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Original Investigation |

The Efficacy of Unilateral Bone-Anchored Hearing Devices in Chinese Mandarin-Speaking Patients With Bilateral Aural Atresia

Yue Fan, MD1; Ying Zhang, MD1; Pu Wang, MD1; Zhen Wang, MD1; Xiaoli Zhu, MD1; Hua Yang, MD1; Xiaowei Chen, MD1
[+] Author Affiliations
1Department of Otolaryngology, Peking Union Medical College Hospital, Beijing, China
JAMA Otolaryngol Head Neck Surg. 2014;140(4):357-362. doi:10.1001/jamaoto.2013.6642.
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Importance  The bone-anchored hearing device (BAHD) was not introduced in China until 2010. To our knowledge, this is the first study to assess the efficacy of Chinese Mandarin-speaking patients with bilateral aural atresia.

Objective  To evaluate the speech recognition of Chinese Mandarin-speaking patients with BAHDs as well as patients’ satisfaction using 2 questionnaires.

Design, Setting, and Participants  A retrospective case review of 16 patients with bilateral aural atresia conducted at a tertiary referral center.

Intervention  A BAHD was implanted during auricle reconstruction surgery or after the auricle was rebuilt. A surgical method to combine the BAHD implantation with the second stage of ear reconstruction was introduced.

Main Outcomes and Measures  Speech audiometry test and mean pure-tone threshold results were compared among patients with unaided hearing and those with BAHDs. Scores from the BAHD user questionnaire and Glasgow Children’s Benefit Inventory (GCBI) were used to measure patients’ satisfaction and subjective health benefit.

Results  The mean (SD) speech discrimination scores measured in a sound field with a presentation level of 45 dB HL (hearing level) were 6.7% (7.4%) unaided and 86.5% (4.4%) with a BAHD. Scores with a presentation level of 65 dB HL were 56.5% (7.4%) unaided and 90.1% (3.4%) with a BAHD. The speech reception threshold was 60.6 (7.5) dB HL unaided and 24.7 (5.0) dB HL with a BAHD. The mean (SD) pure-tone threshold of the patients was 61.6 (7.8) dB HL unaided and 23.8 (5.9) dB HL with a BAHD. The BAHD application questionnaire demonstrated excellent patient satisfaction. The mean (SD) benefit score of GCBI was 45.6 (14.4).

Conclusions and Relevance  For aural atresia, the BAHD has been one of the most reliable methods of auditory rehabilitation. It can improve the patient’s word recognition performance and quality of life. The technique of BAHD implantation combined with auricular reconstruction in a 2-stages-in-1 surgery and the modified incision of patients with reconstructed auricle proved to be safe and effective.

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Figure 1.
Mean Speech Discrimination Scores (SDSs) of 16 Patients With Unaided Hearing and With a BAHD, With Presentation Levels of 45 dB HL and 65 dB HL

Mean (SD) SDSs were 6.7% (7.4%) unaided and 86.5% (4.4%) with a BAHD measured in a sound field of 45 dB HL and 56.5% (7.4%) unaided and 90.1% (3.4%) with a BAHD measured in a sound field of 65 dB HL. BAHD indicates bone-anchored hearing device; and HL, hearing level.

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Figure 2.
Mean Hearing Thresholds at 500, 1000, 2000, and 4000 Hz for All 16 Patients With and Without BAHDs

Mean (SD) pure-tone thresholds of the patients were 61.6 (7.8) dB HL unaided and 23.8 (5.9) dB HL with a BAHD. The longer horizontal lines indicate the mean speech discrimination score. The 2 shorter horizontal lines indicate the standard deviation. BAHD indicates bone-anchored hearing device; and HL, hearing level.

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