Background: While bilateral fitting of bone conduction hearing devices (BCHDs) enhances spatial hearing, further improvements are constrained by crosstalk, which disrupts the binaural acoustic cues of interaural level difference (ILD) and interaural phase differences (IPD).

Methods: Psychoacoustical tests were conducted on 20 healthy volunteers with sound stimulations of 500, 1k and 2k Hz tone-bursts via AC headphones or BC vibrators. The test includes a sound lateralization task across different (ILD, IPD) combinations, a sound tracking task under sound with time-varying ITDs, and a sound localization task (the front half-plane, with 15-degree intervals).

Results: (1) BC sound lateralization patterns across (ILD, IPD) combinations are different from well-established principles under AC (the precedence effect and intensity rule). These patterns are theoretically predicted as a result of sound interference at cochleae. (2) Volunteers feel the sound image monotonically moves under AC stimulations with varying ITDs (corresponding IPDs range from -6 to 6 PI), while most of them (>92%) reported a different “swinging” effect under BC. (3) Sound localization performance is significantly poorer under BC. For AC, the mean absolute errors (MAEs) are 15.3°±3.7° (500 Hz), 18.5°±4.2° (1k Hz), 19.3°±3.4° (2k Hz), and 14.5°±3.8° (gunshot), respectively. For BC, the corresponding MAEs are 22.8°±6.0°, 24.7°±6.7°, 22.7°±5.8°, and 18.6°±4.6°.

Conclusion: Our findings highlight the challenges of sound localization under BC, identifying crosstalk-induced wave interference as a primary obstacle to improved spatial hearing for bilateral BCHD users.

Funding: This research was supported by National Natural Science Foundation of China (No. 82101221 and 11932010).

Background: The Bonebridge implant can be a satisfactory solution for patients with conductive or mixed hearing loss (CHL, MHL), or with single-sided deafness (SSD). The aim of the study was to assess patients' self-reported benefits with the Bonebridge and characterize the relationships between pre-implantation audiometric data, auditory functioning, and satisfaction after implantation. A focus was to see whether different types of hearing loss were associated with particular benefits.
Methods: The study sample consisted of 81 patients divided into three subgroups – CHL, MHL, and SSD. Procedures comprised pure tone audiometry before implantation, the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire, and a structured interview asking about satisfaction.
Results: Statistically significant improvements after implantation were found in all groups (CHL, MHL, SSD) on the APHAB questionnaire. In the structured interview, patients with SSD were the least satisfied. No significant correlation was found between pre-operative air-bone gap and bone conduction thresholds or with APHAB score.
Conclusions: Bonebridge implantation provides measurable benefits for patients with CHL, MHL, and SSD. However, candidate evaluation should go beyond audiometric data, incorporating patient-reported outcomes to better address individual expectations and subjective experiences.

Background:
Binaural hearing abilities may be compromised by bilateral bone conduction (BC) hearing due to limited transcranial attenuation. This prospective longitudinal clinical study aims to investigate whether patients with a bilateral conductive or mixed hearing loss (CMHL) that are using one bone conduction hearing device (BCD), would benefit from having bilateral BCDs when it comes to spatial hearing.

Methods:
Ten subjects (mean age=65.3 years) with bilateral CMHL and users of a unilateral BCD were recruited. BC pure tone average across 0.5, 1, 2 and 4 kHz (PTA₄) in right and left ear were 44 dB HL and 43 dB HL, respectively.

Subjects participated in two listening tasks in a within-subject repeated measures design (unilateral and bilateral BC stimulation) using their existing BCD implant and a BCD fitted on softband contralaterally. Listening tasks were performed acutely after softband fitting (n=10) and after 4 weeks (n=6) of use. Speech recognition thresholds (SRTs) in co-located and symmetrically separated competing speech maskers were estimated. Sound localization accuracy (SLA) was measured using four different stimuli, providing various spatial cues.

Results:
Preliminary findings indicate no immediate bilateral benefit in SRT or SLA. However, after 4 weeks of use, a repeated measures ANOVA showed a significant main effect of listening condition (bilateral vs unilateral) on the SRT (p=0.02) and SLA (p=0.03).

Conclusion:
While no immediate benefit of bilateral BCD stimulation for recognition of speech or sound localization abilities could be measured, results indicate that a bilateral BCD benefit may emerge over a short period of time.

