kHz. Battery duration varied according to the severity of the hearing loss and to the daily use of the device. No major post-operative complications were recorded, whilst explantation was necessary in five subjects, although none for device failure.

Conclusions: The Esteem^® can be considered a reliable device for rehabilitation of sensorineural hearing loss in alternative to conventional hearing aids.     

Audiological application criteria for implantable hearing aid devices: a clinical experience at the Nijmegen ORL clinic

Objectives/Hypothesis: To define audiological application criteria for different implantable hearing aid devices. Study Design: Retrospective study. Methods: Comparisons were made between aided speech recognition scores obtained at conversational level (65 dB) in patients with the Vibrant Soundbridge (VSB) (n = 22), the Otologics middle ear transducer (MET) (n = 10), conventional hearing aids (behind-the-ears) (n = 47), and cochlear implants (CIs) (n = 123). Results: In relation to hearing loss, only for mild hearing loss, speech recognition scores with VSB were comparable to that with conventional hearing aids. In the Otologics MET users, speech recognition scores were comparable with those of the conventional hearing aid users until a mean hearing loss of about 75 dB HL. At a sensorineural hearing loss of about 65 dB HL or more, the Otologics MET users have better speech recognition scores than the VSB users. For comparison with CI users, we followed a more conservative approach. In 90% of the users of a CI, speech recognition scores were better than those in: 1) patients with a conventional hearing aid and a mean hearing loss of about 95 dB HL or worse; 2) patients with an Otologics MET and a mean hearing loss of 85 dB HL or worse. Conclusions: Patients fitted with a VSB or an Otologics MET middle ear implant do not demonstrate better speech recognition scores than patients fitted with today's conventional hearing aids. Results might even been worse. However, the VSB and Otologics MET are a good option in patients with moderate (VSB) to severe (Otologics MET) sensorineural hearing loss and external otitis.     

Long-term assessment after implantation of the Vibrant Soundbridge device.

OBJECTIVE: To present long-term results with a semi-implantable middle ear implant, the Vibrant Soundbridge (VSB), and analyze pre- and post-operative results of audiologic tests. STUDY DESIGN: Retrospective chart review with additional patient interview and audiologic testing. SETTING: One tertiary referral center. SUBJECTS: Twenty patients who met the selection criteria of the manufacturer were evaluated at least two years after implantation. INTERVENTIONS: Monaural Implantation of the VSB in 20 patients, in two of these 20 patients implantation of the second ear in a second stage. RESULTS: Assessment of benefit and satisfaction using the standardized International Outcome Inventory for Hearing Aids, the Glasgow Benefit Inventory, and Visual Analogue Scales in all patients. Fifteen patients agreed to undergo audiologic testing at follow-up including pure-tone- and speech audiometry in silence and noise. The majority of patients (13/20) reported to be satisfied or very satisfied with the VSB. Aided speech perception was comparable between the VSB and the hearing aid preoperatively. When compared to the preoperative audiograms, residual hearing from 0.5-4 kHz was significantly worse in the operated ear with 8 dB (Wilcoxon signed rank test p < 0.001) but only 2.6 dB in the non-operated ear (Wilcoxon signed rank test, p > 0.05). Major surgical complications did not occur. Permanent alteration in taste occurred in three patients and revision surgery was necessary in another three patients. CONCLUSION: Satisfaction with the VSB was not superior to conventional hearing aids in subjective and in audiometric terms. Because of its impact on residual hearing and the requirement of implantation middle ear surgery, implantation of the VSB should be limited to patients with relevant side effects of hearing aids, e.g., severe chronic otitis externa.     

Teilimplantierbare Hörgeräte bei Schallempfindungsschwerhörigkeit und kombinierter Schwerhörigkeit

In recent years semi-implantable hearing aids have become an established option in the treatment of sensorineural hearing loss. In Germany two semi-implantable systems are available, namely the MedEl Soundbridge system and the Otologics MET system, both of which are active middle ear implants. Since 1996 almost 3,500 Soundbridge systems and 300 MET systems have been implanted world-wide. The majority of patients who have received semi-implantable hearing aids consider them to be superior to conventional hearing aids in many respects. Reported benefits include improved speech intelligibility (especially in noise), better sound quality, a more natural sounding own voice and the general advantages of an open ear canal. Implantable hearing systems can be used for a wider range of indications than conventional hearing aids. They are particularly useful in the treatment of patients with high-frequency hearing loss and patients with combined hearing loss. An analysis of the hearing outcomes that have thus far been reported for all patients with a hearing implant shows an average improvement in the hearing threshold by 15 dB, which corresponds to an improvement in hearing of more than 30%. As a consequence semi-implantable hearing systems are an excellent addition to the existing range of conventional hearing aids.     

