Unexplained Variation in Benefit of Treatment of Congenital Unilateral Aural Atresia: A Review of the Literature

Vogt, Katharina; Desmet, Jolien; Janssen, A. Miranda L.; Agterberg, Martijn J.H.; Snik, A.F.M.

doi:10.1159/000512245

Cited by 5 publications

(7 citation statements)

References 37 publications

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“…Scores obtained in our work lead us to make some considerations: Our results reveal that patients of group 1 (affected by bilateral conductive or mixed hearing impairment fitted with bilateral BCI) started from lower hearing thresholds at baseline condition before treatment if compared to group 2 (affected by monaural conductive or mixed hearing loss fitted with unilateral BCI), resulting in a difference between group 1 and group 2 of 5.84 dB for the summation setting, 2.46 dB for the squelch setting and 4.84 dB for the head shadow setting at time 0. In fact, the implantation of a single BCI in subjects affected by bilateral conductive hearing loss results necessary in a disadvantaged starting condition if compared to subjects affected by unilateral hearing loss who received normal hearing input from the contralateral normal-hearing ear since their birth [ 18 ]. In our work, both groups showed a substantial decrement in the signal-to-noise ratio (SNR) at the speech recognition threshold (SRT) for all tested settings.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Active Bone Conduction Hearing Implant Systems in Unilateral and Bilateral Conductive or Mixed Hearing Loss

Canale,

Urbanelli,

Gragnano

et al. 2023

Brain Sciences

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Background: To assess and compare binaural benefits and subjective satisfaction of active bone conduction implant (BCI) in patients with bilateral conductive or mixed hearing loss fitted with bilateral BCI and patients with monaural conductive hearing loss fitted with monaural BCI. Methods: ITA Matrix test was performed both on patients affected by bilateral conductive or mixed hearing loss fitted with monaural bone conduction hearing implant (Bonebridge, Med-El) before and after implantation of contralateral bone conduction hearing implant and on patients with monaural conductive or mixed hearing loss before and after implantation of monaural BCI. The Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire was administered to both groups of subjects and the results were compared with each other. Results: Patients of group 1 reported a difference of 4.66 dB in the summation setting compared to 0.79 dB of group 2 (p < 0.05). In the squelch setting, group 1 showed a difference of 2.42 dB compared to 1.53 dB of group 2 (p = 0.85). In the head shadow setting, patients of group 1 reported a difference of 7.5 dB, compared to 4.61 dB of group 2 (p = 0.34). As for the APHAB questionnaire, group 1 reported a mean global score difference of 11.10% while group 2 showed a difference of −4.00%. Conclusions: Bilateral BCI in patients affected by bilateral conductive or mixed hearing loss might show more advantages in terms of sound localisation, speech perception in noise and subjective satisfaction if compared to unilateral BCI fitting in patients affected by unilateral conductive hearing impairment. This may be explained by the different individual transcranial attenuation of each subject, which might lead to different outcomes in terms of binaural hearing achievement. On the other hand, patients with unilateral conductive or mixed hearing loss fitted with monaural BCI achieved good results in terms of binaural hearing and for this reason, there is no absolute contraindication to implantation in those patients.

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Section: Discussionmentioning

confidence: 99%

Comparison of Active Bone Conduction Hearing Implant Systems in Unilateral and Bilateral Conductive or Mixed Hearing Loss

Canale,

Urbanelli,

Gragnano

et al. 2023

Brain Sciences

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“…Results on speech recognition were more diverse, where four individuals showed a worse performance in the aided setting. In a review by Vogt et al ( 33 ), they found that aided hearing thresholds did not approach normal levels in six out of nine included studies and also suggested that an insufficient degree of amplification might be a part explanation for poorer aided speech recognition scores. Several of the study participants in the present study did not reach normal hearing levels of the atretic ear in the aided setting.…”

Section: Discussionmentioning

confidence: 99%

“…For horizontal SLA in normal binaural hearing, ITDs have been shown to be dominant, overthrowing ILD and spectral cues for low frequency sounds ( 39 ). Monaural spectral cues, resulting from acoustic reflections in the pinna, shoulders, and body are used for localization in the vertical plane in normal hearing listeners ( 40 ) and might be of importance for unaided horizontal sound localization in individuals with UAA ( 8 , 11 , 33 , 34 ). Here, monaural cues were likely available to the children, but not very prominent given the naturally occurring amplitude modulations of the sound.…”

Section: Discussionmentioning

confidence: 99%

A pilot study on spatial hearing in children with congenital unilateral aural atresia

Josefsson Dahlgren,

Engmér Berglin,

Hultcrantz

et al. 2023

Front. Pediatr.

