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.     

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.     

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.     

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.     

The evidence base for the application of contralateral bone anchored hearing aids in acquired unilateral sensorineural hearing loss in adults

? Acquired unilateral sensorineural hearing loss reduces the ability to localize sounds and to discriminate in background noise. ? Four controlled trials attempt to determine the benefit of contralateral bone anchored hearing aids over contralateral routing of signal (CROS) hearing aids and over the unaided condition. All found no significant improvement in auditory localization with either aid. Speech discrimination in noise and subjective questionnaire measures of auditory abilities showed an advantage for bone anchored hearing aid (BAHA) > CROS > unaided conditions. ? All four studies have material shortfalls: (i) the BAHA was always trialled after the CROS aid; (ii) CROS aids were only trialled for 4 weeks; (iii) none used any measure of hearing handicap when selecting subjects; (iv) two studies have a bias in terms of patient selection; (v) all studies were underpowered (vi) double reporting of patients occurred. ? There is a paucity of evidence to support the efficacy of BAHA in the treatment of acquired unilateral sensorineural hearing loss. Clinicians should proceed with caution and perhaps await a larger randomized trial. ? It is perhaps only appropriate to insert a BAHA peg at the time of vestibular schwanoma tumour excision in patients with good preoperative hearing, as their hearing handicap increases most.     

传导性或混合性耳聋患者佩戴骨锚式助听器软带的预期效果

目的 研究分析传导性或混合性耳聋患者进行佩戴骨锚式助听器(BAHA)软带后的听力改善情况。方法 参与研究者62例, 在声场进行BAHA软带佩戴前后纯音听力测试及问卷调查, 了解患者佩戴BAHA后的听力情况及主观感受。结果 62例佩戴BAHA后0.25～4 kHz气导听力均得到了不同程度提高, 对声音的方向感及噪声下言语交流能力提高。结论 BAHA能改善传导性聋或混合性聋患者的听力。     

Patients’ opinions on bilateral bone anchored hearing aid fitting

Introduction. Patients’ opinions on bilateral bone-anchored hearing air (BAHA) fitting compared to unilateral fitting were evaluated. Patients and methods. A study was carried out of 11 patients who had been using a unilateral BAHA before being fitted bilaterally. All patients showed conductive or mixed hearing loss, with an (almost) symmetrical sensorineural hearing loss component. Four out of the 11 patients had bilateral congenital aural atresia and the rest of the patients had a history of chronic otitis media. All 11 patients filled in two questionnaires. Questionnaire 1 consisted of questions about thepatients’ preference in different listening situations. It was filled in 10 weeks after bilateral BAHA fitting. Questionnaire 2 consisted of questions that compared the previous situation (with only a unilateral BAHA) to the situation with the more recent bilateral BAHA application. This questionnaire was filled in before and 10 weeks after bilateral fitting. Results. Ten out of the 11 patients clearly favoured the bilateral BAHA above unilateral. Conclusion. Eight patients were very satisfied and three patients were satisfied with the second BAHA. These positive results agreed with the previously found positive audiological results.     

The bone-anchored hearing aid: quality-of-life assessment

OBJECTIVES: To assess the impact of a bone-anchored hearing aid (BAHA) on the quality of life (QOL) of adults and to test the hypothesis that a BAHA improves QOL because otorrhea and/or skin irritations decrease. DESIGN: Prospective postal-based questionnaire study using validated health-related QOL instruments, combined with hearing-aid-related questions. PATIENTS AND METHODS: The study included 56 consecutive adult patients with acquired conductive or mixed hearing loss who were scheduled for BAHA implantation at the University Medical Centre Nijmegen, Nijmegen, the Netherlands. All 56 patients completed the 36-Item Short-Form Health Survey (SF-36), the EuroQol-5D (EQ-5D), and the Hearing Handicap and Disability Inventory (HHDI); 36 patients had been using an air-conduction hearing aid (ACHA) and 20 patients a conventional bone-conduction hearing aid (CBHA). Questionnaires were filled out before surgery and after 6 months of experience with the BAHA. RESULTS: In the SF-36 group, there was significant improvement in the scores of the mental health domain (P =.02). When the SF-36 patients were classified according to previous hearing aid, there was no statistically significant change in the scores in any of the domains. In the EQ-5D group and in its ACHA and CBHA subgroups, there were no important differences in the results before and after the patients received their BAHAs. In the HHDI group, the handicap and disability scales showed significant improvement (P<.01) irrespective of the type of previously worn hearing aid. CONCLUSIONS: Overall, generic health-related QOL was not influenced significantly by the use of a BAHA according to the SF-36 and the EQ-5D. The more disease-specific scales (HHDI) did show improved QOL with a BAHA.     

