Emmanuel A Mylanus

• Radboud University Medical Centre (Radboudumc)

Objective To compare the 3-year outcomes of the modified minimally invasive Ponto surgery (m-MIPS) to both the original MIPS (o-MIPS) and linear incision technique with soft tissue preservation (LIT-TP) for inserting bone-anchored hearing implants (BAHIs). Study design Prospective study with three patient groups: m-MIPS, o-MIPS, and LIT-TP. Setti...

Purpose This study describes a protocol for a novel individualized phoneme training program for adult cochlear implant (CI) users, based on individual phoneme confusion errors. The protocol is underpinned by a literature review on phoneme training and a focus group with adult CI users. Method After a literature search, five studies were included f...

Objective: The variability in outcomes among adult cochlear implant (CI) users poses challenges for clinicians in accurately predicting the benefits of the implant for individual candidates. This study aimed to investigate the accuracy and confidence of clinicians in predicting speech perception outcomes for adult CI users one-year post-implantati...

Purpose Programming a cochlear implant (fitting) is an essential part of a user’s post-implantation journey, defining how sound will be translated into electrical stimulation and aiming to provide optimal speech perception outcomes. Currently, there are no established, evidence-based guidelines for fitting cochlear implant users, leading to a high...

Objectives: Current surgical techniques aim to preserve intracochlear structures during cochlear implant (CI) insertion to maintain residual cochlear function. The optimal technique to minimize damage, however, is still under debate. The aim of this study is to histologically compare insertional trauma and intracochlear tissue formation in humans...

Background Cochlear implants (CIs) are considered an effective treatment for severe-to-profound sensorineural hearing loss. However, speech perception outcomes are highly variable among adult CI recipients. Top-down neurocognitive factors have been hypothesized to contribute to this variation that is currently only partly explained by biological an...

Introduction When Cochlear implants (CI) were first introduced, only postlingually, profoundly hearing impaired individuals were implanted unilaterally. As experience grew, eligibility was followed by prelingual deaf children, and a second contralateral CI was being considered. Due to surgical and technological improvements, eligibility criteria fo...

Nowadays, several options are available to treat patients with conductive or mixed hearing loss. Whenever surgical intervention is not possible or contra-indicated, and amplification by a conventional hearing device (e.g., behind-the-ear device) is not feasible, then implantable hearing devices are an indispensable next option. Implantable bone-con...

Purpose Some cochlear implant (CI) patients lose their residual hearing during surgery. Two factors that might play a role in residual hearing loss are the change in intracochlear hydraulic pressure and force on the cochlear wall during electrode insertion. The aim of this study is to investigate whether a difference in peak hydraulic pressure and...

Objectives Communicative disorders can complicate social interactions and may be detrimental for one's self-concept. This study aims to assess the self-concept of children with Cochlear Implants (CI). Results of educational peer groups (special needs or typical) were compared. Correlations amongst speech perception, language comprehension, self-con...

Several studies have demonstrated the advantages of the bilateral vs. unilateral cochlear implantation in listeners with bilateral severe to profound hearing loss. However, it remains unclear to what extent bilaterally implanted listeners have access to binaural cues, e.g., accurate processing of interaural timing differences (ITDs) for low-frequen...

The global digital transformation enables computational audiology for advanced clinical applications that have the potential to impact the global burden of hearing loss. In this paper we describe emerging hearing-related artificial intelligence applications and argue for their potential to improve access, precision and efficiency of hearing health...

Background and objective: Performing patient-specific, pre-operative cochlea CT-based measurements could be helpful to positively affect the outcome of cochlear surgery in terms of intracochlear trauma and loss of residual hearing. Therefore, we propose a method to automatically segment and measure the human cochlea in clinical ultra-high-resoluti...

Introduction: The main idea underlying this paper is that impairments such as deafness are particularly relevant to the extent that they lead to deprivation of capability. Likewise, the impact of healthcare services such as cochlear implants and subsequent rehabilitation can best be inferred from the extent that they protect or restore capability o...

Background: Internalizing and externalizing behavioral problems were frequently reported in profoundly hearing-impaired (HI) children with hearing aids. Due to the positive effect of cochlear implants (CIs) on hearing and language development, a positive effect on behavioral problems was expected. However, there is no consensus about the frequency...

