Long-term cognition and speech recognition outcomes after cochlear implantation in the elderly.

OBJECTIVE: The purpose of this study is to investigate how cognition, as measured using the Self-Administered Gerocognitive Examination Test (SAGE), and age affect speech recognition scores in older adults (age > 65) at one year and two years after cochlear implantation. STUDY DESIGN: This is a prospective study. SETTING: This study was conducted at a single institution. METHODS: Unilateral cochlear implantation was performed by two surgeons on adult patients (>65 years) with postlingual bilateral sensorineural hearing loss. There were 230 patients who underwent cochlear implantation from January 2016 to June 2023. Fifty-five of these patients completed the SAGE questionnaire before implantation, one year after implantation, and 2 years after implantation. Paired t-test analysis was used to evaluate pre- and post-operative speech recognition scores (CNC, AzBio in Quiet). RESULTS: Patients who had normal preoperative cognition on SAGE showed greater improvement in postoperative speech recognition tests at 1 year and 2 years after implantation compared with patients who showed preoperative cognitive impairment. There were no significant differences in postoperative speech outcome between age group 1 (between 65 and 80 years old) and age group 2 (over 80 years old) cochlear implant recipients. There were no changes in cognitive SAGE scores after 2 years implantation. CONCLUSION: Cognitive function, as measured by SAGE, is a more reliable predictor than age in determining speech recognition improvement after cochlear implantation. Cochlear implantation did not improve postoperative cognition.

Benefits of unilateral cochlear implantation in adults with asymmetric hearing loss: Audiologic and patient-related outcome measures.

PURPOSE: To investigate the benefits of cochlear implantation in adults with single-sided deafness (SSD) and asymmetric hearing loss (AHL). STUDY DESIGN: Prospective within-subjects repeated-measures. SETTING: Two tertiary cochlear implant centers. PATIENTS: Fourteen adults with severe-to-profound sensorineural hearing loss in the worse hearing ear and up to moderate SNHL in the better hearing ear. INTERVENTION: Cochlear implantation in the worse hearing ear. MAIN OUTCOME MEASURES: Consonant-nucleus-consonant (CNC) test, AzBio sentence test in noise, and lateralization testing were conducted preoperatively and at 3-, 6-, and 12-months post-activation. Patient-related outcomes were measured using the Speech, Spatial, and Qualities of Hearing Scale and Glasgow Benefit Inventory. Tinnitus Handicap Inventory was administered to subjects with tinnitus. RESULTS: Mean length of hearing loss in the worse hearing ear was 3.5 years. The mean CNC change scores from baseline were 54.8, 55.9, and 58.9 percentage points at 3-, 6-, and 12-months (p < 0.001). AzBio sentence test in noise demonstrated improved scores in all spatial configurations, although statistically significant in S0N0 (speech front, noise front) only. Lateralization testing showed significant improvement of 22.9, 24.5, and 24.0 percentage points at 3-, 6-, and 12 months post-activation (p = 0.002). All patient-related outcome measures revealed significant improvement. CONCLUSION: This study demonstrates improved speech perception in noise, sound lateralization, quality of life, and reduction in tinnitus perception in adults with SSD/AHL who undergo cochlear implantation. Our results add to the growing body of evidence that cochlear implant should be offered to this population.

Clinical performance, audiological outcomes, and quality of life of the Cochlear Osia ® system.

