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Objectives: Considering the size of the electromagnetic bone conduction floating mass transducer of Bonebridge implant, its implantation requires adequate anatomical conditions. In case of patients after radical ear surgeries placement of internal part in the typical position, which is in the sinodural angle, may be difficult due to bone defects. The aim of this paper is presentation of a novel technique of Bonebridge implantation with one-time reconstruction of the posterior wall of the external auditory canal (EAC) with autogenous material in a patient after a radical surgery. We present a case of a patient with bilateral mixed hearing loss of moderate degree who, based on the results of laryngological and audiological evaluation, underwent surgery for a Bonebridge implantation. In view of the post-radical ear surgery status of the ear selected for implantation it has been decided to perform at the same time reconstruction of the posterior EAC wall with autogenous bone dust. Material and Methods: In this paper we present the surgical procedure of one-time implantation and reconstruction of the EAC wall as well as the assessment of the effects of the device application. At 12 months after surgery we have noted preserved and correct healing of the posterior EAC wall and hearing benefits involving improved hearing sensitivity and speech discrimination. Results and Conclusions: In the presented case the surgical technique combining simultaneous reconstruction of the posterior EAC and implantation of a bone conduction device has enabled reducing the size of the postoperative cavity, thus facilitating its future debridement and, by covering the floating mass transducer has separated it from the external environment allowing its proper placement. Stable auditory results and local conditions after the posterior EAC wall reconstruction in our case suggest that this method may be an alternative for other bone conduction devices in patients with extensive bony defects. [ABSTRACT FROM AUTHOR]

The main problem of rehabilitation of unilateral conductive hearing loss (UCHL) with a hearing device or surgical repair is that the treated impaired ear has to compete with the normal hearing ear. Because of the impressive capacities of a normal hearing ear, rehabilitation results in a significant hearing asymmetry (20 -30 dB in children), and unilateral absence of spectral information processing. We review binaural hearing data as obtained after treatment in a population of subjects with congenital UCHL. Several measures addressing binaural hearing after treatment have been studied, e.g. directional hearing (detection of interaural time and level differences), binaural summation, binaural squelch and the effective use of head shadow. Whenever possible, binaural outcomes are compared with values obtained in normal hearing subjects, using the same tests. Included in this review are 11 papers, describing results in 169 subjects with treated unilateral aural atresia. Six papers presented binaural data gathered after atresia repair and five papers after application of either a percutaneous bone-conduction device (BCD), an active transcutaneous BCD, a passive transcutaneous BCD or an active middle ear implant. Binaural scores were collected and compared to norm values. Mean binaural scores are expressed, as z-scores; if z < 2 then the mean score falls within the normal range. Subjects with unilateral amplification do not perform as good as normal hearing listeners. It remains uncertain to conclude whether subjects with congenital UCHL have an equal chance for optimal rehabilitation compared to subjects with acquired UCHL. Subjects from the latter group can benefit from a maturated auditory system once they are aided. The congenital group might benefit from auditory system development while in the aided situation. When consistent amplification, although resulting in an asymmetrical input, is present during a certain critical period, it might result in better handling of the listening situation. [ABSTRACT FROM AUTHOR]