Background: Microtia is a malformation of the external ear characterized by a small auricle that causes conductive hearing loss. Microtia-atresia most frequently occurs unilaterally and is associated with stenosis of the external auditory canal. Methods: Twenty-six children diagnosed with microtia atresia, with an average PAT less than 40 dB, in addition to a simple CT scan of the ears and mastoid with a thickness greater than 4.5 mm at the level of the temporal bone were included. Results: The average age was 9.6 ± 3.6 years, 65.4% men and 34.6% women, 75.9% implanted in the right ear and 23.1% in the left ear, 50% with unilateral atresia and 50% with bilateral atresia. PAT4 values before surgery in the 3 groups formed were: 62.1 ± 2.7 dB (n = 7), 65.4 ± 1.2 dB (n = 18) and 61 dB (n = 1), and after Adhear system implantation it decreased to 27.0 ± 1.7 dB (56.5%), with the conventional bone headband system it was 43.3 ± 0.9 (33.8%) and with Ponto-3 system it was 30 dB (50.8%); and after Bonebridge system implantation the values decreased to 15.3±0.6 dB (43.3% compared to the Adhear), to 15.4±0.6 dB (64.4% compared to the conventional bone headband) and to 15 dB (50% compared to Ponto-3). Conclusion: The implantation of the Bonebridge system in children with microtia-atresia generated a much greater hearing improvement than that generated by other hearing technologies, making it an effective option to improve the hearing and quality of life of those who use it.

Background: Bilateral aural atresia presents significant challenges for auditory development, communication, and quality of life in pediatric patients. Traditional bone conduction hearing aids on softbands often provide limited benefit and comfort, especially during active childhood years. This case presents a 12-year-old boy, a war refugee from Ukraine, with congenital bilateral aural, who was fitted with a bone conduction hearing aid on an elastic band since childhood.

Methods: After comprehensive audiological and surgical evaluation in Poland, the patient underwent implantation with the Osia® OSI200 system utilizing a BI300 4 mm implant. Pre- and post-operative audiological assessments were conducted, including aided thresholds and speech perception tests. Quality of life was evaluated using standardized pediatric hearing-related questionnaires (SSQ - Speech, Spatial and Qualities of Hearing Scale).

Results: Post-implantation, the patient demonstrated substantial improvements in aided thresholds and speech perception in quiet and noise. Caregiver and patient reports indicated marked enhancements in communication abilities, social participation, and self-esteem. The patient transitioned to full-time use of the Osia® processor within the first weeks and reported high satisfaction and comfort with the device. No intra- or post-operative complications were observed. The caregivers do not intend to schedule a pinna reconstruction surgery.

Conclusion: The Osia® System provides an effective hearing rehabilitation solution for pediatric patients with bilateral aural atresia. In this case, the transition from a softband to an active implant resulted in improvements in hearing and overall quality of life, underlining the impact of access to reliable auditory input in children affected by hearing loss and displacement due to conflict.

Background: Treatment of Congenital Aural Atresia has 2 main objectives. Functional one, improve the conductive hearing loss, that produces problems in language and schooling. On the other hand, aesthetic solution means for many parents the goal, especially in unilateral cases. Functional stage is earliest (from 5 years), while aesthetic approaching begins 2 or 3 years later on. Sometimes otologists don´t take in account the reconstructive steps generating a conflict with plastic surgeons. A novel endoscopic approach is presented to avoid the damage of tissues around the area, promoting better results in reconstructive surgery.
Method: Novel endoscopic technique is presented. Linear incision of 5cm. was done at 45 degrees, in postero-superior region, 10cm away to the zone of the pinna, enough space for reconstructive flaps. After that, a sub-periosteal pocket is done, up to the mastoid area. (Atretic placode or Henle´s spine are references.) Facelifts endoscopes shaper sheaths with angled spatula tip of 30 and 45 degrees were used.
A bed for Bonebridge is made, modified template is used to check the depth. Finally, the Bonebridge is introduced and attached trough the screws in percutaneous way, using a minimal incision to introduce the screwdriver. Finally, the incision is closed.
Results: After practice the feasibility of approach in 10 temporal bone specimens, patient’s stage began. Approach is easy but needs 2 hours, providing a large zone without incisions, blood supply compromise and intact skin.
Conclusion: Endoscopic approach shows a suitable option to placed Bonebridge for patients that will need a reconstructive surgery time for pinna.

Background: Transcutaneous Bone Conduction Hearing Implants (BCHI) are an attractive option for the BCHI recipients prone to implant site and skin overgrowth issues with Percutaneous BCHI.  


