Background: To determine the long-term outcomes of the currently most used bone conduction devices, BIA400 and Ponto Wide, in terms of implant stability (ISQ), soft tissue reactions, skin thickening and implant loss. The secondary outcome was to examine the relation between ISQ and complications.
Methods: For this single-center retrospective cohort study, adults who had the BIA400 or Ponto Wide implanted between January 2013 and December 2023, and had at least two follow-up appointments, were included. ISQ data and findings of soft tissue reaction skin thickening and implant survival were collected and analyzed.
Results: 93 BIA400 and 114 Ponto Wide implants were included. Significantly more soft tissue reactions Holgers≥1 (p=0.003), adverse soft tissue reactions Holgers≥2 (p=0.018), skin thickening (p<0.001) and skin thickening requiring treatment (p<0.001), occurred in the BIA400 group compared to the Ponto Wide group. No difference in implant stability was found. One implant was lost in the BIA400 group (1.1%) and three in the Ponto Wide group (2.7%). ISQ trends showed an increase after 3 weeks post-implantation, reaching its plateau phase between six months and its first year after implantation. No relationship between ISQ and complications could be demonstrated.
Conclusion: Both implants have excellent implant survival rates and similar implant stability. The Ponto Wide has favorable outcomes in terms of (adverse) soft tissue reaction and skin thickening (requiring treatment). Finally, this database provided no indication of a relationship between complications and ISQ, but firm conclusions cannot yet be drawn.

Background:
Air conduction stimuli for vestibular evoked myogenic potentials (VEMP) require high sound levels and are limited to patients without conductive hearing losses. By using bone conduction (BC) stimuli these drawbacks can be avoided.
This study is investigating how BC stimuli elicit the ocular VEMP reflex which is still under debate.

Methods:
This study is a pilot study using three subjects. VEMP parameters in terms of latencies and amplitudes with a single sine BC stimulus of 250 Hz applied at the forehead using two different transducers; B250 and Minishaker 4810. These parameters will be compared with the mechanical response using a laser doppler vibrometer (LDV) aimed at a reflector placed over the mastoid portion of the temporal bone.
The influence of polarity was investigated by comparing parameters with a first cycle inward directed force with parameters from a 180 degree phase shift (first cycle outward directed) as well as using a tendon hammer force impulse.

Results:
It was found that the polarity of the stimuli will affect both amplitude and latency of the VEMP response. Also, a double response was found when using a first inward force. LDV responses at the mastoid were found to be outward when the stimuli were directed inward. This was also in line with the VEMP responses in terms of latencies.

Conclusion:
It is found that the polarity of the force applied at the forehead is important where a first outward direction is preferred and will best agree with latencies using tendon hammer stimuli.

Background: Bone conduction is a well-established method for treating various hearing pathologies, and cochlear motion is considered a good estimation of hearing sensation. Traditionally, a single-sensitivity-axis laser Doppler vibrometer (1D LDV) has been the most common measurement method due to practical accessibility and availability. However, certain stimulation conditions have been shown to induce 3D motion strongly oriented along a specific direction (i.e., strong directionality). Thus, relying solely on one-dimensional motion measurements may lead to inaccurate estimations of the inner ear’s activation.
Methods: Previously published studies were reviewed to identify factors influencing the directionality of cochlear motion. Of particular interest were those reporting three-dimensional cochlear motion data, which have been obtained using either 3-axial accelerometers attached to the promontory or contactless three-dimensional Laser Doppler Vibrometers (3D LDVs). In addition, the 3D data were compared against experimental conditions, in which different factors affecting directionality were assessed.
Results: The cochlea exhibits a complex motion pattern across the audible frequency range, even under constant stimulation conditions. Factors such as distance from the stimulation site, direction of stimulation, stimulation frequency, coupling mechanisms or the device’s underlying working principle significantly affect directionality. Consequently, under certain conditions, relying solely on one-dimensional measurements may lead to inaccurate estimates of the cochlea’s overall motion.
Conclusions: Single-direction measurements are, in general, not representative of the full cochlea’s motion. Information in all directions of motion is necessary to understand the full propagation of motion in the skull, and eventually make a better assumption about the hearing sensation.

Background: The aim of this qualitative study was to explore and describe patients' experiences of using and living with the bone conduction implant (BCI).

Methods: Semi-structured interviews were conducted with 10 BCI users and analyzed according to the phenomenographic approach.

Results: Four conceptual themes were formed during the analysis; (1) conceptions of the process receiving the BCI, (2) conceptions of handling the BCI on a daily basis, (3) conceptions of hearing with the BCI, and (4) conceptions of health care issues related to the BCI. The participants' statements include experiences of improved hearing and self-esteem by using the BCI. Noisy situations and not being able to hear in daily life situations causes frustrations. The participants described anxiety about consequences following an MRI examination. The audio processor is easy to handle but the fact that it is not waterproof raise concerns. Despite some frustration and concerns, participants state that the audio processor has become a part of them, and they cannot imagine being without it.

Conclusion: The ability to hear and communicate with other people has a great impact on the participants' daily life quality, and their statements show the importance hearing has on their lives and how they perceive themselves. The BCI seems to be a good hearing rehabilitation alternative for the participants, and they state that the audio processor is easy to use and handle.

