Background: Precise understanding of bone conduction (BC) and cochlear mechanics is essential to advance diagnostics and hearing restoration, particularly in cochlear implant (CI) users with residual acoustic hearing. Non-invasive methods to visualize and assess auditory mechanics are critical for optimizing these technologies.

Methods: Optical Coherence Tomography Vibrometry (vOCT) was used to investigate intra- and extracochlear structure motion through the round window membrane in human cadaveric specimens during BC stimulation. Also high-speed vOCT was used. This enabled sub-micrometer displacement measurement and nanometer-scale phase tracking at microsecond resolution. Separately, Electro-Vibrational Stimulation (EVS), combining cochlear implant electrical stimulation with low-frequency BC stimulation, was evaluated in CI users with symmetrical residual hearing. Speech-in-noise perception and music appreciation were assessed.

Results: OCT vibrometry successfully visualized velocity and phase responses of the round window, promontory, stapes, osseous spiral lamina, and basilar membrane, without disrupting cochlear integrity. Arbitrary auditory signals (e.g., speech and clicks) enabled direct observation of wave propagation across ossicular and cochlear structures. In the EVS study, participants showed significant improvement in speech-in-noise perception (average +1.9 dB SNR) and enhanced melody recognition compared to CI-only stimulation.

Conclusion: OCT vibrometry enables high-resolution, real-time visualization of intracochlear and ossicular motion, offering a powerful tool for studying auditory mechanics and validating implant performance. Combined with EVS, these technologies hold promise for improving functional outcomes in CI users by preserving and utilizing residual hearing. Together, they support the development of integrated strategies in hearing research and clinical applications.

Background: In 2012 first Active Transcutaneous Bone Conduction Implant (atBCI) was approved, since that surgeons have the discussion about the best surgical approach for each pathology.
The traditional place suggested for manufacturer was mastoid position, but the different pathology situations in real life obliged to surgeons to widen the surgical options. There are at least three main approaches Mastoid Regular Approach (MARA), Postero-Inferior Approach (PIA) and Supratemporal Line Approach (STELLA) according to Zernotti and Gavilan.
Chronic Otitis Media (COM), Congenital Aural Atresia (CAA) and single sided deafness (SSD) are the most usual indications. Therefore, our goal is to clarify if the pathology determines the approach chosen.
Methods:
192 patients under surgery of atBCI (BonebridgeTM) were studied. 60 suffered from COM, while others 72 from CAA. The rest presented single sided deafness 55, secondary or tertiary surgery of otosclerosis 5 and others minor causes. All of them were previously studied with CT scan, but only less than 10% used a software for analysis of images like Otoplan.
Results
According to our research, despite the routinely nonuse of Otoplan or other software of images, 60% of patients with CAA and 80% with COM received STELLA approach. While in patients with SSD the most usual approach was MARA in 90% of patients.
Conclusion: The best results and less complications were obtain using the correct way to access. In COM and CAA the favorite approach was STELLA, while for SSD and others causes without radical cavities the MARA approach was the chosen option.

Objective: Canal wall-down mastoidectomy is a common surgical intervention for cholesteatoma and chronic otitis media, often resulting in conductive hearing loss due to ossicular chain disruption. Ossiculoplasty, the surgical reconstruction of the ossicular chain, is frequently performed to restore hearing. However, repeated ossiculoplasty may be required due to prosthesis extrusion, disease recurrence, or inadequate hearing improvement.
Bone conductive devices (BCDs), offer an alternative by bypassing the middle ear entirely. This study aims to compare the cost-effectiveness of Bone Bridge versus repeated ossiculoplasty in CWD mastoidectomy patients, leveraging data from recent cost-utility analyses and clinical outcomes studies.

Methods:
A Markov state transition model was developed to simulate the lifetime costs and outcomes of patients undergoing CWD mastoidectomy. The model incorporated data from published studies on ossiculoplasty success rates, BB efficacy, and associated costs.