Candidacy for the bone-anchored hearing aid

The BAHA (bone-anchored hearing aid) is a bone conduction hearing aid with percutaneous transmission of sound vibrations to the skull. The device has been thoroughly evaluated by various implant groups. These studies showed that, in audiological terms, the BAHA is superior to conventional bone conduction devices. In comparison with air conduction devices, the results are ambiguous. However, a positive effect is found with respect to aural discharge. The most powerful BAHA can be applied to patients with a sensorineural hearing loss component of up to 60 dB HL. It was shown that bilateral BAHA application leads to binaural sound processing. Preliminary results on the application of the BAHA in patients with unilateral conductive hearing loss suggest that stereophonic hearing can be re-established. The application of the BAHA as a transcranial CROS (contralateral routing of signal) device in unilateral deafness minimizes head shadow effects.     

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.     

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).     

BAHA in children and adolescents with unilateral or bilateral conductive hearing loss: a study of outcome

OBJECTIVES: Bilateral BAHAs in adults with bilateral hearing loss (BHL) have proven to be superior to unilateral fitting, in both audiologically measurements and in overall patient satisfaction. There have been no similar studies in children. Furthermore, a recent meta-analysis of children with unilateral hearing loss (UHL) has shown numerous negative consequences. The objectives of the study were to investigate whether fitting of bilateral BAHAs in children with conductive BHL give additional hearing benefits, to investigate the effects of unilateral hearing aids in children with conductive UHL, and to identify different aspects of auditory problems in children with conductive UHL or BHL. STUDY DESIGN: This was a prospective study involving 22 children with either conductive UHL (unaided or with unilateral hearing aid) or conductive BHL (with unilateral or bilateral BAHAs) and 15 controls. METHODS: Baseline audiometry, tone thresholds in a sound field, speech recognition in noise and sound localization were tested without, and with unilateral and bilateral hearing aids. Two questionnaires, MAIS & MUSS and IOI-HA, were completed. RESULTS: Two problem areas were identified in the children with hearing impairment: in reactions to sounds and in intelligibility of speech. An additional BAHA in the children with BHL resulted in a tendency to have improved hearing in terms of better sound localization and speech recognition in noise. Fitting of unilateral hearing aids in the children with UHL gave some supplementary benefit in terms of better speech recognition in noise but no positive effect on ability to localize sound could be detected. Even so, all children fitted with hearing aids - either unilaterally or bilaterally - reported a positive outcome with their devices in the self-assessment questionnaire. CONCLUSIONS: Children with either UHL or BHL displayed several problems within the hearing domain. Fitting of bilateral BAHAs in children with BHL and of a single-sided hearing aid in children with UHL appears to have some supplementary audiological benefits and also renders high patient satisfaction. In order to investigate the possible supplementary effects of hearing aids, a 3-month trial of BAHA on Softband, either unilaterally or bilaterally, may be of value in children with conductive UHL or BHL, respectively.     

The bone-anchored hearing device (BAHA)

The bone-anchoring hearing device (BAHA) is an osseointegrated system that is used for hearing rehabilitation through direct bone conduction. The indications for the BAHA include unilateral and/or bilateral conductive or mixed hearing loss, and unilateral profound sensorineural hearing loss. When used for unilateral profound sensorineural hearing loss, the BAHA acts as a bone conduction CROS (contralateral routing of off-side signal) device transmitting the signal from the deaf side through the skull to the contralateral cochlea. The surgical procedure to place the abutment and titanium screw is straightforward. In general, the satisfaction rate is very high for patients using the BAHA system.     

Binaural advantages in using a cochlear implant for adults with profound unilateral hearing loss

Background: Recent studies of cochlear implants (CIs) in profound unilateral hearing loss (UHL) patients have demonstrated a restoration of some binaural hearing.

Aims/Objectives: The objective was to evaluate three possible advantages of binaural hearing in CIs adult users with UHL including single-side deafness (SSD) and asymmetric hearing loss (AHL) subgroups.

Material and methods: A prospective study was conducted that included 70 sequentially implanted patients. Subgroups of these subjects included 64 with a postlingual onset of a profound hearing loss on the implanted side and 6 with a prelingual onset of that loss. Three binaural effects – redundancy, head shadow, and squelch – were evaluated.

