Background:
Verification practices for bone-conduction devices (BCDs) are inconsistently reported in the literature. Most studies focus on pre- to post-surgical comparisons of aided thresholds, often overlooking the impact of device fitting and adjustment. As a result, the relationship between BCD fitting parameters and user performance remains poorly understood.
Methods:
A quasi-experimental, prospective study with a repeated-measures design was conducted with 16 adults using BCDs on skin-penetrating abutments. Devices were fitted according to the DSL-BCD v2.0 protocol and verified using the Audioscan Skull Simulator and a prototype Surface Microphone. Participants were tested in two conditions: (1) with the BCD coupled to the abutment and (2) with the BCD mounted on a soft elastic headband. In each condition, participants completed the QuickSIN, the UWO Plural Test, and the NASA TLX workload questionnaire.
Results:
Performance was significantly better in the abutment condition compared to the soft elastic headband. The average improvement in QuickSIN scores was 1.25 dB. Regression analyses revealed a strong relationship between aided Speech Intelligibility Index (SII) and QuickSIN performance in both conditions, with significant models and large effect sizes.
Conclusion:
These findings demonstrate a significant link between verified BCD fitting characteristics and user performance. Objective verification using tools like the skull simulator may provide meaningful insights into real-world listening outcomes for BCD users.

Background: For percutaneous bone conduction devices (BCDs), implanted commonly retro-auricular at similar locations, standardized methods to determine maximum output (MO) are established. In contrast, clinical methods to determine the frequency-specific MO of transcutaneous BCDs and active middle ear implants (AMEIs), that are inaccessible after implantation, are rare. This is even more important as the MO of BCDs depends on implant’s position.
Methods: The MO of the transcutaneous BCD Bonebridge was determined in patients for audiometric frequencies. Besides predicting the expected MO, the method verified that the MO shows a strong dependence on the distance to the ear canal (see presentation N. Prenzler). A similar method was employed for AMEIs to determine the necessary dynamic range (DR) for sufficient word recognition scores (WRSs) in quiet.
Results: From bone conduction (BC) and direct thresholds the frequency-specific MO of the Bonebridge for the ipsi- or contralateral side was determined. Additionally, from the analysis of the AMEI Vibrant Soundbridge, with a comparable fitting rule, the monaural necessary DR for a sufficient WRS was calculated. The deduction of the necessary DR yields the frequency-specific indication limit based on predicted WRS for ipsi- and contralateral application of the Bonebridge.
Conclusion: The determination of the MO and DR of implants from clinical data allows for a first estimate of frequency-specific indication limits based on predefined criteria. However, a more elaborate determination of limitations needs to include crosstalk between sides, implant position and employed fitting rule.

Background: The hearing ability of patients diagnosed with chronic otitis media (COM) can frequently only be restored through surgical intervention. The persistent inflammatory reaction plays a significant role. This study evaluated the outcomes of patients who had been implanted with the Vibrant Soundbridge (VSB) and who suffered from persistent chronic otitis media
Methods: The study analysed a total of 42 patients diagnosed with otitis media (OM) who had undergone various operations utilising a diode laser and had been implanted with the VSB. The audiometric measurements were evaluated, whilst the quality of life of the participants was assessed using the Glasgow Benefit Inventory. Furthermore, microbial colonisation and the microbiome were examined from persistent COM.
Results: The results of the study demonstrated that following VSB implantation, inner ear performance remained consistent. A paired comparison with the Wilcoxon signed-rank test revealed a significant benefit of the VSB, as evidenced by an enhancement in speech comprehension at rest and in noise. Furthermore, a substantial improvement in quality of life was observed. A notable shift in the composition of the bacterial colonisation was also identified.
Conclusion: The conclusion drawn from this study indicates that functional ear surgery, particularly when employing the diode laser technique in conjunction with VSB rehabilitation, constitutes an optimal treatment modality for patients afflicted with hearing impairment due to COM. The efficacy of this approach is evident in the enhancement of audiological performance, the attainment of a substantial improvement in quality of life, and the modulation of ear pathogens and the microbiome.

