Contribution of monaural and binaural cues to sound localization in listeners with acquired unilateral conductive hearing loss: Improved directional hearing with a bone-conduction device

Contains fulltext : 93639.pdf (author's version ) (Open Access

A Clinical Evaluation of Minimally Invasive Ponto Surgery With a Modified Drill System for Inserting Bone-Anchored Hearing Implants

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The efficacy of bone-anchored hearing implant surgery in children: A systematic review

Contains fulltext : 229804.pdf (Publisher’s version ) (Open Access)OBJECTIVE: To evaluate the efficacy of Bone-Anchored Hearing implants (BAHIs) in children and to elucidate the usage and outcomes of new surgical techniques and implants in this specific population. DATA SOURCES: Embase and PubMed. STUDY SELECTION: We identified studies evaluating surgical outcomes of BAHIs in children. Retrieved articles were screened using predefined inclusion and exclusion criteria. Critical appraisal included directness of evidence and risk of bias. Studies that successfully passed critical appraisal were included. DATA EXTRACTION: Outcome measures included patient demographics, follow-up time, surgical technique (one-versus two-stage surgery), tissue handling technique (reduction versus preservation), type of implant used, and complications. DATA SYNTHESIS: We selected 20 articles published between 2000 and 2017 for data extraction, encompassing 952 implanted BAHIs. The overall mean age at implantation was 8.6 years (range, 2-21 years). Adverse soft-tissue reactions occurred in 251 of the 952 implants (26.4%; range 0%-89% across studies). Revision surgery was performed in 16.8% (142 of the 845) of the implants. The total rate of implant loss, i.e. caused by OIF (n = 61), trauma (n = 33), recurrent infection (n = 15), elective removal due to insufficient benefit (n = 1), cosmetic reasons (n = 1), or unknown reason (n = 16), was 13.3% of the implants (127 out of 952; range 0%-40% across studies). Differences are seen in the type of implants used; wide-diameter implants seem to be superior in terms of implant survival, and similar in terms of adverse skin reactions, while one-stage surgery and soft-tissue preservation do not seem to result in higher implant loss rates or increased adverse skin reactions based upon limited amounts of literature. CONCLUSION: In general, BAHIs are a safe method for hearing rehabilitation in children, although large differences between studies are observed. The outcomes of new surgical techniques and implant designs in the pediatric population seem promising, but more research is needed before definitive conclusions can be drawn

Loading of osseointegrated implants for bone conduction hearing at 3 weeks: 3-year stability, survival, and tolerability

Contains fulltext : 167322.pdf (publisher's version ) (Open Access)The objective of this study was to ascertain the long-term safety of loading osseointegrated implants for bone conduction hearing 3 weeks post-surgery. Thirty consecutive adult patients were implanted with the Baha BI300 (Cochlear Bone Anchored Solutions) in our tertiary referral center. Implants were loaded with the sound processor 3 weeks post-surgery. Follow-up examinations were performed at 10 days; 3, 4, 6, 8, and 12 weeks; 6 months; and 1, 2, and 3 years after implant surgery. At each follow-up visit, implant stability quotient (ISQ) values were recorded by means of resonance frequency analysis, and soft tissue status was evaluated according to Holgers' classification. ISQ trends, implant survival, and soft tissue reactions were compared to a population of 52 patients with the same type of implants loaded from 6 weeks post-surgery as part of another study. Subjective benefit was measured by means of the Glasgow Benefit Inventory (GBI). After an initial dip in ISQ at 10 days after implantation, a gradually increasing trend in ISQ was found until 6 months in both populations, after which ISQ values remained above baseline values. Implant survival was 97 % in the study population and 96 % in the comparison population. Clinically relevant soft tissue reactions were found in 0.9 % (study population) and 1.7 % (comparison population) of all visits. Patients reported subjective benefit; the mean GBI score was 22.8. In conclusion, loading these implants at 3 weeks post-surgery is safe based on the current study, as long-term results show high ISQ values and good implant survival and tolerability

Six-Month Clinical Outcomes for Bone-Anchored Hearing Implants: Comparison Between Minimally Invasive Ponto Surgery and the Linear Incision Technique With Tissue Preservation

Contains fulltext : 219898.pdf (Publisher’s version ) (Closed access)OBJECTIVES: The aim of this study is to investigate and compare the clinical outcomes of minimally invasive ponto surgery (MIPS) to the linear incision technique with soft tissue preservation (LIT-TP) for percutaneous bone-anchored hearing implants (BAHI). STUDY DESIGN: Prospective cohort study with a historical control group. SETTING: Tertiary referral center. PATIENTS: Twenty-five patients were prospectively included in the test group. The control group consisted of 25 patients who previously participated in another clinical trial and already underwent BAHI surgery. INTERVENTION: All patients were implanted with a 4.5-mm-wide implant, using MIPS in the test group and the LIT-TP in the control group. Follow-up visits were scheduled 7 days, 21 days (sound processor fitting), 12 weeks and 6 months after surgery. MAIN OUTCOME MEASURES: The primary outcome measure was skin sensibility around the abutment 6 months after surgery. Secondary outcomes were subjective numbness, surgery time, wound healing, adverse soft tissue reactions, cosmetic outcomes, implant stability quotient (ISQ), implant survival, and sound processor use. RESULTS: Skin sensibility, adverse soft tissue reactions, and sound processor use were comparable between groups. The test group had a shorter surgery time and better cosmetic outcomes. More skin dehiscences and a statistically nonsignificant higher implant loss rate (12% vs 0%, p = 0.079) were observed in the test group. CONCLUSION: MIPS is comparable to the LIT-TP regarding skin sensibility at 6 months and soft tissue tolerability. With MIPS, surgery time is further reduced and better cosmetic outcomes are reported. More research into MIPS, exact drill protocol, used instruments, and associated implant loss is warranted

Hypertension and Vitamin D

The aim of this research was to apply analytical epidemiology to examine associations between hypertension and vitamin D status (serum 25-hydroxyvitamin D (25OHD)). The first objective was to appraise and synthesize the research evidence on the relationship between hypertension and 25OHD. The follow-up objective was to complete a sequence of studies exploring the association between hypertension and 25OHD in two populations with high hypertension and vitamin D deficiency rates, Finland and China. The results of the meta-analysis were that higher vitamin D levels were associated with lower hypertension rates. In a prospective study from Finland higher 25OHD levels at baseline were found to associate with less hypertension and a lower pulse rate. On follow-up only low pulse rate remained associated with higher 25OHD. A hypertension prevalence rate of 34% was reported from a cross-sectional survey in Macau 2012. Potentially modifiable predictors of hypertension were found to be smoking, obesity and lack of exercise, sunlight exposure and low intake of fish. Only 45% of this population on whom blood was collected were found to have sufficient vitamin D status (≥50 nmol/L). Young highly educated women were at greatest risk of not being sufficient. Higher sun exposure, fish intake and more physical activity and less sitting were associated with higher 25OHD levels. In the older population (≥55 years) higher 25OHD levels significantly predicted having either lower hypertension or lower pulse rates. The evidence from these series of studies indicates a small consistent association between vitamin D sufficiency and reduction in hypertension risk. These results are consistent with recent meta-analyses of observational studies. The unique finding from this study is that there is an age cohort differential with younger Chinese having lower vitamin D status and in a population with increasing hypertension this fact may have public health consequences in the future