Background: Cortical auditory evoked potentials (CAEP) are a biomarker of auditory cortex development that has been measured extensively in adults and children with SNHL. Additionally, cortical visual evoked potentials (CVEP) provide further information regarding crossmodal reorganization of the brain due to hearing loss. There is less research on cortical potentials in individuals with conductive/mixed losses, including those with microtia/atresia. The goal of this research is to examine crossmodal reorganization in conductive/mixed hearing losses, including before and after amplification.
Methods: Participants include two case studies of adults with congenital unilateral microtia/atresia. Case #1 has a unilateral conductive hearing loss and not pursuing amplification. Case #2 has a mixed hearing loss in one ear and a high-frequency sensorineural hearing loss in the contralateral ear, tested before and after osseointegrated device (OID) use. Participants underwent electroencephalography (EEG) testing, including CAEPs in response to a speech stimulus and CVEPs in response to a visual motion stimulus to investigate crossmodal reorganization. EEG was measured in a soundbooth using a high-density EEG cap. Source localization was performed to estimate areas of cortical activation.
Results: When analyzing source localization from the CAEP and CVEP, case #1 had expected activations, while case #2 showed evidence of auditory activation during the visual stimulus, indicative of cross modal reorganization. After eight months of consistent OID use, this reorganization reverses.
Conclusion: Results indicate various outcomes of crossmodal reorganization in two cases of adults with congenital microtia/atresia with different configurations of hearing loss. Future steps include testing more participants, including children with conductive/mixed losses.

Background: Bone conduction devices (BCDs) improve hearing and quality of life. Transcutaneous BCDs avoid adverse skin reactions seen with percutaneous devices. In a study, 86.5% of transcutaneous BCD patients had healthy skin compared to 45.5% of percutaneous BCD patients (p = 0.002). Selecting the right BCD involves considering patient preferences, audiological outcomes, safety and potential adverse events, as well as economic implications.
Methods: A Markov model simulated adult patients (≥59 years) receiving Osia or percutaneous BCDs over a lifetime. Utilities and complication rates were sourced from literature. Costs were obtained from the Swedish National Board of Health and Welfare. The outcome was incremental cost per quality-adjusted life year (QALY) gained.
Results: Literature search revealed lower probabilities of complications (both moderate and severe) with Osia compared to percutaneous devices and higher explantation probability for percutaneous devices. Regarding quality of life, the mean change after implantation with Osia is 0.042 higher than the mean change with percutaneous devices. On the contrary some costs were found to be higher for Osia, specifically procedure, explantation and re-implantation. All resulted in an increased costs of 79,293 SEK and increased QALYs of 0.73 for Osia compared to percutaneous devices, leading to an incremental cost-effectiveness ratio of 108,318 SEK per QALY gained that which is lower than other commonly implanted medical devices and overall considered a low cost per QALY gained.
Conclusions: Osia shows lower probability of complications and higher gain in quality of life proving that it is cost-effective compared to percutaneous devices over a lifetime.

Patients with severe mixed hearing loss often rely on powerful bone conduction devices (BCDs). However, as the sensorineural component of their hearing loss progresses, these devices can become insufficient. Despite retaining bone conduction thresholds in the range of 60 dB, these patients frequently experience limitations from their BCDs.
Due to evolving cochlear implant (CI) candidacy criteria, these patients are increasingly considered for cochlear implantation. In patients already using conventional hearing aids who receive a CI, bimodal hearing - using a hearing aid on one side and a CI on the other - is common. For those using a BCD, a similar bimodal approach involves retaining the BCD on one side and placing a CI on the opposite side. However, this presents unique challenges not seen with conventional hearing aids.
One major difficulty is that due to the degree of hearing loss these devices have to produce significant skull vibrations to stimulate the cochlea. This causes the skull to radiate acoustic sound. This sound is so loud that it can be picked up by the CI processor on the contralateral side, potentially interfering with CI function. It remains unclear what the optimal settings are for patients who use both a BCD and a CI, as well as whether these patients truly benefit from bimodal hearing.
We present several cases involving our patients using a BCD on one side and a CI on the other to illustrate the clinical considerations and outcomes of this bimodal configuration. Furthermore we will describe how to fine-tune the BCD fitting.

[Background]
Bone-anchored hearing systems, including Baha implants, are an established treatment for conductive and mixed hearing loss globally. However, in Japan, their clinical application remains limited. Insurance coverage currently applies only to patients with bilateral hearing loss, and the number of institutions performing surgery remains low. Nationwide, the annual number of procedures is estimated at approximately 50, reflecting underutilization despite clinical need.