Background: The Vibrant Soundbridge (VSB) middle ear implant is a partially implantable solution that has been used in clinical practice for over 25 years. It consists of an internal part (implanted behind the ear) and an external part (audio processor). As technology advances, audio processors are constantly being improved to enhance communication, performance and hearing function for users. Samba 2 is the latest audio processor introduced for VSB.
The aim of this study is to compare the benefits of using the latest Samba 2 processor with previous generation processors in a group of experienced VSB users.
Methods: Twenty-two experienced VSB users (mean time using VSB = 9 years, SD = 2) had their processor upgraded to the latest model (Samba 2). The mean age of the subjects was 56 years (SD = 20). Assessment included free-field audiometry, speech tests in quiet and noise, and patient-reported outcome measures (PROMs). In addition, the group of users who underwent subjective assessment using PROMs was expanded to 45 patients.
Results: Free-field audiometry showed statistically significant improvements in hearing sensitivity and speech discrimination in quiet and noise with the Samba 2 compared to the previous technology. PROMs confirmed the benefits of using the latest audio processor and there was greater satisfaction with its ease of use.
Conclusions: The results of the tests performed and the evaluation of the questionnaires indicate that the use of the new audio processor improves the audiological results and the functioning of the users. Access to modern technology for VSB patients provides measurable benefits.

Background:
We present the case of a 97-year-old with severe visual impairment and a bilateral profound mixed hearing loss due to sensorineural hearing loss associated with progressive middle ear tympanosclerosis.
This patient was within UK NICE criteria for cochlear implant (CI) and outside of Pure Tone Audiometry (PTA) criteria for the MED-EL Vibrant Soundbridge (VSB) coupled to the stapes using a CliP coupler. Despite detailed counselling regarding CI, a shared decision was made to proceed with the VSB-CliP. Rationales, surgical approach, outcomes, and learnings are discussed.

Methods:
Audiological assessment revealed all air conduction thresholds ≥100dB and bone conduction (BC) thresholds averaging at 66dB (range 60-75dB); placing the patient at an average of 14dB outside of VSB PTA-CliP BC criteria.
A CT scan revealed advanced middle ear tympanosclerosis with involvement of the malleus on the right side and malleus incus and stapes on the left side.
Surgery involved blind sac closure of the left ear canal along with removal of the tympanic membrane, tympanosclerotic plaque, malleus and incus. A stapes CliP-coupler was used to attach the Floating Mass Transducer to the stapes head.

Results:
Sound-Field Aided Audiometry and aided speech testing along with a qualitative analysis of post-op patient and carer feedback will be presented.

Conclusion:
The vibrogram plateaus within the first fine tune making tuning and rehabilitation demands with VSB less than for CI. Single stage blind sac VSB-CliP is possible in cases of advanced tympanosclerosis. Inferences are that patients with middle ear disease and similar BC thresholds could potentially be offered this option.

Summary
Regional anesthesia is increasingly used in middle ear surgeries and bone conduction procedures, such as those involving the MED-EL Bonebridge BCI 602, to enhance postoperative pain management and reduce opioid consumption. Traditional pain control methods rely heavily on systemic opioids, which are associated with side effects including nausea, vomiting, sedation, and respiratory depression. These adverse effects can delay recovery and reduce patient satisfaction.

Targeted nerve blocks, particularly of the auriculotemporal and great auricular nerves, offer effective site-specific analgesia that minimizes the need for opioids. These blocks can be used alongside general anesthesia or, in certain cases, as a standalone technique. The benefits include improved patient comfort, reduced systemic complications, faster recovery times, and shorter hospital stays. Additionally, regional anesthesia contributes to smoother emergence from general anesthesia and higher patient satisfaction scores.

Implementing these nerve blocks requires thorough anatomical knowledge and careful technique to avoid potential complications such as nerve injury or hematoma. The use of ultrasound guidance has further improved the safety and accuracy of these procedures.