OBJECTIVE: The Cochlear Osseointegrated Steady-State Implant Bone Anchored Hearing Device (Osia) is a surgically implanted titanium apparatus that utilizes a piezoelectric actuator under the skin to address conductive and mixed hearing loss as well as single-sided deafness. The purpose of this study is to examine the clinical, audiologic, and quality-of-life outcomes in patients who underwent Osia implantation. METHODS: This is a retrospective study analyzing 30 adult patients (age 27-86) with conductive healing loss (CHL), mixed hearing loss (MHL), or single-sided deafness (SSD) who were implanted with the Osia device from January 2020 to April 2023 at a single institution by the senior author. Preoperative speech score testing (CNC, AzBio in quiet, AzBio in noise) were performed in all subjects while unaided, wearing conventional air conduction hearing aids, and wearing a softband BAHA. These preoperative speech scores were then compared to post-implantation speech scores using paired t-test analysis to assess for degree of speech improvement. In order to analyze quality of life after Osia implantation, each patient filled out the Glasgow Benefit Inventory (GBI) survey. The GBI is a series of 18 questions answered using a five-point Likert scale that addresses the changes in general health status, physical health status, psychosocial health status, and social support after a medical intervention. RESULTS: CHL, MHL, and SSD patients had significant improvement in hearing and speech recognition scores after Osia implantation compared to preoperative unaided hearing: CNC (14 % vs 80 %, p < 0.0001), AzBio in Quiet (26 % vs 94 %, p < 0.0001), and AzBio in Noise (36 % vs 87 %, p = 0.0001). Preoperative speech scores using the softband BAHA were accurate predictors of post-implantation speech scores and can serve to determine surgical candidacy for the Osia. Post-implantation Glasgow Benefit Inventory patient surveys demonstrated significant improvement in quality of life with patients scoring an average increase of +54.1 points in heath satisfaction. CONCLUSION: Adult patients with CHL, MHL, and SSD can receive significant improvement in speech recognition scores after implantation with the Osia device. This translates to improved quality of life, which was confirmed on the post-implantation Glasgow Benefit Inventory patient surveys.

Vestibular dysfunction in cochlear implant candidates: Prevalence and outcomes.

PURPOSE: Cochlear implantation (CI) has been shown to reduce vestibular function postoperatively in the implanted ear. The objective of this study was to identify the prevalence of preoperative vestibular weakness in CI candidates and identify any risk factors for postoperative dizziness. STUDY DESIGN: Retrospective cohort study. MATERIALS AND METHODS: Patients who underwent CI and had preoperative videonystagmography (VNG) at the Silverstein Institute from January 1, 2017 to May 31, 2020 were evaluated. The primary endpoint was dizziness lasting more than one month postoperatively. RESULTS: One hundred and forty nine patients were evaluated. Preoperative VNG revealed that 46 (30.9%) had reduced vestibular response (RVR) on one side and 32 (21.5%) had bilateral vestibular hypofunction (BVH). Postoperative dizziness occurred in 14 (9.4%) patients. Patients with postoperative dizziness were more likely to have abnormal preoperative VNG (RVR or BVH), compared to patients without postoperative dizziness (78.6% versus 49.6%, p = 0.0497). In cases of RVR, implantation of the weaker or stronger vestibular ear did not affect the postoperative dizziness (16.1% versus 6.7%, p = 0.38). Postoperative VNG in patients with dizziness showed decreased caloric responses in the implanted ear (28.4 to 6.4 degrees/s, p = 0.02). CONCLUSION: Preoperative caloric weakness is prevalent in CI candidates and abnormal preoperative vestibular testing may be a predictor of postoperative dizziness. CI has the potential to cause vestibular injury and preoperative testing may aid in both counseling and decision-making.

Expanding the indications for the bone anchored hearing system (BAHS) in patients with single sided deafness.

PURPOSE: Provide data to support expansion of FDA indications for the Bone anchored hearing system (BAHS). MATERIALS AND METHODS: This retrospective study in a tertiary otologic referral center included106 consecutive subjects who were implanted with a Bone Anchored Hearing System (BAHS) between January 2009 and January 2015 for single sided deafness. Subjects were divided into three groups by bone conduction pure tone average (PTA) of the better hearing ear: 0-20 dB (group 1), 21-40 dB (group 2) and 41-55 dB (group 3). All patients underwent BAHS implantation. Speech perception data (Hearing In Noise Test and Consonant-Nucleus-Consonant testing) was collected before and after surgical intervention. Patient-reported quality of life measures were obtained at least 6 months after activation. These included the Abbreviated Profile of Hearing Aid Benefit and Glasgow Benefit Inventory. RESULTS: All three groups of subjects demonstrated statistically significant improvement in outcome measures following BAHS. Subject reported quality of life outcome measures demonstrated significant improvement in disability from hearing loss and in quality of life. CONCLUSIONS: Patients with single sided deafness who have bone conduction thresholds worse than 20 dB in their contralateral ear are still able to benefit significantly from BAHS.

