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Clinical experience of an adhesive bone conduction hearing system in children with congenital single-sided deafness

Abstract

Objectives:

This study aimed to investigate the effects of an adhesive bone conduction device (aBCD) in children with congenital single-sided deafness (SSD). Specifically, we examined whether the aBCD elicits improvement in the speech perception ability of children with congenital SSD and whether using this device would adversely affect the horizontal localisation abilities of these children.

Methods:

Thirteen school-aged children with SSD and seven children with Normal Hearing (NH) were included in this study. Speech perception in noise was measured using the Mandarin Speech Test Materials and sound localisation performance was evaluated using broadband noise stimuli (0.5–20 kHz), randomly played from seven loudspeakers at different stimulus levels (65-, 70-, and 75-dB SPL).

Results:

All children with SSD showed inferior speech perception and sound localisation performance compared with children with NH. The aBCD use remarkably improved the speech perception abilities of these children under quiet and noise conditions; however, their sound localisation abilities neither improved nor deteriorated.

Conclusion:

This study reveals the effectiveness and safety of a non-surgical aBCD in paediatric patients with SSD. Our results provide a theoretical basis for early hearing intervention with an aBCD in children with congenital SSD who are temporarily unable to undergo ear surgery.

Level of evidence: Level 3.

Keywords
Deafness; Paediatric single-sided deafness; Adhesive bone conduction device; Speech perception; Sound localisation

HIGHLIGHTS

Adhesive bone conduction device elicits improvement in speech perception.

Adhesive bone conduction do not improve sound localisation abilities.

Adhesive bone conduction is useful to children with single-sided deafness.

Introduction

Single-sided deafness (SSD) is characterised by profound hearing loss in the affected ear and Normal Hearing (NH) in the contralateral ear [11 Bernstein JGW, Schuchman GI, Rivera AL. Head shadow and binaural squelch for unilaterally deaf cochlear implantees. Otol Neurotol. 2017;38:e195–202.,22 Yu JW. Understanding patient perspectives on single-sided deafness. JAMA Otolaryngol Head Neck Surg. 2020;146:885–6.]. Because hearing basic speech signals through the healthy ear is possible in a quiet environment, the hearing problems of these patients are usually ignored. However, increasing evidence indicates that patients with SSD present with auditory deficits in speech perception under noise and sound localisation [33 van Wieringen A, Boudewyns A, Sangen A, Wouters J, Desloovere C. Unilateral congenital hearing loss in children: challenges and potentials. Hear Res. 2019;372:29–41.,44 Asp F, Reinfeldt S. Effects of simulated and profound unilateral sensorineural hearing loss on recognition of speech in competing speech. Ear Hear. 2020;41:411–9.]. Consequently, they may experience a lack of security, academic underachievement, and reduced quality of life.

