The benefits of combining a cochlear implant (CI) and a hearing aid (HA) in opposite ears on speech perception were examined in 15 adult unilateral CI recipients who regularly use a contralateral HA. A within-subjects design was carried out to assess speech intelligibility testing, listening effort ratings, and a sound quality questionnaire for the conditions CI alone, CIHA together, and HA alone when applicable. The primary outcome of bimodal benefit, defined as the difference between CIHA and CI, was statistically significant for speech intelligibility in quiet as well as for intelligibility in noise across tested spatial conditions. A reduction in effort on top of intelligibility at the highest tested signal-to-noise ratio was found. Moreover, the bimodal listening situation was rated to sound more voluminous, less tinny, and less unpleasant than CI alone. Listening effort and sound quality emerged as feasible and relevant measures to demonstrate bimodal benefit across a clinically representative range of bimodal users. These extended dimensions of speech perception can shed more light on the array of benefits provided by complementing a CI with a contralateral HA.

Over the last years, less invasive surgical techniques with soft tissue preservation for bone conduction hearing implants (BCHI) have been introduced such as the linear incision technique combined with a punch. Results using this technique seem favorable in terms of rate of peri-abutment dermatitis (PAD), esthetics, and preservation of skin sensibility. Recently, a new standardized surgical technique for BCHI placement, the Minimally Invasive Ponto Surgery (MIPS) technique has been developed by Oticon Medical AB (Askim, Sweden). This technique aims to standardize surgery by using a novel surgical instrumentation kit and minimize soft tissue trauma. A multicenter randomized controlled trial is designed to compare the MIPS technique to the linear incision technique with soft tissue preservation. The primary investigation center is Maastricht University Medical Center. Sixty-two participants will be included with a 2-year follow-up period. Parameters are introduced to quantify factors such as loss of skin sensibility, dehiscence of the skin next to the abutment, skin overgrowth, and cosmetic results. A new type of sampling method is incorporated to aid in the estimation of complications. To gain further understanding of PAD, swabs and skin biopsies are collected during follow-up visits for evaluation of the bacterial profile and inflammatory cytokine expression. The primary objective of the study is to compare the incidence of PAD during the first 3 months after BCHI placement. Secondary objectives include the assessment of parameters related to surgery, wound healing, pain, loss of sensibility of the skin around the implant, implant extrusion rate, implant stability measurements, dehiscence of the skin next to the abutment, and esthetic appeal. Tertiary objectives include assessment of other factors related to PAD and a health economic evaluation. This is the first trial to compare the recently developed MIPS technique to the linear incision technique with soft tissue preservation for BCHI surgery. Newly introduced parameters and sampling method will aid in the prediction of results and complications after BCHI placement. Registered at the CCMO register in the Netherlands on 24 November 2014: NL50072.068.14 . Retrospectively registered on 21 April 2015 at ClinicalTrials.gov: NCT02438618 . This trial is sponsored by Oticon Medical AB.

The Suppression Head Impulse (SHIMP) test was introduced as an alternative to the Head Impulse Paradigm (HIMP) to overcome challenges in VOR gain calculation due to the interference of covert saccades. The objectives of this study were (1) to determine if SHIMP, compared to HIMP, reduces covert saccades in BV patients and (2) to define the agreement on diagnosing BV between SHIMP and HIMP. First, the number of covert saccades was compared between SHIMP and HIMP. Secondly, VOR gain was compared between SHIMP and HIMP. Lastly, the agreement between SHIMP and HIMP on identifying BV (horizontal VOR gain <0.6) was evaluated. A total of 98 BV patients were included. To our knowledge, this is the largest study population on SHIMP testing in BV patients. Covert saccades were significantly reduced, and a lower VOR gain was found during SHIMP compared to HIMP (p < 0.001). However, the clinical relevance of these statistically significant differences is small. In 93% of the patients, an agreement was found between the two paradigms regarding the diagnosis of BV, and both paradigms detect BV in the vast majority of patients.

