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Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Background and Purpose: Nowadays, keratoconus (KC) is very well treatable in a stage-oriented manner. A wide range of designs and materials of contact lenses (CL) are available for the treatment of KC. The aim of this study was to evaluate the possibilities, the possible challenges and the visual outcome of lens fitting in KC eyes., Patients and Methods: This retrospective study includes data from 200 patients who received a lens fitting trial in our contact lens service between 2006 and 2016. We documented ophthalmological parameters, the type of prescribed CL, the number of required trial lenses and possible causes of the failure of the lens fitting., Results: The mean age at initial lens fitting was 33.9 ± 12.5 years. In 98.8% of the cases, the fitting was performed with rigid gas permeable lenses, in 90.1% with four-curve lenses. Of the total number of aspheric lenses prescribed, 87.5% were fitted in keratoconus stages "1" to "2" (topographic keratoconus classification; Oculus Keratograph). Back surface toric lenses or bitoric lenses were fitted to 61.7% in keratoconus stages "2 - 3" to "4". Before patients received their final CL, a median of 2 trial lenses were required (max. 16). Mean visual acuity with lens correction was 0.8 ± 0.2 at the initial fitting, mean visual acuity with glasses correction was 0.5 ± 0.3. In 7.7% of the eyes, the KC lens fitting was discontinued due to the advanced stage of keratoconus, requiring a corneal transplant. Reasons for discontinuing contact lens fitting included lens intolerance (2.3%), application problems (0.3%) or acute corneal hydrops (0.3%). Discontinuation of lens wearing due to incompatibilities or application problems occurred in only four cases (1.1%) in the further course after lens fitting., Conclusions: The use of contact lenses is an integral part of the stage-appropriate therapy of keratoconus. Good visual acuity can be achieved in all stages of keratoconus with a low drop-out rate. In most cases, the adjustment is carried out with rigid gas permeable lenses with a four-curve geometry. In initial stages, aspherical lenses may be sufficient. Toric lenses can be fitted in advanced stages when rotationally symmetrical lenses cannot achieve a satisfactory fit. If contact lenses have been successfully fitted, there are only a few cases in which patients abandon their contact lenses because of intolerance., Competing Interests: The authors declare that they have no conflict of interest. Parts of this work have been presented as free paper at the online congress of the German Ophthalmological Society (DOG) October 2020./Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht. Teile dieser Publikation wurden als freier Beitrag beim Online-Kongress der DOG im Oktober 2020 vorgestellt., (Thieme. All rights reserved.)

In times of unlimited availability of exchange lenses on the internet and in discount stores, the contact lens has increasingly become a lifestyle but also a disposable product. The targeted marketing of the contact lens as a mass product could only be realized because the fitting and application of the contact lenses are presented as very simple. The numbers of contact lens-induced complications, as well as the fact that the German market in particular has not seen any increase in the number of contact lens wearers in recent years (2015 to 2019), however, speak a different language.How to fit your patient correctly after a detailed explanation of the different types of contact lenses and their areas of application, how to instruct him or her on how to use them correctly and what risks the patient must be informed about is the subject of this 2nd part of "The basics of practical contact lens fitting". It also explains how to avoid complications that can occur when wearing contact lenses and how to advise and care for patients with contact lens intolerances., Competing Interests: Erklärung zu finanziellen Interessen Forschungsförderung erhalten: nein; Honorar/geldwerten Vorteil für Referententätigkeit erhalten: nein; Bezahlter Berater/interner Schulungsreferent/Gehaltsempfänger: nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an im Bereich der Medizin aktiven Firma: nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an zu Sponsoren dieser Fortbildung bzw. durch die Fortbildung in ihren Geschäftsinteressen berührten Firma: nein. Erklärung zu nichtfinanziellen Interessen Mitglied in der DOG und dem BVA. Klassifiziererin beim DBS (Dt. Behindertensport). Landesärztin für Blinde und Sehbehinderte für das Bayerische Staatsministerium für Gesundheit und Pflege. Mitherausgeberin bei Thieme up2date., (Thieme. All rights reserved.)

Background: Hearing aid fitting guidelines recommend real ear measures (REM) to verify hearing aid performance. Unfortunately, approximately 70 to 80% of clinicians do not use REM, but instead download manufacturer first-fit. Studies report differences in performance between first-fit and programmed-fit with greatest differences in the higher frequencies. Recently, hearing aid and real ear analyzer (REA) manufacturers allow REA communication with hearing aid software feature to automatically program hearing aids to target. Little research is available reporting the accuracy of this feature., Purpose: The aim of the study is to examine whether differences exist at 50, 65, and 80 dB SPL between two ReSound first-fit formulae (Audiogram+ and NAL-NL2) using ReSound AutoREM and Aurical NAL-NL2 RESEARCH DESIGN:  The study design is of repeated measure type., Study Sample: The study sample includes 48 ears., Data Collection and Analysis: For the two fitting formulae, AutoREM real ear insertion gain (REIG) was measured at 50, 65, and 80 dB SPL and compared with measures from Aurical NAL-NL2., Results: Mean AutoREM REIG for ReSound NAL-NL2 was 3 to 8 dB below Aurical NAL-NL2 for 50 dB SPL, within 1 to 3 dB for 65 dB SPL and 1 to 5 dB above for 80 dB SPL. Mean AutoREM REIG for Audiogram + was 1 to 12 dB below Aurical NAL-NL2 for 50 dB SPL, within 2 to 5 dB for 65 dB SPL and 1 to 7 dB above NAL-NL2 for 80 dB SPL., Conclusion: Relative to the Aurical NAL-NL2, AutoREM REIG 50 for Audiogram + and ReSound NAL-NL2 was lower. Relative to the Aurical NAL-NL2, AutoREM REIG 65 for Audiogram + was higher at 1,000 Hz and lower at 4,000 to 6,000 Hz and for ReSound NAL-NL2 it was lower at 500 Hz and 4,000 Hz and higher at 3,000 Hz. Relative to the Aurical NAL-NL2, AutoREM REIG 80 for Audiogram + was higher at 500 to 3,000 Hz and 6,000 Hz and ReSound NAL-NL2 was higher at 500 to 6,000 Hz. Because of wide intersubject variability clinicians should continue to use REM as a "check and balance" when using AutoREM., Competing Interests: None declared., (American Academy of Audiology. This article is published by Thieme.)

The great potential of contact lenses for improving vision in all forms of corneal irregularities, e. g. keratoconus, after keratoplasty, after keratitis, is in danger of being forgotten. Especially by the younger generation of ophthalmologists and opticians there is a risk that the skill of fitting contact lenses professionally will be lost. There are many situations in which the practicing ophthalmologist should recognize that the contact lens can be a useful option for the visual rehabilitation of his patient. In this article, we provide a summary of "The basics of practical contact lens fitting". The first part is about materials, fields of application and differences in optics compared to glasses., Competing Interests: Erklärung zu finanziellen Interessen Forschungsförderung erhalten: nein; Honorar/geldwerten Vorteil für Referententätigkeit erhalten: nein; Bezahlter Berater/interner Schulungsreferent/Gehaltsempfänger: nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an im Bereich der Medizin aktiven Firma: nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an zu Sponsoren dieser Fortbildung bzw. durch die Fortbildung in ihren Geschäftsinteressen berührten Firma: nein. Erklärung zu nichtfinanziellen Interessen Mitglied in der DOG und dem BVA. Klassifiziererin beim DBS (Dt. Behindertensport). Landesärztin für Blinde und Sehbehinderte für das Bayerische Staatsministerium für Gesundheit und Pflege. Mitherausgeberin bei Thieme up2date., (Thieme. All rights reserved.)

