Blog 2019-1: Percutaneous bone conductor or (active) middle ear implant to treat mixed hearing loss? No clear winner yet

Introduction To rehabilitate patients with mixed hearing loss, implantable devices like the Vibrant Soundbridge middle ear implant (VSB) or percutaneous bone conductors (BCDs) have been applied. Such implantable devices become the next option whenever conventional hearing devices (e.g. behind-the-ear device) or reconstructive surgery are not possible or probably not effective (e.g. in case of aural atresia or chronic draining ears). Using recent publications, describing clinical trails, a comparison Read more [...]

Blog 2018-1: Implantable transcutaneous bone conductors or percutaneous bone conductors; a free choice? Review of the paper by Cedars et al., 2016

The Baha bone-conduction device (BCD) was developed in the eighties for patients with conductive and mixed hearing loss. When this device is percutaneously coupled, the BCD is a powerful hearing solution (see Chapters 2 and 3, this website) and is generally considered as the gold standard. However, in a number of patients, problems occurred with the skin around the percutaneous implant. Although well manageable in adults (Chapter 5, this website) this has lead to revision surgeries, most frequently Read more [...]

Chapter 1. General introduction; outdated fitting protocols?

If reconstructive surgery is not an option, several amplification options are available for patients with conductive or mixed hearing loss. These options (hearing devices, implantable or not) are not equivalents. To find the best device for a patient, the manufacturer’s brochures are often of limited help. A comparison between devices is needed and that is the aim of this blog. Second aim is to give an overview of basic knowledge in this field. To choose for a device, the output capacity is Read more [...]

Chapter 2. Amplification options for conductive and mixed hearing loss; an introduction

2. Amplification options for conductive and mixed hearing loss; an introduction  2.1 Introduction Nowadays, for patients with conductive hearing loss or mixed hearing loss, who need amplification, commonly used options are: 1. conventional acoustic behind-the-ear devices (BTE) or in-the-ear devices, 2. (semi-implantable) bone-conduction devices (BCD) and 3. active middle ear implants with their actuator coupled to one of the cochlear windows; these implantable devices have been described in detail Read more [...]

Chapter 3. Basic considerations; the effect of low MPO on gain

3. Basic considerations; the effect of low MPO on gain What is the effect of a relatively low MPO? Figure 3.1 shows the audiogram of a patient with conductive hearing loss. Cochlear thresholds and LDLs, according to Dillon and Storey (1998), are indicated in Figure 3.1B.        Figure 3.1. Figure A ( upper left) shows the audiogram; figure B (upper, right) present the cochlear thresholds and the LDLs (Dillon & Storey, 1998). Figure C (lower figure) shows the MPO values (labelled Read more [...]

Chapter 4. Longevity and a new fitting model

4. Longevity and a new fitting model  4.1 Introduction Table 2.1 suggested that the only device that enables the full use of the patient’s dynamic range of hearing was the Codacs device. However, the Codacs device has been developed for patients with otosclerosis and is cochlea-invasive. This device is described in more detail in paragraph 5.2 as one of the amplification options for patients with a fixed stapes. Does this mean that we should abandon the other systems? An attempt was made to Read more [...]

Chapter 5. Comparison of interventions in certain groups of patients

5. Comparison of interventions in certain groups of patients 5.1. Congenital middle ear and outer ear anomalies 5.1.1. Surgical repair or amplification? When counselling patients with hearing loss caused by congenital ear anomalies (like aural atresia), firstly, reconstructive surgery should be considered. Congenital ear anomalies might vary from mild (middle ear anomalies) to severe (atresia of the ear canal) with an associated air-bone gap from 40 to 65 dB. Amongst otologists, reconstructive Read more [...]

Chapter 6. Bilateral application should always be considered

6. Bilateral application should always be considered 6.1 Introduction Binaural hearing refers to hearing with two ears. When listening with two ears instead of one, at least four advantages can be distinguished: 1) binaural loudness summation, 2) use of acoustic head shadow to hear better in noisy places, 3) directional hearing and 4) binaural squelch. In normal hearing listeners binaural hearing is obvious, based on accurate processing of bilateral inputs. That is not necessarily the case for Read more [...]

Chapter 7. Challenges in children; critical choices

7. Challenges in children; critical choices 7.1 Introduction; children should not be treated as young adults Counselling adults, who according to their audiogram should profit from amplification, is not always successful. Adults might deny their hearing problems or postpone a hearing aid trial. If their attitude is more positive, they might only be interested in hardly visible devices, even if speech recognition with such devices is not optimal. For children, there is less room to move because Read more [...]

Chapter 8. Sensorineural hearing loss

Part 2. Challenges and limitations of implantable hearing devices (auditory implants) for sensorineural hearing loss  8.  Sensorineural hearing loss  8.1 Auditory implants for moderate to severe sensorineural hearing loss To rehabilitate sensorineural hearing loss, conventional air-conduction hearing aids are the first choice (e.g. behind-the-ear devices or BTEs; Figure 2.1, chapter 2). For patient with severe to profound hearing loss (>80-90 dB HL), such devices might no longer be effective Read more [...]