Background:
We present the case history of a patient that had undergone bilateral percutaneous Bone Anchored Hearing Implants (BAHI) and unfortunately suffered multiple spontaneous fixture extrusions. Each implant was replaced but suffered a further extrusion.
Our patient has recurrent otitis externa, is an insulin dependant diabetic with a mixed hearing loss and inability to wear and gain benefit from air conduction hearing aids. They underwent bilateral percutaneous BAHI insertion and both extruded at different time points.
They were then implanted with bilateral transcutaneous hearing implants - Cochlear Osia implants. One side healed well and was loaded with an Osia processor. The other side suffered a wound breakdown and was subsequently explanted with good wound healing following this.
They were then implanted with an Oticon Sentio implant on the side that had a previous wound breakdown such that they were then using an Osia on one side and a Sentio on the other.

Methods:
The detailed case history and patient management will be discussed along with patient reported outcomes of each hearing implant.

Results:
Our patient derived great benefit from bone conduction hearing and with each device they were satisfied with the hearing gain obtained.
Patient preference on greatest hearing benefit was with the Oticon Sentio hearing implant

Conclusion:
Hearing benefit is similar with transcutaneous and percutaneous bone conduction hearing implants in mild to moderate mixed hearing loss. In a patient that has personal experience of several devices the Sentio was their preferred device

Background: The aim of the study was to assess auditory development in young children with profound hearing loss, cochlear implants (CIs) and congenital cytomegalovirus (cCMV) infection and to determine the effect of comorbidities on their development.
Methods: The study group (cCMV group) consisted of 47 CI children—18 girls and 29 boys—who had been diagnosed as having prelingual hearing loss due to cCMV infection (with or without comorbidities); the mean age at CI activation was 15.2 months (range: 9.7–23.8; SD = 3.5). The reference group (no cCMV) consisted of 117 similar children (57 girls and 60 boys) who had profound sensorineural hearing loss not caused by cCMV infection; they had no comorbidities. The mean age at CI activation in the second group was 14.3 months (range: 7.9–23.5; SD = 4.0). Auditory development in all children was assessed with the LittlEARS Auditory Questionnaire (LEAQ) at CI activation and at about 1, 5, 9, 14, and 24 months of CI use.
Results: The mean LEAQ total score increased over a similar time frame from 9.8 pts to 28.9 pts in the cCMV group without comorbidities, from 4.5 pts to 18.5 pts in the cCMV group with comorbidities, and from 9.2 to 31.6 pts in the reference group with no cCMV infection.
Conclusion: Early cochlear implantation in children with sensorineural hearing loss due to congenital CMV infection and no comorbidities promotes their early auditory development in a similar way to children without cCMV infection.

Background:
The accurate localization of the surgical site is crucial for the safe and effective placement of bone-anchored hearing implants. Variations in bone and skin thickness can compromise outcomes if not properly assessed preoperatively. This study aimed to develop a protocol based on computed tomography (CT) of the temporal bones to guide preoperative site marking and enhance surgical precision.
Methods:
Three standardized points were defined at distances of 5.5 cm, 6.5 cm, and 7.5 cm from the external auditory canal. These were marked on each patient's scalp and on a Perforation Guide to serve as a reproducible reference during surgery. Radiopaque markers were affixed to the scalp at these points, and a CT scan of the temporal bones was performed. Skin and bone thickness were measured at each point to determine the most appropriate site for implantation. Subsequently, patients underwent surgery for the placement of the Ponto™ system.
Results:
The anatomical data obtained from CT scans demonstrated consistent correspondence with intraoperative findings. This concordance confirmed that preoperative imaging with site marking reliably predicted the optimal implant location and anatomical conditions encountered during surgery.
Conclusion:
The protocol developed in this study proved to be effective in preoperatively identifying the ideal site for bone-anchored hearing implants. The strong agreement between CT findings and surgical observations highlights the method’s reliability and its potential to improve surgical planning and outcomes.

Background
The Osia is an active transcutaneous bone conduction hearing implant, manufactured by Cochlear. It is a slim device, which does not require the drilling of a bed in the skull cortex. Surgical insertion involves a single scalp incision, and positioning of the device in a pericranial pocket, secured onto a single implant screw. Improvements and refinements in implant design necessitate corresponding adjustments in surgical technique and culture, to improve service efficiency, accessibility, and patient experience.

The aim of this project was to pilot bone conduction hearing implant surgery under local anaesthesia, in the outpatient setting.

Methods
A business plan was proposed and approved to set up an outpatient bone conduction hearing implant service, and approved by local governance, finance, quality and safety committees. An iterative process to service development was deployed, based on staff debriefs and patient feedback. Twenty patients have been safely and successfully implanted in the outpatient setting, including one bilateral case.

Results
The setup, governance and logistics of the service will be described, along with metrics from the service to date; qualitative and quantitative patient feedback, case studies, and plans for service development and expansion.

Conclusion
Modern hearing implants are specifically designed to facilitate simple and safe surgical insertion. It is imperative that surgeons adapt surgical technique and culture accordingly, to facilitate the continuous improvement and development of hearing implant services. Bone conduction hearing implant surgery in the outpatient setting is feasible, safe, and offers potential benefits for hearing implant programmes, for individual patients, and for industry partners.

Background: Effective mechanical coupling between bone conduction implants and the skull is essential for optimal auditory stimulation. The Bonebridge™ (MED-EL, Innsbruck, Austria) uses cortical screws to secure the transducer to the mastoid bone. However, the biomechanical consequences of varying screw configurations on cochlear activation remain unclear. This study investigates how different fixation strategies affect auditory transmission.
Methods: In total, six Bonebridge implantations were performed in five fresh-frozen human cadaver heads, with ipsilateral cochlear activation assessment. Five coupling conditions were evaluated: (1) both screws fixed, (2) only the superior screw fixed, (3) only the inferior screw fixed, (4) fixation via skin tension alone, and (5) no screws fixed. Cochlear activation was assessed by measuring pressure changes within the scala vestibuli and scala tympani using custom intracochlear acoustic receivers (ICARs). Additionally, 3D velocity measurements via laser Doppler vibrometry (LDV) were performed at multiple locations: the Bonebridge surface (n = 4), the skull surface (n = 4), and the cochlear promontory (n = 1). A 1D scanning LDV further recorded vibratory responses on the implant and skull surfaces.
Results: With decreasing fixation, a consistent trend emerged: Bonebridge surface velocity increased due to reduced mechanical damping, while the velocity of the skull and promontory, and the pressure in the cochlea decreased, reflecting poorer energy transmission.
Conclusion: The absence or reduction of screw fixation weakens mechanical coupling, leading to reduced cochlear activation. These findings suggest that suboptimal coupling strategies may diminish auditory benefit for Bonebridge recipients.