Arjan J. Bosman

Introduction: Although the Baha 5SP has been commercially available for six years, very few studies have been performed on the device's efficacy. The current study aims to evaluate the characteristics and audiological results in patients with severe‐to‐profound mixed hearing loss fitted with this superpower sound processor.Methods: This retrospective evaluation was conducted at a tertiary referral centre where a series of 82 adult patients with severe‐to‐profound mixed hearing loss were implanted with a percutaneous bone‐anchored hearing system and fitted with a superpower sound processor between 2016 and 2019. Patients with incomplete or unreliable audiological data (n = 24) were excluded, resulting in 58 data sets for analysis. The main outcome measures were unaided and aided pure‐tone thresholds and aided free‐field speech perception in quiet.Results: The median unaided air conduction (AC) threshold averaged across 0.5, 1 and 2 kHz (PTA_0.5–2kHz) of all patients was 75 dB hearing loss (HL); the median unaided AC averaged across 1, 2 and 4 kHz (PTA_1–4kHz) was 84 dB HL. For bone conduction and direct bone conduction, the median PTA_0.5–2kHz was 52 and 47 dB HL, respectively. With the superpower device, the median free‐field speech reception threshold was 54 dB sound pressure level (SPL), and the median speech perception score at 65 dB SPL was 80%.Conclusions: At least 75% of the patients reached a maximum phoneme score of 70%. For patients with lower scores, the superpower device still provides a substantial hearing benefit. This makes the superpower device particularly suitable for patients with severe‐to‐profound mixed hearing loss with a contraindication for conventional hearing aids and/or cochlear implants.

The relationship between speech recognition and hereditary hearing loss is not straightforward. Underlying genetic defects might determine an impaired cochlear processing of sound. We obtained data from nine groups of patients with a specific type of genetic hearing loss. For each group, the affected cochlear site-of-lesion was determined based on previously published animal studies. Retrospectively obtained speech recognition scores in noise were related to several aspects of supra-threshold cochlear processing as assessed by psychophysical measurements. The differences in speech perception in noise between these patient groups could be explained by these factors and partially by the hypothesized affected structure of the cochlea, suggesting that speech recognition in noise was associated with a genetics-related malfunctioning of the cochlea. In particular, regression models indicate that loudness growth and spectral resolution best describe the cochlear distortions and are thus a good biomarker for speech understanding in noise.

Purpose: To compare listening ability (speech reception thresholds) and real-life listening experience in users with a percutaneous bone conduction device (BCD) with two listening programs differing only in high-frequency gain. In situ real-life experiences were recorded with ecological momentary assessment (EMA) techniques combined with real-time acoustical data logging and standard retrospective questionnaires. Methods: Nineteen experienced BCD users participated in this study. They all used a Ponto 4 BCD from Oticon Medical during a 4-week trial period. Environmental data and device parameters (i.e., device usage and volume control) were logged in real-time on an iPhone via a custom iOS research app. At the end of the trial period, subjects filled in APHAB, SSQ, and preference questionnaires. Listening abilities with the two programs were evaluated with speech reception threshold tests. Results: The APHAB and SSQ questionnaires did not reveal any differences between the two listening programs. The EMAs revealed group-level effects, indicating that in speech and noisy listening environments, subjects preferred the default listening program, and found the program with additional high-frequency gain too loud. This finding was corroborated by the volume log—subjects avoided the higher volume control setting and reacted more to changes in environmental sound pressure levels when using the high-frequency gain program. Finally, day-to-day changes in EMAs revealed acclimatization effects in the listening experience for ratings of “sound quality” and “program suitability” of the BCD, but not for ratings of “loudness perception” and “speech understanding”. The acclimatization effect did not differ among the listening programs. Conclusion: Adding custom high-frequency amplification to the BCD target-gain prescription improves speech reception in laboratory tests under quiet conditions, but results in poorer real-life listening experiences due to loudness.

