Arndt Susan, Wesarg Thomas, Aschendorff Antje, Speck Iva, Hocke Thomas, Jakob Till Fabian, Rauch Ann-Kathrin
Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland.
Cochlear Deutschland GmbH & Co KG, Mailänder Straße 4 a, 30539, Hannover, Deutschland.
HNO. 2024 Aug;72(8):537-546. doi: 10.1007/s00106-023-01336-4. Epub 2023 Aug 17.
The active transcutaneous, partially implantable osseointegrated bone conduction system Cochlear™ Osia® (Cochlear, Sydney, Australia) has been approved for use in German-speaking countries since April 2021. The Osia is indicated for patients with conductive (CHL) or mixed hearing loss (MHL) with an average bone conduction (BC) hearing loss of 55 dB or less, or with single-sided deafness (SSD).
The aim of this retrospective study was to investigate the prediction of postoperative speech recognition with Osia and to evaluate the speech recognition of patients with MHL and an aided dynamic range of less than 30 dB with Osia.
Between 2017 and 2022, 29 adult patients were fitted with the Osia, 10 patients (11 ears) with CHL and 19 patients (21 ears) with MHL. MHL was subdivided into two groups: MHL‑I with four-frequency pure-tone average in BC (BC-4PTA) ≥ 20 dB HL and < 40 dB HL (n = 15 patients; 20 ears) vs. MHL-II with BC-4PTA ≥ 40 dB HL (n = 4 patients; 5 ears). All patients tested a bone conduction hearing device on a softband preoperatively. Speech intelligibility in quiet was assessed preoperatively using the Freiburg monosyllabic test unaided and with the test system and postoperatively with Osia. The maximum monosyllabic score (mEV) unaided and the monosyllabic score with the test system at 65 dB SPL were correlated with the postoperative monosyllabic score with Osia at 65 dB SPL.
Preoperative prediction of postoperative outcome with Osia was better using the mEV than the EV at 65 dB SPL with the test device on the softband. Postoperative EV was most predictive for patients with CHL and least predictive for patients with mixed hearing loss with 4PTA BC ≥ 40 dB HL. For the test device at softband, results tended to show the minimum achievable outcome and the mEV tended to predict the realistically achievable outcome.
Osia can be used for the treatment of CHL and MHL within the indication limits. The average preoperative bone conduction hearing threshold also provides an approximate estimate of the postoperative EV with Osia, for which the most accurate prediction is obtained using the preoperative mEV. Prediction accuracy decreases from a BC-4PTA of ≥ 40 dB.
主动式经皮、部分可植入的骨整合骨传导系统科利耳™ Osia®（科利耳，悉尼，澳大利亚）自2021年4月起已在德语国家获批使用。Osia适用于平均骨传导（BC）听力损失为55分贝或更低的传导性听力损失（CHL）或混合性听力损失（MHL）患者，或单侧耳聋（SSD）患者。
本回顾性研究的目的是调查使用Osia术后言语识别的预测情况，并评估使用Osia的MHL患者且辅助动态范围小于30分贝时的言语识别情况。
2017年至2022年期间，29例成年患者佩戴了Osia，其中10例CHL患者（11耳），19例MHL患者（21耳）。MHL分为两组：BC四频率纯音平均听阈（BC-4PTA）≥20分贝HL且<40分贝HL的MHL-I组（n = 15例患者；20耳）与BC-4PTA≥40分贝HL的MHL-II组（n = 4例患者；5耳）。所有患者术前在软带装置上测试了骨传导听力设备。术前使用弗赖堡单音节测试在未佩戴辅助设备时以及使用测试系统时评估安静环境下的言语可懂度，术后使用Osia进行评估。未佩戴辅助设备时的最大单音节得分（mEV）以及在65分贝声压级下使用测试系统时的单音节得分与术后在65分贝声压级下使用Osia时的单音节得分相关。
在软带装置上使用测试设备时，使用mEV比在65分贝声压级下使用EV能更好地预测Osia术后结果。术后EV对CHL患者的预测性最强，对BC-4PTA≥40分贝HL的混合性听力损失患者的预测性最弱。对于软带装置上的测试设备，结果倾向于显示可达到的最低结果，而mEV倾向于预测实际可达到的结果。
Osia可在适应症范围内用于治疗CHL和MHL。术前平均骨传导听力阈值也能大致估算使用Osia术后的EV，其中使用术前mEV可获得最准确预测。当BC-4PTA≥40分贝时，预测准确性会降低。