Post-operative infection rates in linear vs. punch technique for bone anchored hearing systems.

PURPOSE: This study investigates the post-operative infection rates between two surgical approaches: linear incision and the punch technique for bone anchored hearing systems. Secondarily, it investigates the impact of smoking, comorbid disease, and operative conditions on post-operative skin reactions and infections. METHODS: A retrospective study was conducted at a single tertiary care institution. A single surgeon completed either of the two techniques on adult patients with mixed, conductive hearing loss, or single sided-deafness. Patients included had at least 6 months follow-up, and were evaluated for preexisting illnesses, perioperative complications, length of surgery, and post-operative complications including infection after surgery. Post-operative soft tissue around the abutment was assessed with Holgers Classification scale. RESULTS: Fifty-one patients were included in this study, 28 female and 23 males with an average age of 68.8. Thirty-three patients underwent linear incision surgery and 18 had the punch technique. Overall 9 patients (17.6%) had post-operative infections requiring topical or oral antibiotic treatment. Six (18.2%) were in the linear group and 3 (16.7%) in the punch group. There was no statistically significantly difference (p = 1). A multivariate analysis compared age, sex, obesity, DM, operative time, skin thickness, and abutment size to post-operative skin infection rates requiring treatment. Only DM was statistically correlative with infection (p = 0.02). CONCLUSION: No significant differences in post-operative infections were identified comparing linear incision and the punch techniques. Patients with diabetes had a higher incidence of post-operative skin infections rates.

Three-week loading of the 4.5mm wide titanium implant in bone anchored hearing systems.

PURPOSE: The purpose of this study is to assess implant stability, implant loss, adverse skin reactions and quality of life benefit following surgical implantation and early processor loading (3-weeks post-implantation) of the Oticon Ponto 4.5 mm osseointegrated auditory implant. This study also investigates the relationship between the type of post-operative skin reactions and the gender, BMI and medical co-morbidities of participants. MATERIALS/METHODS: Using a prospective, multicenter design, thirty adult patients 18 years or older who met medical and audiological candidacy for an osseointegrated auditory bone-anchored hearing device were evaluated. They underwent simultaneous implantation of the Oticon 4.5mm wide implant and a 3.75 mm sleeper implant. Sound processor loading occurred at three weeks post-implantation. Implant stability was measured using Radio Frequency Analysis (RFA) at surgery, 1, 3, 6, 12, 26 and 52 weeks. The Glasgow Benefit Inventory was used to assess quality of life benefit at 12 and 52 weeks following implantation. RESULTS: The results show a positive linear trend in implant stability measures in all subjects over time. There have been no implant losses with early 3-week loading. Skin reactions were limited to grade 0 and 1 of the modified Holger's grading scale. Due to the limited incidence of complications, no conclusion can be made regarding the relationship between patient demographic data and soft tissue reaction. CONCLUSION: Our findings confirm the safety and efficacy of early loading of the Oticon 4.5 mm wide implant. Participants showed satisfaction with the earlier use of their processor with no added complications after one year post-implantation.

Three week loading for the Baha BI-300® implant system.

PURPOSE: The timing of loading of titanium craniofacial implants is dependent upon implant characteristics, host factors, and the bonding of titanium oxide and bone referred to as osseointegration. The purpose of this feasibility study seeks to determine the safety of early loading of the Baha BI-300 implant system (Cochlear Limited, Englewood, CO), which has been modified with novel surface texture and geometric design. SUBJECTS AND METHODS: This prospective study measures implant stability as determined by clinical evaluation and resonance frequency analysis at implantation and at 1, 3, 6, 12, 24 and 52weeks post-op in 20 patients who underwent single-stage implantation and exteriorization of the BI-300. The processor was loaded at 3weeks post-operatively. A modified Holger's classification system was used to evaluate skin reactions. RESULTS: There was a positive linear trend in mean implant stability scores from implantation to 52weeks. Only one subject (5%) had a mild local soft tissue Holger's grade 1 score at 24weeks. No implant loss or postoperative complications were encountered as a result of the 3-week loading. CONCLUSION: Three-week loading of the BI-300 implant did not result in any implant loss or failure of osseointegration. Earlier activation of the external processor with earlier hearing rehabilitation resulted in improved patient satisfaction. Further studies are needed to confirm these results for more universal adoption of early loading in adults.

