Background: Transcutaneous bone conduction devices have replaced percutaneous devices as primary choice for hearing rehabilitation worldwide. The aim of this study is to compare the hearing outcomes of two transcutaneous bone conduction systems regarding functional gain, aided free field speech in quiet, the Client Oriented Scale of Improvement (COSI), and unexpected benefits and setbacks.

Methods: Patients were included with predominantly conductive hearing loss. Ten patients received an Osia 200 implant, and 8 patients received a MedEl Bone Bridge. Pure tone audiometry and speech audiometry were performed preoperatively, and 6-12 months postoperatively. The COSI questionnaire was administered preoperatively, and 6-12 months postoperatively. The participants were also questioned about unexpected benefits and setbacks 6-12 months postoperatively. Differences between the systems in outcomes 6-12 month postoperatively are currently being analyzed.

Results: Preliminary results of functional gain show that both devices close the air bone gap, but do not yield over closure in this population with predominantly conductive hearing loss. The COSI shows that patients experience better to much better performance regarding their first and second priorities in hearing improvement goals, almost all the time. There are differences in unexpected benefits and setbacks between the two systems.

Conclusion: Both the Osia 200 and MedEl Bone Bridge provide good results regarding outcomes in functional gain, free field speech reception in quiet, and the COSI questionnaire. There are differences in unexpected benefits and setbacks between the systems. Awareness of these differences may improve shared decision making when choosing between these systems is an option.

Background:
Measuring sound pressure at various head locations—such as the ear canal, nasal cavity, or skin—provides valuable insights for verifying, fitting, or monitoring bone conduction device (BCD) output during and after surgery. This study explores the use of a surface microphone (SM) as a non-invasive alternative to laser Doppler vibrometry (LDV) for assessing cochlear promontory (CP) vibrations in human cadaver heads.
Methods:
A percutaneous BCD (Ponto system) was implanted at the standard location in five human cadaver heads (10 ears). CP vibrations in response to BCD stimulation were measured using LDV, while simultaneously, an SM placed on the forehead recorded the sound pressure level (SPL) emitted from the skin. A linear regression model was employed to estimate CP vibration amplitudes based on the SPL data.
Results:
The linear relationship between SM-recorded SPL and CP velocity in a single specimen was pronounced (r² < 0.99), the cohort showed a significant but lower correlation (slope = 1.156; r² = 0.581, p < 0.001). However, since the confidence interval excluded a slope of one, inter-individual variability was likely a contributing factor. Using a fixed slope of one (constant = 157.0 dB) produced a mean absolute error (MAE) of 8.9 ± 2.7 dB across frequencies. Incorporating frequency-specific corrections improved prediction accuracy to MAE = 6.4 ± 1.5 dB (r² = 0.558).
Conclusion:
Surface microphone recordings of acoustic emissions from the skin on forehead present a promising, non-invasive alternative to LDV for evaluating BCD output.

Background:
The Osia bone conduction implant offers an advanced solution for patients with conductive or mixed hearing loss and single-sided deafness. We present our experience with Osia implantation in adults, evaluating hearing outcomes and patient satisfaction using objective audiological measures, subjective assessments, and documented surgical outcomes. In addition, we explored the integration of augmented reality (AR) to support preoperative planning and enhance intraoperative localization of the implanted device.

Methods:
This prospective study includes adult patients implanted with Osia devices. Audiological outcomes are assessed through hearing-in-noise testing with and without the device. Speech perception testing uses HAB word lists with speech-shaped noise. Functional gain and speech reception thresholds (SRT) are compared to unaided performance. Subjective outcomes are evaluated using the SSQ12 and IOI-HA questionnaires. Surgical outcomes, including complications, technical considerations, and practical insights, are documented. As part of an exploratory sub-study, we applied AR technology for CT-based preoperative planning and intraoperative overlay of the planned position onto the patient to improve spatial accuracy and surgical confidence.

Results:
At the time of submission, data collection is ongoing. Fifteen adult cases were enrolled, and final data analysis will be completed by July 2025. Results will describe hearing-in-noise performance with and without the device, patient-reported benefit, and surgical outcomes. Exploratory findings on AR feasibility and utility will also be reported.

Conclusion:
This study provides a comprehensive evaluation of Osia implant outcomes, including both objective audiological and subjective patient-reported measures. Preliminary AR data highlight its potential to improve surgical precision and support clinical decision-making in bone conduction hearing implantation.

Background:
The active transcutaneous system Sentio and the percutaneous system Ponto from Oticon Medical are indicated for patients with conductive or mixed hearing losses and single-sided deafness (SSD). The purpose of this analysis was to evaluate the effectiveness of the Sentio system as expressed by the effective gain as well as comparing the results to the outcome achieved with the Ponto system.

Methods:
This investigation analysed the aided threshold, and the effective gain attained for the subjects in the first clinical study with the Sentio system. The effective gain was evaluated as a function of the BC hearing loss for the subjects with conductive and mixed hearing losses.
The outcome obtained with Sentio was compared with the outcome for a comparable group of patients with similar BC hearing losses treated with the percutaneous Ponto system.

Results:
The effective gain was similar for subjects with conductive losses using the Sentio system irrespective if their BC threshold is 0 dB HL or 20 dB HL. For subjects with mixed hearing losses aided with Sentio, the remaining air-to-bone gap was smaller the higher the BC loss was. Similar results were found in the matched group of patients using the Ponto system.

Conclusion:
Patients fitted with Sentio obtained similar effective gain as compared with patients using the Ponto system.