The sound processors compatible with Transcutaneous BCHI are single unit processors, held in place by a magnetic connection. The BCHI manufacturers recommend a skin flap thickness measurement to be 7-9 mm (manufacturer dependent) for adequate retention and optimal sound transmission. This measurement is typically carried out at the time of surgery.


Methods: Skin flap measurements data was analysed for all the Percutaneous surgeries between January 2024 until May 2025.

 

Results:   As the skin flap measurement is carried out at the time of surgery, it is too late for the surgeon to obtain consent to use an alternative implant, such as the Percutaneous implant. Ideally, the recipients need to be counselled about this possibility prior to the surgery. Based on this data, for Transcutaneous recipients, we would recommend an alternative method of skin flap measurement in the beginning of the assessment process.

Conclusion: Future studies need to be carried out on a larger sample where skin flap measurement using a needle is explored as a viable option. An alternative method of skin flap measurement, such as ultrasound technique needs to be explored, as its non-invasive and can be carried out by clinicians in the beginning of the assessment process.

Background: Stapedial fixation coupled with incomplete partition type 2 (IP-2) and enlarged vestibular aqueduct (EVAS) represents a unique challenge in managing hearing loss owing to the risks of stapedial surgery and the need for alternative hearing restoration methods. This case report describes the selection, implementation, and outcomes of an Osia-2 implantable bone conduction device in a 17-year-old male patient with severe bilateral mixed hearing loss.

Case: 17-year-old male patient with severe to profound bilateral mixed hearing loss due to IP-2 and EVAS in the presence of audiolotical findings of stapedial fixation. His bone thresholds pure tone average (bPTA) of 40 dB hearing level (HL) and an air thresholds PTA of 70 dB HL. A nonsurgical bone conduction hearing assistive device demonstrated improved sound performance and high patient satisfaction.

Results: The postoperative outcomes were remarkable, suggesting air-bone gap over-closure with an Osia-aided PTA of 31.67 dB HL and an aided speech discrimination score of 96%. Notably, the unaided bone conduction hearing remained unchanged, underscoring the efficacy of the implant in enhancing auditory function without compromising residual hearing. The patient maintained stable hearing levels up to 18 months, confirming the durability of hearing preservation and gain.

Conclusion: This case underscores the efficacy of the OSI200 device in managing severe mixed hearing loss in patients with inner ear anomalies, such as IP-2 and EVAS. The smooth soft drilling needed for the BI300 implant, and posterior placement, thus improving hearing without altering the unaided bone conduction thresholds.

Background - MRI is one of the fastest growing areas in diagnostic imaging, especially in soft tissue imaging. Chances of needing an MRI in lifetime are nearly 100%. We want to highlight the poten-tial problems and risks when implanting a patient with a transcutaneous magnetic acoustic implants in the light of future need of an MRI.

Methods - An overview of the current available transcutaneous magnetic acoustic implants systems in light of MRI safety issues is given. The rate of MRI's performed worldwide is continuously increasing with currently more than one MRI per second. When counselling a patient or parent before implan-tation of a transcutaneous acoustic implant MRI and his difficulties must be mentioned.

Results - Careful thought is warranted when implanting a child or adult with a transcutaneous mag-netic acoustic implant. Chances are nearly 100% of needing an MRI in lifetime, leading to problems of torque, force and demagnetisation… These problems occur most commonly when an MRI of the foot or knee is needed, and less with MRI’s of the head. An additional problem present when an MRI of the head and neck is taken, is metal artifacts. Metal artifact reduction sequences, such as the SEMAC-VAT WARP sequence significantly improve the diagnostic usefulness of post implantation MRIs of the head and neck area.

Conclusions - Careful thought is warranted when implanting a child or adult with a transcutaneous acoustic implant, as chances are nearly 100% of needing an MRI in the future.

Congenital aural atresia is a spectrum of ear deformities present at birth that involves some degree of failure of the development of the external auditory canal. This malformation may be associated with other congenital anomalies. Congenital aural atresia is considered one of the most difficult and challenging surgeries for the otologic surgeon. .Management options either surgical repair or hearing aid ( BAHA).
In this study, we are going to present 11 cases who have been underwent surgical repair with different approaches .Then we are going to show our result.
CONCLUSION:surgical repair of CAA is visible, can give good results, but need more training and practice to master this surgical .