Background: Questionnaires measuring the subjective outcome of hearing aid benefit are used in diagnostics of hearing loss additionally. Since 2012, the APHAB is part of the quality agreement for statutory insured patients in hearing aid fitting. Actually, calculating the benefit by the given formula (improvement quotient A) causes distortion by patients with negative results. In general, these dues to misinterpretation of the results. In this study, we proposed two alternative ways of calculation and compared the results together., Methods: Using the data of 6861 hearing aid fitted patients from a database, we calculated the benefit by A and two new formulas (improvement quotient B and cumulated benefit) and compared the results together., Results: The average for A was -29.02 % (SD ± 47.94) and a minimum of -637.93 %. The average for B was -13.42 % (SD ± 13.14) and a minimum of -78,63. No relevant differences by calculating the improvement quotients between A and B occurred. The average APHAB-score (EC-, BN-, and RV-subscale) was 50.70 before and 29.29 after hearing aid fitting, the average of the cumulated benefit was 21.41., Conclusions: Quotient B avoids the intrinsic potential of distortion of A in favor of patients with negative results in hearing aid benefit. It would be useful for the further developing of the quality agreement if B in exchange for A and, in addition, the cumulated benefit should be used., Competing Interests: Es bestehen keine Interessenkonflikte für alle Autoren. Die Studie wurde vom Deutschen Berufsverband der HNO-Ärzte e. V., Neumünster, finanziell gefördert., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: One of the most important steps for good user performance with a cochlear implant (CI) is activation and programming, aimed at determining the dynamic range. In adults, current levels are determined by psychophysical measures. In babies, small children, or individuals with multiple disorders, this procedure requires techniques that may provide inconsistent responses because of auditory inexperience or the age of the child, making it a very difficult process that demands the collaboration of both the patient and the family., Purpose: To study the relationship between the electrically evoked stapedius reflex threshold (ESRT) and maximum comfort level for stimulating electrodes (C-level) in postoperative CI users., Research Design: Cross-sectional analytical observational case series study., Study Sample: We assessed 24 patients of both sexes, aged between 18 and 68 yr, submitted to CI surgery., Intervention: Otoscopy and immittance. Next, an implant speech processor connected to an Itautec ® computer containing the manufacturer's software (custom sound Ep 3-2) was used, as well as an AT 235h probe inserted into the ear contralateral to the CI to capture the stapedius reflex, obtaining electrically evoked stapedius reflex thresholds., Data Collection and Analysis: Data from the last programming, defining C-levels for each electrode studied, were extracted from the databank of each patient. The manual decay function of the AT 235h middle ear analyzer was used to observe ESRT response in a same window for a longer response capture time. Electrodes 22, 16, 11, 6, and 1 were tested when active, with the aim of using electrodes over the entire length of the CI, and ESRT was considered present when compliance was ≥0.05 ml. Stimuli, in current units, were always initiated at 20 cu above the C-level. The analysis of variance parametric test, Tukey's honest significant difference test, the t-test, Wilcoxon nonparametric test, and the Kolmogorov-Smirnov test examined whether significant relationships existed between these other factors., Results: The results demonstrate that all the electrodes selected for the study exhibited higher mean reflex threshold values than their mean C-level counterparts. However, there was no significant difference between them, for electrodes 1, 6, 11, and 16. The data provided allow the use of ESRT to define C-level values and make it possible to stipulate a correction factor ranging between 6 and 25.6 electrical units., Conclusion: The use of electrically evoked stapedius reflex thresholds can help the team in charge of programming CIs, making the process faster and safer, mainly for infants, small children, or individuals with multiple disorders., (American Academy of Audiology.)

Background: Current guidelines for adult hearing aid fittings recommend the use of a prescriptive fitting rationale with real-ear verification that considers the audiogram for the determination of frequency-specific gain and ratios for wide dynamic range compression. However, the guidelines lack recommendations for how other common signal-processing features (e.g., noise reduction, frequency lowering, directional microphones) should be considered during the provision of hearing aid fittings and fine-tunings for adult patients., Purpose: The purpose of this survey was to identify how audiologists make clinical decisions regarding common signal-processing features for hearing aid provision in adults., Research Design: An online survey was sent to audiologists across the United States. The 22 survey questions addressed four primary topics including demographics of the responding audiologists, factors affecting selection of hearing aid devices, the approaches used in the fitting of signal-processing features, and the strategies used in the fine-tuning of these features., Study Sample: A total of 251 audiologists who provide hearing aid fittings to adults completed the electronically distributed survey. The respondents worked in a variety of settings including private practice, physician offices, university clinics, and hospitals/medical centers., Data Collection and Analysis: Data analysis was based on a qualitative analysis of the question responses. The survey results for each of the four topic areas (demographics, device selection, hearing aid fitting, and hearing aid fine-tuning) are summarized descriptively., Results: Survey responses indicate that audiologists vary in the procedures they use in fitting and fine-tuning based on the specific feature, such that the approaches used for the fitting of frequency-specific gain differ from other types of features (i.e., compression time constants, frequency lowering parameters, noise reduction strength, directional microphones, feedback management). Audiologists commonly rely on prescriptive fitting formulas and probe microphone measures for the fitting of frequency-specific gain and rely on manufacturers' default settings and recommendations for both the initial fitting and the fine-tuning of signal-processing features other than frequency-specific gain., Conclusions: The survey results are consistent with a lack of published protocols and guidelines for fitting and adjusting signal-processing features beyond frequency-specific gain. To streamline current practice, a transparent evidence-based tool that enables clinicians to prescribe the setting of other features from individual patient characteristics would be desirable., (American Academy of Audiology)

Purpose  Accurate assessment of cup orientation on postoperative pelvic radiographs is essential for evaluating outcome after THA. Here, we present a novel method for correcting measurement inaccuracies due to pelvic tilt and rotation. Method  In an experimental setting, a cup was implanted into a dummy pelvis, and its final position was verified via CT. To show the effect of pelvic tilt and rotation on cup position, the dummy was fixed to a rack to achieve a tilt between + 15° anterior and -15° posterior and 0° to 20° rotation to the contralateral side. According to Murray's definitions of anteversion and inclination, we created a novel corrective procedure to measure cup position in the pelvic reference frame (anterior pelvic plane) to compensate measurement errors due to pelvic tilt and rotation. Results  The cup anteversion measured on CT was 23.3°; on AP pelvic radiographs, however, variations in pelvic tilt (± 15°) resulted in anteversion angles between 11.0° and 36.2° (mean error 8.3°± 3.9°). The cup inclination was 34.1° on CT and ranged between 31.0° and 38.7° (m. e. 2.3°± 1.5°) on radiographs. Pelvic rotation between 0° and 20° showed high variation in radiographic anteversion (21.2°-31.2°, m. e. 6.0°± 3.1°) and inclination (34.1°-27.2°, m. e. 3.4°± 2.5°). Our novel correction algorithm for pelvic tilt reduced the mean error in anteversion measurements to 0.6°± 0.2° and in inclination measurements to 0.7° (SD± 0.2). Similarly, the mean error due to pelvic rotation was reduced to 0.4°± 0.4° for anteversion and to 1.3°± 0.8 for inclination. Conclusion  Pelvic tilt and pelvic rotation may lead to misinterpretation of cup position on anteroposterior pelvic radiographs. Mathematical correction concepts have the potential to significantly reduce these errors, and could be implemented in future radiological software tools. Key Points   · Pelvic tilt and rotation influence cup orientation after THA. · Cup anteversion and inclination should be referenced to the pelvis. · Radiological measurement errors of cup position may be reduced by mathematical concepts. Citation Format · Schwarz TJ, Weber M, Dornia C et al. Correction of Pelvic Tilt and Pelvic Rotation in Cup Measurement after THA - An Experimental Study. Fortschr Röntgenstr 2017; 189: 864 - 873., Competing Interests: Conflict of Interest: The authors declare that they have no conflict of interest.This article does not contain any studies with human participants or animals.This article does not contain any patient data., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: Questionnaires are an important diagnostic elements in audiology. In Germany the APHAB is regularly used for hearing aid fitting. This study is investigating whether there are any specific questions which are answered more rarely by the subjects than other and whether inverted questions have any influence to this. Methods: Between April 2013 and August 2015 the number of 23 557 APHAB forms by 10 associations of statutory health insurance registered physicians have been collected and evaluated. For all questions the frequency of answers before and after hearing aid fitting have been determined. Results: For the EC scale there was one group of patients without hearing aid which a lot of problems of hearing and a second without. For the BN and RV subscale the majority of the patients addresses problems of understanding. For the AV scale no specific kind of problems found has been found. After successful hearing aid fitting problems of understanding for EC, BN, and RV subscale were reduced on average, for the AV scale no relevant change could be observed. Except for the numbers 11, 18, and 21 all APHAB questions were answered by 93-94% by all subjects. The questions number 11 and 18 were answered by 92%, question number 21 by 87%. Some questions have a similar tendency in deviation from the average (1, 3, 13, 16, and 17). Conclusions: Inverted questions have no influence to the frequency of answers in APHAB questions. The 3 questions which are answered more rarely are describing hearing situations in cinemas, theatres, and at church. Presumably, this hearing situations are not so common for most patients than the other described by the APHAB., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: A better understanding of individual differences in hearing aid (HA) outcome is a prerequisite for more personalized HA fittings. Currently, knowledge of how different user factors relate to response to directional processing (DIR) and noise reduction (NR) is sparse., Purpose: To extend a recent study linking preference for DIR and NR to pure-tone average hearing thresholds (PTA) and cognitive factors by investigating if (1) equivalent links exist for different types of DIR and NR, (2) self-reported noise sensitivity and personality can account for additional variability in preferred DIR and NR settings, and (3) spatial target speech configuration interacts with individual DIR preference., Research Design: Using a correlational study design, overall preference for different combinations of DIR and NR programmed into a commercial HA was assessed in a complex speech-in-noise situation and related to PTA, cognitive function, and different personality traits., Study Sample: Sixty experienced HA users aged 60-82 yr with controlled variation in PTA and working memory capacity took part in this study. All of them had participated in the earlier study, as part of which they were tested on a measure of "executive control" tapping into cognitive functions such as working memory, mental flexibility, and selective attention., Data Collection and Analysis: Six HA settings based on unilateral (within-device) or bilateral (across-device) DIR combined with inactive, moderate, or strong single-microphone NR were programmed into a pair of behind-the-ear HAs together with individually prescribed amplification. Overall preference was assessed using a free-field simulation of a busy cafeteria situation with either a single frontal talker or two talkers at ±30° azimuth as the target speech. In addition, two questionnaires targeting noise sensitivity and the "Big Five" personality traits were administered. Data were analyzed using multiple regression analyses and repeated-measures analyses of variance with a focus on potential interactions between the HA settings and user factors., Results: Consistent with the earlier study, preferred HA setting was related to PTA and executive control. However, effects were weaker this time. Noise sensitivity and personality did not interact with HA settings. As expected, spatial target speech configuration influenced preference, with bilateral and unilateral DIR "winning" in the single- and two-talker scenario, respectively. In general, participants with higher PTA tended to more strongly prefer bilateral DIR than participants with lower PTA., Conclusions: Although the current study lends some support to the view that PTA and cognitive factors affect preferred DIR and NR setting, it also indicates that these effects can vary across noise management technologies. To facilitate more personalized HA fittings, future research should investigate the source of this variability., (American Academy of Audiology.)