Introduction
Conductive hearing loss (CHL), caused by middle ear conditions such as malformations of the external/middle ear, otitis media, or cholesteatoma, significantly affects sound perception. When conventional hearing aids are not viable, bone conduction devices (BCDs) offer an alternative by transmitting sound directly to the inner ear. Patients with congenital or chronic conditions often report improved clarity and reduced distortion, especially in noisy settings.
Objective
To describe demographic, surgical, audiological outcomes, and perceived benefit in CHL patients implanted with the Osia®2 system.
Method
Multicenter, prospective study including CHL patients implanted with Osia®2. Data collected: surgical parameters, pre-/post-activation audiometric thresholds (PTA4 for air [AC] and bone conduction [BC]), functional gain (FG), effective gain (EG), and perceived benefit via COSI (before and 12 months after activation).
Results
From June 2020 to September 2024, 759 patients were included (mean age: 20; 40% <12 years). Most had congenital malformations of the external and/or middle ear (71.1%), followed by chronic otitis media and cholesteatoma (9.7%). Surgeries averaged 59 minutes; 3-mm implants used in 40.8%. Mean skin thickness was 4.92 mm; soft tissue reduction was needed in 3.3%.
Pre-op PTA4: 60 dB HL (AC), 10.1 dB HL (BC). At 12 months: aided thresholds averaged 24.4 dB HL; FG: 35.6 dB; EG: –13.7 dB.
COSI showed 49.5% prioritized hearing in noise; 13.4% in quiet. Mean improvement: 4.4/5 in noise (93.7% improved) and 4.74/5 in quiet (94.9% improved).
Conclusion
Osia®2 implantation yields significant audiological and subjective improvements, supporting its use as an effective CHL rehabilitation option.

Background: The aim of the study was to determine the audiological benefit of the current Baha 6 processor worn on a Softband and to its performance to the Baha 5 in terms of sound field hearing thresholds, speech understanding, and patient satisfaction in pediatric patients who have purely conductive, mixed, or single-sided deafness hearing loss
Methods:
A cross-sectional study looking at 30 children with conductive, mixed, or SSD hearing loss included in our study. At the baseline visit, pure-tone audiograms were obtained, including air and bone conduction thresholds with speech recognition scores.
Results:
After a total of four weeks using the Baha 5 processor followed by four weeks with the Baha 6. Free field hearing threshold measurements were conducted for both sound processors, alongside speech discrimination tests based on behavioral mapping. The mean air-conduction thresholds for frequencies from 250 Hz to 8000 Hz were 75 dB unaided. The aided mean threshold with the Baha 6 was 30 dB for the frequency range from 250 to 6 kHz, while the aided mean threshold with the Baha 5 was 35 dB for the frequency range from 0.5 to 4 kHz. There was a statistically significant increase in speech discrimination scores in both devices; however, the scores were higher in the Baha 6. Additionally, patient satisfaction indicated that the Baha 6 is perceived as a better solution.
Conclusions
Pediatric subjects experience significant improvements in hearing thresholds and speech understanding when using both sound processors. However, patient satisfaction suggest that Baha 6 is a superior solution.

Objective: BCHIs are a well-established option for patients with conductive or mixed hearing loss, along with those suffering from single-sided deafness. In the past decade, a new system has emerged that has advantages over the first-discovered percutaneous systems. These are the transcutaneous bone conduction system. A literature search yielded little published data about one of the newest arrivals to this space. So we decided to perform my own study that would evaluate the clinical, audiological, and speech performance of the Osia and to compare it with the Baha 5 attract system.
Methods: A total of 70 patients were included in our study,43 pts with Oisa system and 25 pts implanted with baha. we set out to evaluate speech recognition performance and hearing-aided thresholds along with considering both post-surgical complications and overall patient satisfaction.
Results: In both groups, there were statistically significant post-implant improvements at all frequencies tested compared to the unaided levels. POST operative mean threshold for frequencies from 250 to 8000 Hz with the Osia device was 43 dB. While the mean Preoperative threshold was 80 dB. In the Baha group, the POST operative mean threshold for frequencies from 250 to 6000 Hz was 35 dB. While the mean Preoperative threshold was 70 dB. There were statistically significant increase in speech discrimination scores after the implantation of a device in both groups.
Conclusion:
There were statistically significant improvements in hearing performance compared with unaided hearing in both devices. In comparison to the Baha® Attract, the audiological performane ,indicate that the Osia better solution

Background:
The active middle ear implant (AMEI) Vibrant Soundbridge (VSB, MED-EL) is a well-established treatment option for mild to severe hearing impairment. The first generation (Vibrant Ossicular Prosthesis (VORP) 502) was introduced in 1996, and the next generation (VORP 503) has been available since 2014. In Hannover, the VSB program started in 1997. Here, we present multicentric data on safety and audiological results spanning the lifetime of the VSB.
Methods:
A retrospective analysis was conducted on data from 647 ears (622 adults and 25 children) that had been implanted with this AMEI for a minimum of five years prior to 2022. Patients’ bone conduction (BC) thresholds, sound field (SF) thresholds, and word recognition scores (WRS) were collected up to 24 years postoperatively. Complications were recorded for a survival analysis with the focus on revision surgeries and explantations.
Results:
Safety was established by stable BC thresholds, with a mean difference of -3.86 dB five years or later after implantation. Additionally, safety was confirmed by a low number of technical failures and high survival rates ten years after implantation. Paired mean SF pure tone average thresholds at 0.5, 1, 2, and 4 kHz (PTA4) and WRS showed significant improvement five years after implantation, with a mean functional gain (FG) of 29.87 dB and a mean WRS of 59.81%.
Conclusions:
The findings of this study demonstrate that the AMEI remains safe and effective for up to 10 years with the VORP 502 generation and up to 5 years with the VORP 503 generation.