Department of Otolaryngology and Institute of Audioneurotechnology (VIANNA), Hannover Medical School, Hannover, Germany.
Cluster of Excellence "Hearing4all", Hannover Medical School, Hannover, Germany.
Ear Hear. 2024;45(1):219-226. doi: 10.1097/AUD.0000000000001415. Epub 2023 Aug 15.
The maximum output provided by a bone conduction (BC) device is one of the main factors that determines the success when treating patients with conductive or mixed hearing loss. Different approaches such as sound pressure measurements using a probe microphone in the external auditory canal or a surface microphone on the forehead have been previously introduced to determine the maximum output of active transcutaneous BC devices that are not directly accessible after implantation. Here, we introduce a method to determine the maximum output hearing level (MOHL) of a transcutaneous active BC device using patients' audiometric data.
We determined the maximum output in terms of hearing level MOHL (dB HL) of the Bonebridge using the audiometric and direct BC threshold of the patient together with corresponding force levels at hearing threshold and the maximum force output of the device. Seventy-one patients implanted with the Bonebridge between 2011 and 2020 (average age 45 ± 19 years ranging from 5 to 84 years) were included in this study. The analyses of MOHLs were performed by (1) dividing patients into two groups with better or worse average audiometric BC threshold (0.5, 1, 2, 4 kHz), on the ipsilateral side or (2) by separating the MOHLs based on better or worse frequency-by-frequency specific audiometric BC thresholds on the ipsilateral (implanted) side.
When using a frequency-by-frequency analysis obtained average ipsilateral MOHLs were in the range between 51 and 73 dB HL for frequencies from 0.5 to 6 kHz in the group with better audiometric BC threshold on the ipsilateral ears. The average contralateral MOHLs in the group with better contralateral hearing were in the range from 43 to 67 dB HL. The variability of the data was approximately 6 to 11 dB (SDs) across measured frequencies (0.5 to 6 kHz). The average MOHLs were 4 to 8 dB higher across frequencies in the group with better audiometric BC threshold on the ipsilateral ears than in the group with better audiometric BC threshold on the contralateral ears. The differences between groups were significant across measured frequencies ( t test; p < 0.05).
Our proposed method demonstrates that the individual frequency-specific MOHL on the ipsilateral and contralateral side of individual patients with a transcutaneous BC device can be determined mainly using direct and audiometric BC threshold data of the patients from clinical routine. The average MOHL of the implant was found 4 to 8 dB higher on the ipsilateral (implanted) side than on the contralateral side.
骨导（BC）设备提供的最大输出是治疗传导性或混合性听力损失患者成功的主要因素之一。为了确定植入后无法直接接触的主动经皮 BC 设备的最大输出，之前已经引入了不同的方法，例如在外耳道中使用探针麦克风或额头上的表面麦克风进行声压测量。在这里，我们介绍一种使用患者听力数据确定经皮主动 BC 设备最大输出听力级（MOHL）的方法。
我们使用患者的听力和直接 BC 阈值以及相应的听力阈值下的力水平和设备的最大力输出，确定 Bonebridge 的最大输出听力级（MOHL）（dB HL）。2011 年至 2020 年间植入 Bonebridge 的 71 名患者（平均年龄 45±19 岁，年龄 5 至 84 岁）纳入本研究。通过（1）将患者分为同侧平均听力 BC 阈值较好或较差的两组（0.5、1、2、4 kHz），或（2）根据同侧（植入）侧听力 BC 阈值的特定频率较好或较差来分离 MOHL，对 MOHLs 进行分析。
当使用逐频分析时，同侧听力较好的患者在 0.5 至 6 kHz 的频率范围内获得的平均同侧 MOHL 范围为 51 至 73 dB HL。同侧听力较好的患者的平均对侧 MOHL 范围为 43 至 67 dB HL。在整个测量频率（0.5 至 6 kHz）范围内，数据的变异性约为 6 至 11 dB（标准差）。同侧听力 BC 阈值较好的患者组在整个频率范围内的平均 MOHL 比同侧听力 BC 阈值较好的患者组高 4 至 8 dB。在整个测量频率范围内，两组之间的差异具有统计学意义（t 检验；p < 0.05）。
我们提出的方法表明，可主要使用患者的直接和听力 BC 阈值数据从临床常规中确定经皮 BC 设备个体患者的同侧和对侧的个体频率特异性 MOHL。植入物的平均 MOHL 同侧（植入）侧比对侧高 4 至 8 dB。
