Müller Christoph, Seidler Hannes, Kuch Janina, Tsypina Anna, Zahnert Thomas, Lailach Susen
Department of Otorhinolaryngology Head and Neck Surgery, Ear Research Center Dresden, Carl Gustav Carus Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität (TU) Dresden, Dresden, Germany.
Carl Gustav Carus Faculty of Medicine, TU Dresden, Dresden, Germany.
Ear Hear. 2025;46(4):1095-1110. doi: 10.1097/AUD.0000000000001650. Epub 2025 Mar 20.
In patients with conductive or combined unilateral hearing loss, implantable hearing systems can be a treatment option. Due to the overlapping indications of hearing implants, a systematic evaluation of audiologic differences in terms of speech intelligibility and binaural hearing abilities is necessary. Because of the unilateral cochlear stimulation in patients implanted with an active middle ear implant, we expect superior binaural hearing performance compared with patients implanted with a bone-conducting implant that causes bilateral cochlear stimulation. This study focuses especially on comparing directional hearing abilities between the aforementioned groups of implantable hearing aid users.
In 13 patients unilaterally fitted with Vibrant Soundbridge (VSB) and 8 patients fitted with Bonebridge (BB) (both implants manufactured by MED-EL, Austria) (implantation at least 6 months ago, contralateral ear with at most mild hearing loss [pure tone average across 4 frequencies <30 dB]), sound localization ability, speech intelligibility (Freiburger monosyllabic word test and Oldenburgsentencetest), audiometric threshold-based measurements and patient-reported outcome measures (International Outcome Inventory for Hearing Aids and Speech, Spatial and Qualities of Hearing Scale 12) have been examined.
The groups did not differ significantly ( p > 0.05) in terms of patient age (VSB: 44.6 ± 14.4 years [SD]; BB: 44.5 ± 17.3 years), pure tone average across 4 frequencies of bone conduction (VSB: 26.4 ± 6.9 dB; BB: 23.3 ± 6.7 dB), speech intelligibility (VSB: 80.0% ± 16.7%; BB: 69.4% ± 13.2% [Freiburger]) and Oldenburgsentencetest (VSB -8.9 ± 2.6 dB; BB: -7.2 ± 4.4 dB). Implantation was 4.2 ± 2.7 years (VSB) and 7.5 ± 3.5 years (BB) ( p < 0.05). Sound tended to be localized more frequently (56% ± 16%) within the reference range in the VSB group than in the BB group (49% ± 12.9%) ( p > 0.05). The VSB group tended to show a smaller lateral deviation of sound detection from the actual sound presentation direction, especially with frontal sound presentation, compared with the BB group. Lateral sound presentations above 60° were increasingly perceived in the direction contralateral to the sound source in both groups ( p > 0.05). Subjective hearing disabilities were scored significantly lower in the VSB group compared with the BB group.
When comparing the sound localization ability between BB and VSB users, the study displayed a trend toward better results with the VSB. Further measurement data of patient cohorts with larger group sizes have to be collected for a final judgment on the clinical significance of these differences.
对于传导性或单侧混合性听力损失患者，可植入式听力系统是一种治疗选择。由于听力植入设备的适应证存在重叠，因此有必要对言语清晰度和双耳听力能力方面的听力学差异进行系统评估。由于植入有源中耳植入物的患者存在单侧耳蜗刺激，我们预计与植入导致双侧耳蜗刺激的骨传导植入物的患者相比，其双耳听力表现更优。本研究特别关注比较上述两组可植入式助听器使用者的定向听力能力。
对13例单侧佩戴振动声桥（VSB）的患者和8例佩戴骨桥（BB）的患者（两种植入物均由奥地利美迪普声公司生产）（植入至少6个月前，对侧耳听力损失至多为轻度[4个频率的纯音平均听阈<30 dB]）进行了声音定位能力、言语清晰度（弗莱堡单音节词测试和奥尔登堡句子测试）、基于听阈的测量以及患者报告的结局指标（助听器国际结局量表和听力言语、空间及质量量表12）的检查。
两组患者在年龄（VSB组：44.6±14.4岁[标准差]；BB组：44.5±17.3岁）、4个频率的骨传导纯音平均听阈（VSB组：26.4±6.9 dB；BB组：23.3±6.7 dB）、言语清晰度（VSB组：80.0%±16.7%；BB组：69.4%±13.2%[弗莱堡测试]）和奥尔登堡句子测试（VSB组：-8.9±2.6 dB；BB组：-7.2±4.4 dB）方面差异无统计学意义（p>0.05）。植入时间分别为4.2±2.7年（VSB组）和7.5±3.5年（BB组）（p<0.05）。VSB组声音在参考范围内的定位频率（56%±16%）往往高于BB组（49%±12.9%）（p>0.05）。与BB组相比，VSB组在声音检测方向上与实际声音呈现方向的侧向偏差往往更小，尤其是在声音从正面呈现时。两组中，高于60°的侧向声音呈现越来越多地被感知为来自声源对侧的方向（p>0.05）。VSB组的主观听力障碍评分显著低于BB组。
在比较BB和VSB使用者的声音定位能力时，本研究显示VSB使用者有取得更好结果的趋势。必须收集更大样本量患者队列的进一步测量数据，以便对这些差异的临床意义做出最终判断。
