Objectives: For full benefit in children implanted with a cochlear implant (CI), wearing the device all waking hours is necessary. This study focuses on the relationship between daily use and audiological outcomes, with the hypothesis that frequent daily device use coincides with high device satisfaction resulting in better functional gain (FG). Confounding factors such as implantation age, device experience and type of device were considered. Results: 38 CI children (65 ears) were investigated. In total, 76.92% of the children were using their device for >12h per day (h/d), 18.46% for 9–12 h/d, the remaining for 6–9 h/d and one subject reported 3 h/d. The revision rate up to the 90-month follow-up (F/U) was 4.6%. The mean FG was 59.00±7.67dB. The Audio Processor Satisfaction Questionnaire (APSQ) separated for single unit (SU) versus behind the ear (BTE) devices showed significantly better results for the latter in terms of wearing comfort (WC)(p=0.00062). A correlation between device use and FG was found with a device experience of <2years (n=29; r2=0.398), whereas no correlation was seen with ≥2years of device experience (n=36; r2=0.0038). Conclusion: This study found significant relationships between daily device use and FG, wearing comfort and long-term safety (90 months).

Long-Term Device Satisfaction and Safety after Cochlear Implantation in Children

Objectives: To share the first clinical experience from a novel active transcutaneous bone conduction implant system in users with mixed/conductive hearing lossess and single sided deafness. 

Methods: There is an ongoing long term clinical investigation on the first version of the novel active transcutaneous bone conduction implant system Sentio, Oticon Medical AB, Sweden where so far 16 out of 50 planned patients have been implanted by 2 out of the 6 participating clinics clinicaltrials.gov identifier NCT05166265. This report includes the first observations and clinical reflections on the surgical installation and clinical follow-up for these patients.

Results: The first implanted 16 patients had a mean age of 47 years and with the type of hearing loss being either conductive (n = 12), mixed (n = 3), or single sided deafness (n = 1) on the implanted side. Surgery duration from incision to last suture varied between 45 and 85 minutes, being of influence on the surgical learning curve. Implant installations could be done without any specific preoperative planning. The small size and the design of the implant enabled a smooth surgery installation with minimal bone preparation and with limited impact on surrounding tissue. Implant performance outcomes and safety profile follow expected patterns after the initial observed follow-up period of 6 months, currently. The overall patient satisfaction is highly positive. 

Conclusion: These initial clinical observations indicate that the implant is indeed small and less invasive to install without compromising clinical outcomes. This may indicate opportunity for treatment with an active transcutaneous implant system also in younger ages where bone quantity may be limited. 


First clinical experience from a novel active transcutaneous bone conduction implant system

Background: In 2016, the Baha 5 SuperPower was introduced. This Bone Conduction Device (BCD) provides a higher maximum force output (80-85dB) and broader fitting range (65 dB sensorineural hearing loss) than any other BCD currently available. Therefore, it is particularly suitable for patients with severe-to-profound (mixed) hearing losses and not yet ready for a Cochlear Implant.

Objectives: To evaluate the Cochlear Baha 5 SuperPower (5SP) and its users.

Methods: All 82 adult patients with severe-to-profound hearing loss fitted with the Cochlear Baha 5SP as a percutaneous bone-anchored hearing system in our center between 2016 and 2019 were identified and included in this study for a general description. Patients with incomplete data or criteria known to influence the reliability of audiological tests (n=24) were excluded from the complete audiological analysis, resulting in 58 completely analyzed patients. Main outcome measures: Unaided and aided pure-tone thresholds and aided free-field speech perception in quiet.

Results: The median unaided air conduction (AC) PTA0.5-2kHz of the completely analyzed group was 75 dB; the median unaided AC PTA1-4kHz was 84 dB. For bone conduction and direct bone conduction (dBC), the median PTA0.5-2kHz was 52 and 47 dB, respectively. Based on the median dBC PTA0.5-2kHz, one patient fell outside the 65 dB sensorineural hearing loss (SNHL) fitting range. When fitted with the superpower device, the median free-field speech reception threshold (SRT) shift was 34 dB, and the median speech perception score at 65 dB SPL was 80%.

Conclusion: At least 25% of the studied patients has a cochlear implant indication based on (<70%) speech perception. Although this SNHL-severity, the superpower device provides them with a substantial benefit in hearing. Preferably, the device should be fitted body-worn to work optimally without too many feedback problems.

Evaluation of a Super Powerful Bone-Anchored Hearing System and its users: A Retrospective Study

Background: Fatigue is frequently observed in children with chronic diseases and can affect quality of life (QoL). However, research in children with unilateral hearing loss (UHL) is scarce. Subsequently, no previous studies have investigated the effects of hearing aids on fatigue in children

Objectives: This study investigates subjective fatigue and hearing-related QoL in children with unaided and aided UHL. Furthermore, this study evaluates the influence of different hearing aids, subject-specific factors and respondent-type (parent-proxy versus child-report) on subjective fatigue.

Methods: A cross-sectional study was conducted from June 2020 until September 2020 at the department of otorhinolaryngology in the (tertiary) Radboud University Medical Center. 
Participants: 90 children 8-18 years and 123 parents were asked to participate, of whom 72 (80%) children and 106 (86%) parents completed the questionnaires. Potential participants with UHL were identified via patient databases. Healthy siblings were asked to participate as controls. Inclusion criteria were age 2-18 years and Dutch as primary language. Children were excluded based on criteria known to affect fatigue or to influence reliableunreliable completion of questionnaires. 
Main outcomes and measures: The main study outcome was the difference in subjective fatigue and hearing-related QoL between children with unaided UHL, aided UHL and children with normal hearing. Subjective fatigue and hearing-related QoL were measured using the PedsQLTM-MFS and HEAR-QL questionnaires respectively. 