Round window reinforcement for superior semicircular canal dehiscence: a retrospective multi-center case series.

PURPOSE: To evaluate the outcome of round window (RW) tissue reinforcement in the management of superior semicircular canal dehiscence (SSCD). MATERIALS AND METHODS: Twenty-two patients with confirmed diagnosis of SSCD by clinical presentation, imaging, and/or testing were included in the study. Six surgeons at four institutions conducted a multicenter chart review of patients treated for symptomatic superior canal dehiscence using RW tissue reinforcement or complete RW occlusion. A transcanal approach was used to reinforce the RW with various types of tissue. Patients completed a novel postoperative survey, grading preoperative and postoperative symptom severity. RESULTS: Analysis revealed statistically significant improvement in all symptoms with the exception of hearing loss in 19 patients who underwent RW reinforcement. In contrast, 2 of 3 participants who underwent the alternate treatment of RW niche occlusion experienced worsened symptoms requiring revision surgery. CONCLUSION: RW tissue reinforcement may reduce the symptoms associated with SSCD. The reinforcement technique may benefit SSCD patients by reducing the "third window" effect created by a dehiscent semicircular canal. Given its low risks compared to middle cranial fossa or transmastoid canal occlusion, RW reinforcement may prove to be a suitable initial procedure for intractable SSCD. In contrast, complete RW occlusion is not advised.

Predicting Speech Outcomes After Cochlear Implantation in Older Adults Using the Self-administered Gerocognitive Examination Test.

PURPOSE: The purpose of this study is to determine if a cognitive test, Self-administered Gerocognitive Examination (SAGE), correlates with speech recognition outcomes 1 year after cochlear implantation in adults over 65 years of age. METHODS: Retrospective study was conducted at a single institution. Surgery was performed by two surgeons on adult patients (>65 yrs) with postlingual bilateral sensorineural hearing loss meeting clinical and audiological candidacy for unilateral cochlear implantation. Patients who performed SAGE preimplantation, and speech testing (CNC, AzBio in quiet, AzBio in noise) before and 1 year after implantation were included. RESULTS: Forty patients with a mean age of 78 were included. The overall mean preoperative SAGE score was 17.4 (95% CI 16.2-18.7). Greater than 17 is considered normal. Data demonstrated a statistically significant linear correlation between preoperative SAGE scores with change in speech testing 1 year postoperatively: CNC-Adjusted R-squared: 0.1955, p value: 0.002508; AzBio in quiet-Adjusted R-squared: 0.1564, p value: 0.006686; AzBio in noise-Adjusted R-squared: 0.1543, p value: 0.007053. Multivariate linear regression analysis revealed that age and SAGE scores both statistically correlated with speech testing 1 year after implantation (p = 0.01 for both). Patients who passed the SAGE (≥17) had statistically significant higher CNC, AzBio in quiet, and AzBio in noise scores 1 year postoperatively compared with patients with low SAGE scores (<17) despite statistically similar age means in each group. CONCLUSION: SAGE can predict speech recognition testing 1 year after cochlear implantation in older adults over 65 years of age.

Reconstruction of congenital microtia-atresia: outcomes with the Medpor/bone-anchored hearing aid-approach.

Ideal surgery for congenital microtia-atresia would offer excellent cosmetic and hearing rehabilitation, with minimal morbidity. Classic approaches require multiple procedures, including rib cartilage harvest and aural atresia repair. Our facial plastic and otologic team approach incorporates a high-density porous polyethylene (Medpor, Porex Surgical, Newnan, GA) auricular framework, followed by single-stage bone-anchored hearing aid (BAHA) implantation. We evaluated the efficacy, safety, and morbidity of this 2-stage dual system approach. A prospective database of microtia patients was used to identify patients undergoing combined Medpor/BAHA auricular reconstruction and hearing rehabilitation between 2003 and 2006. The first stage involves placement of a Medpor framework beneath a temporoparietal fascia flap, followed by a second-stage procedure for lobule transposition and BAHA implantation. Twenty-five patients (28 ears) were evaluated. Aesthetic quality of the implants was excellent, with a high degree of framework detail visible, and a postauricular crease created in all patients. All patients were satisfied with the cosmetic result. There were no major Medpor complications such as infection, extrusion, loss of implant, or flap necrosis, and a 10.7% incidence of minor complications requiring operative revision. BAHA significantly improved hearing in all patients, with a complication rate of 31.8%, mainly skin overgrowth and cellulitis. The Medpor/BAHA dual plastic-otologic approach to microtia-atresia has produced excellent cosmetic results and hearing outcomes, which compare favorably to traditional microtia-atresia repair. This is a 2-stage aesthetic and functional protocol with an acceptably low rate of complications, which safely and efficiently achieves both aesthetic and functional goals.