Results: Significant differences between the ‘CI on’ and ‘CI off’ conditions were found for all three binaural effects for the study group as a whole and for the postlingual subgroup. However, results for the subjects in the prelingual subgroup did not demonstrate any of the binaural advantages.

Conclusion and significance: Patients with a postlingual onset of a profound hearing loss in one ear and normal hearing or only a moderate loss in the other ear are able to make the effective use of a CI in the profound-loss ear in conjunction with acoustic stimulation of the other ear.     

Results of pediatric bone-anchored hearing aid implantation

INTRODUCTION: The bone-anchored hearing aid (BAHA) system uses an osseointegrated titanium implant to propagate sound directly to the inner ear through the bones of the skull, bypassing the impedance of the skin and subcutaneous tissues. Children as young as 18 months have had hearing rehabilitated with this device. OBJECTIVES: The goals were to evaluate the efficacy of patient selection criteria, the safety and effectiveness of the implantation procedure, and the level of patient satisfaction after BAHA implantation in children. METHODS: The records of all pediatric patients implanted in Edmonton were retrospectively reviewed. Twenty patients, who received 25 implants, with postimplantation follow-up of 6 months or greater, were included. The average follow-up was 3 years, 7 months. RESULTS: Of 20 original implants, 3 were lost owing to trauma, whereas 2 failed to osseointegrate. All were successfully reimplanted. Complications related to the implants included three instances of skin necrosis around the abutment. All patients and caregivers reported greater than 95% improvement in patient-identified listening situations. Pure-tone averages improved from a mean of 49 dB for the better hearing ear preoperatively to 16 dB with the BAHA set at normal listening levels. CONCLUSIONS: The BAHA provides a safe and effective means of rehabilitation of conductive or mixed hearing loss in the pediatric population. Our patients report a high level of satisfaction and continued use of their devices.     

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.     

Unilateral deafness after acoustic neuroma surgery: subjective hearing handicap and the effect of the bone-anchored hearing aid.

OBJECTIVE: To evaluate the subjective hearing handicap in patients with unilateral deafness after acoustic neuroma surgery and the effect of the Bone-anchored Hearing Aid (BAHA) on test band. STUDY DESIGN: Fifty-nine consecutive patients with unilateral deafness after translabyrintine removal of an acoustic neuroma, treated in Denmark in 2001 and 2002, were included. The patients were asked to complete a questionnaire, which addressed the subjective handicap of unilateral deafness; 90% responded. These patients were invited to test the BAHA on test band, and the subjective and objective effects were recorded. RESULTS: Eighty percent of the patients thought that they had a subjective hearing handicap of some significance. However, only 50% accepted the invitation to test the BAHA. The overall subjective effect was positive, and a significant improvement in speech discrimination in noise with the BAHA was demonstrated. After the test, however, only about 50%, that is, 25% of all patients wished implantation for BAHA treatment. CONCLUSION: This study shows that unilateral deafness after acoustic neuroma surgery is thought as a handicap in most of the patients and confirms that treatment with the BAHA has positive subjective effects and improves speech discrimination in noise. However, only 25% of the patients wished implantation for BAHA treatment. The implications of these findings are discussed. Data from centers that perform simultaneous acoustic neuroma surgery and implantation for BAHA are necessary for firm conclusions.     

Bone conduction improvement after surgery for conductive hearing loss

The objective is to evaluate change in post-operative bone conduction in patients who underwent surgery for conductive/mixed hearing loss due to various reasons. The study design is of retrospective case review and tertiary referral center setting. Five-hundred patients with unilateral conductive/mixed hearing loss were divided into five equal groups (each representing different causes for pre-operative hearing loss), who underwent appropriate surgical correction and had a follow-up audiogram available. The intervention comprises surgery (like myringoplasty and ossiculoplasty with closed or open cavity mastoidectomy for chronic otitis media, stapes mobilization for tympanosclerosis and stapedotomy for otosclerosis) for conductive/mixed hearing loss. Significant improvement or worsening in bone conduction was defined as 15?dB or more improvement or worsening of bone conduction threshold at least in two frequencies between 500 and 4000?Hz. All the other groups also showed a consistent pre-operative bone conduction reduction with an equally consistent improvement in post-operative bone conduction improvement to a varying degree with otosclerosis group having maximum percentage of patients with post-operative bone conduction improvement (60%). The measurement of bone conduction is not necessarily a true reflection of the function of the inner ear. Middle ear makes a contribution to bone conduction and correction of a middle ear conductive lesion causes an apparent improvement in inner ear function. The apparent inner ear hearing loss caused in this way may be reversible to some extent.     

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.