Results: 34 children with unaided UHL, 36 with aided UHL and 36 healthy children were included for data-analysis. Child-reports revealed significantly more cognitive fatigue in children with aided UHL compared to children with normal hearing. Parents reported more fatigue on several domains in children with UHL compared to normal-hearing siblings.  Especially children with aided UHL were seemed at increased risk for fatigue. Children with UHL scored lower on hearing-related QoL than children with normal hearing. No clear differences were found in fatigue and QoL between children with unaided and aided UHL.

Conclusions and relevance: Children with unaided and aided UHL seem to experience more subjective fatigue and lower hearing-related QoL than children with normal hearing. Prospective longitudinal studies are required to investigate the influence of hearing aids on fatigue and QoL in individual patients.

Subjective fatigue in children with unaided and aided unilateral hearing loss

Parental involvement in the development of auditory skills with CI involves exploring the role of parents in supporting their child's auditory development with a cochlear implant. This includes strategies such as auditory verbal therapy, as well as ongoing use and maintenance of the CI. Parents play a crucial role in their child's development, and this topic examines how parents can support their child's progress with the CI.
The impact of CI use on parent-child communication and bonding focuses on how cochlear implants can affect parent-child communication and the relationship between parents and children. This topic explores both the potential benefits and challenges of CI use for parent-child interaction, including the importance of effective communication strategies and the potential for enhanced bonding as well as challenges with technology and other factors.
The decision-making process for getting a cochlear implant involves weighing the benefits and risks of the surgery, as well as the psychological and emotional considerations.
Post-operative recovery and adjusting to a new way of hearing can be a challenging process, both physically and emotionally, as individuals adapt to their new hearing abilities with the implant.
Challenges and successes in speech and language development with a CI highlight the unique difficulties that individuals with cochlear implants face in acquiring language and developing communication skills, as well as the strategies for overcoming these challenges.
Education and school experiences with a CI explore the ways in which hearing loss and cochlear implants impact a student's educational experience, including the challenges of classroom communication and the accommodations and support needed for academic success.
Coping with stigma and misconceptions about hearing loss and CI use address the social and emotional challenges of living with a hearing loss and using a cochlear implant, including the stigma and misconceptions surrounding hearing loss, as well as the strategies for coping and building resilience.

Want to participate as a Observer to inhance my experience for better future of my two cochlear implant children.

Objective: To evaluate the Spanish version of the Speech, Spatial, and Qualities of Hearing Scale for Parents (SSQ-P) of children with cochlear implant (CI).
Methods: The SSQ-P contains 22 questions on different daily listening scenarios. Questions are grouped into three sections: Speech (recognition of speech in several contexts), Spatial Hearing (perception of the position, movement, and distance of sound sources), and Qualities of Hearing (perception of sound, identification of sound sources, naturalness, and clearness).
Moreover, each question considers three domains: 1) a visual analog scale ranging from 0–10 (higher scores represent higher satisfaction), 2) the frequency of the scenario (very often / often / not often), and 3) the importance of the scenario for the child (very important / important / only a little bit important / not important). All answers are from parents’ the point of view.
Completing each section requires an observational period of 1 week, followed by either a phone call or face-to-face meeting with the researcher responsible for the study.
Inclusion criteria: children between 5–11 years old who received one or two MED-EL CI(s) under the age of 24 months. Exclusion criteria: Children with diagnosed or suspected additional needs.
Results: Eleven participants completed the questionnaire (age at evaluation: 8 ±2 years; range: 5–10y). Nine were bilateral CI users, and two were bimodal users.
Mean scores were: 7.1 ±1.3 for speech; 6.5 ±1.6 for spatial hearing; 7.4 ±0.8 for qualities of hearing. Most scenarios occurred “often” or “very often” and were rated “important” or “very important”.
Conclusions: The Spanish version of SSQ-P can be used to assess children’s hearing ability in different daily listening situations. Scores were >5 in each domain, indicating that the children had satisfactory speech, spatial hearing, and qualities of hearing. A validated Spanish translation is needed so professionals can use the SSQ-P to evaluate the hearing performance of children with hearing loss.