Given the need for daily communication, hearing interventions for bilateral sensorineural hearing loss are standardised. However, there is no consensus on the treatment of patients with SSD. Current interventions for paediatric SSD include fitting Cochlear Implants (CIs), Bone Conduction Implants (BCIs), Contralateral-Routing-Of-Signal (CROS) hearing aids, and non-surgical Bone Conduction Devices (BCDs) [55 Monini S, Musy I, Filippi C, Atturo F, Barbara M. Bone conductive implants in single-sided deafness. Acta Otolaryngol. 2015;135:381–8.,66 Skarzynski PH, RatuszniakA, Osinska K, Koziel M, Krol B, Cywka KB, et al. A comparative study of a novel adhesive bone conduction device and conventional treatment options for conductive hearing loss. Otol Neurotol. 2019;40:858–64.,77 Benchetrit L, Ronner EA, Anne S, Cohen MS. Cochlear implantation in children with single-sided deafness: a systematic review and meta-analysis. JAMA Otolaryngol Head Neck Surg. 2021;147:58–69.,88 Peters JP, van Heteren JA, Wendrich AW, van Zanten GA, Grolman W, Stokroos RJ, et al. Short-term outcomes of cochlear implantation for single-sided deafness compared to bone conduction devices and contralateral routing of sound hearing aids–results of a randomised controlled trial (CINGLE-trial). PLoS One. 2021;16:e0257447.]. For patients with cochlear nerve deficiency, inner ear abnormalities, or immature anatomy, which may impede the implantation of CIs or BCIs, CROS hearing aids and non-surgical BCDs are useful alternatives. A CROS hearing aid collects sound signals from the affected ear and transmits them to an output transducer inserted in the canal of the ear with NH; hence, patients are required to wear two hearing aids simultaneously. A more aesthetically pleasing choice is a non-surgical BCD, which is attached to the mastoid region behind the impaired ear using a headband, soft-band, or an adhesive adapter, and it transmits sound signals to the ipsilateral cochlea [66 Skarzynski PH, RatuszniakA, Osinska K, Koziel M, Krol B, Cywka KB, et al. A comparative study of a novel adhesive bone conduction device and conventional treatment options for conductive hearing loss. Otol Neurotol. 2019;40:858–64.,99 Mertens G, Gilles A, Bouzegta R, Van de Heyning P. A prospective randomised crossover study in single sided deafness on the new non-invasive adhesive bone conduction hearing system. Otol Neurotol. 2018;39:940–9.]. BCDs alleviate the Head Shadow Effect (HSE) to improve speech perception, especially for speech signals transmitted from the hearing field of the impaired ear. Notably, as BCDs do not provide actual auditory stimuli to the deaf ear, it is widely accepted that BCDs cannot improve the localisation abilities of patients with SSD [1010 Salcher R, Zimmermann D, Giere T, Lenarz T, Maier H. Audiological results in SSD with an active transcutaneous bone conduction implant at a retrosigmoidal position. Otol Neurotol. 2017;38:642–7.,1111 Huber AM, Strauchmann B, Caversaccio MD, Wimmer W, Linder T, De Min N, et al. Multicenter results with an active transcutaneous bone conduction implant in patients with single-sided deafness. Otol Neurotol. 2022;43:227–35.]. However, some adults with SSD can achieve horizontal directional hearing by learning to use ambiguous monaural cues (e.g. sound level and veridical spectral-shape cues) from the healthy ear [1212 Shub DE, Carr SP, Kong Y, Colburn HS. Discrimination and identification of azimuth using spectral shape. J Acoust Soc Am. 2008;124:3132–41.], especially in familiar environments. Therefore, it is important to clarify whether BCDs will jeopardise patients’ original directional hearing ability [1313 Grantham DW, Ashmead DH, Haynes DS, Hornsby BW, Labadie RF, Ricketts TA. Horizontal plane localisation in single-sided deaf adults fitted with a bone-anchored hearing aid (Baha). Ear Hear. 2012;33:595–603.].

In 2017, ADHEAR, a non-surgical solution based on adhesive BCDs (aBCDs), became available. The ADHEAR (MED-EL,

Innsbruck, Austria) system consists of an adhesive adapter and an audio processor. The audio processor converts sound into mechanical vibrations and transmits the vibrations to the mastoid bone via the adhesive adapter, which is placed on the skin behind the auricle. The efficacy of ADHEAR for improving hearing in patients with conductive hearing loss has been widely reported, with accounts of more aesthetic satisfaction and less skin complications compared with conventional bone conduction hearing aids [1414 Osborne MS, Child-Hymas A, Gill J, Lloyd MS, McDermott AL. First pediatric experience with a novel, adhesive adapter retained, bone conduction hearing aid system. Otol Neurotol. 2019;40:1199–207.,1515 Kuthubutheen J, Broadbent C, Marino R, Távora-Vieira D. The use of a novel, nonsurgical bone conduction hearing aid system for the treatment of conductive hearing loss. Otol Neurotol. 2020;41:948–55.]. However, clinical research on patients with SSD fitted with ADHEAR remains insufficient. To our knowledge, only two studies on the audiological outcomes of ADHEAR in adults with SSD (mean age, 40-years) have been published [66 Skarzynski PH, RatuszniakA, Osinska K, Koziel M, Krol B, Cywka KB, et al. A comparative study of a novel adhesive bone conduction device and conventional treatment options for conductive hearing loss. Otol Neurotol. 2019;40:858–64.,99 Mertens G, Gilles A, Bouzegta R, Van de Heyning P. A prospective randomised crossover study in single sided deafness on the new non-invasive adhesive bone conduction hearing system. Otol Neurotol. 2018;39:940–9.]. Moreover, data on the performance of this new system in school-aged children and adolescents are lacking. This study, therefore, aimed to examine whether an aBCD elicits improvement in speech perception in school-aged children with congenital SSD. In addition, we compared the audiological outcomes of children with SSD with those of children with NH and assessed whether using an aBCD would negatively affect horizontal localization in children with SSD.

