Background:
Non-surgical alternatives for treatment of mixed and conductive hearing loss represent an important modality during the pre-operative evaluation phase or as a long-term solution for children and patients who cannot undergo surgery. Aspects such as an acoustically stable fit across head shapes, comfort and retention stability, ergonomics and ease of positioning are of importance.

Methods:
Anthropometric head form data was used to set the design parameters and geometries covering patients from 3 years and above. The hearband was evaluated in terms of pressure distribution, retention and stability. The sound transmission capability, distortion and feedback margin were determined and compared with softband.

Results:
Three sizes of the metal band were needed for the retention and even distribution of the pressure across head sizes (head width 136-155 mm, head length 174-196 mm). The force of the transmission plates was 1.4-1.8 N, generating a pressure below the capillary pressure limit. The hearband delivered comparable sound transmission performance at 1.4N retention force compared with softband at 2.5N retention force. The feedback performance was better or equal than softband across the frequency range

Conclusion:
The new non-surgical hearband, based on a thin semi-rigid metal band, adjustable ear hooks and transmission plates with a swivel function, was developed and evaluated. Retention and sound transmission capability was equal or better than softband.

Patients with conductive or mixed hearing loss can benefit from bone-conduction hearing devices or active middle ear implants. Available devices differ in coupling site, energy transfer from the sound processor to the implant, and the active or passive actuator technology. The audiological benefit of those devices depends on the maximum stable power output and the noise floor of the device, the degree and expected stability of the sensorineural hearing loss and the coupling efficiency with the aim on achieving a minimum of 30-35 dB effective dynamic range. The choice of the device is often a trade-off between the optimal audiological solution with respect to the hearing loss, technical device-related parameters and the expected coupling efficiency, the optimal surgical solution with respect to patho-anatomical aspects, device dimensions and the coupling site, invasiveness or surgical risks, and other patient factors with respect to the patients' wish and expectations, social aspects, device usability and connectivity.
In this presentation, all currently available implantable and conventional bone-conduction hearing devices and active middle ear implants with respect to technical features like maximum power output, market availability, and the expected effective output dynamic range are analyzed. Effective dynamic range is calculated as a basis for the selection of a particular active middle ear implants and bone-conduction device.

References
[1] Rahne T, Plontke SK. Systematic and audiological indication criteria for bone conduction devices and active middle ear implants. Hear Res. 2022; 421:10842440

Background:

Mechanical Implants (MI) are an alternative for patients without benefit from conventional hearing aids. Reasons may include outer ear deformity or recurrent infections. Bone Conduction Implants (BCI) include the Bone Anchored Hearing Aid (BAHA), PONTO and Osia Middle Ear Implants, whereas examples of (MEI) include the Carina or Vibrant Soundbridge.

This case reports a patient’s experience with trial of multiple MI options, finally resulting in an Osia implant on the left and Vibrant Soundrbidge MEI on the right.

Methods:

Patient case-notes and hearing assessments were reviewed.

Results:

The patient reported best outcome with the combination MEI right side and Osia implant on the left.

Conclusion:

There are advantages of different types of MI, and with shared clinical decision making it is worth considering combined approaches in some patients.