Spanish version of SSQ-P questionnaire for children with cochlear implant

Objectives: to determine the frequency-to-place mismatch in cochlear implant users, and to compare anatomy based fitting (ABF) vs standard fitting in terms of speech tests and subjective outcomes.
Methods: The Synchrony ST Flex28 (MED-EL,Innsbruck/Austria) was used in the eight adults who were enrolled. A postoperative Computed Tomography was performed following surgery. The length of the cochlear duct and the insertion depth for each patient was measured. The tonotopic distribution of each electrode was calculated using the Otoplan software (CAScination AG,Bern/Switzerland). The frequency-to-place mismatch was calculated in octaves through the difference between the ABF distribution and that performed by default in the standard fitting software. Speech tests (disyllables in silence and MATRIX - Oldenburg test with fixed noise at 55dB), the sound quality questionnaire HISQUI19, and the patient preference were used to evaluate the hearing outcomes after nine months with ABF and one month later of the standard fitting.
Results: In 6 out of 8 patients, the cochlear duct length was >35mm, with an insertion angle >600º, while the other two patients had a cochlear duct length between 30 and 35mm, with an insertion depth ≤540º. The mean mismatch for the low frequencies and for the medium frequencies was 0.67 and 0.003 for the wider insertions, and 0.93 and 0.003 for the shallowest insertions, respectively. It was observed that the shallower the depth, the wider the application of bandwidth in the most apical electrodes.
The mean score of disyllables in silence was 73% ±11 vs 72% ±16 with ABF and standard fitting, respectively. The Signal to Noise Ratio to achieve the Speech Recognition Threshold was 4±3 vs 4±5dB with ABF and standard fitting, respectively. Patients considered as moderate their quality of sound with both ways of fitting (77±25 vs 76±24). However, all patients except one preferred ABF when they were asked about their preference between both fitting methods.
Conclusions: Insertion depth is critical in finding the best tonotopic match. In spite of similar hearing outcomes most patients prefer ABF vs standard fitting. More data are necessary to corroborate the benefit of the ABF over standard fitting in speech and subjective tests.

The effect of the Anatomy Based Fitting in postlingually deaf cochlear implant users

Objectives:  To assess the patient-reported quality of life (QoL) and quality of hearing before hearing implant first fitting (FF), and after 6- and 12-months of use.
Methods: The Health Utility Index (HUI3) and the Speech, Spatial and Qualities of Hearing Scale (SSQ12) were administered to individuals who received a MED-EL CI, BONEBRIDGE, or VIBRANT SOUNDBRIDGE. The Nijmegen Cochlear Implant Questionnaire (NCIQ) was only completed by cochlear implant (CI) subjects. The questionnaires were administered at all three test intervals (before FF and after 6- and 12-months after FF). Additionally, the subjects’ satisfaction with their audio processor was recorded at the 6- and 12-month test intervals using the Audio Processor Satisfaction Questionnaire (APSQ).
Results: Data analyses of up to 110 CI and 59 VIBRANT recipients showed that upon activation QoL and quality of hearing increased compared to pre-activation in all measures.
In the SSQ12 the Friedman test showed that at the 6-months the improvement was significant for the total score and for the subscales for both CI and VIBRANT users. These results were confirmed by the pairwise comparisons: Wilcoxon signed-rank test total score pre-activation to 6-months was <0.001 for both the CI and the VIBRANT group.
From the HUI3 data, the multi-attribute scores were calculated, and a clinically relevant improvement was found for both CI and VIBRANT subjects; Friedman test revealed a significant improvement (p<0.001) in both the CI group and the VIBRANT group while the pairwise comparisons (Wilcoxon signed-rank test) showed a significant improvement from pre-activation to 6-months post-activation for both groups (p< 0.001).
NCIQ scores improved significantly from the baseline visit in all 6 subscales (all p<0 .001).
In the APSQ, a highly level of satisfaction with audio processors was detected (4.2 vs 4.1, CI vs VIBRANT users). A significant difference between the 6- and the 12-months study visit on the Wearing comfort subscale (p=0.018) was measured.
Conclusion: QoL and quality of hearing increased upon device activation and up to 12-months of device use. Overall, these results suggest the importance of hearing implant provision on users’ lives beyond simply an increase in speech understanding.

Measuring longitudinal changes in Quality of Life in hearing implant users

Cochlear implant (CI) is an electronic device that provides direct electrical stimulation to the auditory division of the eighth cranial nerve. The integrity of the internal CI part after implantation can be assessed through objective measures, which are a widely used and valuable tool in the field of CIs. Impedance measurement and electrically evoked compound action potential (ECAP) are the most frequently used tests to facilitate programming of the implants especially in young children. Aim This study was carried out to compare ECAP thresholds and electrode impedance at the time of surgery, at the first stimulation session, and monthly for the next 2 months to assess whether a significant change take places with time. Patients and methods Fifteen deaf children implanted unilaterally with a MED-EL Sonata Implant System with an Opus 2 speech processor were included in this study. All patients received the implant if they fulfilled the Alexandria main hospital criteria for receiving CIs. The group studied included seven males and eight females; they ranged in age from 2 to 6 years. Two of the patients had received implantation in the left ear, whereas the rest of the patients had received a CI in the right ear. Results Intraoperative impedance was the lowest among all postoperative readings in all electrodes. The highest value was that measured 1 month after surgery, after which impedance values continued to decrease significantly, but not to the intraoperative values. The ECAP threshold showed no significant P values between the ECAP threshold measured in the intraoperative and the postsurgery follow-up period. Conclusion The measured impedance showed significant changes in the form of increasing values postoperatively relative to the intraoperative time. The ECAP threshold did not change significantly intraoperatively and postoperatively, showing that intraoperative ECAP can be useful in mapping as it shows no changes.