Objectives To report on a retrospective cohort study on the effects of expanding inclusion criteria for application of cochlear implants (CIs) on the performance 1-year post-implantation. Methods Based on pre-implantation audiometric thresholds and aided speech recognition scores, the data of 164 CI recipients were divided into a group of patients...

Purpose Not long after the introduction of osseointegrated implants outside the oral cavity, auricular prostheses are retrained on osseointegrated implants. New insights have been gained with the next-generation percutaneous osseointegrated titanium implants for bone conduction hearing since its introduction in 2010. As a result, the same technolog...

We assessed how synchronous speech listening and lip reading affects speech recognition in acoustic noise. In simple audiovisual perceptual tasks, inverse effectiveness is often observed, which holds that the weaker the unimodal stimuli, or the poorer their signal-to-noise ratio, the stronger the audiovisual benefit. So far, however, inverse effect...

Objectives: To evaluate the three-year clinical and audiological outcomes of soft-tissue preservation compared to soft-tissue reduction in linear incision surgery for percutaneous implant for bone conduction (BC) devices. Methods: Twenty-five patients (25 implants) were enrolled in a prospective cohort for implant surgery with linear incision an...

Objective(s): The aim of the present meta-analysis is to assess the effects of hearing preservation (HP) methods on residual hearing in patients undergoing cochlear implant (CI) surgery and to look at the effect of follow-up time on HP outcome. Data sources: A systematic search was conducted in PubMed, Embase, and Cochrane Library. Only articles...

Objectives To compare the hearing performance of patients with conductive and mild mixed hearing loss and single‐sided sensorineural deafness provided with a new transcutaneous bone conduction hearing implant (the Baha Attract System) with unaided hearing as well as aided with a sound processor on a softband. Furthermore, to evaluate safety and sub...

Objective: To analyze the results of malleostapedotomy performed by applying the self-fixing and articulated titanium piston according to Häusler. Study design: Retrospective case review. Setting: Tertiary referral center. Patients and interventions: This study concerns a retrospective analysis of the results of malleostapedotomy with the us...

Purpose: The objective of this study was to achieve uniform reporting of complications and failures in cochlear implantation, to analyze complications and failures and to identify risk factors for complications in a series of over 1300 cochlear implantations. Methods: In a retrospective chart review and observational study, data from all cochlea...

Objective: To compare 3-year implant stability, survival, and tolerability of a 4.5-mm-wide (test) and a 3.75-mm-wide (control) percutaneous titanium implant for bone-conduction hearing, loaded with the sound processor after 3 weeks. Methods: Sixty implants were allocated in a 2:1 ratio (test-control) in 57 adult patients included in this prospe...

Objectives: Performance of an abutment-level superpower sound processor for bone-anchored hearing, the Ponto 3 SuperPower from Oticon Medical (BCD2), was compared to an earlier model from Oticon Medical (BCD1). Design: A comparative study in which each patient serves as its own control. Setting: Tertiary clinic. Participants: Eighteen experi...

Objective: To answer the dilemma clinician's face when deciding between cochlear implant (CI) and auditory brainstem implant (ABI) treatment options in patients with cochlear nerve deficiency (CND). Study design: Case study supplemented with literature review and meta-analysis. Setting: Tertiary referral center. Patient(s): Child with CHARGE...

In specific patient groups, i.e. children or patients with compromised bone quality, the incidence of implant loss of for bone conduction hearing implants is much higher; further implant optimization is, therefore, needed. The new laser-ablated titanium implant for bone-anchored hearing implantation has an enlarged contact area for osseointegration...

Objectives: Performance of a superpower bone-anchored hearing aid (Baha), the Baha Cordelle from Cochlear Bone-Anchored Solutions (BCD1), was compared to its successor, the Baha 5 SuperPower (BCD2) DESIGN: a comparative study in which each patient served as its own control. Setting: tertiary clinic. Participants: Ten experienced BCD1 users wit...

Prolonged deprivation of auditory feedback may negatively affect speech production accuracy, as shown by reports of reduced vowel space, changed formant values and reduced sound contrasts for challenging sounds such as sibilants in post-lingually deafened adults, compared to normal-hearing controls (e.g. Waldstein, 1990; Lane and Webster, 1990). Po...