Implantable Auditory Devices: Financial Considerations and Office-Based Implantation.

Hearing rehabilitation has been recognized as a crucial tool to maintain communicative and social skills. The availability of hearing aids and auditory implants ought not be limited to the wealthy and to those who can afford them. Multidisciplinary efforts in reducing costs are necessary and include reduction of the item costs, insurance coverage, and the ability to perform certain procedures in an office setting, eliminating hospital and facilities fees and anesthesia bills.

Standardization of the Punch Technique for the Implantation of Bone Anchored Auditory Devices: Evaluation of the MIPS Surgical Set.

OBJECTIVE: To describe and assess intraoperative and postoperative outcomes in the insertion of osseointegrated auditory implants with a newly designed surgical instrumentation set through a punch type technique. STUDY DESIGN: Retrospective case series. METHODS: Patients who underwent bone anchored auditory implant surgery using the Minimally Invasive Ponto Surgery (Oticon Medical, Somerset, NJ) surgical set through a punch technique at nine neurotology tertiary referral based practices were identified. Demographic data, skin thickness at implant site, implant used, duration of surgery, adverse intraoperative events, and postoperative outcomes were recorded. RESULTS: Seventy-five patients comprised the study cohort (32 males, 43 females). Most patients (57. 3%) were aged 51 to 75 years while 30.7% of the cohort comprised those aged 18 to 50 years and 12% were over 75 years. All but two patients received 4 mm fixtured implants and 68% received the Oticon Medical BioHelix implant. Two patients received 3 mm fixture implants and 32% received the Oticon Medical Wide Ponto implant. Mean surgical time was 12.2 minutes (6-45 min, standard deviation of 6.88 min). In three instances, surgery was converted to a linear incision to control brisk bleeding. Skin condition was Holgers 0 to 1 in 91.8%, while 5.5% had Holgers 2, and 2.7% had Holgers 3 at the first postoperative visit. At second postoperative visit, 94.3% had Holgers 0 to 1, 4.3% had Holgers 2, and 1.4% had Holgers 3. All instances of adverse skin reactions were treated with topical or systemic antibiotics and/or local debridement. There were no instances of implant loss. One patient had his implant traumatically displaced to a 45-degree angle necessitating implant replacement at a second site. CONCLUSION: Punch technique placement of osseointegrated auditory implants using the Minimally Invasive Ponto Surgery surgical set represents a safe technique that further simplifies a progressively minimally invasive surgery.

Osseointegrated implants and auricular defects: a case series study.

PURPOSE: The objective of this study was to report on the survival rate of 16 patients treated with extraoral implants in the auricular region, analyze treatment outcomes, and discuss important clinical variables encountered during treatment. MATERIALS AND METHODS: Sixteen patients who received extraoral dental implants to retain auricular prostheses between 1987 and 2003 were followed retrospectively. The variables recorded were gender, initial diagnosis, number and size of implants, implant placement date, age at implant placement, history of radiation to the treated field, abutment size, design of initial prosthesis, age of initial prosthesis (when a remake was indicated), date of prosthesis delivery, soft tissue response, grafting procedure, date of last follow-up, and complications. All patients were thoroughly evaluated presurgically by the reconstruction team, which consisted of prosthodontists, a facial prosthetist, and an otolaryngologist. Surgical templates were used for all patients. The criteria for success of the prostheses included marginal accuracy, overall stability and function, symmetry/position, texture, color stability, and patient acceptance. RESULTS: Thirty-nine implants were placed in 16 patients. All 16 patients were completely satisfied with their reconstructions. No surgical complications, implant failures, or prosthetic failures were encountered. Therefore, the survival rate was 100%. Three patients (18.75%) had grade 0, seven (43.75%) had grade 1, five (31.25%) had grade 2, and one (6.25%) had grade 3 soft tissue inflammation. The inflammation completely resolved in 7 of the 13 patients (54%) with hygiene reinforcement or soft tissue reduction. CONCLUSIONS: The survival rate for bone-anchored titanium implants and prostheses was 100%. Bone-anchored titanium implants provided the 16 patients in this study with a safe, reliable, adhesive-free method to anchor auricular prostheses with recovery of normal appearance. Under the guidance of an appropriate implant team, proper positioning of implants was optimized to allow prosthodontic rehabilitation using implant-retained prostheses.