Background:
This study investigates audiological and speech recognition outcomes in patients with mixed hearing loss (MHL), comparing the bone conduction implant Bonebridge (BB) with the active middle ear implant Vibrant Soundbridge (VSB).
Methods:
We reviewed our surgical database for patients who received either a BB or VSB and identified patients.
To determine functional and effective gain (FG; EG) we evaluated pre- and postoperative pure-tone audiometry. Speech recognition was assessed using pre- and postoperative word recognition score at 65 dB SPL (WRS65) from the Freiburg Monosyllabic Speech Test.
Results:
49 patients with MHL received either VSB (n=48) or a BB (n=5). Four (3 VSB; 1 BB) patients receivd bilateral implants. The average age at implantation was 53.8 years (6-81 yrs) for VSB and 17.4 (9-45 yrs) for BB.
Mean BC-PTA4 was 33.9 dB (SD 10.2 dB) in VSB and 25.9 dB (SD 3.81dB) in BB patients and remained unchanged after implantation.
The average EG was comparable between both implants, with 9.4 dB (SD 16.9) for the VSB and 10.5 dB (SD 12.2 dB) for the BB.
The median FG with VSB was 36.1 dB (SD 19.3 dB) compared to 35.9 dB (SD 8.1 dB) with BB.
Improvement of WRS 65 compared to the preoperative WRS 65 was comparable: VSB from 9.5% (SD 18.0 %) to 70.5% (SD 22.8 %) and BB from 12 % (SD 24%) to 72% (SD 20.4%)
Conclusion:
The results suggest the VSB and BB perform similar in terms of pure tone audiometry and speech recognition.

Background:
Implantable hearing devices offer an effective solution for auditory rehabilitation in patients with conductive hearing loss. This study compares the audiometric outcomes of a bone conduction implant, the Bonebridge (BB), with an active middle ear implant, the Vibrant Soundbridge (VSB).
Methods:
We searched the surgical database to identify patients who received either a BB or a VSB.
Using the four-frequency pure-tone average (4PTA) from pre- and postoperative pure tone audiometry we investigated effective and functional gain after implantation.
Furthermore, we collected data on speech recognition for Freiburg monosyllables presented at 65 dB SPL (WRS65) in free field and after implantation.
Results:
We identified 61 patients who received BB (n=28) or VSB (40), presenting with purely conductive hearing loss. Seven patients received bilateral implants (4 BB, 3 VSB), resulting in a total of 68 implantations. The average age at implantation was 24.5 years (4-65 yrs).
With VSB, the mean functional gain was 29.9 dB (SD 22.9 dB). In comparison, with BB functional gain averaged at 34.8 dB (SD 30.9 dB). Speech recognition improved when comparing the preoperative WRS65 in free field to the WRS65 with implant: from 17.5% (SD 29.8%) to 86.6% (SD 11.5%) with VSB, and from 13.1% (SD 25.1%) to 81.3% (SD 17.5%) with BB.
Conclusion:
Both the VSB and the BB patients showed an improvement in hearing thresholds and speech recognition. These results reveal the efficacy of both implants for hearing rehabilitation in patients with conductive hearing loss.

Background and Objectives:
Sound field (SF) audiometry is widely used to assess the functional gain of hearing aids. However, traditional SF systems require large audiometric booths, limiting their use in space-constrained settings. This study aimed to evaluate the test-retest reliability and clinical equivalence of a newly designed SF audiometry system optimized for small booths compared to the conventional SF system.

Subjects and Methods:
A total of 39 adults (56 ears) wearing hearing aids participated. Each subject underwent SF-aided warble tone audiometry, speech reception threshold (SRT), and word recognition score (WRS) testing using both the traditional SF system and the newly designed small-booth SF system (SF-1®), followed by retesting. Reliability was analyzed using coefficients of variation (CV%) and two one-sided tests (TOST) for equivalence within a 10 dB margin.

Results:
Warble tone thresholds and SRTs showed no significant differences between systems (p > 0.05) and demonstrated statistical equivalence in TOST. WRSs were significantly higher in the newly designed SF system (p < 0.0001). CV% values for warble tone thresholds were generally lower in the new system, indicating superior test-retest reliability.

Conclusion:
The newly developed SF audiometry system for small booths provides comparable audiometric outcomes to traditional systems, with improved speech discrimination scores and better test-retest reliability. It offers a reliable alternative for accurate hearing aid evaluation in compact clinical environments.

Background:
Charge syndrome is a complex condition that can affect hearing, especially in cases of microtia and atresia. The use of bone conduction implants, such as the BONEBRIDGE, has emerged as an effective option to improve hearing in these patients, allowing bilateral auditory integration and improving quality of life.