Purpose: To investigate sound localization in patients bilaterally fitted with bone conduction devices (BCDs). Additionally, clinically applicable methods to improve localization accuracy were explored. Methods: Fifteen adults with bilaterally fitted percutaneous BCDs were included. At baseline, sound localization, (un)aided pure-tone thresholds, device use, speech, spatial and qualities of hearing scale (SSQ) and York hearing-related quality of life (YHRQL) questionnaire were measured. Settings to optimize sound localizing were added to the BCDs. At 1 month, sound localization was assessed again and localization was practiced with a series of sounds with visual feedback. At 3 months¸ localization performance, device use and questionnaire scores were determined again. Results: At baseline, one patient with congenital hearing loss demonstrated near excellent localization performance and four other patients (three with congenital hearing loss) localized sounds (quite) accurately. Seven patients with acquired hearing loss were able to lateralize sounds, i.e. identify whether sounds were coming from the left or right side, but could not localize sounds accurately. Three patients (one with congenital hearing loss) could not even lateralize sounds correctly. SSQ scores were significantly higher at 3 months. Localization performance, device use and YHRQL scores were not significantly different between visits. Conclusion: In this study, the majority of experienced bilateral BCD users could lateralize sounds and one third was able to localize sounds (quite) accurately. The localization performance was robust and stable over time. Although SSQ scores were increased at the last visit, optimizing device settings and a short practice session did not improve sound localization.

Objectives: To compare the hearing performance of patients with conductive and mild mixed hearing loss and single‐sided sensorineural deafness provided with a new transcutaneous bone conduction hearing implant (the Baha Attract System) with unaided hearing as well as aided with a sound processor on a softband. Furthermore, to evaluate safety and subjective benefit before and after implantation of the test device.Participants: Fifty‐four adult patients in five participating centres were enrolled in this prospective study. Baseline data were collected during a pre‐operative visit, and after a softband trial, all patients were implanted unilaterally. Follow‐up visits were scheduled at 10 days, 4, 6, 12 weeks and 6 months.Main outcome measures.Free‐field hearing thresholds pure‐tone average (PTA4 in dB HL; mean threshold at 500, 1000, 2000, 4000 Hz; primary outcome measure). Individual free‐field hearing thresholds, speech recognition in quiet and in noise, soft tissue status during follow‐up and subjective benefit as measured with the Abbreviated Profile of Hearing Aid Benefit (APHAB), Speech, Spatial and Qualities of Hearing Scale (SSQ) and Health Utilities Index (HUI) questionnaires.Results: Implantation of the Baha Attract System resulted in favourable audiological outcomes compared to unaided conditions. On the primary outcome parameter, a statistically significant improvement was observed compared to unaided hearing for the patients with conductive/mixed hearing loss (mean PTA4 difference −20.8 dB HL, SD 9.8; P < 0.0001) and for the patients with single‐sided sensorineural deafness (SSD) (mean PTA4 difference −21.6 dB HL, SD 12.2; P < 0.0001). During all audiology tests, the non‐test ear was blocked. Statistically significant improvements were also recorded in speech tests in quiet and noise compared to unaided hearing for the conductive/mixed hearing loss group and for speech in quiet in the SSD group. Compared to the pre‐operative measurement with softband, no significant differences were recorded in the PTA4 free‐field hearing threshold or the other audiological outcomes in either of the groups (P > 0.05). Soft tissue‐related issues observed during follow‐up included numbness, pain/discomfort at the implant site and to a lesser extent pressure‐related skin complications. A declining trend was noted in the rate of these complications during follow‐up. Approximately 20% of patients reported some degree of numbness and 38% (slight) pain/discomfort at final follow‐up of 6 months. Good results on the subjective benefit questionnaires were observed, with statistically significant improvements on APHAB and SSQ questionnaires, and on the hearing attribute of HUI3.Conclusions: The Baha Attract System provided a significant improvement in hearing performance and subjective benefit compared to the pre‐operative unaided condition (with the non‐test ear blocked). Hearing performance of the Baha Attract was similar to a test situation with the same sound processor on a softband. A proportion of the patients reported numbness and pain/discomfort at the implant site during follow‐up, especially during the first post‐operative weeks. Based on the results of the current multicentre study, the Baha Attract can be considered as a treatment option for patients with the aforementioned hearing losses. Especially in the SSD patients, a careful selection procedure is warranted. Therefore, a pre‐operative trial should be part of the decision‐making process before fitting a patient with the Baha Attract System.

