The bonebridge as a transcutaneous bone conduction hearing system: preliminary surgical and audiological results in children and adolescents

Abstract

The Bonebridge (®) (BB, Med-El) is a newly designed transcutaneous active bone conductive implant with functional outcome similar to percutaneous bone-anchored hearing systems (BAHS). It is currently approved only for patients ≥18 years. Since the BB allows the skin to remain intact and therefore should be able to overcome some of the issues related to percutaneous BAHS including skin reactions, wound infection and implant extrusion, it would be especially attractive for use in children. We present a preliminary series of the first three cases of BB implantation in children/adolescents (10-16 years). Two subjects were affected by conductive hearing loss (CHL) and one subject by single-sided deafness (SSD). The surgical procedure with transmastoid approach was completed in all cases without complications. Both subjects with CHL showed an increase in speech perception thresholds in quiet from preoperative unaided to 6 months postoperatively with BB of 37 dB, respectively, of 12 dB. The adolescent with SSD attained -3.1 dB unaided vs. -5.6 dB with the BB in the "speech and noise from the front" presentation and +0.5 unaided vs. -5.0 dB with the BB in the "speech from the unilateral deaf side/noise from the normal hearing side" presentation using the adaptive Oldenburg Sentence Test. The results show a straightforward surgical procedure and satisfactory functional gain after BB implantation also in children/adolescents. BB implantation in patients ≤18 years is currently an "off-label use" so that detailed information about alternative treatment options, operation risks and the lack of approval for use in children is essential.

Horizontal sound localisation and speech perception in Bonebridge-implanted single-sided deafness patients

“…24 Furthermore, the mean speech recognition thresholds were reduced after implantation when both speech and noise were presented from the front. 28 However, Laske et al state that speech perception was not improved in patients with single-sided deafness in the speech and noise presented from the front condition irrespective of the use of a Bonebridge device. 27 The improvement of speech-to-noise ratio was not statistically significant in the speech and noise presented from the front, and speech and noise presented from the front and contralateral (normal ear) side separately conditions in this study, which is in contrast to that shown in previous studies.…”

Active Bone Conduction Prosthesis: BonebridgeTM

“…Several groups around the world have reported different audiological results (functional gain, speech reception thresholds, and word recognition scores). 2 3 4 6 8 Based on our experience, 90% of patients with conductive hearing loss got the total closure of air-bone gap, which means a gain of 30 to 60dB. In cases of congenital atresia, this is achieved in almost all patients, being less prevalent in patients with other etiologies, such as otosclerosis or chronic otitis media.…”

Safety and efficacy of transcutaneous bone conduction implant surgery for hearing improvement in microtia patients with bilateral hearing impairment

“…The Bonebridge is currently approved only for patients 18 years of age or older. However, Hassepass et al [24] reported a straightforward surgical procedure and satisfactory functional gain after TBCI surgery in an adolescent patient ≥ 12 years old. Baumgartner et al [6] also demonstrated the safety and efficacy of the Bonebridge implant in a 5-year-old child.…”