Clinical Test Protocol for Evaluating Bone Anchored Hearing Benefit During Patient Trial Process

Bone anchored hearing implants are beneficial hearing solutions designed to improve patients’ hearing through direct bone conduction. They are indicated for use in patients who have conductive or mixed hearing loss or in patients with single-sided deafness (SSD).

Adult candidates considering a bone anchored solution have the opportunity to experience sound through an acute simulation during a routine evaluation appointment.  It is during that appointment that the audiologist typically will counsel on device, discuss the benefits and outcomes, and provide the opportunity for the patient to hear sound through a clinic demo device, such as a Ponto 3 SuperPower or a Ponto 4 sound processor. This simulation provides significant value to the patient considering non-surgical versus surgical treatment options.

As clinicians, we are taught the importance of verifying device benefit for patients with hearing loss when considering their hearing device options, and then again as they are being fit with their device. In fact there are well-established protocols and tools in place for hearing aid verifications and cochlear implant assessments. However, there are few recognized protocols in place for validating benefit in a patient using a bone anchored device. It is for this reason that Oticon Medical has developed a bone anchored hearing system test protocol to assess benefit and compare performance with various hearing technologies.

At Oticon Medical, we understand the demands placed on our clinics each day and also know the importance of providing best audiological practice to patients considering a bone anchored solution.  Therefore, we took on the goal developing a simple test protocol for audiologists using the resources already available in their clinic.

The protocol consists of a laminated card outlining four straightforward steps to verify benefit with a bone anchored system or compare performance between different solutions and a test record sheet for documenting the patient’s results. Using published research from Snapp, et al (2010) we modified their suggested protocol to create our version that reinforces the use of a test band for simulations, sound field speech in noise testing using the QuickSin, and the administration of a self-assessment questionnaire. Finally, the protocol outlines additional verification measures that can be completed as well as highlighting the proper reimbursement codes that may be used for this appointment. The protocol is recommended for all bone anchored hearing loss indications.

To learn more about this protocol, we encourage you to register for our upcoming training on February 24, 2021 or reach out to your regional clinical specialist.

About the Author:

Carissa Moeggenberg is an audiologist who has worked in the hearing healthcare field for the past 28 years. She is presently the Training Manager for Oticon Medical.

References:

QuickSin Speech-in-Noise Test. User Manual. Etymotic Research Inc. Version 1.3

Current Procedural Terminology (CPT) Codes. Audiology. American Medical Association 2019

Snapp, H.A. et al (2010) A Clinical Protocol for Predicting Outcomes with an Implantable Prosthetic Device (BAHA) in Patients with Single-Sided Deafness. J Am Acad Audiol, 21: 654-662.
Female audiologist

Reducing the Clinic’s Burden: Online Patient Resources from Oticon Medical

The demand to provide hearing healthcare services remotely has reached new levels this past year due to the COVID-19 pandemic. Remote hearing healthcare is not new—it has been discussed in audiology research circles for more than 20 years, been piloted and launched by Government Services and used by clinicians serving remote geographic locations.

TeleHealth, as defined by the World Health Organization, is “the use of electronic means to deliver information, resources and services related to health”. TeleHealth covers many domains, including electronic health records, mobile health, and health analytics. TeleHealth (also called eHealth) has the potential to provide more services to a wider population in a personalized manner. Prior to 2020, it was primarily intended to supplement in-person appointments, but has taken on a new meaning due to the recent pandemic and need for social distancing.

Reducing the burden on clinics by providing support for patient-related services and offering remote assistance to patients is a priority for us at Oticon Medical, which is why we have either created or further expanded several online support services for our hearing healthcare professionals over the last year. We detail a short summary of these services in this first blog of the New Year.

The Ponto Care™ App was expanded specifically to address the need for social distancing. It now provides your patients with an Aftercare section allowing them to access relevant information about everyday life with the Ponto, including user guides, instructional videos and a diary. More importantly, the Aftercare section allows recipients to monitor their implant site to ensure proper care is taken should an issue with the healing process occur. The app provides recipients with the ability to photograph their implant site documenting any changes that may occur over time. These photos can be shared or discussed with their healthcare provider should an issue occur during their recovery process, thus empowering patients for simple, easy device care.

Replacement Processor Support is an essential service for you and your patients. Should your patient need a replacement sound processor, we will extract their current program from their non-functioning processor, load the program(s) onto their new sound processor and ship directly to the patient. This removes you from the process so that you can focus your time on clinically billable services.

