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Cor W R J Cremers - One of the best experts on this subject based on the ideXlab platform.

  • better performance with bone anchored Hearing Aid than acoustic devices in patients with severe air bone gap
    Laryngoscope, 2011
    Co-Authors: Maarten J F De Wolf, Cor W R J Cremers, Sander Hendrix, A F M Snik
    Abstract:

    Objectives/Hypothesis: A study performed in the 1990s with analogue linear Hearing Aids showed that in patients with mixed Hearing loss and an air-bone gap that exceeded 25 to 30 dB, speech perception was better with a Bone-Anchored Hearing Aid (Baha) than with a conventional behind-the-ear (BTE) device. The objective of the present study was to investigate whether this conclusion applies to today's digital BTEs with feedback cancellation and whether the crossover point still occurs at an air-bone gap of 25 to 30 dB. Study Design: Case control. Methods: Experienced unilateral Baha users with the latest digital Baha processors were fitted with a powerful BTE with feedback cancellation. After an acclimatization period of 4 weeks, Aided thresholds and speech recognition scores were determined and compared to those recorded previously with the Baha. To obtain patients' opinions, a disability-specific questionnaire was used. Participants comprised 16 subjects with bilateral mixed Hearing loss participated Results: Audiometric and speech recognition data showed similar trends to those described previously, but the crossover point had shifted to an air-bone gap of 30 to 35 dB. In the questionnaire, the BTE was rated higher than the Baha, except by the patients with an air-bone gap that exceeded an average of 45 dB. Conclusions: In patients with mixed Hearing loss whose air-bone gap exceeded 35 dB, speech recognition is likely to be better with a Baha than with a BTE. Therefore, the Baha should receive greater consideration when mixed Hearing loss is combined with a significant air-bone gap, even when there are no contraindications for BTEs. Laryngoscope, 2011

  • bone anchored Hearing Aids in patients with acquired and congenital unilateral inner ear deafness baha cros clinical evaluation of 56 cases
    Annals of Otology Rhinology and Laryngology, 2010
    Co-Authors: Sylvia J W Kunst, A F M Snik, Arjan J Bosman, Emmanuel A M Mylanus, Cor W R J Cremers
    Abstract:

    OBJECTIVES: We performed an evaluation of the audiological and subjective benefits of the Bone-Anchored Hearing Aid (Baha) as a device for transcranial routing of sound (Baha CROS) in 56 patients with unilateral inner ear deafness. METHODS: We performed a prospective clinical follow-up study in a tertiary referral center. Previously reported results of 29 patients were supplemented with a second series of 30 patients with unilateral inner ear deafness; 3 patients dropped out during the evaluation. Audiometric measurements were taken before and after Baha CROS fitting. Subjective benefits were quantified with 4 different patient questionnaires. RESULTS: The sound localization results in a well-structured test setting were not differentiable from chance. The 5 patients with congenital Hearing loss showed better scores in the unAided sound localization measurements. Overall, most patients reported some subjective improvement in their capacity to localize sounds with the Baha CROS in daily life. The main effect of the Baha CROS was to alleviate the head shadow effect during the speech-in-noise test. CONCLUSIONS: Poor sound localization in this larger series of patients confirms the findings of previous studies. Improvements in the speech-in-noise scores corroborated the efficacy of the Baha CROS in alleviating the head shadow effect. The 4 different patient questionnaires revealed subjective benefit and satisfaction in various domains.

  • pilot study on the effectiveness of the conventional cros the transcranial cros and the baha transcranial cros in adults with unilateral inner ear deafness
    European Archives of Oto-rhino-laryngology, 2010
    Co-Authors: Myrthe K S Hol, Sylvia J W Kunst, A F M Snik, Cor W R J Cremers
    Abstract:

