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An Experimental Objective Method to Determine Maximum Output and Dynamic Range of an Active Bone Conduction Implant: The Bonebridge

Mertens, Griet*†; Desmet, Jolien*†; Snik, Ad F. M.‡§; Van de Heyning, Paul*†

doi: 10.1097/MAO.0000000000000347

Introduction Recently, a new active bone conduction implant, the Bonebridge, was introduced. This transcutaneous device is proposed as an alternative to previous percutaneous systems. The current study aims to determine the maximum output (MO) of the Bonebridge by making use of Bonebridge-generated sound pressure levels in the occluded ear canal of the unaided ear.

Methodology The test setup consisted of audiometry and input-output measurements. These tests were performed on 3 Bonebridge users with conductive or mixed hearing loss (bone-conduction thresholds, ≤45 dB HL) at least 3 months after implantation surgery. All the patients were implanted and were evaluated in the Antwerp University Hospital. The MO of the device was determined by measuring input-output functions with a microphone placed in the occluded contralateral ear canal using the Aurical REM system. During testing, the sound processor was fitted in linear amplification mode and with unlimited output to determine the MO and the input dynamic range of the Bonebridge. This experimental setup intends to evaluate the device in a fitting program without compression.

Results The mean MO of the device was 55 dB HL (SD, 6 dB HL) at 0.5 kHz, 61 dB HL (SD, 18 dB HL), 71 dB HL (SD, 10 dB HL) at 2 kHz, and 60 dB HL (SD, 10 dB HL) at 4 kHz. The mean dynamic range of the Bonebridge was 41 (SD, 5) dB HL, 46 (SD, 10) dB HL, 46 (SD, 5) dB HL, and 37 (SD, 16) dB HL for 0.5, 1, 2, and 4 kHz, respectively.

Conclusion In summary, ear canal measures can effectively be used to assess input-output behavior of the Bonebridge. The present study indicates that the MO of the Bonebridge ranges from 55 to 71 dB HL, depending on frequency. Accepting a minimum dynamic range of 35 dB with the Bonebridge, fitting of the Bonebridge in a linear program is advocated in patients with a sensorineural hearing loss component of up to 30 dB HL.

*University Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital; †Faculty of Medicine, Antwerp University, Belgium; ‡Hearing and Implants, Department of Otorhinolaryngology, Radboud University Nijmegen Medical Centre; and §Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands

Address correspondence and reprint requests to Griet Mertens, P.h.D., M.S.c., and Jolien Desmet, M.S.c., University Hospital Antwerp, Department of Otolaryngology and Head and Neck Surgery, Wilrijkstraat 10, 2650 Edegem, Belgium; E-mail:,

The authors disclose no conflicts of interest.

G .M. and J. D. Equally contributed to this manuscript and are both first authors.

The Antwerp University Hospital received a research grant from both Cochlear and MED-EL. No grant was however specifically related to the current study. The 3 BONEBRIDGES used in the current research were provided by MED-EL for the purpose of a different study.

Copyright © 2014 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company