Background
Chronic otitis media (COM) and associated hearing loss (HL) affect patients’ health, daily functioning, and quality of life. Despite its burden, there is a lack of research capturing patients’ lived experiences with COM. This qualitative study aims to understand how adults with COM and HL experience and manage their condition in everyday life, and how they perceive and navigate encounters with the healthcare system.

Methods
Semi-structured interviews are being conducted via Zoom with adult patients (≥18 years) who have lived with a COM diagnosis for over 10 years and have a HL of at least 40 dB. Participants are recruited from three Otology Centres in Sweden. The study aims to recruit 15 participants, and to date, three interviews have been completed. All interviews are audio-recorded, transcribed verbatim, and will be analyzed using a qualitative analysis approach. Data collection is currently ongoing.

Results
The study will provide insights into how adults with COM and HL experience their condition, including the challenges they face in daily life and how these affect their well-being. The study will also explore and interpret patients experiences with the healthcare system, including their perceptions of care, for example, met and unmet needs.

Conclusion
This study will contribute to new understandings into the lived experiences of adults with COM and HL. By exploring personal and healthcare-related challenges faced by patients, the findings can inform more individualized clinical practices and support the development of care strategies that are better aligned with patient needs and grounded in their everyday realities.

Background: The first implantation of the novel Sentio System in the United States (FDA approval July 2024) was led by Dennis Pappas, Jr., MD, FACS and supported by manufacturer representatives, on 6 September 2024.

Methods: A 68-year-old male with a history of chronic ear disease and right ear cholesteatoma removal underwent audiometric testing, revealing a severe to profound mixed hearing loss on the right, with flat, Type B tympanometry and a high frequency sensorineural hearing loss on the left. Percutaneous and transcutaneous options from multiple manufacturers were presented to the patient and he ultimately chose the Sentio System.

Results: Under general anaesthesia, an apron incision was utilized in conjunction with a portion of the patient’s original mastoidectomy scar. A subsequent subperiosteal pocket was developed medial to the temporalis muscle for placement of the device’s magnet. A bony well was drilled with sizing and depth confirmed and secured using the supplied 39mm fixation band. The implantation was successful, with no operative or post procedure complications.

The Sentio sound processor was loaded after one month and required no initial or subsequent fine-tuning programming adjustments. The fitting audiologist reported the fitting was ‘intuitive and easy’ and the patient reported immediate hearing improvement and stated that he loved the quality of hearing provided.

Conclusion: The surgical team has now performed over a dozen Sentio placements, and the patient remains an enthusiastic Sentio system advocate. Similar successful surgeries, fittings, and patient outcomes can be expected, similar to the first US Sentio System treatment.

Background: Accurate fitting of bone-conducting hearing devices is essential for optimal performance, particularly as these devices increasingly target an extended frequency range. Current clinical bone conduction (BC) audiometry is limited up to 4 kHz, restricting access to high-frequency threshold data. Extending BC measurements beyond 4 kHz could significantly improve individual fitting precision. Additionally, high-frequency BC thresholds are critical for early detection of high-frequency hearing loss—particularly children undergoing chemotherapy—where air conduction (AC) thresholds are often unreliable due to middle ear pathology. Although reliable high-frequency BC thresholds have been demonstrated (Rhebergen, 2022), clinical implementation remains limited due to the lack of standardized calibration. To address this limitation, the present study aimed to develop a clinically applicable calibration method for the artificial mastoid (AM) to enable accurate BC threshold measurements above 4 kHz.

Methods: A measurement set-up was developed to assess the force sensitivity of the AM from 100 Hz to 20 kHz, supported by a mathematical framework.

Results: A complete calibration set-up and corresponding mathematical framework were established. Procedures for normalization, reference mass validation, and system configuration were defined to ensure accurate and repeatable measurements.

Conclusion: The developed set-up establishes a critical foundation for high-frequency calibration of the AM, enabling precise BC threshold measurements. This advances fitting of bone-conducting devices and improves clinical assessment of high-frequency hearing loss—particularly where air conduction thresholds are unreliable. The measurement system is currently being validated under varying conditions, including test-retest analysis to quantify measurement uncertainty. These data are essential for determining method robustness and guiding clinical implementation.

Background: While single-stage surgery is the standard procedure for placing bone-anchored hearing implants (BAHIs) in adults, two-stage surgery remained the standard for children up to nine years despite its disadvantages.
Objective: To compare the clinical outcomes of single-stage versus two-stage BAHI surgery in children up to nine years.
Material and Methods: A test group of 20 children (30 implants) receiving a wide-diameter implant in a single-stage procedure was compared with 50 historical controls (62 implants) receiving two-stage surgery. Outcome measures included implant survival, surgery duration, loading time, implant stability, soft tissue reactions, and sound processor use over 1 year.
Results: One implant (3.3%) was lost in the test group, compared to three (4.8%) in the control group. The single-stage procedure’s surgery duration and time to loading were significantly shorter (21±7 minutes vs. 54±25 minutes and 6.3±0.9 weeks vs. 19.0±7.7 weeks, respectively).
Conclusion: This first prospective study comparing single- and two-stage BAHI surgery in children aged 4–9 found non-inferior implant survival and shorter surgery and loading times with single-stage surgery.
Significance: We recommend single-stage surgery as the standard for children aged four and older requiring a BAHI.