Background
Bone conduction devices (BCDs) assist those with CHL, MHL and SSD. Percutaneous BCDs (pBCDs) outperform active transcutaneous BCDs (atBCDs) in audiological performance and MRI safety, while atBCDs offer more skin safety and claimed better aesthetics. Despite user satisfaction, no objective comparisons of device appearance exists. This study explores user and non-user preferences regarding BCD appearance and its importance relative to other traits, also evaluating a new questionnaire's broader applicability to support shared decision-making

Methods
An online questionnaire was designed, validated and administered to BCD-users and non-users (i.e., persons with no experience using a BCD). Pair-wise comparisons showing pictures of the latest generation perBCD and atBCD sound processors and implant sites were anonymously provided to participants, who could indicate their preference. Means for the total score as well as sub scores of pictures showing either sound processor or implant site were calculated. Statements were presented in which the appearance of the device was weighed against other traits such as better hearing.

Results
The study population consisted of 102 BCD-users and 105 non-users. An overall preference for perBCD sound processors was observed (mean score - 0.50 (95% CI: -0.63, -0.37). BCD-users had no preference for implant sites whilst non-users preferred atBCDs (-0.03 (-0.27, 0.21) and 0.60 (0.40, 0.80) respectively, p < 0.01). Most participants found better hearing more important than having an appealing device (n = 150, 73.0%).

Conclusion
PerBCD sound processors were preferred over atBCD sound processors by both BCD-users and non-users. Functionality seems to be more important than the appearance of the device.

The Osia OSI300 implant improves hearing in patients with conductive or mixed hearing loss. Its superior performance in speech understanding in quiet and noisy environments, combined with MRI safety and popularity due to its aesthetic appeal and comfort, make it a standout product. This study aimed to assess the efficacy of the Osia OSI300 implant in eight patients with conductive or mixed hearing loss, evaluated before implantation and one month after activation.
This group consisted of patients aged 17 to 51 (mean—29). Each patient received a unilateral Osia OSI300 implant. Pure-tone audiometry, speech understanding tests, and free-field audiometry were performed before and one month after implant activation. Word recognition scores were assessed with the Demenko and Pruszewicz monosyllabic word test, while the Polish Matrix Sentence Test was used to evaluate speech understanding in noisy environments. The Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire assessed patients' subjective impressions.
All patients improved hearing and speech understanding one month after implant activation. The mean free-field thresholds at 500, 1000, 2000, and 4000 Hz frequencies were 32.4, 30.5, 33.8, and 41.9 dB HL, respectively. Speech discrimination under free-field conditions also improved (from 1.7% to 94%). Results from the Matrix test indicated an improvement in speech perception in noise, with the signal-to-noise ratio (SNR) improving from +3.5 dB to −1.3 dB. The APHAB questionnaire results revealed a notable reduction in perceived hearing difficulties.

Background:
Active transcutaneous Bone Conduction Implants (BCI) are very useful in conductive and mixed hearing loss (HL) and unilateral sensorineural HL. These system produces vibration directly to inner ear, bypassing external and middle ear. There are two main energies to do this, electromagnetic and piezoelectric.
Methods: Multicentric retrospective study of two groups of consecutive patients implanted with active BCI. Only patients with conductive or mixed HL. were included. One group was implanted with Osia® and the other with Bonebridge®. Tonal audiometry with pure tone average (PTA4) and Speech Recognition Test (SRT) were done.
Results:
Thirty patients were included, fifteen in each group. In Bonebridge® group the preoperative thresholds were 64,2 dB, while the PTA4 aided reached 17,2 db. The functional gain (FG) was 46,4 dB, in OSIA group unaided condition was 73,5 dB improving to 38,7 dB (34,8 dB of FG). Regarding the SRT (+5 db), Bonebridge group reached 88% and OSIA group 85,6%. (not statistically significant). The main difference between groups was the etiology, meaning probably a bias; BB group presented more aural atresia while in OSIA group most of them presented mixed HL (chronic otitis media). Regarding gain in different frequencies, no difference between the devices was found.
Conclusions:
Both devices showed very good results with a little difference in favor to patients with Bonebridge over OSIA, while discrimination at same condition was similar. Therefore, active percutaneous BCI are the best option to repair conductive and mixed hearing loss specially in patients with congenital aural atresia and chronic otitis media.

Background
Bonebridge is an active transcutaneous bone conduction device, indicated in patients with conductive and mild mixed hearing loss. This situation can be mainly found in patients with aural atresia, radical cavities, chronic otitis media and selected cases of otosclerosis not suitable for stapedectomy or hearing aids.
Initially, implantation was designed for the mastoid region. However, this approach cannot be used in patients with radical cavities and may interfere with future reconstructive surgery in aural atresia. Finally, Bonebridge is embedded in the cranial bone which constitutes a major advantage of the device.
Methods
Alternative implantation sites—retrosigmoid and middle fossa—were developed to overcome anatomical limitations. Despite their efficacy, these terms are associated with skull base surgery and may deter potential users due to perceived surgical complexity.
Results
To avoid the negative reaction of otologic surgeons to these names we propose the use of easy to remember names related to the anatomic location of the implant. These names have been presented to the scientific community in meetings over the last decade and are now published in the literature.
Additionally, the bone bed drilled for Bonebridge has two major advantages: it protects the device from external trauma and protects the skin from excessive elevation and pressure induced by the device.
Conclusion
The proposed anatomical nomenclature is intended to eliminate the unnecessary association of Bonebridge with skull base surgery. By simplifying terminology and emphasizing the protective nature of bone-embedded implantation, we aim to facilitate wider clinical adoption and enhance surgical planning in complex otologic cases.