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Resumen Introduccion y objetivos En la ultima decada se han producido numerosos y relevantes avances en el tratamiento de la hipoacusia transmisiva y mixta que han desembocado en una ampliacion de las indicaciones de los implantes de conduccion de via osea y la aparicion de nuevos dispositivos. La Comision Cientifica de Audiologia de la Sociedad Espanola de Otorrinolaringologia y Cirugia de Cabeza y Cuello (SEORL-CCC), junto con las comisiones de Otologia y Otoneurologia, ha llevado a cabo una revision del estado actual de los implantes de via osea con la finalidad de ofrecer a los especialistas de Otorrinolaringologia, a los profesionales de la sanidad, a las autoridades sanitarias y a la sociedad en general una guia clinica sobre implantes de conduccion de via osea. Metodos Esta guia clinica sobre implantes de conduccion osea contiene informacion sobre los siguientes temas: 1) definicion y descripcion de los implantes auditivos de via osea; 2) indicaciones actuales y emergentes de los implantes de via osea; compatibilidad y resonancia magnetica, y 3) requisitos organizativos para un programa de implantes de via osea. Resultado y conclusiones La finalidad de esta guia es describir los diferentes sistemas de conduccion osea, sus particularidades e indicaciones, con el objeto de aportar unas coordenadas que ayuden a todos estos agentes en las tomas de decisiones que deban asumir en los diferentes ambitos de responsabilidad en los que estan enmarcados en sus areas de trabajo.

Older adults with mild or no hearing loss make more errors and expend more effort listening to speech. Cochlear implants (CI) restore hearing to deaf patients but with limited fidelity. We hypothesized that patient-reported hearing and health-related quality of life in CI patients may similarly vary according to age. Speech Spatial Qualities (SSQ) of hearing scale and Health Utilities Index Mark III (HUI) questionnaires were administered to 543 unilaterally implanted adults across Europe, South Africa, and South America. Data were acquired before surgery and at 1, 2, and 3 years post-surgery. Data were analyzed using linear mixed models with visit, age group (18–34, 35–44, 45–54, 55–64, and 65+), and side of implant as main factors and adjusted for other covariates. Tinnitus and dizziness prevalence did not vary with age, but older groups had more preoperative hearing. Preoperatively and postoperatively, SSQ scores were significantly higher (Δ0.75–0.82) for those aged

Objectives: To assess subjectively perceived, real-world benefits longitudinally for unilateral cochlear implant (CI) recipients in a multinational population treated routinely. To identify possible predictors of self-reported benefits. Design: This was a prospective, multicenter, repeated-measures study. Self-assessment of performance at preimplantation and postimplantation at 1, 2, and 3 years using standardized, validated, local language versions of the Speech, Spatial, and Qualities of Hearing Scale (SSQ), and the Health Utilities Index Mark 3 (HUI3) was performed. Outcomes were analyzed using a longitudinal mixed-effects model incorporating country effect. Patient demographics were explored for associations with change over time. Subjects: Two hundred ninety-one routinely treated, unilateral CI recipients, aged 13-81 years, from 9 clinics across 4 countries. Results: Highly significant improvements were observed for all outcome measures (p < 0.0001). Postimplantation, mean outcome scores remained stable beyond 1 year, with notable individual variability. A significant association for one or more outcomes with preimplantation contralateral hearing aid use, telephone use, age at implantation, implantation side, preimplantation comorbidities, dizziness, and tinnitus was observed (p < 0.004). Conclusions: Longitudinal benefits of CI treatment can be measured using clinically standardized self-assessment tools to provide a holistic view of patient-related benefits in routine clinical practice for aggregated data from multinational populations. Self-reported outcomes can provide medical-based evidence regarding CI treatment to support decision-making by health service providers.

Introduction and goals During the last decade there have been multiple and relevant advances in conduction and mixed hearing loss treatment. These advances and the appearance of new devices have extended the indications for bone-conduction implants. The Scientific Committee of Audiology of the Sociedad Espanola de Otorrinolaringologia y Cirugia de Cabeza y Cuello SEORL-CCC (Spanish Society of Otolaryngology and Head and Neck Surgery), together with the Otology and Otoneurology Committees, have undertaken a review of the current state of bone-conduction devices with updated information, to provide a clinical guideline on bone-conduction implants for otorhinolaryngology specialists, health professionals, health authorities and society in general. Methods This clinical guideline on bone-conduction implants contains information on the following: (1) Definition and description of bone-conduction devices; (2) Current and upcoming indications for bone conduction devices: Magnetic resonance compatibility; (3) Organisation requirements for a bone-conduction implant programme. Results and conclusions The purpose of this guideline is to describe the different bone-conduction implants, their characteristics and their indications, and to provide coordinated instructions for all the above-mentioned agents for decision making within their specific work areas.