Overall, auriculotemporal and great auricular nerve blocks represent a promising strategy for postoperative pain control in otologic surgeries. Their incorporation into standard anesthetic protocols supports enhanced recovery pathways, making them a valuable component of modern perioperative care. Further research, particularly large-scale randomized controlled trials, is necessary to establish standardized guidelines and confirm the long-term benefits of these techniques in clinical practice.

Background: Virtual reality (VR) simulator-based otoscopy systems enhance traditional teaching methods and improve otoscopy skill acquisition; the Earsi Otoscope® is developed for this purpose. With technological advances within the educational space, there may be a need to re-evaluate the role of traditional teaching models against modern VR-based models.

Methods:
This was a prospective, qualitative survey assessing the experiences of novice medical students to a cohort of qualified doctors. Data was collected on pre- and post- otoscopy confidence ratings, previous otoscopy training modalities, fidelity of simulators to real patients and likelihood of recommending VR models; all via 10-point Likert scales and free text boxes. Diagnostic accuracy was assessed using ability to identify all areas of the TM with % scores provided by the model.

Results:
A total of N=33 participants (medical students n=23, doctors n=10) were included.
On average, medical students were able to identify more of the TM compared to the doctors (mean 86% and 83% respectively); increased confidence rating by medical students (pre-event=4.5, post-event=7.35). Despite this, both cohorts acknowledged the realism of the simulator and would recommend this to their colleagues. Pros of this model include good visibility of pathologies and vocal feedback by the model. Cons mentioned included a stiff ear mold, unlike the real patient.

Conclusion:
New technologies in education in otology allow for superior methods of learning. Although this cannot compare to examining real patients, this provides a good experience for the novice to learn the skills.

Background:
The primary stability of an implant and the distribution of surrounding mechanical stress are important for implant longevity. Computational modeling of the dynamic process of self-tapping implant placement is limited in the literature, and most of them have not been experimentally validated. The objective of this study is to develop and validate a dynamic model to simulate the implant insertion process.

Methods:
In this study, the traditional finite element method was combined with a meshless (smoothed-particle hydrodynamics, SPH) method to simulate the dynamic process of bone-anchored hearing aid implant placement. The artificial bone region in direct contact with the implant was modeled using the meshless method to more consistently simulate the destruction and cutting process of the material. The remaining artificial bone portion was modeled using traditional finite element methods to provide a more visually interpretable stress-strain map. The model was validated by comparing it with experimentally obtained insertion torque curves (Wide Ponto 4mm implant and Acorn C4 implant).

Results:
The implantation torque curves of the simulation models for both implants agreed well with the experimental curves. The model could capture the geometric changes of the implants and provided a detailed distribution of stress and strain.

To build a remote 4K/3D microsurgery treatment platform and evaluate the application effect of the 4K resolution 3D style images supported by 5G communication technology in microsurgical remote consultation. A remote surgical treatment platform based on 5G technology and relying on the domestic 4K/3D microsurgical imaging system between Chengdu and Beijing(1,800 kilometers apart) was built to carry out remote surgical consultation of difficult cases of lateral skull base. In the system，the"end-of-cloud" architecture was designed to acquire dual-point-of-view light field, intelligent image processing, hardware 3D interleaving, low-latency network transmission, and ultra-high-definition stereoscopic display of surgical fields. The effectiveness of the platform is evaluated through the following indicators: terms of 4K/3D video transmission delay, peak signal to noise ratio (PSNR) and structural similarity index measure (SSIM), image quality and comfort. Under the non-dedicated 5G networking scheme, the 4K/3D video transmission delay of the platform was 1.18 seconds. The objective indicators PSNR and SSIM suggested the visual differences and structural differences before and after the video transmission of the remote surgical treatment platform were both little. Twenty-seven otolaryngologists viewed and evaluated the videos before and after the transmission, of which 89.35% thought that the image quality did not change or changed slightly after the video transmission without affecting the viewing, and 96.3% thought that the video transmission did not affect the viewing comfort. The ultra-high-definition stereoscopic video produced by the 4K/3D microsurgical imaging system is sufficient to support remote surgical instruction after 5G transmission, which provides new solutions for telemedicine and teaching, disaster and battlefield surgical treatment.