Predisposing factors for inner ear hearing loss association with chronic otitis media

The aim of the present study was to investigate the consequences of chronic otitis media on inner ear function. Retrospective analysis of conventional pure-tone audiometry tests was carried out on 344 patients who were scheduled for surgical treatment of unilateral chronic otitis media without other risk factors for sensorineural hearing loss. Bone conduction thresholds of diseased ears were compared with those of contralateral, non-diseased ears. Selected clinical features were assessed among diseased ears to examine possible influences on inner ear function. Mean bone conduction threshold differences varied from 0.6 dB at 0.5 kHz to 3.7 dB at 4 kHz. These differences augmented with increasing duration of middle ear disease. Impaired hearing by bone conduction thresholds of diseased ears correlated with increased age at every frequency and with an interruption of the ossicular chain only at higher frequencies. The severity of sensorineural hearing loss correlated with longer duration of middle ear disease. Thus, surgical treatment of dry and apparently stable tympanic membrane perforation is warranted.     

Predisposing factors for inner ear hearing loss association with chronic otitis media

The aim of the present study was to investigate the consequences of chronic otitis media on inner ear function. Retrospective analysis of conventional pure-tone audiometry tests was carried out on 344 patients who were scheduled for surgical treatment of unilateral chronic otitis media without other risk factors for sensorineural hearing loss. Bone conduction thresholds of diseased ears were compared with those of contralateral, non-diseased ears. Selected clinical features were assessed among diseased ears to examine possible influences on inner ear function. Mean bone conduction threshold differences varied from 0.6?dB at 0.5?kHz to 3.7?dB at 4?kHz. These differences augmented with increasing duration of middle ear disease. Impaired hearing by bone conduction thresholds of diseased ears correlated with increased age at every frequency and with an interruption of the ossicular chain only at higher frequencies. The severity of sensorineural hearing loss correlated with longer duration of middle ear disease. Thus, surgical treatment of dry and apparently stable tympanic membrane perforation is warranted.     

Comprehensive hearing aid assessment in adults with bilateral severe-profound sensorineural hearing loss who present for Cochlear implant evaluation

PurposeTo comprehensively assess and describe functional auditory performance in a group of adults with bilateral, moderate sloping to profound sensorineural hearing loss who were dissatisfied users of well-fit bilateral hearing aids and presented for Cochlear implant evaluation. Participants were evaluated with bilateral hearing aids and after six months of bimodal (Cochlear implant and a contralateral hearing aid) hearing experience with a Cochlear implant and contralateral hearing aid.MethodsStudy participants were assessed using pure tone audiometry, aided speech understanding in quiet (CNC words) and in noise (AzBio sentences at +10 and +5 dB SNR) in the sound field with unilateral and bilateral hearing aids fit to target. Participants completed subjective scales of quality of life, (Health Utilities Index Mark 3), hearing disability, (Speech, Spatial and Qualities of Hearing Scale) and a device use satisfaction scale. Participants ≥55 years were administered the Montreal Cognitive Assessment screening tool. One-hundred enrolled individuals completed baseline evaluations.ResultsAided bilateral mean speech understanding scores were 28% for CNC words and 31%, and 17% for AzBio sentences at a +10 dB, and +5 dB SNR, respectively. Mean scale ratings were 0.46 for overall quality of life and 3.19 for functional hearing ability. Ninety percent of participants reported dissatisfaction with overall hearing performance.ConclusionsEvaluation results, including functional performance metrics quantifying the deleterious effects of hearing loss for overall wellbeing, underscore that bilateral hearing aids are not an effective treatment for individuals with bilateral, moderate sloping to profound sensorineural hearing loss. Individuals with this degree of hearing impairment, who demonstrate poor aided speech understanding and dissatisfaction with hearing abilities in everyday life, require timely referral to a Cochlear implant clinic for further evaluation.     

The RetroX auditory implant for high-frequency hearing loss.