Study of telemetry changes over time in children with a cochlear implant

Programming of multichannel cochlear implants (CIs) requires subjective responses to a series  of sophisticated psychophysical percepts. It is often diffi cult for young prelinguistically deaf  children to provide adequate responses for device fi tting. This is especially true in setting levels  of maximum comfortable loudness, whereby failure to indicate growth of loudness may result  in elevation of stimulus levels to the threshold of pain. The acoustic or stapedial muscle refl ex  has been used previously to provide objective confi rmation of acoustic stimulation, and there  have been attempts to use the refl ex in hearing-aid fi tting. It has also been suggested that  electrically elicited middle-ear muscle refl exes [electrically evoked stapedial refl ex threshold  ( ESRT)] may have applicability in confi rming and quantifying electrical stimulation through a  CI. To assess the relationship between ESRT characteristics and levels of loudness perception  with CIs, determine the reliability of the response, and investigate the potential use of ESRT  in CI programming, 26 prelinguistically deafened CI users were evaluated. Refl exes have also  been attempted on 312 electrodes, with responses present in 213 (68.3%). Comfort levels  predicted by subjective judgments were highly correlated with the ESRT in individuals with CI.  ESRT provides an objective, accurate, and rapid method of estimating maximum comfortable  loudness levels, which may be useful in the initial programming of young implant recipients

The relationship between the electrical stapedial muscle reflex threshold and electrical and behavioural measures in cochlear implant patients

Objectives: Candidacy for cochlear implantation (CI) has expanded over the years, including individuals with inner ear malformations (IEMs). Individuals with IEMs are likely to present aberrant distribution of the auditory nerve and a low survival rate of the spiral ganglion neurons. The health of the auditory nerve of individuals with the IEMs may play an important role in determining CI outcomes compared to those with the normal cochlea. This study aimed to characterize the influence of IEMs on intraoperative electrically-evoked compound action potential (ECAP) and auditory performance to understand underlying pathophysiology related to variabilities in CI outcomes that individuals with malformed cochlea may present.
Methods: This retrospective study reviewed the medical records of 222 ears implanted with Cochlear Nucleus CI. Subjects were grouped based on imaging study results. 64 ears had radiologic evidence of IEMs; 38 had mild IEMs (e.g., enlarged vestibular aqueduct, incomplete partition type II, etc.) and 26 had severe IEMs (e.g., common cavity, cochlear nerve hypoplasia/aplasia etc.). 158 ears had normal cochlear structures and intact auditory nerve. Intraoperative ECAP thresholds obtained via neural response telemetry (NRT) and the categories of auditory performance (CAP) scores measured at postop 12 months were compared and correlated.
Results: Absent NRT responses were more apparent in the IEM group. Average NRT thresholds were significantly higher in the IEM group compared to the normal group. When two IEM subgroups were compared, the severe IEM group showed highly elevated NRT thresholds, while the mild IEM group had NRT thresholds comparable to the normal group. The mild IEM group was able to achieve CAP scores similar to the normal group. In contrast, the severe IEM group showed considerably lower CAP scores even 12 months after CI. A moderate but significant negative relationship existed between NRT thresholds and CAP scores, indicating subjects who had lower NRT thresholds tended to achieve higher CAP scores.
Conclusion: Measurable ECAP responses and average ECAP thresholds were varied among groups. The inverse relationship between NRT thresholds and CAP scores may suggest that electrophysiological responses measured during the surgery may be indicative of estimating postoperative auditory performance in our CI population.

Effect of inner ear malformations on intraoperative electrically evoked compound action potential (ECAP) thresholds and postoperative auditory performance

DESEAR ESCUCHAR SOCIAL WORK WITH FAMILIES
COCHLEAR IMPLANT IN CHILDREN
TOPIC: Growing whith CI
Submission Categorie : Child-Parent interaction
Presenting Author: Prof. Marcela Barros & Coach Dana Poklepovic
Desear  Escuchar is a civil association that accompanies deaf people to improve their life quality. One area is the donation of hearing aids to children and adults without medical care. Another important area is the workshops to families with children with CI. This work is done by Prof. Marcela Barros, teacher for deaf, speech and language and Dana Poklepovic, PhD, Coach PCC.
OBJECTIVES
Guide children and their families to develop new auditory and language skills with CI.
Coach families to address the impact of deafness on their daily life.
Offer active listening and help them manage their emotions about deafness and CI.
Play games with children to build new social skills and self-confidence.
Provide parents with AVT (Auditory Verbal Therapy) strategies through team games.
Develop parents´ inner child to improve communication.
Empower families to develop resiliency.
Discover daily activities to maximize hearing and oral language.
Encourage executive functions to support the acquisition of auditory skills.
METHODS
Experiential workshops where parents develop dynamic and practical tools to stimulate their children´s brain activity, hearing and language.
Team Sessions to discuss CI, functioning and auditory rehabilitation post-CI.
Theme games (circus, kermese, clown) to enhance life experiences.
Theatre and Music Workshops to develop musical ear, enjoy music and boost personal development.
Activities between parents and children to improve their relationship and communication.
An environment of joy and wellbeing.
Analyse AVT (Auditory Verbal Therapy) videos with parents.
Storytelling Workshop to teach families how to tell stories and maximize their potential as sources of learning and hearing.
RESULTS
110 workshops since 2003.
1400 families participated.
100% satisfaction in surveys.
Parents´ testimonials, highly committed with the process.
Children with incidental hearing, better social skills and school performance.
CONCLUSIONS
The synergy between auditory rehabilitation and coaching leads families to:
- optimize communication through new tools
- gain self-confidence and empowerment
and children with CI to attain:
- better incidental hearing
- excellent benefits from their CI
- social skills and independent adult life.
Finally, both children and families approach deafness with gratitude and a growth mindset.
www.desearescuchar.com.ar
marcela_barrosar@yahoo.com.ar

Desear Escuchar Social Work with Families. Cochlear Implant in Children.

