Active Bone Conduction Prosthesis: BonebridgeTM

Abstract

Introduction Bone conduction implants are indicated for patients with conductive and mixed hearing loss, as well as for patients with single-sided deafness (SSD). The transcutaneous technology avoids several complications of the percutaneous bone conduction implants including skin reaction, skin growth over the abutment, and wound infection. The Bonebridge (MED-EL, Austria) prosthesis is a semi-implantable hearing system: the BCI (Bone Conduction Implant) is the implantable part that contains the Bone Conduction-Floating Mass Transducer (BC-FMT), which applies the vibrations directly to the bone; the external component is the audio processor Amadé BB (MED-EL, Austria), which digitally processes the sound and sends the information through the coil to the internal part. Bonebridge may be implanted through three different approaches: the transmastoid, the retrosigmoid, or the middle fossa approach. Objective This systematic review aims to describe the world́s first active bone conduction implant system, Bonebridge, as well as describe the surgical techniques in the three possible approaches, showing results from implant centers in the world in terms of functional gain, speech reception thresholds and word recognition scores. Data Synthesis The authors searched the MEDLINE database using the key term Bonebridge. They selected only five publications to include in this systematic review. The review analyzes 20 patients that received Bonebridge implants with different approaches and pathologies. Conclusion Bonebridge is a solution for patients with conductive/mixed hearing loss and SSD with different surgical approaches, depending on their anatomy. The system imparts fewer complications than percutaneous bone conduction implants and shows proven benefits in speech discrimination and functional gain.

The Prediction of Speech Recognition in Noise With a Semi-Implantable Bone Conduction Hearing System by External Bone Conduction Stimulation With Headband

“…As the audioprocessor as well as power supply are external yet necessary components of these devices, they are called semi-implantable. One device, Bonebridge (MED-EL, Innsbruck, Austria), is commercially available since 2012 ( Ihler, Volbers, Blum, Matthias, & Canis, 2014 ; G. Sprinzl et al., 2013 ; G. M. Sprinzl & Wolf-Magele, 2015 ; Zernotti & Sarasty, 2015 ). Another similar device was developed independently and is currently being tested in clinical studies ( Reinfeldt, Hakansson, Taghavi, Fredén Jansson, & Eeg-Olofsson, 2015 ; Taghavi et al., 2015 ).…”

Implantierbare Hörsysteme

“…An electromagnetic transducer (bone conduction floating mass transducer, BC-FMT) is fixed at the skull bone and transmits actively sound waves via the bone to the inner ear. The external unit with 2 microphones, speech processor, and battery transmits the acoustic signal transcutaneously with an amplification of up to 45 dB (at 500-4000 Hz) [99], [131]. Advantages: Due to the transcutaneous transmission, classical skin problems such as proliferative growth at the anchoring site and infections can be avoided.…”

“…Indications: The Bonebridge is indicated in cases of conductive hearing loss, combined hearing impairment, or unilateral sensorineural deafness in adults and children from the age of 5 years. In the context of conductive and combined hearing loss, the bone conduction threshold should not be lower than 45 dB; for unilateral deafness, the air conduction threshold should not be below 20 dB in the better hearing contralateral ear [131]. Surgical technique: Surgery can be performed under local or general anesthesia.…”

“…So it is no longer obligatory to completely expose the dura or the sinus [99]. Results: In a first study with 12 adults, the functional hearing improvement after 3 months amounted to about 25 dB [132], later studies reached up to 43 dB [131], [133], [134], [135]. The speech recognition improved in quiet by 80.0±13.8% and in noise by 45.8±14.0% [136].…”

Implantable hearing devices

“…An electromagnetic transducer (bone conduction floating mass transducer, BC-FMT) is fixed at the skull bone and transmits actively sound waves via the bone to the inner ear. The external unit with 2 microphones, speech processor, and battery transmits the acoustic signal transcutaneously with an amplification of up to 45 dB (at 500–4000 Hz) [ 99 ], [ 131 ].…”