Oticon Medical Online Support Pages

Patients often have many questions regarding the insurance reimbursement process during their journey to getting a Ponto System or when upgrading their current sound processor. In order to reduce the amount of time you spend counseling on topics related to insurance reimbursement we have expanded our online services to provide additional support for your patients. Our Insurance Support Team has posted online information that includes the list of in-network insurance providers, frequently asked questions, intake forms and direct contact information on how to reach a member of our team.

Additional online programs to assist your patients can be found on our website under Support.  This section of our website offers instructional product videos, online warranty registration and product use guides.

Ongoing guidance and support from other recipients who have been on the BAHS journey to better hearing play a key role in assisting patients who are new to this technology. We encourage you to direct your patients to our Oticon Medical Friends program

for a deeper connection that only another bone anchored recipient can impart, thus easing the amount of time you spend on counseling.

Finally, to provide a place for you to build your expertise about Oticon Medical’s products, we have partnered with Audiology Online to extend opportunities for you to attend live webinars or watch recorded webinars from the comfort of your home or office. These sessions are typically 60 minutes in length and offer continuing education credits. Topics include clinical evidence, product updates, product fittings and advanced clinical management of bone anchored recipients.

We Value Your Feedback

We are committed to continually evaluating the services we provide and developing innovative remote care solutions that present value to those customers who fit and receive our products. Should you have suggestions or ideas on how we can improve our remote service programs please let us know!

We wish you all the best for 2021! Your dedication and skill make a difference every day to those affected by hearing loss.

Strengthening Connections in Challenging Environments with the EduMic

Whether a child’s learning environment is in the classroom or virtually from their home, the ability to control the acoustics is difficult and underscores the need to optimize the overall speech signal.  Providing clear access to speech is critical for them to learn. Research has shown that children need quieter conditions and better signal-to-noise ratios than adults to have good speech understanding (Bradley & Sato, 2008). This is because children with developing language and auditory systems have a smaller vocabulary and are unable to rely on the redundancy of language to fill in missing words (Neuman, Wroblewski, Hajicek, & Rubenstein, 2010). Other studies have shown that an inability to understand the teacher due to poor listening conditions directly impacts the learning of new concepts (Yang & Bradley, 2009; Leibold, Hillock-Dunn, Duncan, Roush, & Bess, 2013). The exertion of mental energy and listening effort are also much higher when poor acoustic conditions exist (Bess, Gustafson, & Hornsby, 2014; McGarrigle, Gustafsson, Hornsby, & Bess, 2019).

The EduMic classroom solution

With the release of the EduMic™, Oticon Medical offers a unique solution for children to optimize listening effort in challenging environments. The EduMic – a remote microphone system (RMS) –features 2.4 GHz wireless technology and integrates with the Ponto 4 sound processor.  Built on the Velox STM platform, the EduMic features advanced signal processing, including Open Sound NavigatorTM technology. The EduMic preserves speech, operating within a wide bandwidth of 150 Hz to 10000 Hz while analyzing, balancing and applying noise removal to the streamed signal.  To improve the signal in outdoor environments, the EduMic also features Wind Noise Management, which employs an added level of “cleaning” to the signal.

While the primary function of the EduMic is in the microphone and transmitter mode, it has additional modes that are useful in and outside the classroom. The EduMic can stream stereo audio from various sources by connecting via a 3 mm jack cable, connecting to Frequency Modulation (FM) and Digital Modulation (DM) devices via a universal receiver, or it can function in telecoil mode. Additional features to help with the management of the device include LED indicators, a retention clip and protective skins.  The EduMic is robust and durable, provides stable transmission of the speech signal and provides the user with approximately 10 hours of use on a single battery charge based on internal device testing (EduMic Technical Data Sheet).   Figure 1 highlights the EduMic design and functionality.

Clinical evidence concerning EduMic supports both device usability and the improvement of speech understanding in complex listening environments. In fact, when the EduMic was subjectively evaluated by a group of educators, 80 percent reported a preference towards the EduMic over a competitive remote microphone system (RMS) and described it as “easy to use and comfortable to wear” (Gordey & Rumley, 2019).  When assessing the effectiveness in a noisy environment using a simulated classroom study design, the EduMic demonstrated improved speech understanding in children with hearing loss in both noise and noise plus reverberation environments when compared to using their hearing aids alone (Gordey & Rumley, 2019).

We encourage the use of the EduMic in all environments, including a child’s home where incidental learning occurs. This powerful solution provides children with an effortless transition into any environment because of its ease of use.  Finally, this product is a great balance of design and usability combined with advanced hearing technology to optimize the learning experiences of children with hearing loss.