Methods:
We present the case of a 6-year-old male child diagnosed with Charge syndrome, cleft palate, and bilateral microtia-atresia. In March 2023, simultaneous placement of BONEBRIDGE implants was performed on both sides. Functional assessment included free-field cortical potentials, using Samba processing, to assess auditory integration and cortical performance throughout the 2-year follow-up.

Results:
Two years after surgery, the patient showed adequate hearing performance, as evidenced by free-field cortical potentials. Furthermore, his language development and cognitive abilities were within normal ranges, with notable improvements in quality of life and bilateral sound perception.

Conclusion:
Simultaneous bilateral placement of BONEBRIDGE implants in patients with microtia-atresia and Charge syndrome can offer lasting positive results, improving auditory perception and language development, as corroborated by cortical potentials. This approach can be considered an effective option for hearing rehabilitation in complex cases.

Background: The study aimed to assess postoperative changes in skin thickness overlying the Osia implant coil and evaluate the clinical implications of these changes, particularly regarding magnet strength selection and potential complications. According to the manufacturer's recommendation, optimal skin thickness should not exceed 9 mm to ensure effective communication between the implant and the external processor.
Methods: Ten adult patients (mean age: 57.6 years), predominantly male, underwent implantation of the Osia system at the Dr. Roman Ostrzycki Provincial Integrated Hospital in Konin. Indications included mixed and conductive hearing loss or single-sided deafness. Intraoperative skin thickness measurements were performed at three points using a Baha ruler. Postoperative measurements at 1 and 3 months were obtained via Digital Link Calibration. Magnet strength was adjusted based on software recommendations, clinical engineer assessment, and patient comfort.
Results: Intraoperative skin thickness averaged 7.4mm, with one patient (No.8) exceeding 11mm. Postoperative DLC measurements showed a significant reduction in skin thickness from 5.07±1.65mm at 1 month to 3.58±1.20mm at 3 months (p=0.00018). In 60% of patients, magnet strength had to be reduced during follow-up. A case of implant exposure due to wound dehiscence was successfully managed with conservative therapy and enhanced photographic monitoring.
Conclusions: Skin thinning is a consistent phenomenon after Osia activation and may benefit patients with initially suboptimal magnet retention. However, long-term monitoring is critical to avoid excessive pressure. Further studies with a larger patient cohort and longer follow-up are needed to validate the obtained results.

Objective The purpose of this study was to describe the audiological and radiological data, operative findings, surgical management and outcomes of congenital ossicular chain fixation with a mobile stapes footplate.
Methods A retrospective chart review of patients with congenital ossicular chain fixation with a mobile stapes footplate between 2013 and 2023 was performed. Thirty patients (32 ears) were confirmed using exploratory tympanotomy as having congenital ossicular chain fixation with a mobile stapes footplate without any anomalies of the external auditory canal. Demographic data, clinical features, high-resolution computed tomography (HRCT) findings, ossicular chain status, type of ossiculoplasty, preoperative and postoperative audiometric data were summarized and analyzed.
Results Exploratory tympanotomy revealed that 6 ears (18.75%) had isolated ossicular chain fixation, while 26 ears (81.25%) had ossicular fixation combined with other middle ear malformations. The ossiculoplasties performed were as follows: incus repositioning, intact native chain reconstruction, and partial or tortal ossicular prosthesis. The air conduction pure tone average was 59.48 ± 9.91 dB HL preoperatively, and 31.43 ± 12.07 dB HL postoperatively, resulting in a mean hearing gain of 28.05 ± 10.08 dB HL . The mean air–bone gap (ABG) decreased from 41.37 ± 9.4 dB HL preoperatively to 14.44 ± 9.55 dB HL ) postoperatively. The diagnostic accuracy of preoperatively HRCT for ossicular fixation was 90.63%.
Conclusion Ossicular fixation is frequently combined with other middle ear malformations. Exploratory tympanotomy is essential for definitive diagnosis, and releasing the fixation and ossiculoplasty can result in significant hearing improvement.