Background: Research shows that many older children and teenagers who have mild to moderately severe sensorineural hearing loss do not use their hearing instruments during all waking hours. A variety of reasons may contribute toward this problem, including concerns about cosmetics associated with hearing aid use and the inconvenience of daily maintenance associated with hearing instruments. Extended-wear hearing instruments are inserted into the wearer's ear canal by an audiologist and are essentially invisible to outside observers., Purpose: The goal of this study was to evaluate the potential benefits and limitations associated with use of extended-wear hearing instruments in a group of children with hearing loss., Research Design: A two-way repeated measures design was used to examine performance differences obtained with the participants' daily-wear hearing instruments versus that obtained with extended-wear hearing instruments., Study Sample: Sixteen children, ages 10-17 yr old, with sensorineural hearing loss ranging from mild to moderately severe., Data Collection and Analysis: Probe microphone measures were completed to evaluate the aided output of device. Behavioral test measures included word recognition in quiet, sentence recognition in noise, aided warble-tone thresholds, and psychophysical loudness scaling. Questionnaires were also administered to evaluate subjective performance with each hearing technology., Results: Data logging suggested that many participants were not using their daily-wear hearing instruments during all waking hours (mean use was less than 6 h/day). Real ear probe microphone measurements indicated that a closer fit to the Desired Sensation Level Version 5 prescriptive targets was achieved with the children's daily-wear instruments when compared to the extended-wear instruments. There was no statistically significant difference in monosyllabic word recognition at 50 or 60 dBA obtained with the two hearing technologies. Sentence recognition in noise obtained with use of the extended-wear devices was, however, significantly better than what was obtained with the daily-wear hearing aids. Aided warble-tone thresholds indicated significantly better audibility for low-level sounds with use of the daily-wear hearing technology, but loudness scaling results produced mixed results. Specifically, the participants generally reported greater loudness perception with use of their daily-wear hearing aids at 2000 Hz, but use of the extended-wear hearing technology provided greater loudness perception at 4000 Hz. Finally, the participants reported higher levels of subjective performance with use of the extended-wear hearing instruments., Conclusions: Although some measures suggested that daily-wear hearing instruments provided better audibility than the extended-wear hearing devices, word recognition in quiet was similar with use of the two technologies, and sentence recognition in noise was better with the extended-wear hearing technology. In addition, the participants in this study reported better subjective benefit associated with the use of extended-wear hearing technology. Collectively, the results of this study suggest that extended-wear hearing technology is a viable option for older children and teenagers with mild to moderately severe hearing loss., (American Academy of Audiology.)

Background: Bilateral contralateral routing of signals (BiCROS) hearing aids function to restore audibility of sounds originating from the side of the unaidable ear. However, when speech is presented to the side of the aidable ear and noise to the side of the unaidable ear, a BiCROS arrangement may reduce intelligibility of the speech signal. This negative effect may be circumvented if an on/off switch is available on the contralateral routing of signals (CROS) transmitter., Purpose: This study evaluated if the proper use of the on/off switch on a CROS transmitter could enhance speech recognition in noise and sound localization abilities. The participants' subjective reactions to the use of the BiCROS, including the use of the on/off switch in real-life were also evaluated., Research Design: A between-subjects, repeated-measures design was used to assess differences in speech recognition (in quiet and in noise) and localization abilities under four hearing aid conditions (unaided, unilaterally aided, fixed BiCROS setting, and adjusted BiCROS setting) with speech and noise stimuli presented from different azimuths. Participants were trained on the use of the on/off switch on the BiCROS transmitter before testing in the adjusted BiCROS settings. Subjective ratings were obtained with the Speech, Spatial, and Sound Quality (SSQ) questionnaire and a custom questionnaire., Study Sample: Nine adult BiCROS candidates participated in this study., Data Collection and Analysis: Participants wore the Widex Dream-m-CB hearing aid on the aidable ear for 1 week. They then wore the BiCROS for the remainder of the study. Speech recognition and localization testing were completed in four hearing aid conditions (unaided, unilateral aided, fixed BiCROS, and adjusted BiCROS). Speech recognition was evaluated during the first three visits, whereas localization was evaluated over the course of the study. Participants completed the SSQ questionnaire before each visit. The CROS questionnaire was completed at the final visit. A repeated measures analysis of variance with Bonferroni post hoc analysis was used to evaluate the significance of the results on speech recognition, localization, and the SSQ., Results: The results revealed that the adjusted BiCROS condition improved speech recognition scores by 20 rau (rationalized arcsine unit) when speech was presented to the aidable ear and localization by 37% when sounds are presented from the side of the unaidable ear over the fixed BiCROS condition. Statistically significant benefit on the SSQ was also noted with the adjusted BiCROS condition compared to the unilateral fitting., Conclusions: These findings supported the value of an on/off switch on a CROS transmitter because it allows convenient selective transmission of sounds. It also highlighted the importance of instructions and practice in using the BiCROS hearing aid successfully., (American Academy of Audiology.)

Background: The acceptable noise level (ANL) has been proposed as a prehearing aid fitting measure that could be used for hearing aid selection and counseling purposes. Previous work has demonstrated that a listener's ANL is unrelated to their speech recognition in noise abilities. It is unknown what criteria a listener uses when they select their ANL. To date, no research has explored the amount of speech recognized at the listener's ANL., Purpose: To examine the amount of speech recognized at the listener's ANL to determine whether speech recognition in noise is utilized as a factor for setting ANL., Research Design: A descriptive quasi-experimental study was completed. For all listeners, ANL was measured and speech recognition in noise was tested at ANL and at two additional signal-to-noise ratio (SNR) conditions based on the listener's ANL (ANL + 5 and ANL - 5)., Study Sample: Forty-four older adults served as participants. Twenty-seven participants had normal hearing and seventeen participants had mild to moderately-severe, symmetrical, sensorineural hearing loss., Data Collection and Analysis: Acceptance of noise was calculated from the measures of most comfortable listening level and background noise level. Additionally, speech recognition in noise was assessed at three SNRs using the quick speech-in-noise test materials., Results: A significant interaction effect of SNR condition and ANL group occurred for speech recognition. At ANL, a significant difference in speech recognition in noise was found across groups. Those in the mid and high ANL groups had excellent speech recognition at their ANL. Speech recognition in noise at ANL decreased with ANL category., Conclusions: For listeners with mid and high ANLs, speech recognition appears to play a primary role in setting their ANL. For those with low ANLs, speech recognition may contribute to setting their ANL; however, it does not appear to be the primary determiner of ANL. For those with very low ANLs, speech recognition does not appear to be significant variable for setting their ANL., (American Academy of Audiology.)