To learn more about the EduMic and how it might benefit your patients contact your clinical specialist.

References:

Bess, F. H., Gustafson, S. J., & Hornsby, B. W. (2014). How Hard Can It Be to Listen? Fatigue in School-Age Children with Hearing Loss. Journal of Educational Audiology, 20, 1-14.

Bradley, J. S., & Sato, H. (2008). The intelligibility of speech in elementary school classrooms. The Journal of the Acoustical Society of America, 123(4), 2078-2086.

Gordey, D. and Rumley, J. (2019). Enhanced Learning with the EduMic. White Paper. Oticon, Inc.

Leibold, L. J., Hillock-Dunn, A., Duncan, N., Roush, P. A., and Buss, E. (2013). Influence of hearing loss on children’s identification of spondee words in a speech-shaped noise or a two-talker masker. Ear Hear. 34, 575–584.

McGarrigle, R., Gustafson, S. J., Hornsby, B. W., and Bess, F. H. (2019). Behavioral measures of listening effort in school-age children: examining the effects of signal-to-noise ratio, hearing loss, and amplification. Ear Hear. 40, 381–392.

Yang, W., & Bradley, J. S. (2009). Effects of room acoustics on the intelligibility of speech in classrooms for young children. The Journal of the Acoustical Society of America, 125(2), 922-933.

About the Author:

Carissa Moeggenberg is an audiologist who has worked in the hearing healthcare field for the past 28 years. She is presently the training manager for Oticon Medical.

 

Celebrating 10 Years of Delivering Sound that Matters

Part 2 of 2

Part 2 of our series presents evidence that supports the principles championed by Oticon Medical – BrainHearingTM and Direct Sound Transmission. Read below to learn more about these important principles and how they affect patient outcomes based on 10 years of clinical evidence.

Proven Hearing Excellence

As an audiologist, wouldn’t it make your job easier if the simple act of providing a patient with access to sound through hearing technology always equaled excellent outcomes? However, it is not that simple. The right choice of a hearing system will impact every aspect of a recipient’s life – from a conversation with their friend to learning a new subject in school to enjoying a movie at the local theater. At Oticon Medical, our goal is to help our recipients invest their cognitive resources in understanding, remembering, interacting and enjoying, rather than just hearing. We cannot make all situations noiseless and easy, but our solutions should reward the user with increased performance when more effort is necessary to understand an important situation. Through BrainHearing and Direct Sound Transmission, Oticon Medical offers a unique solution for your patients with clinical evidence to support its advantages .

BrainHearing is the Foundation of Better Hearing

BrainHearingTM is the foundation on which we developed the Ponto™ 3 SuperPower (SP) and the Ponto 4 hearing systems. It is about the basic understanding of how hearing works and how the brain makes sense of sound with less effort. Building on our foundation of BrainHearing, we also offer the advantages of Direct Sound Transmission. Direct Sound Transmission delivers the most efficient transmission of speech and sound via the skull bone directly to the cochlea without skin dampening, providing access to a larger range of everyday sounds with less distortion.

The combination of these two principles [BrainHearing and Direct Sound Transmission] demonstrates a significant decrease in listening effort can be achieved with the Ponto 3 SP, as indicated by reduced pupil dilation (Bianchi, F, et al. 2019). This pupillometry study proves that Ponto 3 SP, with its higher MFO level can significantly reduce the effort needed to listen to speech in noise.

An Open and Balanced Sound Experience with OpenSound Navigator

Ponto 4 features the groundbreaking OpenSound Navigator™, offering speed and precision for constant access to 360° sound. The result is a truly open and balanced sound experience in complex listening situations, bringing significant improvement in speech understanding. In fact, clinical evidence indicates a 30% improvement in speech understanding in noise (Bianchi, F, Weile, J N, et al. 2020). Also noted in this same study was that 80% of recipients preferred wearing the Ponto 4 when in a complex listening environment.

These studies show how improved sound quality does not only mean the ability to hear better, but for the first time, learning, memory, and listening effort were evaluated in bone anchored recipients to assess benefits beyond better hearing. The novel research presented here strengthens the evidence that the choice of the system and sound processor may have implications on everyday life activities for your patients. This is why the advanced technology offered by Oticon Medical makes all the difference!

To summarize, ten years after the first recipient received their Ponto sound processor, we have worked strategically to gain insights from surgeons, recipients and clinicians in the field to develop products that improve patient care and outcomes with the Ponto device. Without this research, bone anchored recipients would not be able to benefit from a minimal, suture-free surgical procedure, simple and easy aftercare, improved quality of life and the significant hearing improvements that characterize the Ponto System. To learn more about the studies outlined in this blog please visit our website [insert address].

