Paediatric percutaneous bone anchored hearing aid implant failures: Comparing the experience of a tertiary centre with a systematic review of the literature and meta-analysis.

BACKGROUND: Despite the proven audiological benefits of Percutaneous Bone Anchored Hearing Aids (BAHAs) in paediatric patients with conductive or mixed hearing loss, their adoption has been limited due to concerns over implant failure and associated complications. This paper conducts a systematic review and meta-analysis to assess the prevalence of implant failure in paediatric populations, combined with a case series from our tertiary referral centre. METHODS: A comprehensive literature search identified 562 articles, from which 34 were included in the review, covering 1599 implants in 1285 patients. Our retrospective case series included consecutive patients from our tertiary referral centre who underwent percutaneous BAHA implantation from 2003-2019. RESULTS: Meta-analysis revealed an overall implant failure rate of 11%, predominantly attributed to traumatic extrusion. Our retrospective case series comprised 104 implantations in 76 patients, with a 4.8% failure rate. DISCUSSION: Factors contributing to the lower-than-expected failure rates in the case series likely included consistent use of 4 mm fixtures from a single manufacturer and older age at implantation. The study underscores the need for standardised reporting formats in bone conduction implants research, given the systematic review's limitations in study design heterogeneity, especially with the expected rise in the adoption of novel active devices.

Exploring the Correlations Between Measures of Listening Effort in Adults and Children: A Systematic Review with Narrative Synthesis.

Listening effort (LE) describes the cognitive resources needed to process an auditory message. Our understanding of this notion remains in its infancy, hindering our ability to appreciate how it impacts individuals with hearing impairment effectively. Despite the myriad of proposed measurement tools, a validated method remains elusive. This is complicated by the seeming lack of association between tools demonstrated via correlational analyses. This review aims to systematically review the literature relating to the correlational analyses between different measures of LE. Five databases were used- PubMed, Cochrane, EMBASE, PsychINFO, and CINAHL. The quality of the evidence was assessed using the GRADE criteria and risk of bias with ROBINS-I/GRADE tools. Each statistically significant analysis was classified using an approved system for medical correlations. The final analyses included 48 papers, equating to 274 correlational analyses, of which 99 reached statistical significance (36.1%). Within these results, the most prevalent classifications were poor or fair. Moreover, when moderate or very strong correlations were observed, they tended to be dependent on experimental conditions. The quality of evidence was graded as very low. These results show that measures of LE are poorly correlated and supports the multi-dimensional concept of LE. The lack of association may be explained by considering where each measure operates along the effort perception pathway. Moreover, the fragility of significant correlations to specific conditions further diminishes the hope of finding an all-encompassing tool. Therefore, it may be prudent to focus on capturing the consequences of LE rather than the notion itself.

Hearing preservation via a cochleostomy approach and deep insertion of a standard length cochlear implant electrode.

OBJECTIVE: The suggestion that the depth of insertion of the electrode into the cochlea is critical to hearing preservation has led to the development of a generation of short electrodes designed to minimize intracochlear trauma and avoid contact with the apical region of the cochlea. This study aims to describe our experience of hearing preservation surgery using a deeply inserted standard length electrode array covering the region of residual hearing. STUDY DESIGN: A retrospective case note review was performed identifying cases of attempted hearing preservation using standard length electrodes. SETTING: Study based at Manchester Royal Infirmary, a tertiary referral center. PATIENTS: Fourteen cochlear implants in 13 patients were identified for further analysis from the Manchester Cochlear Implant Programme database. INTERVENTION(S): Each patient received the same design of implant using a "soft" surgical technique. MAIN OUTCOME MEASURE: Preoperative and postoperative air conduction thresholds were compared to assess the degree of hearing preservation. RESULTS: Successful hearing preservation was demonstrated in 12 of 14 cases, and the postoperative residual hearing thresholds in 3 adolescents receiving a standard length electrode array were found to have improved. Preservation of speech recognition was not measured in this study, rather hearing was tested by pure tone audiogram. Follow-up at the time of this study ranged from 1 week to 23 months. CONCLUSION: This study demonstrates that deep insertion of the electrode into the cochlea does not preclude successful hearing preservation. It also highlights that residual hearing can be consistently preserved using a "cochleostomy" approach.