Other implantable devices

Auditory brainstem implants and osseointegrated devices

who are ABIs designed for?

for patients who cannot benefit from a cochlear implant

What does the ABI implant bypass?

the cochlea and auditory nerve entirely

what does the ABI stimulate?

the cochlear nucleus in the brainstem

which pt population commonly uses ABI?

neurofibromatosis type II

what does ABI provide access to?

sound awareness rather than typical speech understanding

ABIs are only used for patients with

Absent or damaged auditory nerve
•Cochlear aplasia or severe malformations
•Represents a neuroprosthetic shift beyond the cochlea
•Requires highly specialized surgical and audiologic care
•Outcomes are highly variable and often limited
•Emphasizes importance of counseling and expectation
management

what does osseointegrated devices bypass?

the outer and middle ear

which patients is osseointegrated used for?

• conductive hearing loss

• mixed hearing loss

• single-sided deafness

• alternative when traditional hearing aids are not appropriate or tolerated

is percutaneous direct or indirect coupling to the bone?

direct

what are the two primary implantable bone conduction approaches?

• percutaneous

• transcutaneous

what is direct BC?

better sound transmission

what does percutaneous implant require?

skin penetrating abutment

no skin attenuation

transcutaneous

Intact skin → improved cosmetic appeal
•Lower risk of skin complications
•Reduced signal transmission due to skin attenuation
•May provide slightly less gain/output

what are the risks associated with percutaneous implant?

• skin irritation

• infection

indications of percutaneous devices

•Conductive or mixed hearing loss
•Single-sided deafness (SSD)
•Patients requiring maximum output and gain
•Bone conduction thresholds typically:
•Up to ~65 dB HL
•Ideal for patients who:
•Can manage skin care at abutment site
•Prioritize sound quality over cosmesis

indications of transcutaneous devices

•Conductive or mixed hearing loss
•Single-sided deafness (SSD)
•Bone conduction thresholds typically:
•Up to ~45–55 dB HL
•Preferred for patients who:
•Want intact skin / better cosmesis
•Are at risk for skin complications
•Slightly reduced output due to skin attenuation

BC HA assessments for candidacy

Comprehensive evaluation includes:
•Audiologic assessment (AC/BC thresholds, speech)
•Medical evaluation (outer/middle ear status)
•Determine:
•Type of hearing loss
•Degree of bone conduction thresholds
•Evaluate benefit from:
•Traditional amplification
•Consider:
•Patient needs, expectations, and lifestyle

pediatric considerations for BC devices

•FDA approval typically ≥5 years old (implantation)
•Younger children may use:
•Softband or headband systems
•Consider:
•Skull thickness and bone quality
•Growth and development
•Early access to sound is critical for language development
•Requires family involvement and consistent use

counseling of BC devices

•Set realistic expectations
•Discuss:
•Surgical procedure
•Device use and maintenance

potential benefits of BC devices

•Improved sound awareness
•Better speech understanding (in conductive losses)
•Improved localization (SSD cases)
•Emphasize adaptation period and rehabilitation

indications of BC devices with unilateral HL

Improved access to sound on affected side
•Better environmental awareness

indications of BC devices with bilateral conductive HL

•Significant improvement in speech understanding
•Often primary treatment option

indications of BC devices with single-sided deafness

•Routes sound to normal-hearing cochlea
•Improves awareness but limited localization benefit

device selection for the BC device for patients

Based on:
•Bone conduction thresholds
•Degree of hearing loss
•Consider:
•Percutaneous vs transcutaneous systems
•Patient preference (cosmesis vs performance)
•Evaluate:
•Skin health and medical history
•Match device to:
•Individual communication needs

cost and reimbursement of BC devices

Often covered by:
•Insurance / Medicaid / Medicare
•Requires:
•Documentation of medical necessity
•May include:
•Device + surgical costs
•Coverage varies by:
•State and payer
•Financial counseling is often needed

postoperative management of percutaneous BC devices

•Routine cleaning of abutment site
•Monitor for skin irritation or infection

postoperative management of transcutaneous BC devices

•Check for skin pressure or discomfort

follow up care after BC implantation

•Regular programming and adjustments
•Ongoing patient education and support

BC sound processor use

•Proper placement and alignment
•Attaching/removing device safely
•Consistent daily use encouraged

what are major BC device manufacturers

• cochlear limited (BAHA)

• oticon medical ( Ponto )