A tutorial on implantable hearing amplification options for adults with unilateral microtia and atresia

Joannie Ka Yin Yu, Lena Lai Nar Wong, Willis Sung Shan Tsang, Michael Chi Fai Tong, Joannie Ka Yin Yu, Lena Lai Nar Wong, Willis Sung Shan Tsang, Michael Chi Fai Tong

Abstract

Background: Patients with unilateral atresia and microtia encounter problems in sound localization and speech understanding in noise. Although there are four implantable hearing devices available, there is little discussion and evidence on the application of these devices on patients with unilateral atresia and microtia problems.

Objective: This paper will review the details of these four implantable hearing devices for the treatment of unilateral atresia. They are percuteaneous osseointegrated bone anchored hearing aid, Vibrant Soundbridge middle ear implant, Bonebridge bone conduction system, and Carina fully implantable hearing device.

Methods: Four implantable hearing devices were reviewed and compared. The clinical decision process that led to the recommendation of a device was illustrated by using a case study.

Conclusions: The selection of appropriate implantable hearing devices should be based on various factors, including radiological findings and patient preferences, possible surgical complications, whether the device is Food and Drug Administration- (FDA-)/CE-approved, and the finances. To ensure the accurate evaluation of candidacy and outcomes, the evaluation methods should be adapted to suite the type of hearing device.

Figures

Figure 1
Figure 1
Flow chart on the clinical decision making process for implantable hearing devices.
Figure 2
Figure 2
The Vibrant Soundbridge (VSB) implantable hearing device. The VSB system is comprised of two parts: the internal component is called the vibrating ossicular prosthesis (VORP) and the external component is an audio processor (AP). The VORP consists of a receiver coil, a magnet to hold the Amadé audio processor over the implant, a demodulator, the conductor link, and the floating mass transducer (FMT). The receiver coil sends the sound signal from the audio processor to the demodulator or electronics package. The demodulator demodulates the signal so that it can be converted into signals that will drive the FMT. The conductor link just sends these signals to the FMT. Adapted from marketing materials on the VSB, with permission of MED-EL, Innsbruck, Austria.
Figure 3
Figure 3
Unaided audiogram before surgery.
Figure 4
Figure 4
Unaided (U) and aided (A) soundfield audiogram obtained 3 months after the implantation of VSB in the right ear. Thresholds were measured with the warble tone signals presented from the poor ear (at 90 degree azimuths). The left (nonimplant) ear was plugged and muffed during testing.
Figure 5
Figure 5
Speech reception thresholds (SRT) obtained in quiet using the Cantonese version of the Hearing In Noise Test (CHINT). SRTs were obtained unaided and aided at 3 months after activation of the VSB.
Figure 6
Figure 6
Speech reception thresholds (SRT) obtained in noise using the Cantonese version of the Hearing In Noise Test (CHINT). SRTs were obtained unaided and aided at 3 months after activation of the VSB.

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Source: PubMed

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