Long-Term, Multicenter Results With the First Transcutaneous Bone Conduction Implant.

OBJECTIVE: Investigation of long-term safety and performance of an active, transcutaneous bone conduction implant in adults and children up to 36 months post-implantation. STUDY DESIGN: Prospective, single-subject repeated-measures design. SETTING: Otolaryngology departments of eight German and Austrian hospitals.∗†‡§||¶#∗∗†† Affiliations listed above that did not participate in the study.‡‡§§||||¶¶. PATIENTS: Fifty seven German-speaking patients (49 adults and eight children) suffering from conductive or mixed hearing loss, with an upper bone conduction threshold limit of 45 dB HL at frequencies between 500 and 3000 Hz. INTERVENTION: Implantation of the Bonebridge transcutaneous bone conduction hearing implant (tBCI). MAIN OUTCOME MEASURES: Patients' audiometric pure tone averages (PTA4) (0.5, 1, 2, 4 kHz) thresholds (air conduction, bone conduction, and sound field) and speech perception (word recognition scores [WRS] and speech reception thresholds [SRT50%]) were tested preoperatively and up to 36 months postoperatively. Patients were also monitored for adverse events and administered quality-of-life questionnaires. RESULTS: Speech perception (WRS: pre-op: 17.60%, initial activation [IA]: 74.23%, 3M: 83.65%, 12M: 83.46%, 24M: 84.23%, 36M: 84.42%; SRT50%: pre-op: 65.56 dB SPL, IA: 47.67 dB SPL, 3M: 42.61 dB SPL, 12M: 41.11 dB SPL, 24M: 41.74 dB SPL, 36M: 42.43 dB SPL) and sound field thresholds (pre-op: 57.66 dB HL, IA: 33.82 dB HL, 3M: 29.86 dB HL, 12M: 28.40 dB HL, 24M: 28.22 dB HL, 36M: 28.52 dB HL) improved significantly at all aided postoperative visits. Air and bone conduction thresholds showed no significant changes, confirming preservation of patients' residual unaided hearing. All adverse events were resolved by the end of the study. CONCLUSIONS: Safety and performance of the tBCI was demonstrated in children and adults 36 months postoperatively.

Neural underpinnings of perception and experience of disgust in individuals with a reduced sense of smell: An fMRI study.

BACKGROUND: Individuals with reduced olfactory function (anosmia, hyposmia) have reported changes in disgust perception and disgust experience compared to normosmic controls. The current functional magnetic resonance imaging (fMRI) study investigated the neural underpinnings of the altered disgust processing. METHOD: Twenty-four patients with anosmia or hyposmia and 26 normosmic controls were presented with images depicting facial expressions and scenes from the categories disgust and neutral. The disgusting scenes depicted stimuli that typically smell repulsive (spoiled food, excrements). Brain activity and structure in the primary olfactory cortex (POC) and in a region that processes affective/motivational olfactory-related information (insula, orbitofrontal cortex, basal ganglia) were compared between the two groups. RESULTS: The anosmic/hyposmic participants were characterized by greater activation in the POC while looking at disgusting scenes. The POC can be activated by olfactory imagery and holds predictive templates of olfactory stimuli. The neural processing of the facial stimuli did not differ between the two groups. Additionally, group differences in functional connectivity and brain structure were not present or only minor. CONCLUSION: The increased POC activation in anosmic/hyposmic patients might reflect a compensatory process that helps to compensate for their olfactory deficit. However, in general, this study identified only small adaptations in the neural disgust system as a consequence of reduced olfactory function.