    The objective of the present pilot study is to evaluate the effectiveness of three conventional contralateral routing of sound (CROS) Hearing Aids in adults with unilateral inner ear deafness. The study included tertiary referral center. Ten patients with unilateral inner ear deafness and normal Hearing in the contralateral ear were selected to evaluate three different methods of amplification: the CROS Hearing Aid, the completely in the canal Hearing Aid and the Bone-Anchored Hearing Aid CROS (BAHA). Each of the three Hearing Aids was tried in a random order for a period of 8 weeks. Audiometric performance, including speech-in-noise, directional Hearing and subjective benefit were measured after each trial period, using the APHAB, SSQ and single-sided deafness questionnaire. Sound localization performance was essentially at chance level in all four conditions. Mixed results were seen on the other patient outcome measures that alternated in favor of one of the three CROS devices. After the trial, three patients chose to be fitted with the BAHA CROS and one with the conventional CROS. In conclusion, most of the patients experienced some degree of benefit with each of the three Hearing Aids. Preference for one of the three Hearing Aids was independent of the order in which they were tried. It would be worthwhile to formulate selection criteria; still, we recommend that all patients with unilateral inner ear deafness should be offered a trial with at least the BAHA CROS.

  • bone anchored Hearing Aid surgery in older adults implant loss and skin reactions
    Annals of Otology Rhinology and Laryngology, 2009
    Co-Authors: Maarten J F De Wolf, Emmanuel A M Mylanus, Myrthe K S Hol, Cor W R J Cremers
    Abstract:

    Objectives:We evaluated the clinical outcome measures of fixture loss and skin reactions in older-adult users of percutaneous Bone-Anchored Hearing Aids (BAHAs).Methods:We performed a retrospective analysis of 224 older adults (at least 60 years of age) who underwent implantation of 248 implants with the simplified Nijmegen surgical technique between January 1995 and May 2007.Results:During a mean follow-up of 39 months (range, 0 to 144 months), 16 of the 248 implants were lost (6.5%). The causes were failed osseointegration in 9 cases, trauma in 6 cases, and implant loss in irradiated bone in 1 case. There were no losses due to infection. Implant loss was not significantly correlated with age. In 40 implants (16.9%), severe skin reactions of Holgers grade 2 or more were observed. Skin revision surgery was performed around 6 implants (2.4%). None of the patients had an 8.5-mm abutment to overcome severe skin reactions.Conclusions:The outcome of BAHA surgery in older adults was favorable. The rate of impla...

  • nijmegen results with application of a bone anchored Hearing Aid in children simplified surgical technique
    Annals of Otology Rhinology and Laryngology, 2008
    Co-Authors: Maarten J F De Wolf, Emmanuel A M Mylanus, Myrthe K S Hol, Patrick L M Huygen, Cor W R J Cremers
    Abstract:

    Objectives:A retrospective analysis was performed to evaluate the clinical outcome of percutaneous Bone-Anchored Hearing Aid (BAHA) application in children with the outcome measures of fixture loss and skin reactions.Methods:An analysis was done of 93 of the 101 children 16 years of age or younger who underwent the simplified Nijmegen surgical technique between January 1994 and July 2007.Results:Twenty-one of 129 fixtures (16.3%) were lost or removed. In 12 cases, osseointegration failed. The majority of the fixture losses (86%) occurred within 1 year after surgery. No differences were found between 3 age groups or between fixture lengths (seven 3-mm implants versus fourteen 4-mm implants). The BAHA fixtures were less stable in children than in adults. In 8 cases, Holgers grade 4 skin reactions were noted at an average (±SD) of 5.5 ± 4.7 months after surgery, ie, significantly sooner than the milder reactions (p = 0.001). In 28 cases (22%), skin reactions of Holgers grades 2 to 4 were observed. Revision s...

Christof Stieger - One of the best experts on this subject based on the ideXlab platform.