Traditionally, Auditory Rehabilitation is carried out with support from a Speech and Language Therapist, usually in a clinical centre. Training may be required to acquire optimal performance from a Cochlear Implant, for example, speech recognition in challenging situations such as distance, background noise, different speakers, telephone use, etc. In addition, sequential cochlear implantation and new indications, such as SSD or asymmetrical hearing loss, require intense and specific auditory training. Clinical studies of auditory plasticity following placement of Cochlear implants suggests that additional auditory training may be needed for reorganization of the brain to occur (1). Traditionally, this training has required an economic and time effort on the part of the patient, family or caregivers. The literature also emphasizes many reasons that support the importance of daily practice taking advantage of routine activities and in natural contexts (2). There are software programs designed for this purpose, but there may be barriers to access such as cost and technical equipment requirements, etc.(3) This paper will present one approach to empowering Cochlear Implant recipients to use the opportunities for listening practice and rehabilitation afforded by the Nucleus 7 sound processor and streaming with IOS devices. Options for using a range of different commercially available apps, many of them free, will be shared along with ideas for using data streaming, not always with a specific educational purpose, but through activities that can be more pleasant, engaging and entertaining for the patient such as listening to audiobooks, podcasts and other listening resources to build auditory experience and confidence. This paper will present options for using the N7 MFI processor for self-directed rehabilitation using streaming, to provide the patient with training possibilities tailored to his or her interests and needs, adapted to maximize and motivate their time availability; the incentive being the ability to select and design their own varied listening program. The key elements of how to support and motivate recipients to design their own listening program plus the options and how this has been applied in clinical practice as well as clinical examples and outcomes will be addressed. 1. Polonenko, Melissa Jane,Gordon, Karen Ann, Cushing, Sharon Lynn, Papsin, Blake Croll. Cortical organization restored by cochlear implantation in young children with single sided deafness. Scientific Reports. 04.12.2017. DOI:10.1038/s41598-017-17129-z 2. Lone Percy-Smith, Tenna Lindbjerg Tønning, Jane Lignel Josvassen, Jeanette Hølledig Mikkelsen, Lena Nissen, Eveline Dieleman, Maria Hallstrøm & Per Cayé-Thomasen. Auditory verbal habilitation is associated with improved outcome for children with cochlear implant. Cochlear Implants International Vol. 19, Iss. 1, 2018 3. Olson AD. Options for Auditory Training for Adults with Hearing Loss. Seminars in Hearing. 2015;36(4):284-295. doi:10.1055/s-0035-1564461. [ABSTRACT FROM AUTHOR]

Recent trends in bone conducting hearing implant technology have led to the development of a range of transcutaneous (i.e. no skin penetrating components) devices, both for bone conduction hearing devices and middle ear implants. Transcutaneous devices promise the possibility of fewer wound complications, but are surgically more complex. Two such devices are MED-EL's Bonebridge bone conduction hearing device and Vibrant Soundbridge middle ear implant. As part of both a multicentre NHS UK study to review the long term complication rates and reliability and the development of a UK national registry of the outcomes of the Bonebridge and Vibrant Soundbridge, intra-operative and post-operative surgical questionnaires have been developed for both devices. This paper reports the development of these questionnaires through an iterative process based on available literature and expert review [ABSTRACT FROM AUTHOR]

Introduction: Cochlear implants have revolutionised the management of patients with severe to profound sensorineural losses. Preoperative investigations involve radiological assessment of the cochlear by MRI scan, CT imaging or both. For parents and patients one of the main focuses is understanding and hopefully having surgery. In our unit patients have choice of devices. The reasons for varied are quite varied. Issues such as accessories and water compatibility appear to be significant factors to the patients and families. Clinically, it is clearly understood that the magnetic components, and to a certain degree the internal electronics, have a compatibility issue with MRI scanning. Some devices require removal of magnets. Others, are conditional to 1.5 Tesla. No matter what system is used significant voids and distortions are produced by the magnet when imaging the brain. There is a high chance that a child would require an MRI during his/her lifetime. Information from Germany indicates 114 MRI / 1000 inhabitants with head scans using CT / MRI being fairly equal (55% v 45%). Spine and extremities have higher proportion of MRI. The aim of this paper is to investigate what information is given pre implant to ensure informed consent is given. How issues are managed in the acute and non-acute situation will be reviewed. Methods: A survey was sent to all UK implant centres asking them about the giving of information, formal surgical consent, their experience of dealing with patients potentially needing and actually having MRI scans. Final questions focused on any subsequent issues that arose. Results were used to compare our practice and subsequent management. Results: 22 centres were approached and 18 replied. - Is departmental information given about MRI scanning? 69% No - Which/how is MRI related information is given? - Verbal 38%, - BCIG safety guidelines 35%, - Manufactures literature 23%, - No specific advice 4%. - Specifically mentioned at surgical consent? Yes 46% - In the past 12 months; median (range) - What external request for advice has been received? - 3 (1 - 25) - What number of actual known MRI scans have your patients had? - 2 (1 - 10) several centres did not know.- What reported issues have been reported? - demagnetised; displacement; pain. Conclusion: MRI scanning can be performed without side effects. However, there does seem to be a range of patient experiences and varied outcomes. As a result of our own experience we have developed a mould to cover the implant and offer local anaesthetic before firm head bandaging. From the survey reasons behind the need for an MRI scan should always be investigated. Would other imaging such a s CT +/- contrast be more appropriate? Also, clearly we need to pay more attention to consenting with future MRI scanning. [ABSTRACT FROM AUTHOR]

