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Early hearing outcomes and experience with the MedEl Bonebridge in single-sided sensorineural
hearing loss
Acharya A. , Marino R. , Tavora D. , Rajan G.P.
Fremantle Hospital & Health Service, ENT Department, Fremantle, Australia, 2Princess Margaret Hospital for Children, Perth, Australia,
University of Western Australia, Perth, Australia
Introduction: The optimum technique for hearing rehabilitation in patients presenting with single-sided
sensorineural hearing loss (SSSNHL) is evolving. Contralateral routing of sound (CROS) by air conduction
hearing aids is the most commonly employed technique. CROS by bone conduction is an alternative option for
those patients who are unable to wear conventional hearing aids (due to the occlusion effect or adverse reaction
to the mould). Such techniques can only deliver monaural stimulation (with an awareness of sound on the
implanted side) and are thus limited by poor sound localisation and impaired perception of speech in noise.
Binaural hearing could be reinstated in some cases by use of a cochlear implant, however use of a cochlear
implant in this context is limited as compared with CROS options. The use of percutaneous bone conduction
devices is complicated by skin problems associated with the percutaneous abutment and passive devices are
limited in power. As a transcutaneous active bone conduction device, the MedEl Bonebridge avoids these
complications and may offer a suitable alternative for hearing rehabilitation in patients with SSSNHL with
published recommended hearing thresholds for its use in this context. Positioning of the floating mass transducer
(FMT) within the mastoid bone must satisfy the requirements of adequate depth of recess, adequate thickness of
adjacent bone for fixation and avoidance of critical anatomical structure. We present the outcomes from our early
experience in the use of the MedEl Bonebridge in SSSNHL.
Methods: A retrospective case note analysis was carried out of all patients who have undergone MedEl
Bonebridge implantation by a tertiary referral implant team for SSSNHL. The pre-operative and post-operative
subjective (Abbreviated Profile of Hearing Aid Benefit - APHAB; Speech, Spatial and Qualities of Hearing - SSQ)
and objective (speech in quiet, speech in noise) outcomes of hearing performance are presented and compared.
Results: There were no peri-operative or post-operative complications associated with the implant. Improvement
in hearing was demonstrated by both objective and subjective measurements in all cases. In patients with
chronic ear disease or a modification of the surgical technique may require to ensure safe and effective
positioning of the FMT.
Conclusion: Our early experience supports the use of the MedEl Bonebridge in patients with SSSNHL.
Learning outcome: The MedEl Bonebridge represents a safe and effective CROS alternative in the hearing
rehabilitation of patients presenting with SSSNHL. Surgeons must be vigilant to the requirements for appropriate
positioning of the FMT. Thorough preoperative planning aids in anticipating the need for modifications to the
standard surgical technique.