  • the floating mass transducer at the round window direct transmission or bone conduction
    Hearing Research, 2010
    Co-Authors: Andreas Arnold, Martin Kompis, Claudia Candreia, Flurin Pfiffner, Rudolf Hausler, Christof Stieger
    Abstract:

    The round window placement of a floating mass transducer (FMT) is a new approach for coupling an implantable Hearing system to the cochlea. We evaluated the vibration transfer to the cochlear fluids of an FMT placed at the round window (rwFMT) with special attention to the role of bone conduction. A posterior tympanotomy was performed on eleven ears of seven human whole head specimens. Several rwFMT setups were examined using laser Doppler vibrometry measurements at the stapes and the promontory. In three ears, the vibrations of a bone anchored Hearing Aid (BAHA) and an FMT fixed to the promontory (pFMT) were compared to explore the role of bone conduction. Vibration transmission to the measuring point at the stapes was best when the rwFMT was perpendicularly placed in the round window and underlayed with connective tissue. Fixation of the rwFMT to the round window exhibited significantly lower vibration transmission. Although measurable, bone conduction from the pFMT was much lower than that of the BAHA. Our results suggest that the rwFMT does not act as a small bone anchored Hearing Aid, but instead, acts as a direct vibratory stimulator of the round window membrane.

J S Quinn - One of the best experts on this subject based on the ideXlab platform.

  • how we do it a novel approach to the skin abutment interface of the bone anchored Hearing Aid use of local skin flaps
    Clinical Otolaryngology, 2006
    Co-Authors: R Persaud, N Papadimitriou, T Siva, P Kothari, J S Quinn
    Abstract:

    Various techniques involving skin grafts have been described to obtain thin hairless immobile skin at the abutment interface of the Bone-Anchored Hearing Aid (BAHA), but none are without significant complications such as necrosis and/or infection leading to total graft failure. A novel technique involving four local thin skin flaps was developed to prevent serious complications. The procedure essentially involves raising skin flaps at the intradermal level leaving the hair follicles in the subcutaneous tissue, which is subsequently excised. We have used the skin-flap approach around 21 BAHAs on 19 patients (two patients had bilateral devices) and the only complications were minor skin loss immediately adjacent to the implants in two patients and mild skin infections, which settled with topical antibiotics, in three patients. The innovative technique described is simple and straightforward, and does not require any special instrumentation. Furthermore, it may have specific advantages, in terms of morbidity, over contemporary skin grafting methods primarily because of the retained intrinsic blood supply of the skin flaps.

Paul G. C. Gluckman - One of the best experts on this subject based on the ideXlab platform.

  • wound related complications following full thickness skin graft versus split thickness skin graft on patients with bone anchored Hearing Aids
    Clinical Otolaryngology, 2005
    Co-Authors: G K Lekakis, A Najuko, Paul G. C. Gluckman
    Abstract:

    Objectives:  The aim of this study was to review complications occurring in bone anchored Hearing Aid (BAHA) patients in relation to wound healing following full thickness skin graft versus split thickness skin graft. Design:  Retrospective study. The medical notes of 22 patients who underwent insertion of BAHA over 24 months were reviewed. Setting:  ENT Department at a District General Hospital in the UK. Participants:  All patients were adults and underwent one stage procedure following the standard Branemark technique. In 11 cases the skin abutment interface was established by use of full thickness skin graft inset around the implant, and in the other 11 by use of split thickness skin graft. Main outcomes measures:  The incidence of delayed wound healing resulting in an increase of number of visits for change of wound dressings. In addition the degree of soft tissue reactions around the interface was examined. Results:  There was a clear difference between the split and full thickness skin graft groups in relation to the severity of adverse skin reactions and number of visits required for change of dressings. The split thickness group required from three minimum to 13 maximum (median 4) visits in outpatients during the initial observation period until healing was complete. The full thickness group demonstrated one minimum and three maximum (median 2) visits. Conclusions:  In our hands the full thickness skin graft is superior to a split thickness graft.

Anders Tjellstrom - One of the best experts on this subject based on the ideXlab platform.