Methods

Participants

Thirteen school-aged children with SSD (age range, 5–12 years; mean, 7.46-years; Standard Deviation [SD = 2.22-years], Table 1) were recruited in our hospital. All participants had a Pure Tone Audiometry (PTA) threshold ≥ 90dB HL across the standard audiometric frequencies from 500 Hz to 4000 Hz in the impaired ear and a normal PTA threshold ≤ 20dB HL from 500Hz to 4000Hz in the healthy ear. Hearing loss was detected either incidentally or from neonatal hearing screening results. To identify the aetiology and exclude other possible inner ear diseases, all patients underwent imaging examinations, including computed tomography and magnetic resonance imaging before enrolment; eight patients had inner ear malformation. Seven children with NH, aged 6–12 years (mean, 9-years; SD = 2.16-years) were recruited as the comparison group. NH was defined as bilateral normal PTA thresholds ≤ 20dB HL from 500 Hz to 4000 Hz.

Table 1
Demographic data of 13 patients with congenital SSD.

In the 13 patients, we examined the sound field hearing threshold, speech perception in quiet, and binaural hearing effects. Five patients did not participate in the examination of sound localisation because of time constraints or lack of cooperation with the measurement process. Therefore, only seven patients (P1–7) underwent sound localization assessment.

Experimental design

Speech perception (including speech perception in quiet and binaural hearing conditions) and sound localisation were assessed in children with congenital SSD (when unaided and aBCD-aided) and healthy controls.

Settings

The experiment was conducted in a sound-attenuated audiometric booth with seven audiometric loudspeakers positioned 1 m from the centre of the participant’s head, spanning from +90° to –90° (at 30° intervals) on the horizontal plane. All patients were fitted with a non-surgical aBCD (ADHEAR), which was uniformly programmed with an omnidirectional microphone during all experimental procedures. The volume setting of the aBCD was determined based on the patient’s preference, and the optimal level remained constant throughout all experiments.

Outcome measures

Sound field hearing thresholds and speech perception in quiet

Warble tones at frequencies of 0.5, 1, 2, and 4kHz, presented from the front (0°, azimuth), were used to determine the hearing thresholds (in dB HL) in the sound field. Speech perception in quiet was assessed using the speech discrimination score (SDS, in %) of each participant. Disyllabic speech signals, presented by a male speaker, were selected from the Mandarin Speech Test Materials [1616 Wang S, Mannell R, Newall P, Zhang H, Han D. Development and evaluation of Mandarin disyllabic materials for speech audiometry in China. Int J Audiol. 2007;46:719–31.]. The healthy ears were covered in this test session with an earmuff and earplug applied to the external auditory canal.

Binaural hearing effects

The binaural summation effect, squelch effect, and HSE were measured using the speech reception threshold (SRT) of each participant, which was tested under a constant masker of Speech-Spectrum Noise (SSN) fixed at 65 dB SPL. The target disyllabic speech signals from the Mandarin Speech Test Materials began at 65 dB SPL and adaptively fluctuated in 2 dB intervals depending on the participant’s response. SRT was defined as the speech signal level at which the participant identified the disyllabic word correctly 50% of the time. We calculated the Speech-to-Noise rRatio (SNR) as the difference between speech stimuli levels and SSN.

We conducted tests in different spatial configurations as follows: 1) Binaural summation effect (S0N0): speech signals and SSN were presented from the front (0°, azimuth). 2) Binaural squelch effect (S0NSSD): speech signals were presented from the front (0°, azimuth), while SSN was presented from the SSD side (–/+90°, azimuth). 3) HSE (SSSDNNH): speech signals were presented from the SSD side (–/+90°, azimuth), while SSN was presented from the NH side (–/+90°, azimuth).

In patients with NH, SSN was uniformly presented from the left side for points (2) and (3).

Sound localisation

Participants were placed at the centre of the semicircle (radius: 1 m) formed by seven loudspeakers. Broadband noise (0.5–20kHz), with a duration of 1s, was randomly played at three different sound levels (65-, 70-, and 75-dB SPL). During the formal test, each loudspeaker randomly provided sound stimuli twice at each sound-level burst. After each presentation, participants were allowed to promptly indicate the orientation without any feedback information.