OBJECTIVE: The objective of this study was to analyze the subjective satisfaction and measure the hearing gain provided by the RetroX (Auric GmbH, Rheine, Germany), an auditory implant of the external ear. STUDY DESIGN: We conducted a retrospective case review. SETTING: We conducted this study at a tertiary referral center at a university hospital. SUBJECTS: We studied 10 adults with high-frequency sensori-neural hearing loss (ski-slope audiogram). INTERVENTION: The RetroX consists of an electronic unit sited in the postaural sulcus connected to a titanium tube implanted under the auricle between the sulcus and the entrance of the external auditory canal. Implanting requires only minor surgery under local anesthesia. MAIN OUTCOME MEASURES: Main outcome measures were a satisfaction questionnaire, pure-tone audiometry in quiet, speech audiometry in quiet, speech audiometry in noise, and azimuth audiometry (hearing threshold in function of sound source location within the horizontal plane at ear level). RESULTS:: Subjectively, all 10 patients are satisfied or even extremely satisfied with the hearing improvement provided by the RetroX. They wear the implant daily, from morning to evening. We observe a statistically significant improvement of pure-tone thresholds at 1, 2, and 4 kHz. In quiet, the speech reception threshold improves by 9 dB. Speech audiometry in noise shows that intelligibility improves by 26% for a signal-to-noise ratio of -5 dB, by 18% for a signal-to-noise ratio of 0 dB, and by 13% for a signal-to-noise ratio of +5 dB. Localization audiometry indicates that the skull masks sound contralateral to the implanted ear. Of the 10 patients, one had acoustic feedback and one presented with a granulomatous reaction to the foreign body that necessitated removing the implant. CONCLUSION: The RetroX auditory implant is a semi-implantable hearing aid without occlusion of the external auditory canal. It provides a new therapeutic alternative for managing high-frequency hearing loss.     

Evaluation of hearing organ in patients with Turner syndrome

Hearing loss and middle ear diseases are often reported in some of Turner patients. In most of the reports hearing organ was evaluated with the use of subjective methods. The aim of the work was subjective and objective evaluation of hearing organ with an attempt to set the correlation between the results and the genotype of the patients with Turner syndrome (Ts). MATERIAL: 51 Ts patients aged 14.3 years on average. There were 29 girls with monosomy X and 22 having mosaicism. A detailed medical history was taken in each case with attention given to the hearing loss risk factors. METHOD: Physical ENT examination, hearing evaluation: pure tone audiometry, impedance audiometry, distortion products otoacoustic emissions (DPOAEs), brain auditory evoked potentials (BAEP). The control group consisted of 30 healthy patients. RESULTS: Recurrent acute otitis media was reported by 19.6% of Ts patients. Pure tone audiometry was improper in 36.3% ears; conductive hearing loss was present in 11.7% ears, mixed hearing loss in 5.9% ears and the moderate sensorineural hearing loss in 18.6% ears. Impedance audiometry was impaired in 14.7% of the cases. DPOAE disturbances were present in 41.4% of Ts patients, BAEP was improper in 52.0%. The percentage of the disturbances in DOPAEs and in BAEP in patients with mosaicism was 45.4 and 40.9% while in patients with monosomy 68.9 and 62%. CONCLUSIONS: Ts patients present predisposition to hearing disturbances. The disturbances seem to be connected with middle ear infections and with sensorineural hearing losses. Hearing loss in Ts women is not clinically apparent in most of the cases; this fact reflects the need of early evaluation and further monitoring of hearing organ in those patients. Sensorineural hearing loss seems to prevail in patients with 45,X genotype, so perhaps attention should be paid to this subgroup of Ts patients.     

Evaluation of the subjective effect of middle ear implantation in hearing-impaired patients with severe external otitis

The subjective benefit of middle ear implantation was studied in a group of 23 hearing-impaired patients who could not use conventional hearing aids owing to severe chronic external otitis. Changes in hearing disability (Abbreviated Profile of Hearing Aid Benefit [APHAB]) and changes in quality of life (Glasgow Benefit Inventory [GBI]) were determined. Mean benefit value on the APHAB for the subscale Ease of Communication was close to the mean reference value for conventional hearing aids. For the subscales Reverberation and Background Noise, a poorer result was found. Individual analysis of the APHAB scores showed significant benefit in 12 out of the 23 patients. According to the GBI, 16 out of 17 patients reported that middle ear implantation had made a positive impact on their quality of life. It is concluded that middle ear implantation has a positive effect on hearing difficulties and quality of life in hearing-impaired subjects who cannot use conventional devices. The APHAB outcomes were not better than those reported for conventional devices.     

Speech perception for adults who use hearing aids in conjunction with cochlear implants in opposite ears.