Introduction: The goal of all surgery is the best results with the least possible damage to anatomical structures involved in the procedure. This premise has led in recent years to find methods that allow us to reduce the risks associated with surgery. In the case of cochlear implant surgery, in recent years many surgical techniques have been described. This paper presents our experience in cochlear implant surgery assisted with endoscopy. Objective: To describe the usefulness of the endoscopy in the classical approach to cochlear implant surgery Method: Retrospective study from September 2015 to January 2018 in the Sótero del Rio Hospital. During this period 49 surgeries were performed with this technique. All were evaluated previously with audiological and imaging studies. Surgery was performed with an anterior tympanomeatal flap, identifying the anatomy of the middle ear. Later mastoidectomy and posterior tympanotomy is made. One advantage of this technique is that the posterior tympanotomy is smaller. Once this process is completed, opening round window and inserting the electrode in the scala tympani is performed. Result: Endoscopic Assisted Cochlear Implant had no complications, 100% of the inserts were by round window into the scala tympani. In one patient with inner ear malformation (incomplete partition), it allowed detailed visualization of the middle ear. The same occurs in a patient with a bilateral cochlear fracture. In 4 patients with advanced otosclerosis, there was no problem in the approach to the round window or the insertion of the electrodes. There were no problems with the tympanomeatal or infections. Conclusion: The use of endoscopy seems a good tool with many advantages for cochlear implant surgery independent of alterations that may exist in both the middle ear and internal ear. [ABSTRACT FROM AUTHOR]

Objectives: Main aim of the cochlear implantation in congenital or acquired total and partial deafness is provision of development of hearing, speech and communicaton skills. Excellent results of rehabilitation in a group of implanted patients made the development of artistic skills of patients a measure of progress in therapy. Results of active and passive music therapy indicate that children rehabilitated with music have accelerated auditory development have as well as developed their cognition. The best results were obtained in patients rehabilitated with active music therapy (systematic music training. Aim of this paper is to present a study of implanted patients whose hearing development was supported with acvtive and passive music therapy. Material and methods: Material includes a group of CI patients presenting musical skills. All patients were operated according to the 6 step Skarzynski's precedure. Patients using active and passive music therapy accelerated the process of hearing rehabilitation. In addition, they have developed other skills, including linguistic, communication, cognitive and general development skills. Results and conclusions: In all operated patients, the standard- shaped, and personalized post-operative rehabilitation program was supplemented with musical activities. Inclusion of musical activities contributed to the intensification of the rehabilitation program and quick acquisition of auditory, linguistic and additionally musical skills. At the same time, in the group of teenage and adult patients, the positive influence of music contributed to the reduction or elimination of tinnitus. Results: Supplementing the traditional post-operative rehabilitation program after cochlear implantation in various types of deafness and profound sensorineural hearing loss with properly selected musical elements has a significant impact on the acquisition of auditory, linguistic, musical and general development skills. It also reduces tinnitus. [ABSTRACT FROM AUTHOR]

Cochlear implant site infection and/or skin extrusion remain challenging issues in cochlear implant field. Staged procedures with implant removal is the standard treatment in most of cochlear implant centers. However, in many areas, this may be very difficult due to budget restrain. In this paper, I'm going to present our personal experiences in managing those cases without removal of the implant. We had total of 6 cases of either postoperative infection with skin breakdown or skin breakdown over the implant with infection. We could treat 5 cases without removal of the implant. The key steps are covering the implant with skin flap together with use of local antibiotic powders over the implant (in the 5 cases we used vancomycin powder). The failure case in which we had to remove the implant had vancomycin hypersensitivity. We believe that there is a chance with this technique to treat implant site infection and biofilm formation without removal of the implant with high success rate. [ABSTRACT FROM AUTHOR]