Statistical analysis

M A E = i = 1 n | α R E S P i α T A R G i | n

We assessed the accuracy of sound localisation under different conditions by calculating the Mean Absolute Error (MAE) using the above equation. αRESP and αTRAG denote the response and target azimuths (in degrees), respectively. For participants with an optimal localisation ability, MAE is 0. A paired t-test was used for the analysis of differences between the unaided (aBCD off) and aided (aBCD on) conditions for each participant, whereas an independent t-test was used for comparisons between groups; p-values < 0.05 were considered statistically significant. Statistical analyses and diagram drawings were performed using SPSS 26.0 and GraphPad Prism 8.0, respectively.

Results

Hearing thresholds and speech perception in quiet

The mean (SD) hearing thresholds of patients with SSD in the unaided (aBCD off) and aided (aBCD on) conditions were 53.31 (4.23) and 35.54 (9.26) dB HL, respectively, indicating an average functional gain of 17.77 (7.11) dB HL (p < 0.01); however, the mean aided hearing threshold was still inferior to that of children with NH (15 [4.58] dB HL, p < 0.01). The hearing threshold data of the SSD (aided and unaided) and NH groups for each frequency are presented in Fig. 1a. Compared to the unaided condition, the mean (SD) SDS in quiet improved from 32.54% (16.28%) to 80.31% (11.51%) with an aBCD (p < 0.01). However, the aided SDS in patients with SSD was still worse than that of the NH group (97.71% [2.43%]; p < 0.05); (Fig. 1b).

Fig. 1
(a) Mean sound field hearing thresholds and (b) the mean speech discrimination score in a quiet environment in children with SSD (in unaided and aided conditions) and controls with NH. The speech reception threshold in noise for spatial configurations of (c) the summation effect (S0N0), (d) the squelch effect (S0NSSD), and (e) HSE (SSSDNNH). Group means are presented as mean ± two standard deviations. Significant differences are defined as *(p < 0.05), **(p < 0.01). SDS, speech discrimination score; NH, normal hearing; SSD, single-sided deafness; SRT, speech reception threshold; SNR, speech-to-noise ratio; HSE, head shadow effect; NH, normal hearing; ns, not significant.

Binaural hearing effects

Fig. 1 (c–e) shows the SRTs of binaural effects in the different spatial configurations. For children with NH, the mean SRTs (SD) for the summation effect, squelch effect, and HSE were –6.57 (0.79), –9.43 (1.27), and –12.57 (3.26) dB SNR, respectively. For patients with SSD, the mean SRTs (SD) for the summation effect, squelch effect, and HSE in the unaided condition were –3.23 (1.88), –7.62 (2.22), and 0.23 (2.95) dB SNR, respectively. The corresponding mean SRTs (SD) in the aided condition were –5.54 (1.56), –8.15 (2.97), and –3.31 (2.53) dB SNR, respectively. There were significant differences between the SRTs for the summation effect and HSE in the unaided and aided conditions (all p < 0.01). In the spatial setting of the squelch effect, in which noise was presented from the impaired side, the aBCD did not improve speech perception (p = 0.407), which was within the expectations. There was an obvious discrepancy in the summation effect (p < 0.05) and HSE (p < 0.01) between the children with NH and those who used the aBCD.

Sound localisation abilities

A comparison of the individual changes in sound localization (Fig. 2a) shows negative delta MAE for P3, P4, P5, and P7, indicating that their sound localization performance improved with the aid of the aBCD. However, the mean MEA for all patients in the unaided conditions was 58.77° (17.11°), which changed to 54.7° (15.1°) when patients used an aBCD; statistical analysis revealed no significant difference between the two conditions (p = 0.276). All individual scores are shown in Table 2.

Fig. 2
(a) Delta MAE values for each patient in the unaided and aided conditions. MAEs of unaided conditions (x-axis) are plotted against those of aided conditions (y-axis) and mean absolute errors are calculated on the (b) SSD side and on the (c) contralateral NH side. MAE, mean absolute error; P, patient; SSD, single-sided deafness; NH, normal hearing.

Table 2
MAEs for patients (P1–7) with congenital SSD and listeners with NH (N1–7).