Background: A coordinated fitting of a cochlear implant (CI) and contralateral hearing aid (HA) for bimodal device use should emphasize balanced audibility and loudness across devices. However, guidelines for allocating frequency information to the CI and HA are not well established for the growing population of bimodal recipients., Purpose: The study aim was to compare the effects of three different HA frequency responses, when fitting a CI and an HA for bimodal use, on speech recognition and localization in children/young adults. Specifically, the three frequency responses were wideband, restricted high frequency, and nonlinear frequency compression (NLFC), which were compared with measures of word recognition in quiet, sentence recognition in noise, talker discrimination, and sound localization., Research Design: The HA frequency responses were evaluated using an A B₁ A B₂ test design: wideband frequency response (baseline-A), restricted high-frequency response (experimental-B₁), and NLFC-activated (experimental-B2). All participants were allowed 3-4 weeks between each test session for acclimatization to each new HA setting. Bimodal benefit was determined by comparing the bimodal score to the CI-alone score., Study Sample: Participants were 14 children and young adults (ages 7-21 yr) who were experienced users of bimodal devices. All had been unilaterally implanted with a Nucleus CI24 internal system and used either a Freedom or CP810 speech processor. All received a Phonak Naida IX UP behind-the-ear HA at the beginning of the study., Data Collection and Analysis: Group results for the three bimodal conditions (HA frequency response with wideband, restricted high frequency, and NLFC) on each outcome measure were analyzed using a repeated measures analysis of variance. Group results using the individual "best bimodal" score were analyzed and confirmed using a resampling procedure. Correlation analyses examined the effects of audibility (aided and unaided hearing) in each bimodal condition for each outcome measure. Individual data were analyzed for word recognition in quiet, sentence recognition in noise, and localization. Individual preference for the three bimodal conditions was also assessed., Results: Group data revealed no significant difference between the three bimodal conditions for word recognition in quiet, sentence recognition in noise, and talker discrimination. However, group data for the localization measure revealed that both wideband and NLFC resulted in significantly improved bimodal performance. The condition that yielded the "best bimodal" score varied across participants. Because of this individual variability, the "best bimodal" score was chosen for each participant to reassess group data within word recognition in quiet, sentence recognition in noise, and talker discrimination. This method revealed a bimodal benefit for word recognition in quiet after a randomization test was used to confirm significance. The majority of the participants preferred NLFC at the conclusion of the study, although a few preferred a restricted high-frequency response or reported no preference., Conclusions: These results support consideration of restricted high-frequency and NLFC HA responses in addition to traditional wideband response for bimodal device users., (American Academy of Audiology.)

Background: An important goal of providing amplification to children with hearing loss is to ensure that hearing aids are adjusted to match targets of prescriptive procedures as closely as possible. The Desired Sensation Level (DSL) v5 and the National Acoustic Laboratories' prescription for nonlinear hearing aids, version 1 (NAL-NL1) procedures are widely used in fitting hearing aids to children. Little is known about hearing aid fitting outcomes for children with severe or profound hearing loss., Purpose: The purpose of this study was to investigate the prescribed and measured gain of hearing aids fit according to the NAL-NL1 and the DSL v5 procedure for children with moderately severe to profound hearing loss; and to examine the impact of choice of prescription on predicted speech intelligibility and loudness., Research Design: Participants were fit with Phonak Naida V SP hearing aids according to the NAL-NL1 and DSL v5 procedures. The Speech Intelligibility Index (SII) and estimated loudness were calculated using published models., Study Sample: The sample consisted of 16 children (30 ears) aged between 7 and 17 yr old., Data Collection and Analysis: The measured hearing aid gains were compared with the prescribed gains at 50 (low), 65 (medium), and 80 dB SPL (high) input levels. The goodness of fit-to-targets was quantified by calculating the average root-mean-square (RMS) error of the measured gain compared with prescriptive gain targets for 0.5, 1, 2, and 4 kHz. The significance of difference between prescriptions for hearing aid gains, SII, and loudness was examined by performing analyses of variance. Correlation analyses were used to examine the relationship between measures., Results: The DSL v5 prescribed significantly higher overall gain than the NAL-NL1 procedure for the same audiograms. For low and medium input levels, the hearing aids of all children fit with NAL-NL1 were within 5 dB RMS of prescribed targets, but 33% (10 ears) deviated from the DSL v5 targets by more than 5 dB RMS on average. For high input level, the hearing aid fittings of 60% and 43% of ears deviated by more than 5 dB RMS from targets of NAL-NL1 and DSL v5, respectively. Greater deviations from targets were associated with more severe hearing loss. On average, the SII was higher for DSL v5 than for NAL-NL1 at low input level. No significant difference in SII was found between prescriptions at medium or high input level, despite greater loudness for DSL v5 than for NAL-NL1., Conclusions: Although targets between 0.25 and 2 kHz were well matched for both prescriptions in commercial hearing aids, gain targets at 4 kHz were matched for NAL-NL1 only. Although the two prescriptions differ markedly in estimated loudness, they resulted in comparable predicted speech intelligibility for medium and high input levels., (American Academy of Audiology.)

Background: A reliable and valid method for the automatic in situ measurement of hearing thresholds is a prerequisite for the feasibility of a self-fitting hearing aid, whether such a device becomes an automated component of an audiological management program or is fitted by the user independently of a clinician. Issues that must be addressed before implementation of the procedure into a self-fitting hearing aid include the role of real-ear-to-dial difference correction factors in ensuring accurate results and the ability of potential users to successfully self-direct the procedure., Purpose: The purpose of this study was to evaluate the reliability and validity of an automatic audiometry algorithm that is fully implemented in a wearable hearing aid, to determine to what extent reliability and validity are affected when the procedure is self-directed by the user, and to investigate contributors to a successful outcome., Research Design: Design was a two-phase correlational study., Study Sample: A total of 60 adults with mild to moderately severe hearing loss participated in both studies: 20 in Study 1 and 40 in Study 2. Twenty-seven participants in Study 2 attended with a partner. Participants in both phases were selected for inclusion if their thresholds were within the output limitations of the test device., Data Collection and Analysis: In both phases, participants performed automatic audiometry through a receiver-in-canal, behind-the-ear hearing aid coupled to an open dome. In Study 1, the experimenter directed the task. In Study 2, participants followed a set of written, illustrated instructions to perform automatic audiometry independently of the experimenter, with optional assistance from a lay partner. Standardized measures of hearing aid self-efficacy, locus of control, cognitive function, health literacy, and manual dexterity were administered. Statistical analysis examined the repeatability of automatic audiometry; the match between automatically and manually measured thresholds; and contributors to successful, independent completion of the automatic audiometry procedure., Results: When the procedure was directed by an audiologist, automatic audiometry yielded reliable and valid thresholds. Reliability and validity were negatively affected when the procedure was self-directed by the user, but the results were still clinically acceptable: test-retest correspondence was 10 dB or lower in 97% of cases, and 91% of automatic thresholds were within 10 dB of their manual counterparts. However, only 58% of participants were able to achieve a complete audiogram in both ears. Cognitive function significantly influenced accurate and independent performance of the automatic audiometry procedure; accuracy was further affected by locus of control and level of education. Several characteristics of the automatic audiometry algorithm played an additional role in the outcome., Conclusions: Average transducer- and coupling-specific correction factors are sufficient for a self-directed in situ audiometry procedure to yield clinically reliable and valid hearing thresholds. Before implementation in a self-fitting hearing aid, however, the algorithm and test instructions should be refined in an effort to increase the proportion of users who are able to achieve complete audiometric results. Further evaluation of the procedure, particularly among populations likely to form the primary audience of a self-fitting hearing aid, should be undertaken., (American Academy of Audiology.)

Preservation of residual hearing after cochlear implantation allows patients the synergetic use of electric and acoustic stimulation (EAS). The application of specific surgical and therapeutic techniques enables the reduction of inner ear trauma, which leads otherwise to complete hearing loss. Due to simultaneous electric and acoustic stimulation, speech understanding is improved especially in noise. EAS is a well-accepted therapeutic treatment for subjects with profound hearing loss in the higher frequencies and no or mild hearing loss in the low frequencies. Several Manufacturers offer individual soft electrodes specially designed for hearing preservation as well as combined electric-acoustic audio processors., (© Georg Thieme Verlag KG Stuttgart · New York.)