Objectives :Deafness affects the lives of children which were born deaf. Cochlear implantation offers a solution for the development of language skills, and often, the implanted children manage to catch up with their hearing peers. Early diagnosis and implantation, as well as the appropriate type of intervention are of upmost importance for the efficiency of cochlear implantation. In this paper, we deal with factors of pediatric patients' management strongly impacting the development of communication skills early after cochlear implantation. The literature reports several investigations on the management of the hearing recovery procedures after cochlear implantation, or the achievement indicators in communication of preschool implanted children, however examined in isolation from each other. In this work, we move towards the development of a questionnaire that will encompass both of these factors and will attempt to investigate their potential relations and relevance. Methods: We propose a novel questionnaire resulting from the reprocessing of established and commonly used questionnaires (CAP, SIR, GBI, MEDEL LittlEARS Auditory Questionnaire and a questionnaire constructed after a joint research project between the Attikon Hospital 2nd ENT University Clinic, Athens, Greece and the AHEPA Hospital 1st ENT University Clinic, Thessaloniki, Greece), with item selection based on comparative and correlational control in which communality between questions was compensated by exclusion after expert paneling. Results and Conclusions: Aspects of the construction and initial evaluation are presented together with a planning towards analyzing of relations between factors of pediatric CI population management and performance achievement. The application of the questionnaire to a larger sample will hopefully provide important information and constitute a useful guide for parents and specialists involved in the restoration and rehabilitation process chain of implanted children. [ABSTRACT FROM AUTHOR]

The cochlear implant is a technical and surgical creation, being the first direct connection between the brain and an electronic device, opening new perspectives in the field of neurobiology. The purpose of the study was to investigate the variations in the impedance values of intraohlear electrodes in implanted patients, taking measurements in three different stages: intraoperatively, upon activation of the cochlear implant (1 month after surgery) and to the first fitting after activation. This study is a retrospective view on patients who underwent implantation of a cochlear implant. The general objective of this paper, what we are focusing on, will show the change in impedance measurement before and after nerve stimulation, meaning during the operation, at the time of device activation and at the first fitting. This monitors the function of- and the healing process around the electrode which reflects the success rate. This may show that continuous electrical stimulation and repeated measurement of electrical is important for sufficient setting and functioning of the complete device and each electrode, and might be beneficial as not only a diagnostic or monitoring, but also as a therapeutic tool in cochlear implantation and fitting process. [ABSTRACT FROM AUTHOR]

This paper will present a case study of a post-lingually deaf adult who reported a significant difference in pitch perception between the two ears after receiving sequential bilateral cochlear implants. In spite of one ear sounding lower in pitch than the other, speech perception tests using open set sentences showed maximum scores in each individual ear. Inter-aural comparison of pitch perception of every electrode in each ear confirmed patient's report that one side sounded lower in pitch than the other. Imaging studies of the petrous temporal bones using high resolution CT-scans revealed cochlear implant electrode array insertion to be deeper in the ear with lower pitch perception in comparison to the side with higher pitch perception. Interestingly, 6 months after consistent usage of bilateral cochlear implants, the difference in pitch between the two ears was no longer noticed suggesting that neural plasticity had taken place. [ABSTRACT FROM AUTHOR]