To further determine whether the use of an aBCD would jeopardise the original localisation abilities of a patient, especially in the ear with NH, the MAEs for both sides were calculated. Fig. 2b–c shows the plots of the MAE values for the unaided condition versus those for the aided condition. Data points below the diagonal demonstrate an improvement in sound localization in the aided condition compared with the unaided condition. Overall, no significant differences were found on either side between conditions (SSD side: unaided MAE vs. aided MAE, 82.86° [32.92°] vs. 71.72° [35.91°], p = 0.416; contralateral side: unaided MAE vs. aided MAE, 36.67° [25.18°] vs. 40.71° [26.02°], p = 0.689), which suggests that the use of aBCDs did not have an obvious effect on sound localisation accuracy in the contralateral ear.

Discussion

The high prevalence of inner ear malformation in children with SSD [1717 Dewyer NA, Smith S, Herrmann B, Reinshagen KL, Lee DJ. Pediatric single-sided deafness: a review of prevalence, radiologic findings, and cochlear implant candidacy. Ann Otol Rhinol Laryngol. 2022;131:233–8.] necessitates the consideration of fitting of non-surgical aBCD as a vital hearing reconstruction strategy. Our results demonstrated that aBCDs considerably improved speech perception in children with SSD without worsening their original localisation abilities. To our knowledge, this is the first study assessing the effects of aBCDs in paediatric patients with SSD.

To avoid clinical heterogeneity among tests, the design of the audiological tests performed in the present study was based on the SSD testing framework published in 2016 [1818 Van de Heyning P, Távora-Vieira D, Mertens G, Van Rompaey V, Rajan GP, Müller J, et al. Towards a unified testing framework for single-sided deafness studies: a consensus paper. Audiol Neurootol. 2016;21:391–8.]. In this study, children who used an aBCD showed lower response thresholds in the summation effect and HSE tests (all p < 0.01), indicating improved speech perception in a challenging environment. This promising result is consistent with those of some previous studies [88 Peters JP, van Heteren JA, Wendrich AW, van Zanten GA, Grolman W, Stokroos RJ, et al. Short-term outcomes of cochlear implantation for single-sided deafness compared to bone conduction devices and contralateral routing of sound hearing aids–results of a randomised controlled trial (CINGLE-trial). PLoS One. 2021;16:e0257447.,1010 Salcher R, Zimmermann D, Giere T, Lenarz T, Maier H. Audiological results in SSD with an active transcutaneous bone conduction implant at a retrosigmoidal position. Otol Neurotol. 2017;38:642–7.,1919 Laske RD, Röösli C, Pfiffner F, Veraguth D, Huber AM. Functional results and subjective benefit of a transcutaneous bone conduction device in patients with single-sided deafness. Otol Neurotol. 2015;36:1151–6.,2020 Yang J, Wang Z, Huang M, Chai Y, Jia H, Wu Y, et al. BoneBridge implantation in patients with single-sided deafness resulting from vestibular schwannoma resection: objective and subjective benefit evaluations. Acta Otolaryngol. 2018;138:877–85.,2121 Kurz A, Rak K, Hagen R, Ehrmann-Müller D. Evaluating the decision for cochlear implantation in individuals with single-sided deafness (SSD); implementing the SSD consensus protocol into clinical routine. Otol Neurotol. 2020;41:727–35.,2222 Potier M, Seldran F, Sonthonnax M, Péan V, Berger P, Norena A, et al. Evaluation of a new bone conduction device for the rehabilitation of single-sided deafness: effects on speech understanding in noise. Otol Neurotol. 2022;43:105–12.] in which speech tests with competing noise were also performed on patients with SSD fitted with various BCDs. However, in the squelch effect test, the noise masker at the affected side provided less favourable SNRs, which may indicate some degradation of the speech perception of patients with SSD using an aBCD. Significant degradation of the response thresholds in patients with SSD fitted with BP100 hearing aids has been previously reported [2323 Krempaska S, Koval J, Schmid C, Pfiffner F, Kurz A, Kompis M. Influence of directionality and maximal power output on speech understanding with bone anchored hearing implants in single sided deafness. Eur Arch Otorhinolaryngol. 2014;271:1395–400.]. Similar to the majority of related studies [2020 Yang J, Wang Z, Huang M, Chai Y, Jia H, Wu Y, et al. BoneBridge implantation in patients with single-sided deafness resulting from vestibular schwannoma resection: objective and subjective benefit evaluations. Acta Otolaryngol. 2018;138:877–85.,2424 Bernardeschi D, Russo FY, Nguyen Y, Vicault E, Flament J, Bernou D, et al. Audiological results and quality of life of Sophono alpha 2 transcutaneous bone-anchored implant users in single-sided deafness. Audiol Neurootol. 2016;21:158–64.], our study found that the use of the aBCD did not substantially degrade the overall speech perception in noise.

