Atypical Bimodal Hearing Rehabilitation Solution: Implantable Bone conduction and Cochlear implantation.
Dana Egra-Dagan, Ranin Khair, Amir Hamud, Talma Shpak, Riad Khnifies
The Ear and Hearing Program, ENT dept., Bnai-Zion MC Medical Center, Haifa;
Technion – The Bruce Rappaport Faculty of Medicine, Haifa.
Introduction: Bilateral hearing is a fundamental property of the auditory system. Bilateral hearing rehabilitation options for mixed hearing loss (HL) may include bilateral conventional hearing aids, bilateral cochlear implants, bilateral bone conduction hearing systems, or a combination of the two modalities depending on residual bone conduction hearing thresholds and the condition of the outer and middle ear.
Aim: To demonstrate the possible added benefit of speech perception outcomes in bimodal users who wear implantable bone anchored hearing system (BAHI) in conjunction with a contralateral cochlear implant (CI).
Series Case presentation: Six adult patients with bilateral asymmetric mixed hearing loss aged 40 to 80 years old had been referred to the Bnai Zion Ear and Hearing program for hearing rehabilitation in both ears. All patients were diagnosed with bilateral chronic otitis media; two of them had also Cholesteatoma, and one had suffered additionally from long standing deafness (>40 years) in the worse ear due to head trauma. Bone thresholds in the BAHI side ranged between 15 to 20 dB at 250 Hz and 30 to 90 dB at 4 KHz, air thresholds ranged between 55 to 70 dB at 250 Hz and 100 to 110 90 dB at 8 KHz. Two patients underwent cochlear implantation with a MEDEL Synchrony Flex 24 system and a contralateral BCI 602 Bone Bridge system, and four patients underwent cochlear implantation with Cochlear system (CI24RE (CA), CI 522, CI422, and CI532) and BAHA-5 attract in the opposite ear. The duration of CI use ranged between 1 to 10 years and the duration of BAHI use ranged between 9 months and 7 years.
Results: Speech perception abilities in quiet and noise and self-rating SSQ questionnaire scores will be administered at three hearing conditions: CI alone, BAHI alone and the bimodal condition (CI&BAHI). Most patients achieved added bimodal benefit of speech perception in quiet and in noise as compared to each unilateral condition (e.g., CI alone, BAHI alone). Additionally, most patients (5/6) reported via the SSQ questionnaire similar or better scores compared to a cohort of well-established CI/HA bimodal users.
Conclusions: The study provides some evidenced-based data as for: 1) The possible bimodal benefit for auditory outcomes in adult patients who use BAHI in conjunction with a contralateral CI and; (2) auditory outcomes for most of these patients are higher than in traditional bimodal CI/HA users.

Atypical Bimodal Hearing Rehabilitation Solution: Implantable Bone conduction and Cochlear implantation.
_Dana Egra-Dagan, Ranin Khair, Amir Hamud, Talma Shpak, Riad Khnifies_
The Ear and Hearing Program, ENT dept., Bnai-Zion MC Medical Center, Haifa;
Technion – The Bruce Rappaport Faculty of Medicine, Haifa.
**Introduction:** Bilateral hearing is a fundamental property of the auditory system. Bilateral hearing rehabilitation options for mixed hearing loss (HL) may include bilateral conventional hearing aids, bilateral cochlear implants, bilateral bone conduction hearing systems, or a combination of the two modalities depending on residual bone conduction hearing thresholds and the condition of the outer and middle ear.
**Aim:** To demonstrate the possible added benefit of speech perception outcomes in bimodal users who wear implantable bone anchored hearing system (BAHI) in conjunction with a contralateral cochlear implant (CI).
**Series Case presentation:** Six adult patients with bilateral asymmetric mixed hearing loss aged 40 to 80 years old had been referred to the Bnai Zion Ear and Hearing program for hearing rehabilitation in both ears. All patients were diagnosed with bilateral chronic otitis media; two of them had also Cholesteatoma, and one had suffered additionally from long standing deafness (>40 years) in the worse ear due to head trauma. Bone thresholds in the BAHI side ranged between 15 to 20 dB at 250 Hz and 30 to 90 dB at 4 KHz, air thresholds ranged between 55 to 70 dB at 250 Hz and 100 to 110 90 dB at 8 KHz. Two patients underwent cochlear implantation with a MEDEL Synchrony Flex 24 system and a contralateral BCI 602 Bone Bridge system, and four patients underwent cochlear implantation with Cochlear system (CI24RE (CA), CI 522, CI422, and CI532) and BAHA-5 attract in the opposite ear. The duration of CI use ranged between 1 to 10 years and the duration of BAHI use ranged between 9 months and 7 years.
**Results:** Speech perception abilities in quiet and noise and self-rating SSQ questionnaire scores will be administered at three hearing conditions: CI alone, BAHI alone and the bimodal condition (CI&BAHI). Most patients achieved added bimodal benefit of speech perception in quiet and in noise as compared to each unilateral condition (e.g., CI alone, BAHI alone). Additionally, most patients (5/6) reported via the SSQ questionnaire similar or better scores compared to a cohort of well-established CI/HA bimodal users.
**Conclusions**: The study provides some evidenced-based data as for: 1) The possible bimodal benefit for auditory outcomes in adult patients who use BAHI in conjunction with a contralateral CI and; (2) auditory outcomes for most of these patients are higher than in traditional bimodal CI/HA users.

Atypical Bimodal Hearing Rehabilitation Solution: An Implantable Bone Conduction and a Cochlear Implant

It is with great pleasure and enthusiasm, that on behalf of the Cochlear Implant centers of the Radboud UMC in Nijmegen and Erasmus MC Sophia Children’s Hospital in Rotterdam to invite you to attend the 16th European Symposium on Pediatric Cochlear Implantation to Rotterdam, the Netherlands in 2023.

Yours sincerely, on behalf of the CI Centers at Radboud UMC and Erasmus MC,