Objectives. It has been suggested that the density of spiral ganglion neurons will affect on speech intelligibility. The results of previous studies shows that the supra-threshold characteristics of the Evoked Compound Action Potentials (ECAP) characterize the condition of spiral ganglion neurons. Aim of this paper is to evaluate the dependence of maximum comfort levels on ECAP parameters (threshold and amplitude). Materials and methods. The study included fitting data of 20 patients with sensorineural hearing loss with unilateral cochlear implantation. All patients were implanted with the Med-El (Sonata or Concerto) CI system with a standard electrode array. The results of electrodes impedance did not exceed 10 kΩ. Auditory development was assessed depending on the age of the patient and the condition of the hearing skills. Recognition results exceeded 90%. Results. A correlation between comfort levels and ECAP thresholds was found. The values of the comfort levels were reduced when ECAP amplitude was increased. Conclusions. ECAP thresholds can not be considered as an absolute reference point for determining the CI comfort levels. The amplitude of the ECAP response is one of the indicators of the preservation of the neurons of the auditory nerve. The correlation of the ECAP thresholds and comfort levels higher when ECAP amplitude values increase. [ABSTRACT FROM AUTHOR]

Background: Increases in the demand and range of cochlear implant services due to expanded criteria over the past 30 years have not correlated with increases in funding. Quality standards for CI service delivery must be maintained. This paper outlines the mapping of value stream of the CI model of service and the financial implications for ensuring standard of care is maintained whilst maximising economic efficiencies. Method: A total of 56 intervals of service delivery over a 10 year period was mapped across the journey of adult CI recipients. A review of the profit and loss of service delivery over this 10 year period based on a range of parameters cost of service, recipient and clinician numbers and appointment types. Results: Results indicated that cochlear implant services were not profitable until 5 years post cochlear implantation. All service delivery prior to that point was running at a significant loss. Costs did not even out until approximately 9 years following cochlear implantation. Five areas emerged that showed cost inefficiencies. Conclusion: Cost inefficiencies of a cochlear implant service delivery model were identified using the value stream mapping approach. This enabled steps to be taken toward implementing a more sustainable model of CI service delivery whilst maintaining good quality of care. [ABSTRACT FROM AUTHOR]

In the past decade, numerous papers have published on variability in speech recognition in adults with a cochlear implant (CI). Many variables thought to influence the outcome of cochlear implantation have been investigated both in retrospective and prospective studies. In this study, we investigated different biographic, audiologic and electrode position related variables for their relation with speech recognition performance in both quiet and in noise. Participants were 134 adults with post-lingual onset of deafness, with Cochlear CI systems (either with a Contour Advanced or with a Slim Straight electrode) implanted at one single CI center. Biographic factors were: age, level of education and psychological screening questionnaires. Audiologic factors were: duration of hearing loss, and pre-implantation speech recognition scores. The electrode position was determined on a high-resolution CTscan post-implantation, using "Matlab" software. Electrode position variables were: electrode scalar position, electrode insertion angle and wrapping factor (electrode proximity to the modiolus). NVA-wordlists, (55 dB and 70 dB) were used to measure speech recognition scores in quiet at three time-points post-implantation: three months, 12 months and at the time of post-implantation CT-scan. Speech recognition scores in noise were assessed using the digits-innoise (DIN) test at 12 or more months post-implantation. To investigate the influence of biographic, audiologic and electrode position related variables of adult CI patients on speech perception performance in quiet and in noise, we used multivariate linear regression analysis. [ABSTRACT FROM AUTHOR]

Background: An increased number of children and adults with SSD receiving cochlear implants over the past 10 years has guided clinical protocols for evaluation and ongoing management. The benefits of CI are clear for hearing in background noise, localising sound, and decreased overall listening effort. This paper will provide an outline of SCIC's protocols including pre-operative support and counselling, guidelines for device programming, & rehabilitation. Outcomes and rate of progress will also be discussed. Methods: A total of 65 people with SSD were included in this retrospective review of management pathways. This included 5 groups of children that received specialist advice, assessment and management by a multidisciplinary team. These groups included those with absent auditory nerves, benefit from conventional devices, no devices who received ongoing monitoring, children who received a CI, and those suitable for CI, but did not proceed to surgery. Results: In adults, approximately 30% of those assessed chose to use a conventional device or have no intervention. Children who received CI's for SSD comprised only 29% of the children in the entire sample of those assessed. Auditory nerve was absent in 43% of the children. Recipients showed functional benefit on one or more of the subtests of the Speech Spatial Qualities questionnaire. Methodologies for device programming and rehabilitation varied across the cohort. A review of these processes was required for ensuring protocols were addressing client need. Conclusions: Evaluation and intervention protocols for SSD must take into account the onset and duration of the hearing loss; integrity of the cochlear nerve on the affected side; benefit received from other hearing devices; current functional hearing performance, and the investment in time and resources that will be required to facilitate the integration of the acoustic hearing from the better ear and electrical hearing. [ABSTRACT FROM AUTHOR]