Auditory neural responses: Do we need special consideration for the paediatric population?
A Falistocco1, A Kontides2, M Takanen2, A Linares1.
(1) Grupo Orono, Rosario, Argentina. (2) MED-EL , Innsbruck, Austria.
Introduction
Audio processors of cochlear implant (CI) users need individualized adjustment of the fitting parameters. Fitting methods are mainly based on behavioural responses, but sometimes combined with objective measures. From the objective measures, the most extensively used is to use electrically evoked compound action potential (ECAP) data to create an initial profile (Vaerenberg et al., 2014).
Accordingly in this study, we compare ECAP data from children and adults to see whether there are any differences that might affect the fitting procedure.
Method
Twelve children and eight adults (altogether four bilateral) participated in the study. Their age varied between 5 and 70 years (mean=22.4, SD=±20.3 years) and their experience with the CI was between 1 month and 13 years at the time of testing. The ECAPs were obtained on all active electrodes using the AutoART task of the  clinical software MAESTRO. All measurements were performed using default parameters (stimulation range 0-30 charge units, phase duration determined automatically according to individual compliance limit and stop criteria on ECAP threshold finding).
Only data from the highest-ranked recording electrode from such measurements, where the AutoART algorithm determined an ECAP threshold, were considered for data analysis. Specifically, ECAP thresholds, slopes and supra-threshold N1 latencies (at 30% above threshold) were considered for comparison.
Results
No statistically significant differences were found between the groups for any of the investigated aspects. ECAP thresholds exhibited larger values for basal electrodes for all the participants. Steeper slopes were found in the apical area and a general, albeit statistically non-significant, trend of steeper slopes in children. Regarding latency, larger values at apical electrodes were observed in the adult group, but the difference failed to reach statistical significance.

Auditory neural responses: Do we need special considerations for pediatric population?

Introduction
Loudness as the perceptual attribute related to intensity is usually distorted in those suffering from
hearing loss. Nevertheless is frequently requested from the subjects wearing a cochlear implant (CI) to report
their auditory sensation in order to adjust their fitting map (Wolfe & Schafer,2014; Messersmith et al 2019).
In this pilot study we aim to apply a digital loudness scale synchronized with the stimulus level provided by the
fitting software, in order to monitor the subjective response to the mentioned stimulus.
A tablet containing a digital categorical loudness scale was provided to the participants with categories ranking from “no audible” to “too loud” to which they have to point in reaction to a continuous increasing stimulus.
Materials and Method
Six CI users, three children and three adults participated in the pilot study (Ages: 8 to 71 years) . As two children were bilateral, a total of eight measurements were obtained. All CI users had at least one year of experience in the use of their devices and were instructed on the procedure before the stimulation.
The stimuli consisted of 60-pps pulse train sequence used for measuring neural responses in AutoARTtask.
Within the pulse train, the stimulus amplitude was gradually increased from 0 to maximally 25 charge units.
The task of the participant was to use the tablet to report the perceived loudness continuously during the stimulation.
Results
All subjects, children and adults, were able to perform the task, with more accuracy observed within the adults.
For all adults the softest reported level was on average at 13.66 QU across electrodes, while for children was around 12.23 QU with an upward trend at median contact (Fig. 1).
In children softest reported loudness was >1% higher than ECAP thresholds (1.0, 1.7 and 1.2% for apical, medial and basal regions respectively, while in adults the difference was pronounced of 1.2, 1.9 and 1.4% being the difference between perceptual and neurophysiological thresholds. The loudness contour followed the one of the thresholds of neural responses (Fig. 2).
Regarding loudness at the individual maximum stimulation level (required to define the ECAP) the majority of the subjects (41%) reported it as “loud”. None of the responses fell above the “too loud” category (Fig. 3).
Conclusions
This pilot experiment provided encouraging results, bolstering reliable usage of the tool
Application of this tool benefits from synchronization with the stimuli which allows to precise continuosmonitoring of loudness
After a short introduction, participants of all ages could consistently report their loudness perceptsusing the device
The loudness rankings increased with stimulus amplitude
Further experiences are needed to confirm the reproducibility of the responses.

Synchronized digital scale as a tool to report loudness in cochlear implant patients

The World Health Organization (WHO) defines health as "a state of complete physical, mental and social well-being and not merely freedom from disease [...]". Consequently, measuring “health” and the impact of health care must include changes in the incidence and severity of disease, as well as improvements in quality of life (QOL) related to health care (e.g., cochlear implant provision and rehabilitation). Furthermore, patient self-reported outcomes (PROs) have gained importance and attention as part of an increased focus on patient-first medicine.
Several QOL questionnaires specific to the situation of individuals with hearing loss have already been developed. However, they often have a strong focus on auditory abilities (in terms of hearing performance) at the undue expense of other dimensions, e.g., emotional impact. Furthermore, because these questionnaires were developed many years ago, the question arises how applicable they still are. Based on the above definition of health and the WHO definition of QOL as “an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns”, a new questionnaire was developed to assess the QOL in hearing loss in various everyday situations. When formulating the items, we also considered the International Classification of Functioning, Disability and Health, better known as ICF/WHO. This is a supplement to ICD-11 (International Classification of Diseases). This classification model describes a person's health status and functional capacity (body functions, activities, participation) as well as disability (impairments, activity limitations, participation limitations). Based on these framework and classification systems, the “Hearing loss Quality of Life” questionnaire was developed. In addition to the quality of life with hearing loss in various everyday situations, this questionnaire also considers the emotional dimensions of hearing loss and users‘ expectation regarding the quality and clarity of hearing with a cochlear implant.
The development of the HL-QOL questionnaire and validation will be presented.

