**8. Our results**

*Advances in Rehabilitation of Hearing Loss*

outcomes (**Figures 14** and **15**).

between them.

mastoid bone, transmits mechanical vibrations directly to the inner ear jumping middle and outer ear. The conduction system is light (∼10 g), and it has an area of ∼8.7 mm (height) × 15.8 mm (diameter). Two titanium screws—responsible for the vibrations transduced to the system—are located to a distance of around 24 mm

Bonebridge is the unique BAHI with active mechanism; the information analyzed by the audio-processor are sent to the antenna and transmitted through the skin to the system. It converts the received signals into mechanical vibrations, which are transmitted to the inner ear by bone conduction. The transductor is surgically positioned at the seno-dural angle. However, due to its slightly bulky internal implant, the most optimal location for placing BB implant should be carefully

As compared to percutaneous BCI, Bonebridge's transcutaneous technology enables the avoidance of several complications including skin reaction, growth of

and currently nobody described severe complications by using this implant. We suggest to use a double flap for minimizing the skin trauma and improving the

*(A) After lodged BAHI is fixed to the temporal bone with a screw and (B) way in which the implant appears* 

*(A) Measurement of temporal bone thickness before surgery and (B) lodgment for BAHI created posteriorly to* 

*before the closure of the skin. Live surgery: https://www.youtube.com/watch?v=Wlh6YxEnJl8.*

BB presents the same risks of the other BAHIs (skin infection and skin necrosis),

selected preoperatively using 3D reconstruction software [32].

skin over the abutment, implant extrusion, and wound infection.

**84**

**Figure 15.**

**Figure 14.**

*the pinna.*

We widely use BAHIs both in the case of aural atresia (singular or bilateral form) [1, 15, 21] and as treatment of single side deafness [1], and our results are supported by other authors' observations [16–19, 29, 30].

We observed that BAHI not only improved the hearing abilities of children in noise condition but also their dictation capacity during the school activity [1, 15, 21].

We compared children wearing BAHI immediately after the implant and then 3 months later they were implanted, and we noticed that their abilities in speech perception increased time by time by reaching the same scores observed in healthy children after 3 months [1]. In addition, we analyzed the short and working memory abilities in children with BAHI, before and after implantation, and we identified that both these memory functions improved by restoring the hearing with BAHIs. The memory abilities, as the speech perception done, increased time by time by overlapping the score obtained by healthy children in the same age range [1]. Finally, we observed that children after being implanted with BAHI improved their school scores and increased their relationship with friend and environment [21].

Reported complications are slight skin problems as localized irritation and hypertropic scare around the titanium implant. The skin inflammation may be explained as an immune answer to an external body (the screw). In the literature the rates go from 5 to 7.5% for skin regrowth and from 1.3–10% for extrusion of the abutment [15].

## **9. Conclusions**

We think that BAHIs are a very good solution for restoring hearing abilities. Although we have a wide experience on children, due to the excellent results obtained on these patients, in terms of speech discrimination but much more for the impressive benefit obtained in memory function, we suggest BAHIs as treatment of hearing loss in adults' population too.

As we have shown in our chapter, BAHIs are simple to implant, with very low side effects, and their surgery is poor and time-consuming. We speculate that due to the new theories on BAHIs' stimulation of the inner ear [33–37], these implants could be a valid alternative to the traditional hearing aids in slight-mild form of asymmetric hearing loss; we suggest BAHIs not only in the case of conductive hearing loss (CHL) but also in the sensorineural form (SNHL).

### **Conflict of interest**

The authors declare no conflict of interest.

*Advances in Rehabilitation of Hearing Loss*