Background: Auditory training (AT) is a sound-based intervention aimed at improving individuals' speech and hearing skills through varied listening exercises. It has been used with individuals using hearing aids and/or cochlear implants (CIs) to maximize benefit of hearing devices. Objective: The purpose of this systematic review PROSPERO (2017:CRD42017057346) is to evaluate the published research in AT for pediatric CI recipients. This review investigates whether AT in children with CIs leads to improvements in speech and language, cognition, and/or quality of life; and whether improvements, if any, remain over time post AT intervention. Outcomes of this review may help clinicians to make informed decisions about the usefulness and type of AT for pediatric CI users. Method: A systematic search of seven databases identified 96 papers published up until January 2017, 9 of which met the set criteria. Data were extracted and independently assessed for risk of bias and quality of study against a PICO framework. Results: All studies reported improvements in the trained AT tasks including speech discrimination/identification and working memory tasks. Retention of improvements overtime was found whenever it was assessed. Transfer of learning was measured in four out of six studies, which assessed generalization. Quality of life was not assessed in any of the reviewed studies. Level of evidence for the included studies was determined to be low. Conclusion: Benefits of AT were clearly illustrated through the improvement of all trained tasks across all studies regardless of the duration or type of training. Transfer of improvement to other domains and retention of benefits post AT were evident when assessed. However, higher quality evidence to further examine outcomes of AT in pediatric CI recipients is needed. [ABSTRACT FROM AUTHOR]

Introduction: Eosinophilic otitis media (EOM) is an uncommon type of chronic suppurative otitis media characterized by recurrent or persistent thick glue like discharge, resistant to medical treatment or tympanoplasty and progressive gradual deterioration of hearing. EOM is a challenging clinical entity which imposes difficulty management problem to otologists. Method: A case of a patient suffered bilateral discharging ear and bilateral profound hearing loss due to EOM underwent two sequential cochlear implantations were reported in this paper. And a literature review of cochlear implantation for patients suffering from hearing loss resulted from EOM is also presented. Results and Conclusion: Typically, patients suffering from EOM have strong atopic history including asthma, nasal polyposis, allergic rhinitis and drug allergy. Tympanoplasty and mastoidectomy were ineffective treatments for the inflammatory disease process. Repeated topical steroid to the middle ear or systemic steroid therapy can alleviate the local inflammation and decrease the ear discharge. However, topical or systemic steroid therapy will not alter the natural course of illness with progressive gradual deterioration of hearing and some patients will eventually suffer from bilateral profound deafness. As reported in the literature, cochlear implantation is a feasible treatment of deafness in patients suffering from EOM. In our opinion, it is necessary to eradicate the mucosal disease in the middle ear and isolated the middle ear and the surgical implant to prevent secondary bacterial infection. [ABSTRACT FROM AUTHOR]

Aim: To assess whether a single, peri-operative, high dose of methylprednisolone can improve hearing preservation following cochlear implantation (CI). Methods: Patients with hearing at 85 dB or better at 500 Hz in the ear to be implanted were randomly allocated to either treatment (methylprednisolone, 1g i.v. on induction of anaesthesia) or control (normal saline infusion). All patients received a routine "anaesthetic" dose of dexamethasone (8 mg i.v. on induction of anaesthesia). Implantation was undertaken with Cochlear's Slim Straight electrode via the round window. Audiometry was performed prior to implantation, and again at 3 and 12 months. The primary outcome was the level of residual hearing 12 months following cochlear implantation. Secondary outcomes included audiometry, lectrode impedance, and speech perception scores at 3 and 12 months after surgery. Results: Forty-six patients were enrolled into the control group and 48 patients received the steroid. There was no statistical difference in hearing at 12 months, nor at 3 months following surgery. Electrode impedances did not differ between the groups. Conclusions: There is an extensive experimental literature to suggest that steroids can reduce the loss of residual hearing during CI surgery, including when the steroid is given systemically. This paper demonstrates that high-dose local steroid injection at surgery is not effective in preventing a loss of residual hearing. Similarly, electrode impedances are not reduced by the high-dose steroid regime. Recent studies have suggested that steroid treatment may be more effective if used for a period of weeks after implantation. Future studies should explore this approach, or prolonged local steroid delivery via the cochlear implant. [ABSTRACT FROM AUTHOR]