“Hearing loss Quality of Life” questionnaire – Development and Face Validity

Objectives: Atresia auris affects 1 in every 10,000 - 20,000 live births, with prevalence in Latin America much higher at 5 to 21 of every 10000 newborns. The important conductive hearing loss is crucial for the development of children.
There are aesthetic and functional aspects of treating these patients. For functional treatment, there are surgical and non-surgical alternatives like rigid and softband systems. The disadvantages of these prostheses include limited functional gain, cosmetic unattractiveness, and pain due to pressure on skin. Active transcutaneous bone conduction implants (BCI) achieve better sound transmission stimulating the bone directly. In 2016, an adhesive bone conduction device (aBCD) was introduced. The main objective of study was to assess the audiological performance and subjective satisfaction of children implanted with an active transcutaneous BCI over one year and to compare the outcomes with a non-surgical aBCD in the same users.
Methods: Prospective, multicentric study. Audiological performance and subjective satisfaction were evaluated at 1, 6 and 12 months post-implant activation, and after a 1-month trial with the non-surgical device. Tests: sound field audiometry; sound field speech in quiet and in noise; hearing-specific and audio processor-specific questionnaires.
Results: 10 patients completed all tests. The average PTA4 in the unaided condition was 65 dB HL and improved significantly to 20 dB HL after using the BCI for 12 months; with the aBCD an average PTA4 of 33 dB HL was measured. The speech recognition in quiet in the unaided condition was on average 33 %, which improved significantly using the BCI or aBCD. A mean WRS of 99 % with the BCI and 91 % with the aBCD could be achieved. The daily wearing time was 11 hours per day with the BCI and 9 hours using the aBCD. Overall, the BCI showed better results than the aBCD regarding subjective satisfaction.
Conclusions: The aBCD demonstrated sufficient hearing improvement and subjective satisfaction and thus is a good solution for hearing rehabilitation if surgery is not desired or not possible. If surgery is an option, the bone conduction implant is better device in terms of hearing outcomes, and subjective satisfaction.

Comparison of audiological performance and subjective satisfaction between surgical and non-surgical bone conduction hearing aids in children with atresia auris

The World Health Organization (WHO) defines health as "a state of complete physical, mental and social well-being and not merely freedom from disease [...]". Based on this definition of health and the WHO definition of Quality of Life (QOL), a new questionnaire was developed to assess the quality of life in hearing loss in various everyday situations: the Hearing Loss Quality of Life (HL-QOL) questionnaire.
84 patients completed the HL-QOL questionnaire for validation purposes. The questionnaire consists of 23 items on a seven-point Likert scale (always (>95%) to never (≤5%)). Items' characteristic values were assessed; reliability was determined using internal consistency (Cronbach's α). Exploratory factor analysis was used to examine the factor structure of the questionnaire. Test-retest reliability was tested in 63 subjects. Criterion validity was tested with the Nijmegen Cochlear Implant Questionnaire (NCIQ). In addition, the correlation between age at implantation and duration of hearing loss was tested with the HL-QOL total score.
The results confirm the HL-QOL as a valid and reliable instrument to assess perceived quality of life for German-speaker with a hearing implant. Its general clinical applicability will still be evaluated in further studies.

Hearing loss Quality of Life” questionnaire validation

It is our main objective to present the outputs of the VOICE project (Erasmus + Ka2 capacity building project). In this project, a consortium of 4 countries was created - romania, portugal, belgium and the netherlands, which focused on the creation of a document of standards of good practices validated by an international panel of experts following the modified Delphi method, as well as a manual with up-to-date, evidence-based information that informs training for parents and professionals. In this case, it focuses on parents and professionals in Romania, but it can be used in other countries. We would also like to present the VOICE site for disseminating all the information collected over the two years of joint work, as well as an evaluation of its effectiveness.In conclusion, we want to show a perfectly replicable model of training in the educational and clinical contexts (parents, formal educators and health professionals) of children with hearing loss and deafness as a factor to promote their quality of life and developmen