Results:
1. Cost Analysis: The lifetime cost of repeated ossiculoplasty was estimated to be higher compared to BB, primarily due to lower reoperation rates and reduced follow-up expenses.
2. Effectiveness: BCDs provided a slightly higher level of effectiveness than repeated ossiculoplasty, reflecting improved hearing outcomes and patient satisfaction.
3. Cost-Effectiveness: The incremental cost-effectiveness ratio (ICER) for BB was indicating cost-effectiveness.
4. Sensitivity Analysis: Results remained robust across varying assumptions, with BB being cost-effective in a large proportion of simulations.


Conclusion:
BB offers a cost-effective and clinically viable alternative to repeated ossiculoplasty in CWD mastoidectomy patients. Future research should focus on long-term outcomes and patient-reported quality-of-life measures to further validate these findings.

Bilateral hearing loss presents major challenges, particularly in speech understanding in noisy environments and sound localization, especially in cases of asymmetrical hearing loss. Conductive hearing loss can be managed through various treatments, including active bone conduction implants. This case study aims to evaluate the auditory benefits and sound localization accuracy of sequential bilateral active bone conduction implants compared to unilateral implantation in a patient with congenital bilateral conductive hearing loss due to outer ear malformations.
A 15-year-old patient with bilateral congenital malformations of the outer ears and associated conductive hearing loss underwent sequential bilateral implantation with Bonebridge active bone conduction devices. Audiological assessments included free-field hearing thresholds, speech recognition tests in quiet and noise, and sound localization accuracy. These tests were conducted under three conditions: unaided, unilateral (right-side implant), and bilateral (both implants). Additionally, the patient completed the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire to assess subjective hearing-related limitations in daily life.
The bilateral implantation led to significant improvements in hearing thresholds and speech discrimination in both quiet and noisy environments compared to unilateral implantation and unaided conditions. The patient reported fewer difficulties in everyday hearing situations with bilateral devices, as reflected in the APHAB scores. Sound localization accuracy was notably better with bilateral implants than with unilateral use.
Unilateral Bonebridge implantation in this patient did not provide complete auditory benefits. Bilateral sequential implantation significantly enhanced speech understanding in noise and sound localization, highlighting the importance of bilateral bone conduction implants in managing congenital bilateral conductive hearing loss.

Background
Several companies manufacture bone conduction hearing devices. There are besides the percutaneous solution, active and passive transcutaneous devices as well as devices on the skin. No consensus agreement has been reached regarding the nomenclature of bone conduction hearing devices.

Method
Literature search for different abbreviations used for bone conduction hearing devices.

Results
Below are a few examples of different abbreviations:
• BAHI - Bone Anchored Hearing Implant
• OADs: Osseointegrated auditory devices
• BAHS: Bone Anchored hearing systems
• BAHSs: Bone Anchored Hearing Systems
• Transcutaneous BAHA
• OIHA – Osseointegrated hearing aid
• I-BCDs – Implantable Bone Conduction devices

In Sweden recently a “Guideline for Bone Conduction Devices in Sweden” was created. One part of the guideline is a nomenclature suggestion based on Sabine Reinfeldt et al. 2022“, Long-term follow-up and review of the Bone Conduction Implant.”
Reinfeldt S, Eeg-Olofsson M, Fredén Jansson KJ, Persson AC, Håkansson B.
Hear Res. 2022 Aug;421:108503.

Conclusion
It is of fundamental importance for all researchers and clinicians involved in bone conduction hearing to use the same nomenclature. This abstract proposes a Round table discussion on the topic “Nomenclature of bone conduction hearing devices”. The abstract author would in case of acceptance be responsible for inviting suitable panel members for the discussion.