A cochlear implant (CI) programme brings together a number of professionals who, during the stages of selection, surgery, programming, rehabilitation and monitoring, develop a series of tasks aimed at promoting comprehensive attention to the implanted patient. The aim of this paper was to describe in detail the tasks in each of the phases described in a programme of CI, materials and necessary equipment and the role of the professionals involved. It also raised a number of recommendations on how to develop a CI programme gradually to facilitate the progression from the simplest to the most complex cases.

The study aim was to determine the benefit of cochlear im- plantation and hearing aids in older adults diagnosed with hearing loss and to evaluate the index of depression, anxiety and quality of life after such treatments. A retrospective co- hort comprised 117 patients older than 65 years and diag- nosed with moderate to profound hearing loss who were included and classified into 2 groups (treated vs. non-treat- ed). A battery of tests including auditory (pure-tone average, disyllabic words in quiet at 65 dB SPL) and findings from a series of questions relevant to quality of life were compared between both groups. Auditory outcomes for disyllabic words were 58.21% for the cochlear implant-treated group and 82.8% for the hearing aid-treated group. There was a positive effect on anxiety, depression, health status and quality of life in the cochlear implant group versus the pro- found hearing loss control group. We conclude that older adults with moderate to profound hearing loss gain benefit from hearing aids or cochlear implants not only in terms of improved hearing function, but also in terms of positive ef- fects on anxiety, depression, health status and quality of life.

Patients with cochlear implants should be treated no differently than non-implanted patients with similar symptomatology.To describe the spectrum of symptomatology, treatment, and long-term follow-up of patients with cochlear implant and vestibular complaints.This retrospective study included 25 patients with late onset vestibular complaints (more than 1 month post-implantation). Each patient underwent an extensive interrogatory and physical exam with ancillary test to complete a diagnosis. Treatment was given according to this and all patients followed a vestibular rehabilitation program.The total population was 72% male and 28% female, median age was 58 years; minimal follow-up was 9 months (mean = 51, median = 34). Cochleostomy was performed in eight cases and round window insertion was performed in 19 (two patients were removed from each group in the analysis due to their bilateral implantation under a different approach). The mean time from implant to vestibular symptoms was 53 months, median = 32; a Kaplan Meier graphic showed the round window approach has faster onset of symptoms with statistical significance (p = 0.020). The most common complaint was instability in all patients and after both surgical approaches. No difference in symptoms was found with a Kruskall Wallis test except for vertigo spells (more common in the round window approach). In 12 patients the symptomatology was attributed to the implanted side. In the long-term follow-up a relatively high number of patients (20/25) recovered with standard treatment, suggesting the presence of the implant is not associated with poor recovery prognosis.

Resumen Un programa de implantes cocleares (IC) reune a una serie de profesionales, que durante las fases de seleccion, cirugia, programacion, rehabilitacion y seguimiento, desarrollan una serie de tareas enfocadas a promover una atencion integral al paciente implantado. El objetivo de esta publicacion es describir con detalle cuales son las tareas a realizar en cada una de las fases descritas en un programa de IC, los materiales y equipos necesarios, y el papel que juegan los profesionales implicados. Asi mismo, se plantearan una serie de recomendaciones sobre como desarrollar de forma paulatina un programa de IC, con el fin de facilitar su progresion desde los casos mas sencillos a los mas complejos.

The Nucleus CI24RE Freedom device offers higher stimulation rates and lower noise levels in action potential measurements (ECAPs) than previous devices. A study including ten European implant teams showed that the effect of changes in rate from 250 to 3500 pulses per second on tilt and curvature of the T and C profiles is insignificant. When changing rate one may change the levels at all electrodes by the same amount. Using an automated procedure ECAPs could be measured quickly and reliably at a noise level of only 1 μV. However, this did not result in improved correlations between the tilt and curvature parameters of the ECAP profiles and those of the T and C profiles. Average C levels appear to differ markedly among implant centers; a better assessment protocol is required. When increasing stimulus rate one should take into account that this requires higher pulse charges per second and more power consumption.

Active middle ear implants are classified as piezoelectric implants, which use the properties of piezoelectric materials. There are two types of piezoelectric implants: monomorphic and dimorphic; electromagnetic transduction uses a magnet, usually a rare earth magnet (e.g. samarium cobalt) and an energizing coil. This magnetic field causes the magnet to vibrate, which in turn, through the tympanic-ossicular chain, causes movement of the cochlear fluids. Electromechanical transduction is a variation of electromagnetic transduction.