The bone-anchored hearing aid enhanced performance in different hearing configurations, albeit to different extents.

Recent findings support the efficacy of the direct acoustic cochlear implant (DACI) in patients with advanced otosclerosis whose rehabilitation is very challenging. Standard treatment consists of stapes surgery combined with hearing aids or a cochlear implant (CI). CI surgery, however, is often challenging depending on the grade of otosclerosis. This study aims to compare speech perception scores in quiet and noise of 6 DACI and 12 CI patients with advanced otosclerosis at 3 and 12 months after fitting. Preoperative computed tomographic scans of all patients were scored by experts using an existing otosclerosis grading system (stages 1–3). Speech perception in quiet was significantly better for DACI compared to CI users at 3 months after fitting. At 12 months, no difference was found between DACI and CI patients. Speech perception scores in noise were significantly better in the DACI group. In summary, a DACI system seems to provide an effective treatment option as the acoustic component can be preserved in patients with advanced otosclerosis.

No abstract

A cochlear implant is a neuroprosthetic device that can restore speech perception for people with severe to profound hearing loss. Because of recent evolutions, a growing number of people with a cochlear implant have useful residual acoustic hearing. While combined electro-acoustic stimulation has been shown to improve speech perception for this group of people, some studies report limited adoption rates. Here, we present electro-vibrational stimulation as an alternative combined stimulation strategy that similarly targets the full cochlear reserve. This novel strategy combines the electrical stimulation by the cochlear implant with low-frequency bone conduction stimulation. In a first evaluation of electro-vibrational stimulation, speech perception in noise was assessed in 9 subjects with a CI and symmetrical residual hearing. We demonstrate a statistically significant and clinically relevant improvement for speech perception in noise of 1.9 dB signal-to-noise ratio. This effect was observed with a first prototype that provides vibrational stimulation to both ears with limited transcranial attenuation. Future integration of electro-vibrational stimulation into one single implantable device could ultimately allow cochlear implant users to benefit from their low-frequency residual hearing without the need for an additional insert earphone.

Objective: We prospectively evaluated safety and clinical efficacy of an active bone conduction implant, named Bonebridge, in patients with conductive hearing loss (CHL). Performance was compared with the preoperative aided condition. Methods: Nine Dutch-speaking patients were implanted with Bonebridge in a single tertiary referral center and were followed up for 4 years and 11 months (mean). Six patients had CHL, one had mixed hearing loss (MHL), and two had single-sided deafness. Preoperatively, patients were fitted with a conventional air conduction hearing aid (HA) and/or a bone-anchored HA processor worn on a headband. Intra-and postoperative complication rates were assessed for all patients. Five patients with CHL/MHL participated in an extensive audiological evaluation, including regular measurements of hearing thresholds (air and bone conduction), speech reception in quiet (consonant vowel consonant or CVC words) and noise (sentences), and subjective satisfaction (Abbreviated Profile of Hearing Aid Benefit questionnaire and the Speech, Spatial and Qualities of Hearing Scale). Results: Patients' residual hearing was not deteriorated by the implantation, and no adverse events were reported. For CHL and MHL cases (n=5), the median functional gain was 20 dB at activation and remained stable thereafter. After 3 months, the median word recognition score in quiet at 40 dB A was 80%. The median speech reception threshold in noise was 4.8 dB signal to noise ratio 1 year postoperatively. Comparison with preoperative scores with a bone conduction device on a headband revealed no significant differences. Questionnaires demonstrated subjective satisfaction. Stable performance was observed along the entire follow-up period. Conclusion: Bonebridge can be considered a safe and effective treatment option for patients with CHL.