Background: Chronic otitis media with cholesteatoma requires surgical treatment. One of the techniques used is radical modified mastoidectomy. However, despite surgical treatment, hearing loss is often a consequence of the disease. In such cases, hearing prosthesis is necessary, and the choice of a specific solution depends mainly on the type and extent of hearing loss, the local condition of the ear and anatomical possibilities. One of the devices used in clinical practice in such cases is the bone-anchored hearing aid - Ponto (Oticon Medical).
Methods: The study included 27 patients implanted unilaterally using the Ponto system. All of them had previously undergone radical modified mastoidectomy. The mean age of the patients at the time of implantation was 59 years, SD = 11. The benefits of using the Ponto system were assessed using free-field audiometry, speech tests, as well as using the APHAB (Abbreviated Profile of Hearing Aid Benefit) and SSQ (Speech, Spatial and Qualities of Hearing Scale) questionnaires.
Results: In the study group, statistically significant improvements in hearing sensitivity and speech discrimination were observed after using the Ponto system. The questionnaires confirmed the benefits in everyday life in various acoustic conditions.
Conclusions: The Ponto system is a safe and effective tool in compensating conductive and mixed hearing loss in patients after radical modified mastoidectomy. The system can provide good support for those who are at risk of recurrent otitis media with cholesteatoma and who may therefore require later revision or further surgical intervention.

Background:
Bone conduction hearing implants (BCHIs) are a well-established option for patients with conductive or mixed hearing loss and single-sided deafness (SSD). The Osia® 2 system is an active transcutaneous BCHI designed to improve both comfort and audiological performance. This study presents adult clinical results and surgical experience from Copenhagen, Denmark.

Methods:
Fourteen adult patients were implanted with the Osia® 2 system between April 2022 and November 2023: 10 with conductive hearing loss, 3 with mixed hearing loss, and 1 with SSD. Audiological outcomes included warble tone thresholds, PTA4, and Speech Discrimination Scores (SDS) in quiet and noise, compared unaided and aided. Patient-reported outcomes were assessed using the IOI-HA and SSQ12b questionnaires.

Results:
No major complications occurred; however, four patients experienced unexpected postoperative pain, primarily those with a history of otologic surgery. This led to a mid-study revision of the surgical technique—from a direct periosteal incision to a staggered musculoperiosteal layer closure—resulting in improved postoperative comfort. Audiologically, warble tone thresholds improved by an average of 27 dB. SDS improved by 57.3% at 50 dB, 55.6% at 65 dB, and 43.9% in noise. The mean IOI-HA score was 3.8, and the mean SSQ12b score was 6.6.

Conclusion:
The Osia® 2 system demonstrated favorable surgical, audiological, and patient-reported outcomes in adults. Early clinical experience highlights the importance of optimizing surgical approach to minimize postoperative discomfort and support recovery.

Background:
The characteristics of measured intracochlear pressures during bone conduction (BC) differ markedly from those observed in air conduction, where a differential pressure between the scalae is a key indicator of auditory perception. The mechanisms underlying these differences remain poorly understood, particularly regarding the role of vibrational stimulation of the inner ear during BC and contributions from various BC pathways.
Methods:
We used a finite element model of the inner ear to investigate sound pressure distributions during BC stimulation. BC input was separated into vibrational stimulation of the inner ear, capturing fluid inertial effects, and input via the oval window, representing outer and middle ear BC pathways.
Results:
Vibrational stimulation produced distinct pressure distributions characterized by:
• Pressure proportionality to stimulation velocity and frequency, confirming a fluid inertia-driven response
• Uniform pressure across planes perpendicular to vibration direction, with linear gradients along the direction
• A pressure minimum and π phase shift near the plane of the round window centroid
These features contrast sharply with pressure distributions resulting from oval window input.
Conclusion:
Our findings show that vibrational stimulation produces substantial spatial pressure variations, exceeding those known from air conduction. Together with the variability in vibration directions observed in cadaver measurements, these findings help explain the pronounced frequency-dependent fluctuations seen experimentally. The study underscores the necessity of superimposing all BC components based on their spatial pressure distributions to accurately capture the inner ear response. It also highlights the challenge of isolating a pressure representative of auditory stimulation using only two intracochlear probes.