Osseointegration timing for Baha system loading.

OBJECTIVES: The process of osseointegration for creating a biological bond between titanium oxide and bone is time dependent. However, different surgeons have used very varied time frames before loading the implant. The waiting time in dental implant loading ranged from immediate to 6 months. The Baha system (Cochlear Limited, Englewood, CO) traditional waiting period consisted of 3 months for adults and 4 to 6 months for children. The purpose of the study was to evaluate the safety of reducing the waiting time to 6 weeks in adults. STUDY DESIGN: Retrospective study of patients who underwent Baha implantation and exteriorization between March, 2004 and July 2005. METHODS: Twenty-six adult patients underwent Baha titanium implantation and exteriorization in a single stage. They were loaded with the external processor after an average of 6.5 weeks. The etiology of their hearing loss (HL) included conductive HL, mixed HL, and unilateral sensorineural HL. Follow-up period ranged between 6 and 20 months. RESULTS: All patients were successfully implanted with the titanium implants, loaded at the 6 week interval, and have safely retained their prosthesis. The only reported complication was dermatitis, which occurred in three patients. Patients were pleased to receive the external processor earlier. CONCLUSION: The reduction of the waiting period from 3 months to 6 weeks did not result in any failure of osseointegration of the titanium implants. The earlier activation resulted in enhanced patient satisfaction. A larger series would be needed to definitively recommend shortening of the interval between Baha implantation and device loading.

An update on the surgical treatment of Ménière's diseases.

Various surgical procedures have evolved for the treatment of Ménière's disease patients who are refractory to medical therapy. These can be in the form of conservative surgeries as in endolymphatic sac surgery or in the form of destructive procedures. The latter include labyrinthectomy and vestibular nerve section, which result in deafferentation of the vestibular end organ. In the past decade, intratympanic therapy with gentamycin and steroids has evolved as new methods for the treatment of Ménière's disease. The literature witnesses controversies in the effectiveness of endolymphatic sac surgery in the treatment of Ménière's disease. The choice of the surgical procedure depends on the degree of serviceable hearing, the severity of the spells, and the condition of the contralateral ear. The most commonly used procedures in the treatment of Ménière's disease and their indications are reviewed.

Minimally Invasive Surgery for the Treatment of Hyperacusis.

OBJECTIVE: To evaluate the efficacy of a minimally invasive surgical procedure in patients with severe hyperacusis. STUDY DESIGN: Prospective, longitudinal design. SETTING: Tertiary referral center. PATIENTS: Adult patients with history of severe hyperacusis. INTERVENTION: Using a transcanal approach, the round and oval window was reinforced with temporalis fascia or tragal perichondrium in six subjects (nine ears) and was subdivided into two groups (unilateral or bilateral reinforcement procedure). MAIN OUTCOME MEASURES: Pre- and postoperative noise tolerance was measured using uncomfortable loudness level (ULL) test scores. In addition, a self-report hyperacusis questionnaire (HQ) was used to assess hypersensitivity to sound before and after the intervention. RESULTS: Analysis of the data reveals improved postoperative mean ULL test scores of 14 dB (confidence interval [CI], 70-98 dB) in the unilateral group. For the bilateral group, improved mean scores were 13 dB (CI, 63-88 dB) in the first ear and 8 dB (CI, 71-86 dB) for the second ear. Further, a negative linear trend was observed in the mean subjective scores for the HQ when both groups measures were analyzed together decreasing from a mean score of 32.0 (standard deviation [SD] = 3.32) preoperative to a mean score of 11.5 (SD = 7.42) after surgery. Postoperatively, the patients reported no change in hearing and improved quality of life after the procedure. CONCLUSION: The results suggest that reinforcement of the round and oval window with temporalis fascia or tragal perichondrium may offer significant benefit for individuals with severe hyperacusis that has not responded to traditional therapy. ULL scores and self-report measures postoperatively demonstrate improved noise tolerance, high patient satisfaction, and enhanced quality of life.