There was an obvious discrepancy in the thresholds for the summation effect and HSE between the aided SSD and control groups. For patients with SSD, sufficient bone conduction signals are necessary to stimulate the contralateral cochlea, which is associated with a certain pressure caused by fitting the device [2525 Reinfeldt S, Håkansson B, Taghavi H, Eeg-Olofsson M. New developments in bone-conduction hearing implants: a review. Med Devices (Auckl). 2015;8:79–93.]. The HSE contributes to the underdeveloped ability of patients with SSD to recognise speech in noise. Therefore, low transcranial attenuation is beneficial as it allows the conduction of more sound signals to the functional contralateral cochlea [2626 Snapp HA, Morgenstein KE, Telischi FF, Angeli S. Transcranial attenuation in patients with single-sided deafness. Audiol Neurootol. 2016;21:237–43.]. The aBCD attached to the mastoid of the impaired ear acts as a bone conduction signal transducer that transmits these signals from the affected side to the contralateral ear with NH. Consequently, it reduces the HSE to improve the SNR in the healthy ear and broadens the range of hearing perception. However, this does not provide sufficient binaural cues for patients with SSD to show speech recognition abilities similar to those of their peers with NH.

It has been demonstrated that some patients with unilateral hearing loss have relatively good directional hearing, especially in familiar environments [2727 Van Wanrooij MM, Van Opstal AJ. Contribution of head shadow and pinna cues to chronic monaural sound localisation. J Neurosci. 2004;24:4163–71.,2828 Vogt K, Frenzel H, Ausili SA, Hollfelder D, Wollenberg B, Snik AF, et al. Improved directional hearing of children with congenital unilateral conductive hearing loss implanted with an active bone-conduction implant or an active middle ear implant. Hear Res. 2018;370:238–47.]. In this study, most patients with SSD showed poor horizontal-localisation performance (gain < 0.75), whereas the age-matched NH group showed perfect localisation performance in the same test procedure. This is inconsistent with a previous report of good sound localisation performance shown by some patients with SSD [2929 Agterberg MJH, Snik AFM, Van de Goor RMG, Hol MKS, Van Opstal AJ. Sound-localisation performance of patients with single-sided deafness is not improved when listening with a bone-conduction device. Hear Res. 2019;372:62–8.]. In that study, adults with SSD (age range: 17–68 years) learned to use monaural cues (e.g., spectral pinna cues) and HSE to maintain relatively good directional hearing. As monaural localisation takes a long time to develop, the monaural localisation development of the children in this study (average age: 9 [3.65] years) may have been immature; therefore, they showed worse localisation accuracy than the adults with SSD in the previous study.

Because BCDs do not provide actual binaural hearing for patients with SSD, using them may not improve their sound localisation abilities. This opinion was confirmed by our results and those of previous studies [55 Monini S, Musy I, Filippi C, Atturo F, Barbara M. Bone conductive implants in single-sided deafness. Acta Otolaryngol. 2015;135:381–8.,88 Peters JP, van Heteren JA, Wendrich AW, van Zanten GA, Grolman W, Stokroos RJ, et al. Short-term outcomes of cochlear implantation for single-sided deafness compared to bone conduction devices and contralateral routing of sound hearing aids–results of a randomised controlled trial (CINGLE-trial). PLoS One. 2021;16:e0257447.,99 Mertens G, Gilles A, Bouzegta R, Van de Heyning P. A prospective randomised crossover study in single sided deafness on the new non-invasive adhesive bone conduction hearing system. Otol Neurotol. 2018;39:940–9.,2020 Yang J, Wang Z, Huang M, Chai Y, Jia H, Wu Y, et al. BoneBridge implantation in patients with single-sided deafness resulting from vestibular schwannoma resection: objective and subjective benefit evaluations. Acta Otolaryngol. 2018;138:877–85.,3030 Saroul N, Akkari M, Pavier Y, Gilain L, Mom T. Long-term benefit and sound localisation in patients with single-sided deafness rehabilitated with an osseointegrated bone-conduction device. Otol Neurotol. 2013;34:111–4.], which indicated no substantial differences in localisation performance between adults with SSD with and without BCDs. Grantham et al. reported significant deficits in localisation performance after the use of a BCD; however, this result was insignificant owing to the small sample size [1313 Grantham DW, Ashmead DH, Haynes DS, Hornsby BW, Labadie RF, Ricketts TA. Horizontal plane localisation in single-sided deaf adults fitted with a bone-anchored hearing aid (Baha). Ear Hear. 2012;33:595–603.]. Although most studies revealed no obvious benefits for adults with SSD in using BCDs in audiological tests, higher subjective satisfaction with spatial hearing is encouraging. Huber et al. used the ‟Speech, Spatial, and Qualities of Hearing” questionnaire to evaluate the subjective benefits of BCDs in 17 adults