This study aimed to (a) investigate the effect of using a hearing aid in conjunction with a cochlear implant in opposite ears on speech perception in quiet and in noise, (b) identify the speech information obtained from a hearing aid that is additive to the information obtained from a cochlear implant, and (c) explore the relationship between aided thresholds in the nonimplanted ear and speech perception benefit from wearing a hearing aid in conjunction with a cochlear implant in opposite ears.Fourteen adults who used the Nucleus 24 cochlear implant system in 1 ear participated in the study. All participants had either used a hearing aid in the nonimplanted ear for at least 75% of waking hours after cochlear implantation, and/or, hearing loss less than 90 dB HL in the low frequencies in the nonimplanted ear. Speech perception was evaluated in 3 conditions: cochlear implant alone (CI), hearing aid alone (HA), and cochlear implant in conjunction with hearing aid in opposite ears (CIHA). Three speech perception tests were used: consonant-vowel nucleus-consonant (CNC) words in quiet, City University of New York style (CUNY) sentences in coincident signal and noise, and spondees in coincidental and spatially separated signal and noise. Information transmission analyses were performed on the CNC responses.Of the 14 participants tested, 6 showed significant bimodal benefit on open-set speech perception measures and 5 showed benefit on close-set spondees. However, 2 participants showed poorer speech perception with CIHA than CI in at least 1 of the speech perception tests. Results of information transmission analyses showed that bimodal benefit (performance with CIHA minus that with CI) in quiet arises from improved perception of the low frequency components in speech. Results showed that participants with poorer aided thresholds in the mid-to-high frequencies demonstrated greater bimodal benefit. It is possible that the mid-to-high frequency information provided by the hearing aids may be conflicting with the cochlear implants.     

Long-term results of bone-anchored hearing aid recipients who had previously used air-conduction hearing aids

OBJECTIVE: To study the long-term results (use, care, satisfaction, ear infections, and audiometry) of the application of a bone-anchored hearing aid (BAHA) to patients with conventional indications who had previously used air-conduction hearing aids. DESIGN: Follow-up study (mean duration, 9 years). SETTING: Tertiary referral center. PATIENTS: The study population comprised 27 patients with conductive or mixed hearing loss and who had participated in a previous study (N = 34). Seven could not be included anymore as a result of death, Alzheimer disease, or problems related to the implant. Everyone filled out the questionnaire, and 23 patients underwent audiometric evaluation. MAIN OUTCOME MEASURES: The patients filled out the adapted Nijmegen questionnaire. Aided free-field thresholds were measured as well as scores for speech in noise and in quiet. Results were compared with those obtained in the initial study. RESULTS: All 27 patients were still using their BAHA and appreciated it with regard to speech recognition in quiet, sound comfort, and improvements in ear infections. The audiometric results showed that most patients tested had stable bone-conduction thresholds over the years (after correction for age). Despite the treatment with BAHA, a significant deterioration in the cochlear hearing was observed in the other patients in the ear under study (their best hearing ear). CONCLUSIONS: Positive patient outcome measures emphasized the importance of BAHA application to patients with conventional indications. The audiometric data showed fairly stable cochlear function but not for all patients. This underlines that conservative treatment should be chosen (fitting of bone-conduction devices).     

Bullous myringitis and sensorineural hearing loss

A prospective study was undertaken to investigate the incidence of sensorineural hearing loss in bullous myringitis. Fifteen patients with 21 ears diagnosed as bullous myringitis were seen over a 24-month period. Pure tone and speech audiometry were performed as early in the clinical course as possible; 7 ears demonstrated a sensorineural hearing loss and 7 ears a mixed loss. There were no purely conductive hearing losses. Recovery of hearing was complete in 8 of 14 ears. The findings of this study suggest that sensorineural hearing loss is common in bullous myringitis. The literature regarding bullous myringitis is briefly reviewed and the implications of this study are discussed.     

The active middle ear implant for the rehabilitation of sensorineural, mixed and conductive hearing losses

Active middle ear implants, such as the Vibrant Soundbridge, are used as an important part in the rehabilitation of sensorineural, conductive hearing, or mixed hearing loss. The attachment of the Vibrant Soundbridge at the round window and the usage of the Vibroplasty couplers strongly expanded the application of the Vibrant Soundbridge.The Vibrant Soundbridge is developed for patients who have an intolerance to hearing aids and a moderate to profound sensorineural hearing loss. The VSB also provides an optimal solution for patients with failed middle ear reconstructions or patients with atresia. To capture the improvement with the VSB Implant with different hearing losses a literature analysis was conducted. The functional gain was analyzed for 107 patients with conductive hearing loss and for 214 patients with sensorineural hearing loss out of 14 studies.Patients with conductive and mixed hearing loss resulted in a functional gain from 30 to 58?dB with the VSB. Patients with a pure sensorineural hearing loss showed a functional gain of 23-30?dB. The VSB bone conduction threshold shift was analyzed for all studies conducted in the years between 2000 and 2009. In 11 of the 16 studies there was no significant (p=0.05) change found. In 5 studies, the pre- to post-surgical bone conduction threshold shift was less than 10?dB. None of these studies measured a threshold shift of more than 10?dB.The flexible attachment at either the long process of the incus with sensorineural hearing loss, with an conductive hearing loss at the round window or the use of Vibroplasty couplers at the oval window, head of the stapes or round window makes the VSB an extremely versatile instrument. If patients can't wear conventional hearing aids, had failed middle ear reconstructions or atresia the VSB presents, due to the significant hearing improvement in any type of hearing loss, an ideal solution.