Introduction
Chronic otitis media (COM) is a persistent inflammatory disease of the middle ear that can lead to significant hearing loss and reduced quality of life. When middle ear damage prevents the use of conventional hearing aids, bone conduction devices (BCDs) provide an effective alternative by transmitting sound directly to the inner ear, bypassing the affected structures. These devices have shown superior sound clarity and less distortion, especially in noisy environments.
Objective
To compare surgical outcomes, audiological results, and perceived benefit between COM patients implanted with Baha® or Osia®2 systems.
Methods
This prospective, multicenter study included patients with COM rehabilitated using Baha® or Osia®2. Functional gain (FG) and effective gain (EG) were calculated from PTA4 values, distinguishing between conductive and mixed losses. Subjective benefit was assessed using the COSI questionnaire at baseline and 12 months post-activation.
Results
A total of 343 patients were included (16% Baha®, 84% Osia®2; mean age: 45.4 years). In conductive losses, 12-month FG was 16.5 dB (Baha®) and 31.6 dB (Osia®2); in mixed losses, 41.7 dB and 39.8 dB, respectively. EG was –13.5 dB (Baha®) and –10 dB (Osia®2) for conductive losses; –8.4 dB and 1.2 dB for mixed. Improvement in noisy environments was prioritized by 30% (Baha®) and 50% (Osia®2), with mean benefit scores of 3.8/5 and 4.3/5. In quiet environments, scores were 4.8/5 (Baha®) and 4.7/5 (Osia®2).
Conclusion
Both systems proved effective, with Osia®2 offering greater gains and satisfaction in noisy conditions.

Introduction
Mixed hearing loss (MHL) significantly impairs audibility, speech understanding, and sound localization, necessitating advanced rehabilitation strategies. Conventional hearing aids may be inadequate in cases of MHL with large air–bone gaps due to their reliance on a compromised middle ear. Active bone conduction systems such as Osia®2 bypass the dysfunctional conductive pathway, delivering sound vibrations directly to the cochlea. This direct stimulation enhances audibility and speech perception, particularly in challenging acoustic environments.
Objective
To report surgical outcomes, audiological performance, and self-perceived benefit in a large national cohort of patients with MHL implanted with the Osia®2 system.
Methods
This was a national, multicenter, prospective study with repeated measures. Patients with MHL who received Osia®2 implants were included. Data collected included surgical variables, pre- and post-activation audiometric thresholds (PTA4 via air and bone conduction), functional gain (FG), effective gain (EG), and subjective benefit as measured by the COSI questionnaire, administered at baseline and 12 months post-activation.
Results
A total of 521 patients (mean age:42 years; 84%adults) were implanted between June2020 and September2024. Main diagnoses included chronic otitis media with or without cholesteatoma (41%) and microtia/atresia (28.4%). Surgeries averaged 54 minutes; 81.8% used a 4 mm implant. Mean preoperative PTA4 thresholds were 71.65 dB HL (air) and 29.5 dB HL (bone). At 12 months, aided thresholds averaged 28 dB HL (FG: 43.7 dB; EG: 1.53 dB). COSI results indicated significant benefit in noisy (mean: 4.35/5) and quiet (4.58/5) settings.
Conclusion
Osia®2 implantation appears safe, effective, and associated with high patient satisfaction in individuals with mixed hearing loss.

The evaluation of hearing devices such as bone conduction implants requires a comprehensive approach that integrates both objective outcomes and patient-reported benefits. Tools like the Client Oriented Scale of Improvement (COSI) provide valuable insights into individual expectations and perceived improvements, which are essential for tailoring rehabilitation strategies and maximizing clinical outcomes.

To analyze self-reported benefits using the COSI in users of bone conduction implants with conductive, mixed, or single-sided deafness (SSD), comparing selected priorities and the magnitude of perceived improvement across hearing loss types.
Methods
This was a national, multicenter, prospective repeated-measures study. Before activation, patients selected five priority situations from 16 predefined options. Perceived improvement was assessed 12 months post-activation. Priorities were grouped into six categories: (1) Speech-in-Noise, (2) Speech-in-Quiet, (3) Socio-environmental, (4) Emotional, (5) Telephone, and (6) Other.
Results
COSI data from 540 patients were analyzed: 291 with conductive loss, 203 with mixed loss, and 46 with SSD. “Speech-in-Noise” was the most commonly selected first priority across all groups (49.5% in conductive, 58.6% in mixed, 58.7% in SSD), with improvement scores of 4.4, 4.3, and 3.8 out of 5, respectively. The second most frequent priority was “Socio-environmental” in the conductive group (18.9%, 4.5/5), and “Speech-in-Quiet” in the mixed (18.7%, 4.6/5) and SSD groups (23.9%, 4.7/5). Overall reported benefit was conductive 4.6, mixed 4.5, and SSD 4.0.
Conclusion
Speech understanding in noise was the primary patient-reported need across all groups. High levels of perceived improvement were observed, although SSD users reported slightly lower scores, underscoring the importance of expectation alignment in this population.