with SSD and reported an improvement in the spatial hearing subscale in the aided condition: patients reported having better lateralisation (the ability to locate a speaker to the right or the left) after their devices were implanted [1111 Huber AM, Strauchmann B, Caversaccio MD, Wimmer W, Linder T, De Min N, et al. Multicenter results with an active transcutaneous bone conduction implant in patients with single-sided deafness. Otol Neurotol. 2022;43:227–35.]. Considering these promising findings, we believe that aBCDs do not worsen the intrinsic localisation ability of paediatric patients with SSD.

The efficacy of transdermal Bone Conduction Hearing Implants (BCHI) for SSD has been proven in previous studies [3131 Mylanus EAM, Hua H, Wigren S, etal. Multicenterclinical investigation of a new active osseointegrated steady-state implant system. Otol Neurotol. 2020;41:1249–57.], and the results of this study further confirm the effectiveness of BCDs in treating SSD.

In our study, all patients with single-sided deafness (SSD) had normal hearing in the contralateral ear, with hearing thresholds ≤ 20dBHL. Will patients still benefit from BCDs if they also have impaired hearing in the contralateral ear, resulting in Asymmetric Hearing Loss (AHL)? Previous research has shown that bone conductive implantation can decrease the hearing thresholds and improve the quality of life for AHL patients [3232 Monini S, Battilocchi L, Salerno G, et al. Bone conductive implantation in asymmetric hearing loss (AHL). Acta Otolaryngol. 2020;140:651–8.,3333 Ratuszniak A, Skarzynski PH, Gos E, et al. Self-rated benefits of auditory performance after bonebridge implantation in patients with conductive or mixed hearing loss, or single-sided deafness. Life (Basel). 2022;12, undefined.]. This suggests that AHL patients can also benefit from BCDs.

Previous studies have shown that cochlear implantation is also an effective method for treating SSD [3434 Marx M, Mosnier I, Venail F, et al. Cochlear implantation and other treatments in single-sided deafness and asymmetric hearing loss: results of a national multicenter study including a randomized controlled trial. Audiol Neurootol. 2021;26:414–24.]. However, for patients with ossified cochlear, the anatomical structures of these patients’ cochlears have changed, which makes the cochlear implantation become an infeasible option, and BCDs may become the sole method for improving their hearing.

One important limitation was that subjective satisfaction could not be assessed because we only tested the short-term influence of ADHEAR systems. In addition, the sample size was small owing to the low availability of patients, and some patients were unwilling to use a BCD. Further studies with a larger sample of patients and subjective evaluations are imperative for yielding a more comprehensive presentation of spatial hearing outcomes. Moreover, longitudinal studies are needed to examine whether the limited benefits of BCDs for sound localisation performance can be improved in the long-term.

Conclusion

Overall, our findings confirmed that children with SSD have a worse speech perception ability and worse sound localisation than children with NH. The fitting of non-surgical aBCDs was a useful hearing reconstruction strategy for improving speech perception in challenging environments without affecting the original sound localisation ability of the patient. These results provide a theoretical basis for early hearing intervention in children with SSD and the prognosis of subsequent bone conduction implantation.

Acknowledgement

None.

  • Funding
    The study was supported by the National Natural Science Foundation of China (Grant nº 81770989) and the Capital Health Research and Development of Special (Grant nº 2020-2-2057) through Professor Shouqin Zhao.

Data availability statement

All data generated or analysed during this study are included in this article and its supplementary material files. Further enquiries can be directed to the corresponding author.

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Publication Dates

  • Publication in this collection
    23 Aug 2024
  • Date of issue
    2024

History

  • Received
    28 Nov 2023
  • Accepted
    27 Feb 2024
  • Published
    25 Mar 2024
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