Over the last decade there have been a number of seismic shifts in the hearing implant landscape. This has been led by marked advances in hearing implant technology, surgery and rehabilitation. The criteria for cochlear implantation has broadened dramatically for all ages. At the same time, there has been heightened clinical expertise in hearing implants demonstrated by clinicians across the industry. People are now more knowledgeable and demanding of independent decision-making so they can actively control their own hearing implant care. Australia has excellent access to cochlear implant innovation, technology and clinical care, with well qualified medical and allied health professionals. When indicated, hearing implants are available for unilateral and bilateral hearing losses, in children and adults and across all socioeconomic strata. Despite this rich and ripe environment, we have in Australia the embarrassing statistic that only one in ten adults who could benefit from a cochlear implant eventually accesses the benefit of such technology. Furthermore, those people who eventually do receive a cochlear implant often do so after years of unnecessary and unacceptable delay. This inadequacy is a reflection of a wanting healthcare delivery model for implantable hearing solutions in Australia, particularly in its regional areas. Presently there are the technological tools to address this, including e-consultation, remote programming and the utilisation of cloud--based technology. This paper will review an innovative new hearing health service established in Australia and take a detailed look at the barriers experienced by people considering hearing implants and how each are being address to improve access to implantable hearing devices. this includes challenging all medical and hearing clinicians to rethink, revisit and re-shape the means of referring people for the hearing implant care they need and deserve. [ABSTRACT FROM AUTHOR]

Introduction: There are many rehabilitation tools and programs available for adults receiving cochlear implants, with a strong emphasis on self management. Recipient suitability of technology based tools varies, hence the CI clinician must identify the most appropriate methodology for their client. Further, these tools, do not provide the opportunities to develop the social wellbeing that many recipients seek following CI. This paper will identify methods of supporting adult CI recipients through the use of available resources as well as identifying the role of direct traditional 1:1 therapy and the use of volunteers in the rehabilitation process. Method: Two to four weeks post device activation clients were screened to determine and review preoperative goals to determine rehabilitation approaches to be used. Outcomes were measured following a series of individual sessions; therapy supported through self management with support from a volunteer or a combination of both. Results : One or more of the client goals were achieved in all conditions within the period of intervention following device activation. Subjective data and self rating scores showed no significant difference regardless of the type of intervention provided. A longer term rehabilitation program was required in most of the cases which was readily accommodated through ongoing self management and volunteer support. Conclusion : A blend of post operative auditory training approaches in the acute phase following device activation was recommended for clients requiring support in their rehabilitation process. Generalisation of skills was facilitated through the use of volunteers and through self management following a period of individual sessions whereby the recipient gained confidence in their skills and abilities. This study provided a template for managing newly implanted CI recipients across the organisation to ensure that immediate and longitudinal training needs were. [ABSTRACT FROM AUTHOR]