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Despite normal hearing in one ear, individuals with congenital unilateral aural atresia may perceive difficulties in everyday listening conditions typically containing multiple sound sources. While previous work shows that intervention with bone conduction devices may aid spatial hearing for some children, testing conditions are often arranged to maximize any benefit and are not very similar to daily life. The benefit from amplification on spatial tasks has been found to vary between individuals, for reasons not entirely clear. This study has sought to expand on the limited knowledge on how children with unilateral aural atresia recognize speech masked by competing speech, and how horizontal sound localization accuracy is affected by the degree of unilateral hearing loss and by amplification using unilateral bone conduction devices when fitted before 3 years of age. In a within-subject, repeated measures design, including 11 children (mean age = 7.9 years), bone conduction hearing device (BCD) amplification did not negatively affect horizontal sound localization accuracy. The effect on speech recognition scores showed greater inter-individual variability. No benefit from amplification on a group level was found. There was no association between age at fitting and the benefit of the BCD. For children with poor unaided sound localization accuracy, there was a greater BCD benefit. Unaided localization accuracy increased as a function of decreasing hearing thresholds in the atretic ear. While it is possible that low sound levels in the atretic ear provided access to interaural localization cues for the children with the lowest hearing thresholds, the association has to be further investigated in a larger sample of children.

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“…Brotto et al reinforce the idea that using BCIs in UCHL might improve speech perception in noise thanks to the summation effect, but the setting of the study prevented the investigation of real binaural hearing 15 . Vogt et al, in a 2021 review, suggest instead that the benefits of BCIs might be related to bilateral hearing (2 “separate” inputs) rather than “binaural hearing” (a fused concept) 16 .…”

Section: Introductionmentioning

confidence: 99%

Binaural hearing in monaural conductive or mixed hearing loss fitted with unilateral Bonebridge

Canale,

Urbanelli,

Albera

et al. 2024

Acta Otorhinolaryngol Ital

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SUMMARY Objective To determine the benefits of binaural hearing rehabilitation in patients with monaural conductive or mixed hearing loss treated with a unilateral bone conduction implant (BCI). Methods This monocentric study includes 7 patients with monaural conductive or mixed hearing loss who underwent surgical implantation of a unilateral BCI (Bonebridge, Med-El). An ITA Matrix test was performed by each patient included in the study - without and with the BCI and in three different settings – to determine the summation effect, squelch effect and head shadow effect. Subjective hearing benefits were assessed using the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire. Results The difference in signal to noise ratio of patients without and with BCI was 0.79 dB in the summation setting (p < 0.05), 4.62 dB in the head shadow setting (p < 0.05) and 1.53 dB (p = 0.063) in the squelch setting. The APHAB questionnaire revealed a subjective discomfort in the presence of unexpected sounds in patients using a unilateral BCI (aversiveness score) compared to the same environmental situations without BCI, with a mean discomfort score of 69.00% (SD ± 21.24%) with monaural BCI versus 25.67% (SD ± 16.70%) without BCI (difference: -43.33%, p < 0.05). In terms of global score, patients wearing a unilateral Bonebridge implant did not show any significant differences compared to those without hearing aid (difference: -4.00%, p = 0.310). Conclusions Our study shows that the use of a unilateral BCI in patients affected by monaural conductive or mixed hearing loss can improve speech perception under noise conditions due to the summation effect and to the decrease of the head shadow effect. However, since monaural BCIs might lead to discomfort under noise conditions in some subjects, a pre-operative assessment of the possible individual benefit of a monaural BCI should be carried out in patients affected by unilateral conductive or mixed hearing loss in order to investigate the possible additional effect of the fitting of hearing aids.

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Unexplained Variation in Benefit of Treatment of Congenital Unilateral Aural Atresia: A Review of the Literature

Cited by 5 publications

References 37 publications

Comparison of Active Bone Conduction Hearing Implant Systems in Unilateral and Bilateral Conductive or Mixed Hearing Loss

Comparison of Active Bone Conduction Hearing Implant Systems in Unilateral and Bilateral Conductive or Mixed Hearing Loss

A pilot study on spatial hearing in children with congenital unilateral aural atresia

Binaural hearing in monaural conductive or mixed hearing loss fitted with unilateral Bonebridge

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