VOICE Project :Learning to Listen to Learning Talk

Active transcutaneous Bone Conduction Implant: Benefit in children
Objectives: The latest generation of the Bonebridge, the BCI 602 is intended to treat individuals with either conductive or mixed hearing loss (C/MHL) or single sided deafness (SSD). Here we present preliminary data of conductive and mixed hearing loss in children implanted with Bonebridge, in a prospective multicentric study conducted in Spain. The main objective is to demonstrate the effectiveness and safety of the Bonebridge system in the pediatric population using free field tonal and verbal thresholds.
Methods: A total of 19 paediatric patients (≤17 years) were analysed. This group encompassed 12 female, 8 male, 13 right-side and 6 left-side implanted patients with an average age of 11 years. The pure tone average (PTA4= 0.5, 1, 2,4 kHz) air bone gap measured was greater than or equal to 15 dB. Patients were their own controls (single-subject repeated measures), comparing the unaided or pre-operative to the post-operative outcomes. Performance was evaluated by sound field thresholds (SF), word recognition scores (WRS) and/or speech reception thresholds in quiet (SRT). Safety was demonstrated by stable pure-tone measurements and adverse events reported.
Results: The Bonebridge improved SF thresholds (+25.3 dB), speech intelligibility in WRS (+72,3%), SRT in quiet (+28.9 dB), speech in noise with SNR0 (+16%) and for speech in noise with SNR5 (+45,9%). AC and BC thresholds remained stable over time.
So far, only 1 paediatric individual has been excluded from the study, as it was not within the audiological criteria to participate in it. We have 2 minor adverse events to report from 2 patients that did not perform the tests on the time frame permitted. 15 out of these 19 patients have already submitted the last tests (12-month tests), which corresponds to 78,9% of the population.
Conclusions: With now more than 10 years of experience with the Bonebridge system in its latest implant generation the BCI 602 significantly improves hearing thresholds and speech understanding in patients suffering from CHL/MHL.
Authors: Dr Raúl Mellidez Acosta, Dra Natalia Jaramillo Ángel, Dr Carlos de Paula Vernetta, Dra Laura Cavallé Garrido, Hospital Universitario y Politécnico La Fe de Valencia, Spain; Dr Iñigo Ruiz de Erenchun Lasa, Dra Manuela del Carmen Zapata, Hospital Universitario de Navarra, Pamplona, Spain; Dr Pedro Sarría Echegaray, Dr Claudio Carnevale, Hospital Universitario Son Espases, Palma de Mallorca, Spain.

Active transcutaneous Bone Conduction Implant: Benefit in children

We examined the effect of neonatal deafening on frequency-specific pathways for processing of interaural time differences (ITDs) in cochlear-implant stimuli. Animal studies have demonstrated differences in neural ITD sensitivity in the inferior colliculus (IC) depending on the intracochlear location of intracochlear stimulating electrodes. We used neonatally deafened (ND) rats of both sexes and recorded the responses of single neurons in the IC to electrical stimuli with ITDs delivered to the apical or basal cochlea and compared them with acutely deafened (AD) rats of both sexes with normal hearing (NH) during development. We found that neonatal deafness significantly impacted the ITD sensitivity and the ITD tuning patterns restricted to apically driven IC neurons. In ND rats, the ITD sensitivity of apically driven neurons is reduced to values similar to basally driven neurons. The prevalence of ITD-sensitive apical neurons with a peak-shaped ITD tuning curve, which may reflect predominant input from the medial superior olivary (MSO) complex, in ND rats was diminished compared with that in AD rats (67%, AD vs 40%, ND). Conversely, monotonic-type responses rarely occurred in AD rats (14%) but were approximately equally as prevalent as peak-type tuning curves in ND rats (42%). Nevertheless, in ND rats, the ITD at the maximum slope of the ITD tuning curve was still more concentrated within the physiological ITD range in apically driven than in basally driven neurons. These results indicate that the development of high ITD sensitivity processed by low-frequency pathways depends on normal auditory experience and associated biases in ITD tuning strategies.

Neonatal Deafening Selectively Degrades the Sensitivity to Interaural Time Differences of Electrical Stimuli in Low-Frequency Pathways in Rats

Cochlear implant stimulation parameters depending on the type of electrode array
  Pashkova A.E.1, Naumova I.V.1, Voevodina K.I.1, Pashkov A.V.1,2
 1 Pediatric and Child Health Research Institute of the Petrovsky National Research Centre of Surgery, Moscow, Russian Federation
 2 Central State Medical Academy of Department of Presidential Affairs, Moscow, Russian Federation
▪ Objectives
Among the many factors affecting the results of cochlear implantation (CI), the design of the electrode array determines the distance between the contact of the electrode and the spiral ganglion of the auditory nerve. The perimodiolar electrode array (due to the shape memory effect) is positioned along the medial wall of the cochlea canal in close proximity to the modiolus, whereas the straight one is located along the lateral wall. The aim of our study is to assess the relationship between the electrophysiological responses of the auditory nerve (electrically evoked compound action potential - ECAP) and the levels of comfortable stimulation (С - levels) of the fitting map in patients with good speech intelligibility.
▪ Methods
30 patients aged 6 to 17 years (average 10, 73 土 3.05) after unilateral cochlear implantation with good speech intelligibility (above 90%). 15 patients are users of the Cochlear Ci 512 (perimodiolar electrode array) CI system with CP 910 processor, 15 patients use the Med-El system (straight electrode array, standard electrode) with a Sonnet 2 processor. We were compared of the relationship between the values of ECAP thresholds and C - levels (as percentage) in groups with straight and perimodiolar electrode arrays.
▪ Results
Comparison of the values of the thresholds of comfortable stimulation on the channels of CI systems in comparison with ECAP thresholds showed that in systems with a perimodiolar array, the differences between these indicators are lower (2.5 土 2%, p <0.05) than in systems with a straight electrode array (30.6土6,05%, p<0.05).
▪ Conclusion
Understanding of the relationship between ECAP thresholds and С - levels increases the efficiency of fitting CI processors in patients with different types of electrode arrays. This is important in young children and patients with combined neurological pathology.