Aim: Abdominal wall defects in children can present a challenge to the pediatric surgeon. Despite the development of new materials and modifications of surgical technique, no single approach has been established. The purpose of this study was to evaluate the authors experience using porcine small intestine submucosa for abdominal closure., Patients and Methods: A retrospective review of all patients with abdominal wall defects who underwent reconstruction with Surgisis at the authors' institution from 2004 to 2011 was performed. Patient demographics, cause of defect, recurrence, rate of infection, and length of follow-up were reviewed., Results: A total of 24 patients were identified as having Surgisis implanted for abdominal wall defects. The most common etiology of abdominal defect was omphalocele. All patients went on to heal wounds. Four patients developed postoperative seroma formation and another two had wound infection. Two recurrences in the form of incisional hernia were observed. Both resolved spontaneously without intervention during the follow-up. The median follow-up period was 5 years (range 2-9 y). No significant predictors of complications were identified., Conclusions: Surgisis is an effective adjunct in the repair of abdominal wall defects in children. Complication rates remain low. In addition, recurrence may disappear spontaneously as the patch absorbed and replaced by scar tissues. Further studies are warranted., (Georg Thieme Verlag KG Stuttgart · New York.)

Background: Large variations in perceptual directional microphone benefit, which far exceed the variation expected from physical performance measures of directional microphones, have been reported in the literature. The cause for the individual variation has not been systematically investigated., Purpose: To determine the factors that are responsible for the individual variation in reported perceptual directional benefit., Research Design: A correlational study. Physical performance measures of the directional microphones obtained after they had been fitted to individuals, cognitive abilities of individuals, and measurement errors were related to perceptual directional benefit scores., Study Sample: Fifty-nine hearing-impaired adults with varied degrees of hearing loss participated in the study., Data Collection and Analysis: All participants were bilaterally fitted with a Motion behind-the-ear device (500 M, 501 SX, or 501 P) from Siemens according to the National Acoustic Laboratories' non-linear prescription, version two (NAL-NL2). Using the Bamford-Kowal-Bench (BKB) sentences, the perceptual directional benefit was obtained as the difference in speech reception threshold measured in babble noise (SRTn) with the devices in directional (fixed hypercardioid) and in omnidirectional mode. The SRTn measurements were repeated three times with each microphone mode. Physical performance measures of the directional microphone included the angle of the microphone ports to loudspeaker axis, the frequency range dominated by amplified sound, the in situ signal-to-noise ratio (SNR), and the in situ three-dimensional, articulation-index weighted directivity index (3D AI-DI). The cognitive tests included auditory selective attention, speed of processing, and working memory. Intraparticipant variation on the repeated SRTn's and the interparticipant variation on the average SRTn were used to determine the effect of measurement error. A multiple regression analysis was used to determine the effect of other factors., Results: Measurement errors explained 52% of the variation in perceptual directional microphone benefit (95% confidence interval [CI]: 34-78%), while another 37% of variation was explained primarily by the physical performance of the directional microphones after they were fitted to individuals. The most contributing factor was the in situ 3D AI-DI measured across the low frequencies., Conclusions: Repeated SRTn measurements are needed to obtain a reliable indication of the perceptual directional benefit in an individual. Further, to obtain optimum benefit from directional microphones, the effectiveness of the microphones should be maximized across the low frequencies., (American Academy of Audiology.)

Unlabelled: Transcatheter aortic valve implantation (TAVI) is currently considered an acceptable alternative for the treatment of patients with severe aortic stenosis and a high perioperative risk or a contraindication for open surgery. The benefit of TAVI significantly outweighs the risk of the procedure in patients requiring treatment that are not suitable for open surgery, and leads to a lower mortality in the one-year follow-up. The absence of a direct view of the aortic root and valve remains a challenge for the transcatheter approach. While direct inspection of the aortic valve during open surgery allows an adequate prosthesis choice, it is crucial for TAVI to know the individual anatomical details prior to the procedure in order to assure adequate planning of the procedure and proper prosthesis choice and patient selection. Among the imaging modalities available for the evaluation of patients prior to TAVI, computed tomography (CT) plays a central role in patient selection. CT reliably visualizes the dimensions of the aortic root and allows a proper choice of the prosthesis size. The morphology of the access path and relevant comorbidities can be assessed. The present review summarizes the current state of knowledge regarding the value of CT in the evaluation of patients prior to TAVI., Key Points: CT plays a central role in patient selection and planning prior to TAVI. ▶ CT reliably detects the dimensions of the aortic root including the size of the aortic annulus, the degree of valve calcification and the morphology of the access routes. ▶ CT provides a more accurate measurement of the aortic annulus than 2D TEE and CT is the only imaging modality that allows a risk assessment for paravalvular leakages based on the calcification of the aortic valve., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Hearing aid prescriptive recommendations for hearing losses having a conductive component have received less clinical and research interest than for losses of a sensorineural nature; as a result, much variation remains among current prescriptive methods in their recommendations for conductive and mixed hearing losses (Johnson and Dillon, 2011)., Purpose: The primary intent of this brief clinical note is to demonstrate differences between two algebraically equivalent expressions of hearing loss, which have been approaches used historically to generate a prescription for hearing losses with a conductive component. When air and bone conduction thresholds are entered into hearing aid prescriptions designed for nonlinear hearing aids, it was hypothesized that that two expressions would not yield equivalent amounts of prescribed insertion gain and output. These differences are examined for their impact on the maximum power output (MPO) requirements of the hearing aid. Subsequently, the MPO capabilities of two common behind-the-ear (BTE) receiver placement alternatives, receiver-in-aid (RIA) and receiver-in-canal (RIC), are examined., Study Samples: The two expressions of hearing losses examined were the 25% ABG + AC approach and the 75% ABG + BC approach, where ABG refers to air-bone gap, AC refers to air-conduction threshold, and BC refers to bone-conduction threshold. Example hearing loss cases with a conductive component are sampled for calculations. The MPO capabilities of the BTE receiver placements in commercially-available products were obtained from hearing aids on the U.S. federal purchasing contract., Results: Prescribed gain and the required MPO differs markedly between the two approaches. The 75% ABG + BC approach prescribes a compression ratio that is reflective of the amount of sensorineural hearing loss. Not all hearing aids will have the MPO capabilities to support the output requirements for fitting hearing losses with a large conductive component particularly when combined with significant sensorineural hearing loss. Generally, current RIA BTE products have greater output capabilities than RIC BTE products., Conclusions: The 75% ABG + BC approach is more appropriate than the 25% ABG + AC approach because the latter approach inappropriately uses AC thresholds as the basis for determining the compression ratio. That is, for hearing losses with a conductive component, the AC thresholds are not a measure of sensorineural hearing loss and cannot serve as the basis for determining the amount of desired compression. The Australian National Acoustic Laboratories has been using the 75% ABG + BC approach in lieu of the 25% ABG + AC approach since its release of the National Acoustic Laboratories--Non-linear 1 (NAL-NL1) prescriptive method in 1999. Future research may examine whether individuals with conductive hearing loss benefit or prefer more than 75% restoration of the conductive component provided adequate MPO capabilities to support such restoration., (American Academy of Audiology.)