Localization by unilateral BAHA users.

OBJECTIVES: Patients with unilateral hearing loss report difficulty hearing conversation on their impaired side, localizing sound, and understanding of speech in background noise. The bone-anchored cochlear stimulator (BAHA) (Entific, Gothenburg, Sweden) has been shown to improve performance in persons with unilateral severe-profound sensorineural loss (USNHL). The purpose of this study is to evaluate the effectiveness of BAHA in sound localization for USNHL listeners. STUDY DESIGN: Prospective study of 12 USNHL subjects, 9 of whom received implants on the poorer hearing side. A control group of 10 normal hearing subjects were assessed for comparison. Localization with and without BAHA was assessed using an array of 8 speakers at head level separated by 45 degrees. Error analysis matrix was generated to evaluate the confusions, accuracy in response, and laterality judgment. RESULTS: The average accuracy of speaker localization was 16% in the unaided condition, with no improvement with BAHA use. Laterality judgment was poorer than 43% in both aided and nonaided conditions. CONCLUSIONS: Patients with UNSNHL had poor sound localization and laterality judgment abilities that did not improve with BAHA use.

Consensus statements on the BAHA system: where do we stand at present?

After more than 25 years of clinical experience, the BAHA (bone-anchored hearing aid) system is a well-established treatment for hearing-impaired patients with conductive or mixed hearing loss. Owing to its success, the use of the BAHA system has spread and the indications for application have gradually become broader. New indications, as well as clinical applications, were discussed during scientific roundtable meetings in 2004 by experts in the field, and the outcomes of these discussions are presented in the form of statements. The issues that were discussed concerned BAHA surgery, the fitting range of the BAHA system, the BAHA system compared to conventional devices, bilateral application, the BAHA system in children, the BAHA system in patients with single-sided deafness, and, finally, the BAHA system in patients with unilateral conductive hearing loss.

High-frequency pulsed electromagnetic energy in tinnitus treatment.

OBJECTIVES/HYPOTHESIS: Electromagnetic therapy has been used with reported success in multiple clinical settings, including the treatment of seizure disorders, brain edema, migraine headaches, revascularization of burn wounds, and diabetic ulcers. The purpose of the study was to investigate the effect of pulsed high-frequency electromagnetic therapy on chronic tinnitus. STUDY DESIGN: A randomized, prospective, double-blind, placebo-controlled pilot study was conducted to evaluate the effectiveness of high-frequency pulsed electromagnetic energy using the Diapulse device in the treatment of chronic tinnitus. Thirty-seven adult patients with chronic tinnitus of at least 6 months' duration were recruited and randomly assigned to either a treatment or a placebo group. METHODS: Patients received 30-minute treatments with the Diapulse device three times a week for 1 month. The unit was set to deliver electromagnetic energy at a frequency of 27.12 MHz at a repetition rate of 600 pulses per second. All subjects had pretreatment and post-treatment audiological testing, including tinnitus frequency and intensity matching. They responded to a tinnitus rating questionnaire and the Tinnitus Handicap Inventory before and after treatment. RESULTS: There was no significant change in the pretreatment and post-treatment audiometric thresholds in either group. There were no significant differences between the pretreatment and post-treatment Tinnitus Handicap Inventory scores or the tinnitus rating scores in either subject group (Student t test). No diagnosis-specific differences were identified. CONCLUSION: High-frequency pulsed electromagnetic energy (Diapulse) at the settings used in the study showed no role in the therapy of patients with chronic tinnitus.