Background:
Chronic Otitis Media (COM) can result in persistent hearing loss even after surgical interventions such as tympanoplasty for some patients. Despite their effectiveness, bone conduction (BC) solutions are often introduced too late in the treatment process. This expert initiative advocates for earlier consideration of BC options and a shift toward a hearing and patient-centered, interdisciplinary approach to rehabilitation.
Methods:
An interdisciplinary “tiger team” of experts in otology and audiology will conduct structured meetings and asynchronous discussions to develop consensus-based recommendations for managing COM-related hearing loss. The team is reviewing current practice trends, identifying key clinical decision points, and proposing a framework for earlier BC integration. Preliminary findings will be presented to gather feedback from a wider community of clinical experts and inform the final results.
Results:
Initial discussions suggest BC options are underutilized in COM patients with residual hearing loss post-tympanoplasty. Emerging recommendations include implementing structured clinical reassessment (e.g., 6–12 months post-surgery), promoting interdisciplinary collaboration, and incorporating both subjective and objective outcome measures. Barriers identified include outdated perceptions of BC technology, unclear referral pathways, and limited patient engagement. A decision-making framework will be developed to guide timely BC adoption.
Conclusion:
COM-related hearing loss remains undertreated in patients with suboptimal surgical outcomes. Early, structured integration of BC solutions can provide effective, timely rehabilitation. This expert opinion promotes a patient-centered, function-first model supported by expertise of interdisciplinary clinicians with the aim to improve long-term hearing outcomes and quality of life for this group.

Background: Traditional transcutaneous bone conduction implants (BCIs) typically involve extensive incisions, bone drilling, and anchoring screws, increasing surgical risks. The MI-OSI-R (Minimally Invasive OSIA in Reverse Position) technique eliminates anchoring and drilling, placing the thinner magnet anteriorly and the actuator posteriorly to optimize audiological outcomes and aesthetics with minimal invasiveness.

Methods: Fifteen MI-OSI-R procedures were performed in 14 patients (mixed hearing loss, n=10; single-sided deafness, n=4). Audiological assessments (pure tone audiometry [PTA] and speech recognition threshold [SRT]) were done preoperatively and up to six months postoperatively. Surgical data, tolerance, and safety outcomes were recorded. Procedures involved a small vertical retroauricular incision (~3 cm) and a reusable endoscopic subperiosteal pocket without anchoring screws or bone drilling.

Results: Audiological improvements were significant, with a mean PTA gain of 37.8 ± 9 dB HL and a mean SRT gain of 27.7 ± 17.6 dB SPL at three months post-implantation. Surgical efficiency was high, with mean operative time reduced to 30 minutes. No perioperative complications were reported, implant stability was excellent, and early activation and fitting within 15 days was achievable. Patients expressed high satisfaction, particularly regarding minimal invasiveness and early processor loading.

Conclusion: The MI-OSI-R technique is a safe, effective, and minimally invasive alternative for active transcutaneous BCIs, compatible with subperiosteal pocket approaches. By avoiding anchoring screws and bone drilling, it maintains audiological efficacy, simplify surgery with minimal or no surgical complication, supporting future advancements toward smaller, non-anchored implant BCI technologies.

Background
Active transcutaneous hearing implants provide effective rehabilitation for patients with conductive or mixed hearing loss, and single-sided deafness. Currently, data pertaining to patient’s experience of these hearing implants are scarce, with most published data focussing on objective outcomes. The objective of this study was to better understand patients’ perspectives, experiences and challenges, during their hearing implant journey.

Methods
Patients implanted with an active transcutaneous hearing implant in our centre were invited to complete an open-ended questionnaire via an online form. Responses were qualitatively analysed using NVIVO software using a grounded theory approach. Data were coded according to the underlying idea or sentiment, and analysed via a constant comparison technique, to develop themes that characterise patient experience.

Results
There was a 69% response rate (31 responses from 45 invited patients). Six themes were identified: detrimental impact of hearing loss; pre- and peri-operative experience; positive impact of the hearing implant; drawbacks of the hearing implant; varied experience of audiology, and awareness of hearing implants among audiologists and the public.

Conclusion
Active transcutaneous hearing implants have a significant impact on patient’s lives. Overall, patients regard the experience as worthwhile. This study identifies a lack of awareness of these hearing implants resulting in avoidable delays for patients. Being able to share first-hand experience from patients is invaluable when informing prospective patients of the patient journey, and of what life is like with a hearing implant.

Objective:
Conventional hearing aids (HAs) and bone conduction devices have limitations in providing clear and audible sound
in some cases and situations. The clinicians' primary purpose is to enhance audibility and intelligibility in hearing, offering a
solution for users dissatisfied with current hearing technologies. This study proposes a novel hybrid system and investigates its performance compared to HAs.

Methods:
This pilot study compares the performance of a novel hybrid system with traditional HAs. Ten HA users underwent a prospective intra-subject study at a tertiary hearing center. Audiological tests measured unaided and aided thresholds across specific frequencies in two conditions (HAs and Hybrid system). Furthermore, subjective outcomes were assessed via a questionnaire on the perceptual consequences.

Results:
The patient's mean age was 36 years. The mean PTA4 values were 63.75, 40.74-, and 37.88-dB HL in the unaided, HAaided, and Hybrid-aided groups, respectively. The speech reception thresholds varied significantly between the unaided and (i) aided using HA (p=0.0009) and (ii) aided using the Hybrid solution (p=0.0001). There is no significant variation between HA and Hybrid solutions (p<0.4195). The mean SDS at 65dB using the HA and Hybrid solution was 87% and 90%, respectively.

Conclusion:
The proposed Hybrid system, combining conventional air-conduction HAs with bone-conduction devices, offers
promising improvements in sound quality and user satisfaction. Further studies are essential to fully understand the Hybrid system's capabilities and evaluate its ability to avoid the dissatisfaction that could result from HA in some instances.
Level of Evidence: Prospective cohort study (Level 3).