The construction of facial prostheses is frequently used as a remedial treatment method in otorhinolaryngology. Modern prostheses are often attached to the face via bone anchored titanium implants and magnetic attachments. The use of specialised silicones and colouring techniques produces prostheses which realistically mimic lost facial tissues and significantly enhance patient quality of life. The article provides an overview of the possibilities of modern epithetics in the treatment of facial defects resulting from head and neck tumors., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Despite evidence suggesting inaccuracy in the default fittings provided by hearing aid manufacturers, the use of probe-microphone measures for the verification of fitting accuracy is routinely used by fewer than half of practicing audiologists., Purpose: The present study examined whether self-perception of hearing aid benefit, as measured through the Abbreviated Profile of Hearing Aid Benefit (APHAB; Cox and Alexander, 1995), differed as a function of hearing aid fitting method, specifically, manufacturer's initial-fit approach versus a verified prescription. The prescriptive fit began at NAL-NL1 targets, with adjustments based on participant request. Each of the two fittings included probe-microphone measurement., Research Design: A counterbalanced, cross-over, repeated-measures, single-blinded design was utilized to address the research objectives., Study Sample: Twenty-two experienced hearing aid users from the general Bay Pines VA Healthcare System audiology clinic population were randomized into one of two intervention groups., Intervention: At the first visit, half of the participants were fit with new hearing aids via the manufacturer's initial fit while the second half were fit to a verified prescription using probe-microphone measurement. After a wear period of 4-6 wk, the participants' hearing aids were refit via the alternate method and worn for an additional 4-6 wk. Participants were blinded to the method of fitting by utilizing probe-microphone measures with both approaches., Data Collection and Analysis: The APHAB was administered at baseline and at the end of each intervention trial. At the end of the second trial period, the participants were asked to identify which hearing aid fitting was "preferred." The APHAB data were subjected to a general linear model repeated-measures analysis of variance., Results: For the three APHAB communication subscales (i.e., Ease of Communication, Reverberation, and Background Noise) mean scores obtained with the verified prescription were higher than those obtained with the initial-fit approach, indicating greater benefit with the former. The main effect of hearing aid fitting method was statistically significant [F (1, 21) = 4.69, p = 0.042] and accounted for 18% of the variance in the data (partial eta squared = 0.183). Although the mean benefit score for the APHAB Aversiveness subscale was also better (i.e., lower) for the verified prescription than the initial-fit approach, the difference was not statistically significant. Of the 22 participants, 7 preferred their hearing aids programmed to initial-fit settings and 15 preferred their hearing aids programmed to the verified prescription., Conclusions: The data support the conclusion that hearing aids fit to experienced hearing aid wearers using a verified prescription are more likely to yield better self-perceived benefit as measured by the APHAB than if fit using the manufacturer's initial-fit approach., (American Academy of Audiology.)

ESKA-Herrmann voice prosthesis are available for almost 30 years and are used for the vocal rehabilitation of laryngectomees. Nevertheless there are no studies about this voice prosthesis. Especially because of the smaller external diameter of 5.5 mm differents to other voice prostheses may be expected.We analyzed the 10-year patient documentation in retrospect.67 patients (63 m/4f) got the ESKA-Herrmann voice prosthesis, which could be used with a mean lifetime of 131.4 days. The main reason of changing the prostheses were dislocation (34/119), loss by coughing (34/119) and the leakage around the prostheses. In total a good voice was documented in 83.9% of the prostheses.ESKA-Herrmann voice prostheses are an alternative to other prostheses. Because of the smaller external diameter the dislocation and loss of the prosthesis occur more often than other models. But it's the only model that allows a designated spontaneous closure of the trachea-esophageal fistula after prosthesis removal., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Measurement of the real ear response of a fitted hearing aid allows matching of the frequency response to prescriptive targets, as well as comparison of the response to both threshold and loudness discomfort level (LDL). These processes are recommended procedures for hearing aid fittings. The real ear aided response (REAR) is often predicted based on the coupler response of the device, the real-ear-to-coupler difference (RECD), and the microphone location effect (MLE). Individualized measurement of the RECD tends to increase the accuracy of this prediction. A commercial hearing aid has been developed that measures the individual RECD and incorporates the data into the software-assisted fitting process., Purpose: This study evaluated the test-retest reliability and predictive validity of this particular method for measuring the RECD., Research Design: A repeated measures design was used to evaluate differences between subsequent measures of the RECD in the same ear, and prediction differences associated with using the RECD (and other information) to predict the REAR., Study Sample: Fifteen ears, on a convenience sample of ten adults (45-86 yr) and five children (6-15 yr) were tested. All participants were hearing aid users., Data Collection and Analysis: Predicted and measured REARs were collected using normal clinical procedures, on an Audioscan Verifit VF-1 for two test signals/levels. Reliability, mean differences between predicted and measured REARs, and 95% confidence intervals of the prediction accuracy are reported., Results: The RECD procedure had test-retest reliability within 2.5 dB for 14 out of 15 ears between 500 and 4000 Hz, and had predictive accuracy within 5 dB between 500 and 4000 Hz for 14 out of 15 ears. However, errors associated with earhook misalignment were discovered. Also, the RECD values measured using this hearing-aid-specific procedure differ somewhat from the normative data available from insert earphone RECDs., Conclusions: This procedure, when measured according to recommendations, provides a reasonably accurate prediction of the REAR. Functionally, this procedure does not replace the range of measures offered by modern real ear measurement systems. However, given the inaccuracy of software-assisted fittings without a measure of individual ear canal acoustics, use of this procedure may have the potential to improve the accuracy of fittings versus fittings completed without real ear measurement., (American Academy of Audiology.)

Background: The International Outcome Inventory for Hearing Aids (IOI-HA) is a seven-item hearing-specific questionnaire. It was developed with the purpose of evaluating the efficacy of hearing aid rehabilitation. Few psychometric properties have been presented for a Swedish translation of the IOI-HA. Furthermore, previous studies have examined the IOI-HA in mainly sensorineural hearing losses, and we do not know how the type of hearing loss affects the outcome., Purpose: To evaluate the hearing aid fitting outcome measured in a clinical setting using a Swedish translation of the International Outcome Inventory for Hearing Aids (IOI-HA), to determine the psychometric properties of the translation, and to examine how a number of demographic variables such as type of hearing loss affect the outcome., Research Design: A descriptive and correlational study in a retrospective sample., Study Sample: Two hundred and twenty-four (107 females and 117 males; ages 27-94 yr with an average of 66.1 yr) first-time hearing aid users., Intervention: Mostly digital hearing aids (97.8%) were fitted monaurally (60%) or binaurally (40%) between 2007 and 2009., Data Collection and Analysis: The subjects were mailed the IOI-HA questionnaire six months after their final appointment, and the completed questionnaire was returned by mail to the clinic. The psychometric properties were evaluated and compared to previous studies using the IOI-HA. The associations between the outcome scores and a number of demographic variables (age, gender, degree of hearing loss, type of hearing loss, number of hearing aids, and type of hearing aids) were examined. Based on the pure tone audiograms, the subjects were divided into three groups; those with conductive hearing losses, sensorineural hearing losses, and mixed hearing losses. For these groups, the differences in outcome measured as IOI-HA were examined., Results: The psychometric properties of the present translation of the IOI-HA showed resemblance in many aspects to previous reports. Furthermore, the type of hearing loss seems to affect the IOI-HA outcome. Hearing loss increases with increasing age, and hearing aid use increases with increasing degree of hearing loss. Subjects with sensorineural hearing losses show significantly poorer scores on items concerning introspective aspects of the outcome in comparison to subjects with mixed hearing losses and subjects with conductive hearing losses. Monaurally fitted subjects tend to report lower scores on average, but monaural or binaural hearing aid fitting do not significantly affect the subjective outcome., Conclusions: The psychometric properties of the present Swedish translation of the IOI-HA show resemblance in many aspects to previous reports, but the differences observed could be due to differences in the study populations. Overall, the demographic variables examined could not be used as predictors for the hearing aid fitting outcome, and more reliable predictors need to be identified., (American Academy of Audiology.)

Introduction: Patients with air-bone-gaps that cannot be corrected successfully by tympanoplasty or with mixed hearing loss may be treated with bone conducting hearing aids. Their disadvantages are the obvious external fixation components or the biological and psychosocial problems of open implants., Patients and Methods: The principle of these new bone conducting hearing aids is the magnetic coupling between implanted and external magnets. Twin-magnets are implanted into shallow bone beds in a one step procedure. The skin above the magnets is thinned out to a thickness of 4-5 mm, which reduces the attenuation to less than 10 dB compared to direct bone stimulation., Results and Discussion: The holding strength of the external components is equivalent to partially implantable hearing aids and Cochlea implants and the hearing improvement is similar to other bone conducting hearing aids. We have found the comfort and safety of this system is significantly improved compared to conventional or percutaneous bone conducting hearing aids., (Georg Thieme Verlag KG Stuttgart, New York.)