Objectives: Performance of an abutment‐level superpower sound processor for bone‐anchored hearing, the Ponto 3 SuperPower from Oticon Medical (BCD2), was compared to an earlier model from Oticon Medical (BCD1).Design: A comparative study in which each patient serves as its own control.Setting: Tertiary clinic.Participants: Eighteen experienced BCD1 users with profound mixed hearing loss.Main outcome measures: Speech reception thresholds in noise; APHAB and SSQ questionnaires.Results: In a group of 18 patients with severe mixed hearing loss, the performance of a recently introduced bone conduction device (BCD2) is evaluated relative to that of an earlier model (BCD1). Speech reception thresholds for the sentence‐in‐noise test in the speech and noise frontal condition are not significantly different (P > .05) for BCD1 and BCD2. Speech reception thresholds for frontal speech and three identical noise sources are 1.7 dB lower for BCD2 than for BCD1 (P < .05). With the APHAB questionnaire, the score for background noise is significantly lower (P < .01), that is more favourable, for BCD2 than for BCD1 with an effect size of 0.91. The APHAB domain scores for ease‐of‐communication, reverberation and aversiveness of loud sounds are not significantly different for both devices (P > .05). Scores for the speech, spatial and quality of hearing domains of the SSQ questionnaire are significantly higher (P < .01), that is more favourable, for BCD2 than for BCD1 with effect sizes of 1.22, 0.71 and 1.05, respectively. Scores for the SSQ‐factors “speech understanding,” “spatial,” “clarity, separation and identification” and “listening effort and concentration” were all significantly higher (P < .05) for BCD2 than for BCD1, with effect sizes of 1.28, 0.64, 0.98 and 0.78, respectively. On a proprietary questionnaire, 16 patients indicate a preference for BCD2 over BCD1 for conversations in a small group and two patients have no preference for either device. In a large group, one patient prefers BCD1, six patients have no preference, and eleven patients prefer BCD2. When listening to music, all patients prefer BCD2 over BCD1, with a strong preference for BCD2 for seven patients. When asked for an overall preference, all patients prefer BCD2 over BCD1, with nine patients strongly preferring BCD2.Conclusions: The lower speech reception thresholds in noise with BCD2 relative to BCD1 can be attributed to the “speech omni” directionality mode of BCD2. The combination of an improved directionality for primarily low‐level inputs and a higher maximum force output, relevant for mid‐ and high‐level inputs, results in a clear preference for BCD2 over BCD1.

Objectives: Performance of a superpower bone‐anchored hearing aid (Baha), the Baha Cordelle from Cochlear Bone‐Anchored Solutions (BCD1), was compared to its successor, the Baha 5 SuperPower (BCD2).Design: A comparative study in which each patient served as its own control.Setting: Tertiary clinic.Participants: Ten experienced BCD1 users with profound mixed hearing loss. For comparison, data from another study with 10 experienced users with a severe mixed hearing loss using a Cochlear Baha 5 power sound processor (BCD‐P) were included.Main outcome measures: Speech reception thresholds in noise and APHAB and SSQ questionnaires.Results: Speech reception thresholds for the digits‐in‐noise (DIN) test were significantly lower (P < 5%), that is more favourable, for BCD2 in the speech and noise frontal condition and in the speech frontal and noise contralateral condition than for BCD1. For the group with severe mixed loss fitted with BCD‐P, the SRTs were not significantly different (P > 5%) from the BCD2 values.With the APHAB questionnaire scores were significantly lower, that is more favourable, for the ease of communication (P < 5%) and the background noise (P < 1%) domains for BCD2 than for BCD1. APHAB scores for the aversiveness of loud sounds domain were not significantly different for both devices (P > 5%). Scores for the speech and quality domains of the SSQ questionnaire were significantly higher, that is more favourable, for BCD2 than for BCD1. APHAB and SSQ scores for BCD‐P were not significantly different from those for BCD2 (P > 5%).Conclusions: Data for BCD2 in profound mixed loss are similar to those for BCD‐P and a severe mixed loss. Of 10 patients, 2 expressed a strong preference for BCD2 over BCD1, and 7 patients had a preference for BCD2 over BCD1. One patient preferred BCD1 because of its built‐in telecoil facility.

