Background: Virtual healthcare services offer significant benefits by reducing the clinical workload for healthcare professionals and improving access for individuals facing various barriers. This pilot project evaluated a direct-to-recipient upgrade service designed for users of Bone Conduction Implants (BCIs). The main goal was to assess both the feasibility of the service and user satisfaction.

Methods: Participants in the study, who were recipients of BCIs, received customised communications about the pilot initiative and were asked to complete a service evaluation questionnaire six weeks after receiving their new devices. Audiologists used the patients' previous processor settings to tailor programs for the latest Ponto 5 systems. The updated settings were then securely transmitted to Oticon Medical, which downloaded them onto the new processors and shipped them directly to the patients.

Results: The study involved ten adult recipients of the Ponto system, including individuals with single-sided deafness, conductive hearing loss, and mixed hearing loss. The method of service delivery proved successful, as participants reported high levels of satisfaction with their new devices and indicated that no further adjustments were needed. They particularly appreciated the improved auditory clarity provided by their new devices.

Conclusion: In conclusion, remote programming represents a feasible and efficient model for service delivery, demonstrating significant potential for achieving high patient satisfaction. The ongoing development of BCI programming software, combined with digital tools that facilitate hearing performance assessments, could effectively reduce clinical burdens, enhance resource efficiency, and improve patient outcomes, especially in underserved populations.

Background:
SENTIO is transcutaneous implantable bone conduction hearing implant, launched in 2024, that is suitable for those with conductive, single-sided sensorineural, or mixed hearing loss. There is minimal literature on SENTIO use in paediatric population, especially those with syndromes.

Methods:
Retrospective study with ongoing prospective data collection including patient demographics, surgical learning points and outcomes, and audiological assessment pre- and post-operatively.

Results:
4 patients were included with total of 5 SENTIO implants. The average age was 13 years (range 11-15 years). Hearing loss was conductive in 3 patients and unilateral sensorineural in 1 . Surgical learning points included consideration of implant’s location for future ear reconstruction (microtia); less drilling required in children to create well as thinner cranium; fixation band orientation modification to accommodate smaller cranium; consideration of drilling depth and position in one patient with craniofacial abnormality (square head shape); and care in patients with previous drill holes and scarring from craniofacial surgery (potential exposed dura).
Speech tests (BKB word list) from one patient showed improvement at 60:55 (+5db SNR) speech/noise level from 90% to 94% and at 60:60 (0db SNR) level from 72% to 80%. The OpenSound Navigator system, together with a well-established processor, allow for better hearing outcomes especially in noisy environments.

Conclusion:
SENTIO provides satisfactory audiological and surgical outcomes when used in appropriate paediatric patients. Our experience reflects on the importance of modification of the insertion steps specifically for paediatric patients with associated syndromes and craniofacial abnormalities as well as the avoidance of complications from previous surgeries

Background: Mixed hearing loss in the context of chronic otitis media poses significant therapeutic challenges, particularly in patients unsuitable for conventional hearing aids. The Osia® system, an active bone conduction implant, offers a promising alternative. The BI300 4 mm implant is indicated for cases with limited temporal bone thickness, addressing anatomical constraints.

Methods: A 50-year-old female with chronic otitis media and left-sided mixed hearing loss unresponsive to hearing aids underwent Osia® implantation. Audiometry confirmed severe mixed hearing loss on the left with bilateral type A tympanograms. CT and MRI were used to assess surgical feasibility, revealing granulation tissue in the left mastoid without bone destruction. During surgery, anatomical limitations, including dural proximity, were carefully evaluated. A 4 mm BI300 implant was selected, and the OSI200 processor was placed subperiosteally.

Results: Intraoperative challenges included significant intraosseous bleeding at several drilling sites, managed with bone wax. A final site 1 cm superior to the external auditory canal was selected. At 4 mm depth, dural exposure occurred without bleeding. The implant was placed successfully, surrounded by autologous bone dust. Postoperative healing was uneventful. The sound processor was activated on day 19. Audiological outcomes demonstrated significant hearing improvement (PTA₄BCD = 22.5 dB), with high patient satisfaction.

Conclusion: This case highlights the effective use of the Osia® system in a patient with complex anatomy due to chronic otitis media. The BI300 4 mm implant enabled successful implantation despite dural exposure, offering a viable solution for patients ineligible for traditional hearing aids.

Background
Bone conduction delivers sound to the cochlea via skull vibrations, bypassing the outer ear. While traditionally used in bone-anchored hearing aids, this mechanism is now applied to consumer earphones using skin-contact transducers placed at the preauricular area. These devices rely on static force for stable contact and efficient energy transmission. However, little study has quantified hearing thresholds at this location or investigated the role of static force.
Methods
An experimental system was developed to measure bone conduction hearing thresholds at the preauricular area. Sine wave stimuli were generated in MATLAB and amplified to drive a B71 transducer. The transducer was mounted on the skin using a compact manual adjuster to apply controlled static forces ranging from 0.5 N to 5 N. Hearing thresholds were measured in both the mastoid and preauricular areas with participants aged 20–30 years with normal hearing. For validation, mastoid thresholds were also obtained using a commercial clinical bone conduction audiometer.
Results
Mastoid thresholds from the experimental system closely matched audiometer results within ±5 dB, confirming setup reliability. Preauricular thresholds were generally lower than mastoid values at frequencies below 1 kHz but showed reduced sensitivity at higher frequencies. Thresholds varied significantly with applied static force, enabling identification of an optimal range for effective energy transmission.
Conclusion
This study confirms the importance of static force in bone conduction at the preauricular area. The validated measurement system and quantified force range offer practical insights for developing skin-contact bone conduction devices with improved acoustic performance.

Background
Bilateral microtia atresia presents surgical and functional challenges for hearing rehabilitation in the pediatric population, especially when the anatomy prevents conventional placement, with the Bonebridge system being an effective alternative.

Objective.
To demonstrate positive objective functional results in audiological follow-up and quality of life in a case with an unconventional surgical approach.

Methods
Male 10 years 6 months from the Children's Hospital of Mexico 'Federico Gómez'. History of cousin with microtia. Diagnosis: bilateral microtia atresia grade IIA of Tanzer. Tonal audiometry: severe conductive hearing loss in the right ear and moderate in the left ear, with an ascending pattern. Auditory rehabilitation with Bonebridge BCI 602 system with Samba processor (Med-el). Craniofacial anatomical alterations that warranted an atypical placement in the left anterior temporal region. Surgery without complications and stable fixation of the system.

Results.
Activation was performed at 4 weeks, with a PTA = 15 dBHL. Phonemic discrimination of 100% at 40 dBHL and Noise Competence Test = 100% at 40 dBHL. ABEL questionnaire: showed high auditory and behavioral satisfaction in their biopsychosocial environment.

Conclusion.
This case confirms the auditory benefits and improvement in the quality of life in the pediatric patient with microtia bilateral atresia with complex anatomy that requires an atypical placement of the Bonebridge System, supporting early intervention to optimize language development.