[Methods]
A retrospective analysis was conducted on 17 patients (25 ears; age range: 12–88 years) who underwent Baha connect implantation at our institution. All patients had bilateral conductive or mixed hearing loss due to various etiologies. As there is limited evidence in the literature regarding the quality of life (QOL) outcomes of Baha users in Japan, we performed a patient-reported outcome survey using the Chronic Otitis Media Questionnaire-12 (COMQ-12) before and after surgery in nine patients to assess auditory-related QOL changes.

[Results]
COMQ-12 results demonstrated statistically significant improvements in hearing in daily life, including in noisy environments and at home, as well as in mental well-being and reduced outpatient visits (p<0.05). Mild postoperative discomfort around the implant site was noted in some cases.

[Conclusion]
Although BAHS use is still limited in Japan, our findings support their effectiveness in improving both auditory performance and quality of life. Starting in fiscal year 2025, the Osia system is expected to become available in Japan, and indications are likely to expand to include patients with single-sided deafness (SSD). These developments may accelerate the adoption and clinical integration of bone-anchored hearing solutions in Japan.

Introduction
Osseointegrated hearing devices have been used to treat conductive and mixed hearing loss along with single sided deafness. Traditionally these devices include an internal implant with a percutaneous abutment. As technology has advanced, transcutaneous devices have become available with reduction in the risk of skin infection.Recent release of a new transcutaneous device has created another option for patients. The purpose of this study was to evaluate speech scores and aided thresholds post-operatively in patients with this latest transcutaneous device.

Methods
A retrospective chart review was performed to identify adults with mixed/conductive hearing loss who were implanted with an Oticon Medical Sentio transcutaneous osseointegrated device. Primary outcome measures were postoperative speech recognition aided Az-Bio open set recognition in quiet and in +10 signal to noise ratio. Aided thresholds of the implanted ear was a secondary measure. Testing was collected at activation of the external device two to four weeks after surgery.

Results
Fifteen patients were identified for this study. Postoperative aided Az-Bio testing in quiet and in noise indicated significant improvement compared to unaided testing. Aided thresholds also showed a significant improvement compared to preoperative air conduction thresholds.

Conclusion
Results of this study show participants performed well with the transcutaneous osseointegrated device, Oticon Medical Sentio. This is a valid device option for patients with skin infections from percutaneous implants with similar audiologic outcomes.

Background: In contrast to percutaneous implants, active transcutaneous implants come with a reduced soft tissue complication rate und facilitate a direct, efficient vibration transmittance to the skull. Since September 2024 the bone conductive device Sentio™ (Oticon Medical AB, Askim, Sweden) is a newly eligible active transcutaneous implant. This study aims to evaluate the surgical, clinical and audiological outcome of 15 patients with Sentio™ Implants.

Methods: The study is conducted retrospectively, gathering data of 15 adult patients suffering from conductive hearing loss, combined hearing loss and single sided deafness (SSD). They were fitted with the Sentio™ System, with SSD Patients receiving a CROS-type solution. The follow-up rate is 3 and 6 months. We investigated surgical events, audiological outcomes and subjective assessments using questionnaires (Glasgow Benefit Inventory (GBI); Speech, Spatial and Qualities of Hearing Scale (SSQ12)).

Results: The implantation and the postoperative phase were complication free, with little preoperative planning necessary. A significant improvement of the hearing threshold could be detected, the functional gain being 42 dB and the effective gain 10 dB. The language understanding in quiet surroundings was at 98% while the subjective life quality could be enhanced.

Conclusion: In summary, the Sentio™-System system has proven to be a safe and effective solution for improving hearing in patients with conductive hearing loss, mixed hearing loss as well as single sided deafness. It contributes to the existing repertoire of implantable hearing aids as a valuable extension.

Background:
Bone conduction implants (BCIs) are an effective method of auditory rehabilitation for various types of hearing loss. Transcutaneous BCIs aim to reduce the complications associated with percutaneous systems. Although the incidence of skin-related complications and device extrusion is relatively low, such events may still occur postoperatively. These risks may increase when transitioning from one type of device to another.

Despite this, some surgical teams consider extrusion an indication for explantation without attempting to salvage the implant. This report presents a case of transcutaneous BCI extrusion successfully managed with a salvage flap technique.

Materials and Methods:
A literature review was conducted using PubMed, ScienceDirect, and Google Scholar to identify previously reported cases of BCI extrusion. We also present a clinical case treated at our institution.