Unlabelled: SUPERELASTIC NITINOL STAPES PROSTHESESINTRODUCTION: Many different prostheses are available for stapes surgery. The newly designed Nitinol piston band-shaped stapes prosthesis could minimize postoperative complications due to its new superelastic characteristic and design., Patients and Methods: A stapedectomy and implantation of superelastic Nitinol piston stapes prosthesis was performed in 22 patients with a mean age of 45.2 years. Examination and audiometry was performed pre- and postoperatively., Results: The average observed air-bone-gap in all frequencies was 12.8 dB postoperatively, whereas in the frequencies 0.5-4 kHz ABG was under 10 dB in 68.2% of the patients, between 10 and 15 dB in 18.2% and between 15 and 20 dB in 9.1% of the patients. No patient showed air-bone-gap of more than 20 dB. One patient missed follow-up examination., Conclusion: In stapes surgery the step of fixation of the prosthesis onto the incus is critical. Implantation of the new Nitinol piston stapes prosthesis is facilitated due to the superelasticity and the design of the prosthesis. Crimping is not needed anymore. Postoperative hearing results are very good comparable to other Nitinol (shape memory) or titanium prostheses. Long-term results in a larger number of patients will be studied in the future.

Background: Hollow earmolds have become a popular type of earmold used in thin-tube, microsize hearing aid fittings. It is desirable for clinicians to be familiar with their characteristics and limitations., Purpose: This investigation compared the effects of vent diameter between a traditional solid earmold and a hollow earmold that is used in modern thin-tube hearing aid fittings., Research Design: A single-blind, 2 x 4 factorial design was used., Study Sample: Eight adults with a high-frequency hearing loss participated., Intervention: Custom earmolds for use with thin-tube hearing aids were made for each participant. Two types of earmolds were made: a solid earmold with a traditional vent length and a hollow earmold where the thickness of the shell was the length of the vent. Vent diameters were 0, 1, 2, and 3 mm., Data Collection and Analysis: The vent effect was evaluated on real-ear aided response, real-ear occluded response during vocalization, subjective occlusion rating, insertion loss, and maximum available gain before feedback. Real-ear measurements were made with the Fonix 6500 probe-microphone real-ear system. Vocalizations from the participants were analyzed with a custom MATLAB program, and statistical analysis was conducted with SPSS software., Results: A systematic vent effect was seen with each earmold type as the nominal vent diameter changed. For the same vent diameter, the vent effect seen with the hollow earmold was greater than that of the solid earmold., Conclusions: Because of the difference in vent length (and thus acoustic mass) between a solid and a hollow earmold, the effect of vent diameter in a hollow earmold is more pronounced than that seen in a solid earmold of the same nominal vent diameter. Thus, a smaller vent diameter will be needed in a hollow earmold than in a solid earmold to achieve similar vent effects.

Introduction: Mesh shrinkage is one of the unsolved problems of laparoscopic hernia repair., Methods: A literature search via the online database DIMDI and Pubmed with the key words "ventral hernia, incisional hernia, laparoscopic hernia repair, mesh shrinkage" was carried out. Surface and volume changes caused by insufflation of the abdomen were estimated with a simplified hemisphere model., Results: Eleven experimental and 3 clinical studies published data referring to shrinkage of intraperitoneally placed meshes. Polypropylene meshes showed shrinkage in the order of 3.6-25.4 %, PTFE meshes 4.0-51.0 %, coated polypropylene and polyester meshes 6.1-33.6 %. Three clinical studies confirmed these data (5-57 %). Since gas insufflation of the abdomen is essential for laparoscopic hernia repair, the volume and surface of the abdominal wall are intraoperatively significantly increased. An additional volume of 3 l increases the abdominal surface by about 80 %. This is more than the published shrinkage rates can compensate., Consequences: The surgeon has to anticipate significant mesh shrinkage in laparoscopic hernia repair. The measurement of the proper mesh dimensions has to consider the changes of volume and surface of the insufflated abdomen and the expected mesh shrinkage.

Introduction: A large variety of prostheses are available for stapes surgery. The newly designed Soft-CliP Piston is an alloplastic prosthesis used in patients with Otosclerosis which has been available since May 2007. With the new design, an intra- and postoperative damage of the ossicle chain should be minimized., Patients and Methods: A Laser-Stapedotomy was performed in 11 patients with a mean age of 45.7 years. Soft-CliP pistons with a shaft diameter of 0.4 mm and a length of 4.5 mm were used. An accurate examination and an exact audiometric testing were performed pre- and postoperative., Results: The average observed air-bone-gap in the frequencies from 0.5 to 4 kHz was postoperatively in 2.9% of the patients greater than 20 dB, in 5.7% between 15-20 dB, in 14.3% between 10-15 dB and less than 10 dB in 77.1% of the patients. Despite the new design of the prostheses it wasn't possible to slit the prosthesis onto the incus in two cases, and in one case there wasn't the needed size available., Conclusion: A critical point in every stapes surgery, the prosthesis fixation onto the incus, is facilitated by the novel Soft-CliP Piston. Crimping is not needed anymore. Very good hearing results are achieved postoperatively, comparable to other Titanium Prostheses. However the surgeon needs adequate experience to insert the Soft-CliP Piston. Long-term results in a larger group of patients are needed and pending.

Cochlear implants (CI) represent the "gold standard" for the treatment of congenitally deaf children and postlingually deafened adults. Thus, cochlear implantation is a success story of new bionic prosthesis development. Owing to routine application of cochlear implants in adults but also in very young children (below the age of one), high demands are placed on the implants. This is especially true for biocompatibility aspects of surface materials of implant parts which are in contact with the human body. In addition, there are various mechanical requirements which certain components of the implants must fulfil, such as flexibility of the electrode array and mechanical resistance of the implant housing. Due to the close contact of the implant to the middle ear mucosa and because the electrode array is positioned in the perilymphatic space via cochleostomy, there is a potential risk of bacterial transferral along the electrode array into the cochlea. Various requirements that have to be fulfilled by cochlear implants, such as biocompatibility, electrode micromechanics, and although a very high level of technical standards has been carried out there is still demand for the improvement of implants as well as of the materials used for manufacturing, ultimately leading to increased implant performance. General considerations of material aspects related to cochlear implants as well as potential future perspectives of implant development will be discussed.

Background: While there have been many studies of real-world preferred hearing aid gain, few data are available from participants using hearing aids with today's special features activated. Moreover, only limited data have been collected regarding preferred gain for individuals using trainable hearing aids., Purpose: To determine whether real-world preferred hearing aid gain with trainable modern hearing aids is in agreement with previous work in this area, and to determine whether the starting programmed gain setting influences preferred gain outcome., Research Design: An experimental crossover study. Participants were randomly assigned to one of two treatment groups. Following initial treatment, each subject crossed to the opposite group and experienced that treatment., Study Sample: Twenty-two adults with downward sloping sensorineural hearing loss served as participants (mean age 64.5; 16 males, 6 females). All were experienced users of bilateral amplification., Intervention: Using a crossover design, participants were fitted to two different prescriptive gain conditions: VC (volume control) start-up 6 dB above NAL-NL1 (National Acoustic Laboratories-Non-linear 1) target or VC start-up 6 dB below NAL-NL1 target. The hearing aids were used in a 10 to 14 day field trial for each condition, and using the VC, the participants could "train" the overall hearing aid gain to their preferred level. During the field trial, daily hearing aid use was logged, as well as the listening situations experienced by the listeners based on the hearing instrument's acoustic scene analysis. The participants completed a questionnaire at the start and end of each field trial in which they rated loudness perceptions and their satisfaction with aided loudness levels., Results: Because several participants potentially experienced floor or ceiling effects for the range of trainable gain, the majority of the statistical analysis was conducted using 12 of the 22 participants. For both VC-start conditions, the trained preferred gain differed significantly from the NAL-NL1 prescriptive targets. More importantly, the initial start-up gain significantly influenced the trained gain; the mean preferred gain for the +6 dB start condition was approximately 9 dB higher than the preferred gain for the -6 dB start condition, and this difference was statistically significant (p < .001). Partial eta squared (n2) = 0.919, which is a large effect size. Deviation from the NAL-NL1 target was not significantly influenced by the time spent in different listening environments, amount of hearing aid use during the trial period, or amount of hearing loss. Questionnaire data showed more appropriate ratings for loudness and higher satisfaction with loudness for the 6 dB below target VC-start condition., Conclusions: When trainable hearing aids are used, the initial programmed gain of hearing instruments can influence preferred gain in the real world.

Since the last decade of the last century, surgical voice restoration with the use of voice prostheses has become a standard after total laryngectomy. About 80-90 % of the patients are capable to speak well or even very well with a voice prosthesis. Although severe complications have become rare since special pharynx protectors are in use for the implantation of the voice prostheses, minor problems are quite common. Primarily, these are frequent leakages through the prosthesis caused by fast wear and tear of the material and biofilms on the surface of the prosthesis, granulation tissue around the prosthesis, loss of the prosthesis with either aspiration or ingestion and migration or enlargement of the fistula. This paper explains the application of the most common kinds of voice prostheses and the management of the most frequent problems.