  • Skin reactions after BAHA surgery: a comparison between the U-graft technique and the BAHA dermatome.
    Otology & Neurotology, 2008
    Co-Authors: Joacim Stalfors, Anders Tjellstrom
    Abstract:

    OBJECTIVE: To compare and evaluate 2 surgical methods for handling the soft tissues in Bone-Anchored Hearing Aid (BAHA) surgery: the U-graft technique versus the dermatome designed for BAHA site preparation. BACKGROUND: Skin reactions surrounding the percutaneous titanium abutment of the BAHA are a matter of clinical concern. Excessive residual soft tissue surrounding the implant is thought to be the principal cause of this complication. To address the challenge of adequately thinning the soft tissue, a dermatome has been introduced to facilitate BAHA site preparation. METHODS: All patients fitted with a BAHA between 2001 and 2004 at our clinic were included in the study. Resection of soft tissue associated with the use of the U-graft technique or the dermatome was documented. At follow-up, skin reactions were registered according to Holgers. Here, we comparatively analyze the fate of the implant site according to the soft tissue resection technique used. RESULTS: We used a U-shaped graft in 45 patients; the dermatome was used in 25 patients. A total of 373 observations were recorded in follow-up. In the U-shaped graft group, 29 (64%) of 45 patients experienced no adverse skin reactions. In the BAHA dermatome group, 21 (84%) of the 25 patients experienced no skin reactions. The difference in adverse skin reactions between the 2 groups was 19.6% (p = 0.14; 95% confidence interval, -3.6 to 42.7%). CONCLUSION: The BAHA dermatome is a tool, which achieves BAHA skin-healing outcomes at least as good as U-graft flaps created by long-experienced BAHA surgeons. Perhaps, this tool allow other BAHA surgeons to achieve similar outcomes without having to experience as many skin reactions as occurred in the evolution of skin management around BAHA abutments.

  • Transmission of bone-conducted sound in the human skull measured by cochlear vibrations
    International Journal of Audiology, 2008
    Co-Authors: Mans Eeg-olofsson, Anders Tjellstrom, Stefan Stenfelt, Gösta Granström
    Abstract:

    One limitation with the Bone Anchored Hearing Aid (Baha) is too poor amplification for patients with moderate to severe sensorineural Hearing losses. Therefore, we investigated if bone conducted (BC) sound transmission improves when the stimulation approaches the cochlea. Also the influence from the squamosal suture on BC sound transmission was investigated. Both sides of the heads on seven human cadavers were used and vibrational stimulation was applied at eight positions on each side with a frequency range of 0.1-10 kHz. A laser Doppler vibrometer was used to measure the resulting velocity of the cochlear promontory. It was found that the velocity of the promontory increases as the stimulation position approaches the cochlea; this was especially apparent at distances within 2.5 cm from the ear canal opening and when the stimulation position was in the opened mastoid. At frequencies above 500 Hz there was on average 10 to 20 dB greater vibrational response at the cochlea when the stimulation was close to the cochlea compared with the normal Baha position. Moreover, even if there were general indications of attenuation of BC sound when passing the squamosal suture, an effect from the suture could not be conclusively determined.

  • high age at the time of implant installation is correlated with increased loss of osseointegrated implants in the temporal bone
    Clinical Implant Dentistry and Related Research, 2007
    Co-Authors: Vassilis Drinias, Gösta Granström, Anders Tjellstrom
    Abstract:

    Background  The implant failure rate in temporal bone has been reported to be about 5 to 10% over a 10-year period. A number of our elderly patients have shown increased failure rates over a long time period, which is the reason for the present study. Purpose  The aim of the present study was to find out if age is correlated with implant failure and to measure blood flow in implant sites. Materials and Methods  The long-time survival of 131 osseointegrated implants installed in the temporal bones of 81 patients was correlated with the age of the patient at the time of installation. The blood flow in 37 fixture installation sites in 22 patients was recorded by means of laser Doppler flowmetry. Results  The mean implant failure rate in the study group was 9.8% after a mean follow-up time of 7.6 years. There was a significant increase of implant failure in patients above 60 years of age. There was further a trend that implants used for the Bone-Anchored Hearing Aid were lost to a higher proportion than implants used for Bone-Anchored episthesis. There was also a trend that female patients lost fewer implants than males. Blood flow in the temporal bone correlated well with the age of the patient in that the highest values were recorded from the youngest patients. Conclusions  Increasing age affects failures of osseointegrated implants in the temporal bone. Blood flow is higher in the child’s temporal bone, a factor that can be of importance to understand why age influences implant survival.