Clinical Cases:
We describe three cases of patients with BCIs who underwent a transition from one implant system to another and subsequently experienced extrusion of the internal component, in the absence of infection. One patient had been implanted with an OSIA system, and another with a Bonebridge device. In both cases, the extrusion was managed using a salvage flap technique, with no recurrence observed during a six-month follow-up period.

Conclusions:
BCI extrusion is a multifactorial complication. Prevention requires careful attention to patient-specific risk factors, surgical technique, and implant design. Salvage flaps represent a valuable and effective alternative to explantation, offering favorable outcomes without short- or long-term complications

• Background

The case study addresses the evolution of a 26-year-old female patient who developed hearing loss after contracting meningitis. Previously, treatment for these severe hearing losses was involving the use of conventional hearing aids through the CROSS-SYSTEM. In addition to hearing loss, the patient also presented motor sequelae after treatment of the disease.

• Methods:

The patient's medical record was reviewed for the research at the Evandro Ribeiro Hospital, Brazil. The APHAB satisfaction questionnaire was included in the survey, and was completed based on the patient's answers during equipment activation and returns. Finally, the results were compared with bibliographic studies of patients with the same disease. We use the Signal-to-Noise Ratio (SNR), subjective assessment and quality of life: Validated questionnaires, such as the SSQ (Speech, Spatial and Qualities of Hearing Scale), the APHAB (Abbreviated Profile of Hearing Aid Benefit) and the Glasgow Benefit Inventory (GBI).

• Results


The overall results of the Bonebridge implant, with the patient with unilateral hearing loss due to meningitis, showed benefits with significant improvement in hearing, with an average increase of 25 dB. In addition, hearing-related quality of life also improved significantly, as indicated by the APHAB questionnaire.

• Conclusion

It is important to highlight that the factors that contribute to the success of rehabilitation are directly related to the auditory abilities preserved by the recent auditory memory due to the short period of deafness. This current work encourages future research to assess the quality of care, create new protocols, and establish new recommendations.

Background: With the advancement in implantable hearing technologies and with increasing intervention options for hearing impaired people, particularly those with special medical complexities, professionals have access to different surgical and non-surgical treatment options. When non-surgical devices don’t meet the patient expectations, an implantable solution is warranted. The Cochlear™ Osia® System is the world’s first active implantable bone conduction system that uses unparalleled digital piezoelectric stimulation to bypass non-functional areas of the natural hearing system and send sound directly to the cochlea. It is designed to improve hearing outcomes for patients with conductive hearing loss, mixed hearing loss and single-sided deafness (SSD).

Cases: Pediatric case: 4 years old, suffering from bilateral atresia causing moderate conductive hearing loss in the left ear and a progressive moderately severe hearing loss at birth dropped down to profound hearing loss in right ear. Adult cases: a group of complex 2 cases complaining from severe sensorineural hearing loss in one ear and a different form of conductive and mixed hearing losses in the other ear due to different medical and or surgical complications. Medical, radiological, and audiological assessments were performed, and careful decision of cochlear implant and Osia surgeries made at different stages of these patients hearing journey.

Treatment: Pediatric case: A simultaneous cochlear Implant (right side) and Osia (left) surgeries. Adult cases: A sequential cochlear Implant and Osia surgeries.

Results: Pediatric case: Surgery went well with the cochlear Implant electrode fully inserted and and intra-operative testings (impedance and NRT) were present. The child attended regular ...

Background: Many implantable bone conduction devices (BCD) are commercially available. New technologies and implant developments have been adopted and utilized over the last few years.
Objectives: We aim to evaluate the new surgical technique in terms of minimizing surgical intervention and giving patients more options for management, even for those who are contraindicated for BCD surgeries
Materials and Methods: This is a review of patients who underwent bone conduction implant surgery from March 2022 to November 2025. We reviewed all the clinical data of patients, including preoperative data.
Results: A total of 14 patients enrolled in this review, and all patients received unilateral implants. 9 patients underwent ossia2TM surgery, and five patients underwent bone bridge surgery. Four of these patients underwent conscious sedation Surgery, and three of them are contraindicated for general anesthesia. Patients of Ossia2TM had three different skin incision designs that had not been described before the date of surgery.

Conclusions: Minimal invasive surgery for bone conduction implants under conscious sedation is feasible for patients. These techniques have advantages in terms of cosmetic outcomes and operative duration.

Limitations: A multicenter study involving a larger patient population is needed