Objective: The efficacy of wireless connectivity in bone-anchored hearing was studied by comparing the wireless and acoustic performance of the Ponto Plus sound processor from Oticon Medical relative to the acoustic performance of its predecessor, the Ponto Pro. Study sample: Nineteen subjects with more than two years' experience with a bone-anchored hearing device were included. Thirteen subjects were fitted unilaterally and six bilaterally. Design: Subjects served as their own control. First, subjects were tested with the Ponto Pro processor. After a four-week acclimatization period performance the Ponto Plus processor was measured. In the laboratory wireless and acoustic input levels were made equal. In daily life equal settings of wireless and acoustic input were used when watching TV, however when using the telephone the acoustic input was reduced by 9 dB relative to the wireless input. Results: Speech scores for microphone with Ponto Pro and for both input modes of the Ponto Plus processor were essentially equal when equal input levels of wireless and microphone inputs were used. Only the TV-condition showed a statistically significant (p p Conclusion: Equal input levels for acoustic and wireless inputs results in equal speech scores, showing a (near) equivalence for acoustic and wireless sound transmission with Ponto Pro and Ponto Plus. The default 9-dB difference between microphone and wireless input when using the telephone results in a substantial wireless benefit when using the telephone. The preference of wirelessly transmitted audio when watching TV can be attributed to the relatively poor sound quality of backward facing loudspeakers in flat screen TVs. The ratio of wireless and acoustic input can be easily set to the user’s preference with the streamer’s volume control.

Background:The recent introduction of digital hearing aid technology for bone-conduction devices employing percutaneous stimulation may be beneficial for patients with conductive and mixed hearing loss and single sided deafness.Purpose:Performance of a recently released sound processor for bone-anchored implants, the Ponto Pro Power from Oticon Medical (bone-conduction device 2 [BCD2]), was compared with that of the Baha Intenso from Cochlear (bone-conduction device 1 [BCD1]).Research Design:Direct comparison of the subject's own device (BCD1) with the new device (BCD2) was examined in a nonrandomized design. Subjects were initially tested with BCD1. BCD2 was tested after a 4 wk acclimatization period.Study Sample:Eighteen subjects with mixed hearing loss and with at least 4 mo experience with BCD1 completed the study. Mean air-conduction and bone-conduction thresholds averaged across the frequencies of 500, 1000, 2000, and 4000 Hz were 73.9 and 34.2 dB HL, respectively.Data Collection and Analysis:Performance of the two devices was evaluated objectively by measuring aided free-field thresholds, speech perception in quiet, and speech perception in noise. A subjective evaluation was carried out with the Abbreviated Profile of Hearing Aid Benefit (APHAB) (Cox and Alexander, 1995) and the Speech, Spatial and Qualities of Hearing Scale (SSQ) questionnaire (Gatehouse and Noble, 2004). In addition, user experiences, user satisfaction, and device preference were obtained via proprietary questionnaires. Statistical significance was established with analysis-of-variance (ANOVA) and paired t-statistics with Bonferroni correction.Results:Aided free-field thresholds and speech reception thresholds (SRTs) in quiet were not statistically significantly different for either device (p > 0.05). In contrast, SRTs in noise were 2.0 dB lower (p < 0.001) for BCD2 than for BCD1. APHAB questionnaire scores on all subscales provided statistically significantly greater benefit (p < 0.05) for BCD2 than for BCD1. Also, with the SSQ most items in the speech and sound quality domain were significantly more favorable (p < 0.05) for BCD2 than for BCD1. Finally, all subjects preferred BCD2 over BCD1 with 14 subjects reporting a strong preference and four subjects an average preference for the digital signal processing provided by BCD2 over previous technology provided by BCD1.