Background: Chronic tinnitus can have an immense impact on quality of life. Despite recent treatment advances, many tinnitus patients remain refractory to them. Preclinical and clinical evidence suggests that deep brain stimulation (DBS) is a promising treatment to suppress tinnitus. In rats, it has been shown in multiple regions of the auditory pathway that DBS can have an alleviating effect on tinnitus. The thalamic medial geniculate body (MGB) takes a key position in the tinnitus network, shows pathophysiological hallmarks of tinnitus, and is readily accessible using stereotaxy. Here, a protocol is described to evaluate the safety and test the therapeutic effects of DBS in the MGB in severe tinnitus sufferers. Methods: Bilateral DBS of the MGB will be applied in a future study in six patients with severe and refractory tinnitus. A double-blinded, randomized 2 × 2 crossover design (stimulation ON and OFF) will be applied, followed by a period of six months of open-label follow-up. The primary focus is to assess safety and feasibility (acceptability). Secondary outcomes assess a potential treatment effect and include tinnitus severity measured by the Tinnitus Functional Index (TFI), tinnitus loudness and distress, hearing, cognitive and psychological functions, quality of life, and neurophysiological characteristics. Discussion: This protocol carefully balances risks and benefits and takes ethical considerations into account. This study will explore the safety and feasibility of DBS in severe refractory tinnitus, through extensive assessment of clinical and neurophysiological outcome measures. Additionally, important insights into the underlying mechanism of tinnitus and hearing function might be revealed. Trial registration: ClinicalTrials.gov NCT03976908 (6 June 2019).

Background/objective: Different testing paradigms have been proposed to investigate perceptual self-motion thresholds. They can differ regarding the amount of possible motions that patients have to choose from. Objective of this study was to compare the two-option paradigm and twelve-option paradigm, to investigate whether reducing the choice options significantly influences the reported thresholds of self-motion perception of healthy subjects. Methods: Thirty-three volunteers with no prior vestibular complaints were included and sequentially tested with both paradigms at a random sequence. Perceptual self-motion thresholds were measured using a hydraulic motion platform in the absence of external visual and auditory cues. The platform delivered twelve different movements: six translations and six rotations. Each subject had to report the correct type and direction of movements. Thresholds were determined by a double confirmation of the lowest threshold, in combination with a double rejection of the one-step lower stimulus. Perceptual self-motion thresholds of both paradigms were compared using the mixed model analysis. Results: The twelve-option paradigm showed significantly higher reported thresholds for yaw rotations and translations left, right and down (p < 0.001), compared to the two-option paradigm. No statistical difference was found for rolls and translations up. No significant gender effect, learning effect and carry-over effect were present in any of the applied motion directions. Conclusion: Reported thresholds of self-motion perception of healthy subjects are influenced by the testing paradigm. The twelve-option paradigm showed significantly higher thresholds than the two-option paradigm. Results obtained with each testing paradigm should, therefore, be compared to paradigm-specific normative data.

Background: Limited information is available on factors that affect the burden tinnitus. The aim of this study is to investigate the association between tinnitus burden and demographic, patient-specific and tinnitus characteristics. Secondly, it was examined which variables could predict a change in tinnitus burden after 12 months. Method: In a prospective Dutch cohort of 383 tinnitus patients seeking medical help, tinnitus complaints, demographics, tinnitus characteristics, psychological wellbeing and quality of life were assessed using an online self-report survey at three timepoints (start, 6 months, 12 months). The main outcome variables for tinnitus burden are the Tinnitus Questionnaire (TQ) and Visual Analog Scale (VAS) for tinnitus burden and loudness. Results: Several variables (time, sex, education level, life events, anxiety and depression, sleep issues, tinnitus loudness, hearing impairment and treatment) were significantly associated with tinnitus burden. Additionally, tinnitus burden after 12 months was associated with anxiety, following treatment, sleep issues, negative life events and hearing impairment (increase) and anxiety, total of life events and environmental quality of life (decrease) predicted the tinnitus burden after 12 months. Conclusions: Several factors, such as education level, life events, psychological factors and sleep quality, are related to tinnitus burden and can predict tinnitus burden over time.