References:

Bianchi, F, et al. (2019). Benefit of higher maximum force output on listening effort in bone-anchored hearing system users: A pupillometry study. Ear Hear 40:1220-1232.

Bianchi, F, Weile, J N, et al. (2020). OpenSound Navigator™ for Ponto, Oticon Medical white paper 215170.

About the Author:

Carissa Moeggenberg is an audiologist who has worked in the hearing healthcare field for the past 28 years. She is presently the training manager for Oticon Medical.

Celebrating 10 Years of Delivering Sound that Matters

Part 1 of 2

As a clinical audiologist, I am rarely awestruck by manufacturing claims; however, I encourage all audiologists in the field to take a moment to review Oticon Medical’s 10-Year Evidence Campaign.  I’ve provided a  brief summary of this two-part series below. Following this review, please reach out to your clinical specialist if you would like additional information or have any questions on the evidence  highlighted in these two blogs.

A Small Procedure with Huge Benefits – The Minimally Invasive Ponto Surgery

When we think of a surgical procedure, I believe most of us envision cutting, sutures, pain and recovery. In fact, the implantation of a traditional bone anchored solution involves an incision, sutures, thinning of the soft tissue and a slower healing process. And like traditional bone anchored solutions, Oticon Medical also followed this path 10 years ago, until the introduction of the minimally invasive Ponto surgery (MIPS) procedure. This procedure has revolutionized the industry by offering patients a less-invasive approach to better hearing with a Ponto™ device. The MIPS technique is a suture-free procedure with a unique approach to tissue preservation that is completed in minutes. It is truly minimally invasive because the soft tissue excised exactly matches the shape of the percutaneous abutment. All preparations for the implant installation are done through this circular incision, eliminating the need for sutures and thinning of the soft tissue. Utilizing tailor-made surgical components, 80% of US surgeons have gravitated to this new procedure offering their patients a simple, safe and easy surgery with huge benefits.

The clinical evidence gathered over the past 10 years supports the benefits of the MIPS procedure  Recent studies suggest that 98% of patients report an improvement in their quality of life after Ponto surgery. The reported improvement is greater than for middle ear implants, and almost as significant as for cochlear implants (Hendry et al., 2016). Additional studies highlighting the features and benefits of the surgical aspects of the Ponto System can be accessed through the link.

Designed for Simple, Easy Care

A topic professionals often counsel patients on during the candidacy process is what type of aftercare is necessary following placement of the implant. Many candidates are reluctant to take that next step towards surgery because of aftercare concerns with regard to the abutment.

In an effort to improve tissue preservation, Oticon Medical has refined the model of the Ponto abutment utilizing a unique OptiFit™ design– offering a straight neck and perfect match to the soft tissue. Because of this design, the Ponto abutment family is a proven skin-friendly concept. What’s more, in 95% of follow-up visits, no skin-related aftercare treatment was required based on systematic literature review reporting on ten years of experience with the Ponto System (Lagerkvist et al, 2020). This indicates that six out of seven patients will not need treatment due to a skin reaction. As a professional, you could then expect less than one follow-up visit in 20 would require the need to take action when using Ponto abutments and the modern surgical technique. These outcomes are representative of what any patient choosing to undergo a Ponto surgery can expect.

New for our family of Ponto recipients is the Ponto Care app. This tool, specifically designed during social distancing times, provides your patients with an Aftercare section allowing them to access relevant information about everyday life with the Ponto, including user guides, instructional videos and a diary. More importantly, the Aftercare section allows recipients to monitor their implant site to ensure proper care is taken should an issue with the healing process occur. The app provides recipients with the ability to photograph their implant site documenting any changes that may occur over time. These photos can be shared or discussed with their healthcare provider should an issue arise during their recovery process, thus empowering patients and enabling simple, easy device care.

Stay tuned as next month we will continue with our 10-Year Evidence Campaign by reviewing the studies focused on Proven Hearing Excellence. 

References:
Hendry J, Chin A, Swan IR, Akeroyd MA, Browning GG.  The Glasgow Benefit Inventory: a systematic review of the use and value of an otorhinolaryngological generic patient-recorded outcome measure. Clin Otolaryngol. 2016; 41(3):259-75.
Lagerkvist, H, et al. (2020). Ten years’ experience with the Ponto bone anchored hearing system – a systematic literature review (under review).

About the Author

Carissa Moeggenberg is an audiologist who has worked in the hearing healthcare field for the past 28 years. She is presently the training manager for Oticon Medical.