Cochlear implant stimulation parameters depending on the type of electrode array

In XXI century more and more people suffer from hearing problems. It translates into social problems,  breaking of interpersonal contacts, decrease of self-assessment and rise of mental disorders. The development and access to new technologies brings hope to people in whom it is impossible to remove or cure the reason behind hearing disfunction. Moreover, these technologies decrease the severity of mentioned above problems.
The aim of the study was the assessment of potential hearing benefits in patients after the implantation of the bone-anchored hearing device (transcutaneous grapple)

Hearing satisfaction in patients after implantation of bone-anchored implants based on the experience of the Otolaryngology Clinic UJ CM of Cracow

Objective
The Bonebridge® (MED-EL, Innsbruck, Austria) is a partially implantable active transcutaneous Bone Conduction hearing Implant (BCI) approved in Europe for adults and children since 2012 (MED-EL, Innsbruck, Austria). The 2nd generation of the Bonebridge the BCI 602 was launched in 2019. The purpose of this post-market clinical follow-up (PMCF) study is to confirm long-term safety and performance and user device satisfaction of the BCI 602.
Patients and methods
Here we present preliminary 12 Months follow up data of 15 children with a mean age of 7 years (range 5 to 12 years) suffering from CHL (N=12) or MHL (N=3) . Patients were their own controls (single-subject repeated measures), comparing the unaided or pre-operative to the 12-month post-operative outcomes. Performance was evaluated by sound field thresholds (SF), word recognition scores (WRS) and/or speech reception thresholds in quiet (SRT) and in noise (SNR). Safety was demonstrated with a device-specific surgical questionnaire, adverse event reporting and stable pure-tone measurements. Study endpoints were stable BC PTA4 thresholds (≤ 10 dB) and improvements of ≥ 10 dB in PTA4 Functional Gain (FG), ≥ 15% in WRS, ≥ 15 dB SPL in SRT in quiet and ≥ 1.0 dB SNR in SRT in noise. The Speech Spatial Qualities questionaire for Parents (SSQ-P) was used to evaluate hearing satisfaction with the Bonebridge post-operatively.
Results 12-months post operative
Safety
The average surgery duration was 54 min. The BCI 602 (reduced drilling depth and ability to bend the transition for optimal placement) allows treatment of children with pre-operated and malformed anatomies. Air conduction (AC) and bone conduction (BC) thresholds remained stable. Only one adverse events was reported until 12 months post operative.
Performance
The Bonebridge BCI 602 significantly improved SF thresholds (+ 28.94 dB), speech intelligibility in WRS (+ 64.34% ) and SRT in quiet (− 20.77 dB ) and in noise (− 6.93 dB SNR). All audiological endpoints were reached.
Satisfaction
Mean audio processor wearing times were ~ 10.6 hours per day. The SSQ-P shows improvements of 1.6, 2.8, 1.0 and 1.7 respectively for speech understanding, spatial hearing, listening qualities and total hearing.
Conclusion
12 months after treatment the new BCI 602 in children
• allows for more placement options due to a new geometry that may be advantageous for use  in children
acknowledging thin bones, malformations, or pre-operated ears
��� is safe with one AE and stable hearing thresholds
• improves hearing thresholds and speech understanding
• improves subjective listening ability and listening experience

Surgical information and 12 months safety and performance results with the Bonebridge BCI 602 in the pediatric population.

Objectives:
The use of objective measures in cochlear implant (CI) mapping, has greatly contributed to the refinement of the setting of audible and comfortable stimulation levels, which serve as the basis of the mapping process, especially in cases of infants and young children. In addition, objective measures can also confirm the integrity of the CI system. Current CI objective measures mainly reflect neural activity from the auditory nerve and brainstem site. An objective cortical CI measure that reflects directly central auditory activity is greatly needed, especially since it is closely related to CI outcomes in both children and adults. Recording the brain activity currently requires an external evoked potential (EP) system including scalp electrodes, rendering it impractical for widespread clinical use. This study aimed to assess the feasibility of recording Cortical Auditory Evoked Potentials (CAEPs) directly and solely through the cochlear implant in response to external acoustic stimulation in the non-implanted ear.
Design:
A total of 9 CI users (4 females and 5 males) participated, including 7 post-lingual adults (23-72 years), and two pediatric cases, one teenager (15 years), and one child (8 years) - both pre-lingual. All participants had a residual hearing in the ear contralateral to the ear with CI. CAEPs were recorded in the implanted ear in response to acoustic stimulation of the non-implanted ear, consisting of a brief tonal stimulus at comfortable listening levels. Recordings used an intracranial montage consisting of an intracochlear apical electrode (active) and one of the two (case and ring) extra-cochlear implanted electrodes serving as reference electrodes. The CI CAEPs were compared to a single-channel conventional CAEP recording obtained simultaneously via scalp electrodes (Fz-mastoid) using a standard EP system and an external trigger from the CI system. Statistical comparisons were made between the CI and the scalp recorded CAEPs and for differences between the CI CAEP measures acquired using the ring and the case as the reference electrode.
Results:
CAEPs recorded directly and solely through the CI were equivalent to the standard scalp recorded CAEP responses. CAEP responses acquired using the caseelectrode as the reference were highly correlated in terms of morphology, latencies, and amplitudes of the CAEP components. The CI CAEP latencies of the two pediatric cases were consistent with their normal developed age group and delayed relative to adult CAEP latencies, as expected.
Conclusions:
This study demonstrated the feasibility of recording long latency CAEPs directly and solely through CI in adults with residual hearing, in response to acoustic stimulation of the non-implanted ear. The CI CAEPs closely resembled the CAEPs recorded simultaneously by an external EP system and via scalp electrodes. The ability to record directly from the implant, without the need of an external recording system, presents an innovative 

A Novel Brain Objective Measure: Auditory Cortical Potentials Recorded only by the CI- Neurophysiological and Clinical Correlates

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,