Hearing-Related Quality of Life in 75 Patients With a Percutaneous Bone Conduction Device.

OBJECTIVE: To evaluate long-term hearing-related quality of life (HRQoL) and device use in bone conduction (BCD) users. Furthermore, to assess differences between indications and changes in HRQoL over time. STUDY DESIGN: Prospective questionnaire survey. SETTING: Tertiary referral center. PATIENTS: Seventy-five patients with a percutaneous BCD. MAIN OUTCOME MEASURES: Glasgow Benefit Inventory (GBI) at 3 and 12 months postoperatively, Glasgow Health Status Inventory (GHSI) preoperatively, and 6 and 36 months postoperatively, device use at 6, 12, and 36 months. Changes over time were assessed and outcomes were compared between indications. RESULTS: After implantation, 97% of all patients reported a positive benefit on the GBI total. The GHSI total had improved with median 15 points (Interquartile range [IQR] 12). At 36 months, median device use was 15 hours/day (IQR 10) and one nonuser was reported. Patients with bilateral hearing loss (BHL) showed greater improvement on the GHSI total (median 18 vs 14, p < 0.0001) and used their devices more frequently (median 16 vs 8 h/day, p < 0.0001) than patients with unilateral HL (UHL). Postoperative GHSI and GBI scores were consistent over time, in the entire patient population and for every indication. Between 6 and 36 months, device use was stable over time, except for patients with single-sided deafness (SSD; median -6.4 h/day, p = 0.009). CONCLUSION: The BCD improves HRQoL in patients with BHL, in patients with unilateral conductive/mixed hearing loss and in patients with SSD. Patients with BHL experienced a greater improvement in hearing status compared to patients with UHL. Although use decreased over time in SSD patients, device use was high for every indication.

Patient Preferences in Sound Processor Loading Time After BAHI Surgery.

OBJECTIVE: Sound processor loading times after bone-anchored hearing implant (BAHI) surgery have gradually decreased over time. This study assessed patient preferences in loading time. STUDY DESIGN: Prospective patient questionnaire study. SETTING: Tertiary referral center. PATIENTS: Patients indicated for BAHI surgery received two questionnaires preoperatively: the validated Glasgow Health Status Inventory (GHSI) and a nonvalidated questionnaire that assessed patient preference for loading time and the rationale behind it. This preference questionnaire was also provided immediately, 7 days and 3 weeks (moment of sound processor loading at our center) postoperatively. MAIN OUTCOME MEASURES: The preoperative and postoperative preferred loading time and the postoperative changes in preference were determined. Correlations between preference and patient-specific variables were assessed. RESULTS: Sixty patients were included. Preoperatively, 70% preferred loading within 1 week after surgery. Of all patients, 43% preferred loading on the day of surgery, mainly motivated by the fast hearing rehabilitation and practical considerations. These preferences were not correlated with the total GHSI score or duration of hearing loss. Directly postoperatively, no change in preference was observed. However, 7 days and 3 weeks after surgery, significantly more patients preferred loading at a later moment. At 7 days and at 3 weeks, 50 and 40% preferred loading within 1 week, and 12.5 and 7.5% preferred loading on the day of surgery, respectively. CONCLUSION: The preference for the timing of sound processor loading varied among patients and differed pre- and postoperatively. Despite the postoperative decline in patients preferring earlier loading, approximately half of all patients preferred sound processor loading within 1 week after BAHI surgery.

Clinical Presentation, Management, and Outcomes of Idiopathic Pain in Percutaneous Bone-anchored Hearing Implants.

OBJECTIVE: To identify clinical features and investigate treatment outcomes of patients with idiopathic pain related to a percutaneous bone-anchored hearing implant (BAHI) and to propose management recommendations. STUDY DESIGN: Retrospective chart analysis. SETTING: Tertiary referral center. PATIENTS: The clinical data of 14 patients who were treated for idiopathic pain around their percutaneous BAHI between May 2007 and February 2018 at our tertiary referral center were reviewed. MAIN OUTCOME MEASURES: Pain after treatment and implant loss. RESULTS: All 14 patients received treatment with oral antibiotics. Nine patients received oral antibiotic combination therapy for 4 weeks, whereafter pain resolved in 4. Out of the five other patients, receiving either antibiotic monotherapy or shortened antibiotic combination therapy, pain resolved in two. In case of persistent pain (57.1%) after initial treatment, other pain management therapies were attempted, however all with only limited effect. Six patients (42.8%) underwent elective removal of the implant. In two patients spontaneous implant loss occurred. In two of the four patients who underwent reimplantation, pain relapsed. In one of these, pain resolved after the removal of the new implant. In the other patient, pain persisted, despite abutment removal. With exception of this latter patient, all other 13 patients were pain free at the latest follow-up. Cone beam computed tomography did not offer additional information regarding diagnosis or treatment. CONCLUSION: Idiopathic pain in BAHI is a rare but bothersome symptom which can result in implant removal. After oral antibiotic combination treatment, symptoms resolved in approximately 40% of patients. Therefore, we think conservative treatment with these antibiotics before implant removal surgery, is worth considering.

Three-Year Clinical and Audiological Outcomes of Percutaneous Implants for Bone Conduction Devices: Comparison Between Tissue Preservation Technique and Tissue Reduction Technique.

OBJECTIVES: To evaluate the three-year clinical and audiological outcomes of soft-tissue preservation compared to soft-tissue reduction in linear incision surgery for percutaneous implant for bone conduction (BC) devices. METHODS: Twenty-five patients (25 implants) were enrolled in a prospective cohort for implant surgery with linear incision and tissue preservation. The control group consisted of 25 patients (25 implants) from a previous randomized controlled trial in which a linear incision with soft-tissue reduction was applied. Follow-up visits were scheduled at 7 and 21 days (fitting of sound processor); 12 weeks; 6 months; and at 1, 2, and 3 years after implantation. Main outcome measures were skin sensibility, soft-tissue status, Implant Stability Quotient (ISQ), skin height, implant survival, revision surgery, scar assessment, and hearing thresholds (BC in-situ between 250 Hz and 8 kHz with BC device on testband and abutment, and BC thresholds at 250Hz-4 kHz with a B71 bone conductor). RESULTS: Tissue preservation resulted in superior sensibility (mean percentage correct responses 99.7% [SD 1.7] vs 92.0% [SD 9.2], p = 0.0001). No spontaneous implant loss occurred in either group. The abutment was removed in two tests and in one control patient. Two control patients needed skin revision surgery. Although not statistically significant, more adverse soft-tissue reactions (Holgers ≥2) were observed in the test-group (n = 9 [36%] vs n = 3 [12%], p = 0.095). ISQ increased significantly more in the test group compared to the control group (7.64 [SD 4.05] vs 4.29 [SD 3.93]). Skin thickening, scar assessment, and hearing outcomes were comparable. CONCLUSION: Tissue preservation demonstrated superior skin sensibility compared to tissue reduction while other clinical outcomes were comparably excellent.