The purpose of the current study was to evaluate the consistency and reliability of user adjustments to hearing aid gain and the resulting effects on speech understanding. Sixteen bilaterally aided individuals with hearing loss adjusted their hearing aid gain to optimize listening comfort and speech clarity while listening to speech in quiet and noisy backgrounds. Following these adjustments, participants readjusted their aids to optimize clarity and comfort while listening to speech in quiet. These final gain settings were recorded and compared to those provided by NAL-NL1 prescriptive targets. In addition, speech understanding was tested with the hearing aids set at target and user gain settings. Performance differences between the gain settings were then assessed. Study results revealed that although some listeners preferred more or less gain than prescribed, on average, user and prescribed gain settings were similar in both ears. Some individuals, however, made gain adjustments between ears resulting in "gain mismatches." These "mismatches" were often inconsistent across trials suggesting that these adjustments were unreliable. Speech testing results, however, showed no significant difference across the different gain settings suggesting that the gain deviations introduced in this study were not large enough to significantly affect speech understanding.

Patients with bony defects of the proximal femur after trochanteric fracture, implant failure (cut-out), periprosthetic fracture or aseptic loosening of prosthesis are difficult to treat with primary or revision endoprosthesis. Modular femoral hip prosthesis (MHP) with stems of different length and the possibility of distal interlocking screws are an operative solution for those patients. In a prospective study from January 1996 to January 2002 all patients treated with a MHP because of proximal and / or distal femoral bony defect or fracture were included. Follow-up after 6 to 30 months was evaluated clinically and radiologically in hospital. Change of modified Harris Hip Score and radiological signs of loosening (radiolucent line, migration of MHP, breaking interlocking screw) were documented. 106 patients with a follow-up of 58.5 % were included in the study. At time of follow-up clinical and radiological outcome after trochanteric fracture was good. Harris Hip Score was comparable to the situation of patients before fracture, only one MHP was loose. However in patients after revision arthroplasty 25 % of MHP were loose and in many patients the interlocking screw was broken. Distal interlocking screw in MHP prevents stability after trochanteric fracture to achieve osseointegration. However in case of periprosthetic fracture or revision arthroplasty MHP shows insufficient stability in many cases.

Purpose: Overview over the single independent error contributions of IOL power calculation and their currently achievable lower limits., Method: Analysis of the reasons of avoidable and unavoidable single errors which contribute to the overall error: measuring errors of axial length and corneal radii; errors due to neglecting of relevant influences such as pupil width, asphericity of cornea and IOL and IOL geometry; calculation errors from inadequate calculation methods; estimation errors of postoperative IOL position; IOL manufacturing errors. The said error contributions are to be compared with the reproducibility error of the refraction. All calculations use a numerical raytracing based on the geometric-optical IOL manufacturing data., Results: Axial eye length with an error of approximately 0.2 D is no longer the dominating error if the measurements are performed by interferometry, the same is true for corneal readii in normal eyes. The latter, however, causes the dominant error in eyes after corneal refractive surgery ( approximately 1.5 D) if measured only by keratometry. This error can be avoided if a topographic measurement is included into the raytracing, and in some cases also the measurement of posterior corneal surface has to be included. Currently the dominant unavoidable error contribution results from the uncertainty of postoperative IOL position ( approximately 0.35 D)., Conclusion: Some errors of classical IOL formulae can be avoided by raytracing. But if the total error threshold shall be below the error of refraction, the prediction accuracy of postoperative IOL position must be improved.

The effects of low-frequency expansion on the objective and subjective evaluation of four channel in-the-ear hearing instruments was investigated. Three expansion settings were programmed in each device: expansion off, expansion restricted to channel one, and expansion restricted to channels one and two. Objective evaluations were conducted in quiet (Connected Speech Test) and in noise (Hearing in Noise Test) with speech levels fixed at 40 dB SPL. Subjectively, each participant rated expansion satisfaction in quiet and listening to low-level speech in a sound-treated room then indicated the expansion condition preferred overall. Listeners performed significantly better in quiet and in noise for the Off and Channel 1 conditions than the Channels 1 and 2 condition; however, performance was similar between the Off and Channel 1 conditions. Expansion effects on listener satisfaction ratings depended on the listening environment. Overall, listeners preferred expansion in Channel 1 to expansion in Channels 1 and 2; however, preference was not significantly different between the Channel 1 and Off conditions. Results indicate restricting expansion to 1000 Hz overcomes speech-recognition deficits observed with expansion active across a broader spectrum without significantly reducing subjective benefit or preference.

The main aims of this study were: (1) to determine whether routine real ear insertion gain (REIG) measurement is necessary in fitting digital hearing aids; and (2) to assess the extent to which modifying the frequency-gain response of an aid can lead to better matches to the target in cases where the target gain was not initially achieved. The target formula was selected as NAL-NL1 in the programming software of four types of digital hearing aids. REIG measurements on 42 ears showed that 64% of cases failed to come within +/-10 dB of the target at one or more of the following frequencies: 0.25, 0.5, 0.75, 1, 1.5, 2, and 4 kHz. After adjusting the frequency-gain response of the aids, based on the REIG results, 83% of cases came within +/-10 dB of the target. The target was met more often, both before and after adjustment, for aids with seven gain "handles" than for aids with four gain "handles". The results indicate that REIG measurements can and should be used to achieve more accurate fittings but that accurate adjustments are difficult with some aids.

Currently published hearing aid fitting protocols recommend speech-in-noise testing and loudness measures, but it remains unclear how these measures affect hearing aid benefit and user satisfaction. This study compared two protocols in their effects on benefit and satisfaction. Protocol A included an electroacoustic analysis, real-ear measures, and hearing aid adjustments based on users' comments. Protocol B included all of Protocol A and a speech-in-noise test, loudness discomfort levels, and aided loudness. Thirty-two participants completed the Abbreviated Profile of Hearing Aid Benefit (APHAB) and the Satisfaction with Amplification in Daily Life (SADL) at 45 days and three months post-initial fitting. Fewer hearing aid adjustments were made to the hearing aids for participants fitted with Protocol B than participants fitted with Protocol A, but final gains were similar for both groups. Although similar APHAB scores were obtained for both protocols, SADL scores decreased between 45 days and three months for Protocol A.

The purpose of this study was to evaluate a clinical protocol for setting hearing aid maximum output (MPO) in adult users. The protocol consisted of matching prescriptive targets for MPO followed by aided loudness validation and adjustment. Twenty-eight adults fit with multichannel hearing aids during the previous two years were recalled for unaided loudness measures. During the recall visit, unaided frequency-specific loudness discomfort levels were measured for frequencies between 250 and 3000 Hz. These values were converted to real-ear levels by adding individually measured real-ear dial differences. Real-ear saturation responses (RESR) were measured using a 90 dB pure-tone sweep and compared to the real-ear loudness discomfort levels. All participants completed the APHAB Aversiveness scale and Munro-Patel loudness questionnaire. A subset of participants (n = 20) completed the Profile of Aided Loudness. The average RESR-UCL difference was -5.7 dB, and the maximum difference was 15 dB. For all but one participant, the average RESR values (.5-3 kHz) were either less than or no more than 5 dB above the LDLs, and the aided APHAB Aversiveness scores were below the 80th percentile. There were no significant correlations between the scores on the loudness questionnaires and the differences between RESR and LDL values. Results suggest that unaided LDL measures may be redundant if aided loudness validation measures are completed.

A total of 190 individuals participated in a clinical visit during the Cooperative Studies Program (CSP) 418-A Long Term Follow-Up Study. Of this cohort, 158 participants were considered current hearing aid users, and 32 were non-hearing aid users. Of the current hearing aid users, 81 were still using their original 418 study devices, and 77 had acquired new hearing aids. Coupler and real ear measurements were completed on all available hearing aids. Results showed that study aids had remained relatively stable over the six years between CSP 418 and CSP 418-A. On average, these hearing aid wearers preferred use gain settings that were 6-9 dB less than current NAL-RP insertion gain targets. Mean real ear insertion gain (REIG) was comparable to the mean real ear insertion gain of the same participants in the original study, and users did not tend to increase gain as hearing decreased. Real ear saturation responses (RESR) remained unchanged. Loudness discomfort levels (LDL) obtained during 418-A were significantly lower than LDLs obtained on those same participants at both the initial and final visits in the previous study.