Introduction: Mixed hearing loss affects not only audibility but also speech perception and sound localization, requiring effective rehabilitation strategies. Conventional hearing aids may be insufficient when a significant conductive component is present. Bone conduction implants transmit sound directly to the cochlea, bypassing the outer and middle ear. Among these, piezoelectric and electromagnetic systems represent distinct approaches, with piezoelectric devices potentially offering better sound quality and hearing gain. Subjective evaluation tools such as COSI are essential, as patient perception strongly influences clinical success.

Objective:
To compare audiological outcomes and patient-reported benefit between piezoelectric and electromagnetic bone conduction implants in individuals with mixed hearing loss.

Methods:
An observational study included 303 patients: 203 received piezoelectric implants (PI) and 100 received electromagnetic implants (EI). Aided air conduction thresholds and effective gain (PTA4) were measured at 12 months. Subjective benefit was assessed using COSI, where patients identified five key situations pre-activation and rated perceived improvement after 12 months (1 = worse to 5 = much better). Situations were categorized into six domains for analysis.

Results:
No significant differences in effective gain were found between groups. However, PI showed significantly better aided thresholds (28dBHL vs. 31.8dBHL; p < 0.05). Both groups shared similar improvement priorities—‘Speech in Noise’ ranked first. PI reported higher improvement scores across key domains: 4.35vs.4.0 (Noise), 4.58vs.4.2 (Quiet), and 4.52vs.4.3 (Social) (p < 0.05).

Conclusion:
Piezoelectric systems were associated with better aided thresholds and greater subjective benefit. Transducer type may influence both audiological outcomes and patient satisfaction in mixed hearing loss.

Background: The Contact Forte system from BHM Inc. is a non-implantable bone conduction device allowing different wearing options.

Methods: Both ears of 15 subjects with normal hearing were occluded to simulate a bilateral conductive hearing loss. The average hearing threshold became 45dB HL (500 to 4000Hz). Measurements were performed in unaided conditions, with Contact Forte devices (unilateral and bilateral), with a headband, and with the self-adhesive wearing option. Speech understanding was measured in quiet (Freiburg words) at 50 and 65dB and in noise (OLSA) in a diffuse noise field.

Results: The self-adhesive adapter option resulted in a mean improvement in free sound field hearing thresholds of 16.3dB for unilateral fitting and 19.1dB for bilateral fitting. With the headband, the thresholds were, on average, better by 1.0dB. Word understanding in quiet improved by 58% to 75% and was slightly better with the headband (3%) and with two devices (5%). In background noise, speech understanding from the front was improved by an average of 2.8dB. When speech was presented from the contralateral side, speech understanding deteriorated slightly by -0.8dB with the unilateral fitting, whereas bilateral fitting led to an improvement of +4.2dB. In noise, there was no significant difference between the headband and the self-adhesive adapter.

Conclusions: Significant improvements in speech understanding in quiet and noise were found, both with the headband and with the self-adhesive adapter. Using a bilateral fitting can improve speech understanding in noise.

Background:
Frequency compression (FCO) is a well-established feature in hearing aids. If conventional amplification of high-frequency sounds like consonants is not sufficient to make it audible to the hearing aid user it can be helpful to compress, i.e., to map this no longer audible frequency range into a lower audible range. Recently, FCO became available for active middle ear implant users. The aim of this investigation is to assess the effects of this feature in terms of hearing outcome subjective hearing performance.
Methods:
Up to 10 active middle ear implant users with steeply sloping high-frequency sensorineural hearing loss (SNHL) are participating in a longitudinal cross-over study in a multi-center setting. Participants are using their implant with and without FCO for a period of three months, the order is determined by randomization. After each take-home period functional gain as well as speech perception performance is assessed. Further, participants complete the SSQ-C questionnaire at every visit to assess subjective hearing performance during the test period.
Results:
Preliminary data indicate that the FCO setting is able to restore the perception of high frequency content and can improve speech perception in patients who fit the indication criteria of steeply sloping SNHL well.
Conclusion:
Frequency compression could be a valuable option to enhance hearing performance in active middle ear implant users who otherwise might become non-users when the hearing system can no longer compensate for the degree of hearing loss in certain frequencies.