Background: There are cases of hearing loss, where air conduction prostheses either cannot be used at all or there are significant limitations as to their use. For this group of patients, an alternative can be bone conduction systems. Currently in clinical practice there are several systems of this type -- some of them do not require surgical intervention, but others are partially implantable. The aim of this paper is the compare modern bone conduction systems, i.e. BAHA Attract and ADHEAR. Although both devices are not percutaneous, the former one requires screw and magnate implantation, the latter one is non-implantable. The systems differ in the method of mounting the processor and transmission of bone vibrations. Those differences influence the range of indications, application possibilities and comfort of use. Material and Methods : The study involved a group of 5 adult patients from the Institute of Physiology and Pathology of Hearing with unilateral or bilateral conductive hearing loss, who use BAHA Attract system in one ear. Audiometric tests in free field -- audiometry, speech audiometry in quiet and noise both unaided and aided with BAHA Attract and ADHEAR system -- were performed in all patients. Results: The obtained results indicate a statistically significant improvements both in audiometry and word tests in free field after the BAHA Attract and ADHEAR systems had been used. In both solutions comparable results were obtained in terms of increasing both the sensitivity of hearing and speech discrimination. Conclusions: Those preliminary results indicate a comparable effectiveness of the presented solutions, however, due to a small group of patients, it is recommended to continue studies. The analysis of the history of the development of bone conduction systems shows a clear tendency to use transcutaneous devices, thus minimalizing dermatological complications. Manufacturers of those devices, trying to meet patients' needs, create more and more modern systems, which not only are characterised by a higher degree of technological sophistication but also the location and nature of the transmission of vibrations allows safer and more comfortable use of the prosthesis. [ABSTRACT FROM AUTHOR]

Introduction : Longitudinal use of telepractice as a model for service delivery is reliant on integration of new technologies and practices whilst adhering to basic principles underpinning quality standards of care. This paper will focus on innovations that have made the longevity of the telepractice model possible for all aspects of CI management, with particular focus on an APP that has been designed and verified for use in measuring speech discrimination in enabling self efficacy of clients with ongoing evaluation and monitoring of performance. Method: A model to evaluate effectiveness and efficiencies of telepractice in clinical service delivery was used to evaluate evaluation, mapping and rehabilitation of CI recipients using telepractice. Clients, clinicians and facilitators in the telepractice process completed survey's questionnaires and outcomes measured to provide this information. Results :Effectiveness of speech discrimination measures were not impacted by the service model. This is consistent with longitudinal findings from the implementation of telepractice in other aspects of cochlear implant management including counselling, device mapping, and rehabilitation. Efficiencies in timeliness of service and reductions in travel time were reported. Satisfaction ratings revealed that most of the clients felt more integrated into their device management and reported a deeper understanding of their technology and the processes involved. Conclusion : Longitudinal implementation of telepractice model must readily adapt to new technologies and the evolving landscape within the field of CI. Evidence is required to ensure that any changes to the model are efficient and effective. Telepractice models will continue to evolve for all aspects of management for CI and can provide a service delivery model that can benefit a range of clients. [ABSTRACT FROM AUTHOR]

In far the most cases spiral canal ossification primarily affects the descending part of the basal turn. In this paper the method of atraumatic drilling of the ossified spiral canal is proposed. In the experimental procedure on 25 cadaveric temporal bones we revealed that the distance between round window membrane and basal turn curvature equals 8.0 mm; the width of labyrinthine capsule which borders spiral canal and internal auditory canal amounts to 0.36 mm and its width between spiral canal and internal carotid artery accounts for 0.77 mm. The original method, which is based on atraumatic drilling out of the ossification, was put forward. The drilling starts from the ossified round window membrane and proceeds till the basal turn curvature. Notable color difference between otic capsule and ossified tissue is observed: labyrinth capsule tends to look greyish and ossified tissue -- whitish. This enables gradual drilling out of the ossification along the descending part of the cochlea basal turn and preservation of modiolus. Taking into consideration close adjacency of the internal auditory canal and internal carotid artery lateral basal turn wall should always be kept in mind the landmark. The above-described surgical technique was applied in 62 patients with the ossification of the basal turn descending part. In 22 cases the length of the ossified spiral canal varied from 1 to 3 mm, in 40 patients it was in the interval of 4-6 mm and proceeded till the basal turn curvature. In all the 62 patients the proposed method enabled adequate approach to the cochlea spiral canal and full CONCERTO (MED-EL, Innsbruck, Austria) standard electrode insertion. In these cases only straight rigid electrode can be used to make its way through the drilled out spiral canal lumen. Postoperative audiological performance of the implanted patients correlated with the ones without ossification. [ABSTRACT FROM AUTHOR]