Importance: To date, no randomized clinical trial on the comparison between simultaneous and sequential bilateral cochlear implants (BiCIs) has been performed. Objective: To investigate the hearing capabilities and the self-reported benefits of simultaneous BiCIs compared with those of sequential BiCIs. Design, setting, and participants: A mul...

Percutaneous titanium implants for bone conduction devices (BCDs) have offered, since 1977, a solution for patients with hearing loss not treatable by conventional hearing aids, such as patients with chronic ear infections or microtia and/or ear canal atresia. Percutaneous implants imply a continuous breach in the mechanical defensive barrier of th...

Objectives: Usher syndrome type IIa (USH2a) is characterized by congenital moderate to severe hearing impairment and retinitis pigmentosa. Hearing rehabilitation starts in early childhood with the application of hearing aids. In some patients with USH2a, severe progression of hearing impairment leads to insufficient speech intelligibility with hea...

Existing literature only reports a few patients with Noonan syndrome (NS) and Noonan syndrome with multiple lentigines (NSML) who underwent cochlear implantation (CI). The present study describes four NS patients and one NSML patient with a PTPN11 mutation. They all had severe to profound hearing loss, and they received a CI. The age at which the C...

To provide an overview of anomalies of the temporal bone in CHARGE syndrome relevant to cochlear implantation (CI), anatomical structures of the temporal bone and the respective genotypes were analysed. In this retrospective study, 42 CTs of the temporal bone of 42 patients with CHARGE syndrome were reviewed in consensus by two head-and-neck radiol...

The surgical installation of bone anchored hearing systems (BAHS) has after decades finally undergone changes towards more minimally invasive techniques without soft tissue thinning. Some surgeons are also performing the surgery and installation, using the classical drilling system, through a single punch entry. This article is protected by copyrig...

The objective of this historical cohort study was to compare soft tissue reactions in adults after bone-anchored hearing implant (BAHI) surgery when the percutaneous implant is placed inside or outside the line of incision. All adult patients who received a percutaneous BAHI between 1 January 2010 and 31 January 2014 in our tertiary referral centre...

Background: Impaired auditory speech perception abilities in deaf children with hearing aids compromised their verbal intelligence enormously. The availability of unilateral cochlear implantation (CI) auditory speech perception and spoken vocabulary enabled them to reach near ageappropriate levels. This holds especially for children in spoken lang...

Objective: Identifying aspects for establishing cochlear implantation guidelines for patients with ocular coloboma, heart defects, atresia of the choanae, retardation (of growth and/or of development), genital anomalies, and ear anomalies (CHARGE) syndrome (CS). Study design: Explorative retrospective study. Setting: Cochlear implant (CI)-cent...

Objectives/hypothesis: To investigate hearing capabilities and self-reported benefits of simultaneous bilateral cochlear implantation (BiCI) compared with unilateral cochlear implantation (UCI) after a 2-year follow-up and to evaluate the learning effect of cochlear implantees over time. Study design: Multicenter randomized controlled trial. Me...

Objective: To compare implant stability, survival, and soft tissue reactions for a novel (test) and previous generation (control) percutaneous auditory osseointegrated implant for bone conduction hearing at long-term follow-up of 5 years. Study design: Single follow-up visit of a previously completed multicenter, randomized, controlled trial. P...

Criteria for cochlear implants are expanding and now include children with disabilities in addition to hearing loss, such as those with Kabuki syndrome (KS). This case report describes language outcomes and changes in the quality of life of a female child with KS after cochlear implantation. The subject had a profound progressive sensorineural hear...

Objective: To analyse the benefit of cochlear implantation in young deaf children with Waardenburg syndrome (WS) compared to a reference group of young deaf children without additional disabilities. Method: A retrospective study was conducted on children with WS who underwent cochlear implantation at the age of 2 years or younger. The post-opera...

Objective: The efficacy of wireless connectivity in bone-anchored hearing was studied by comparing the wireless and acoustic performance of the Ponto Plus sound processor from Oticon Medical relative to the acoustic performance of its predecessor, the Ponto Pro. Study sample: Nineteen subjects with more than two years' experience with a bone-anc...

Hearing loss and cognitive delay are frequently occurring features in CHARGE syndrome that may contribute to impaired language development. However, not much is known about language development in patients with CHARGE syndrome. In this retrospective study, hearing loss, cognitive abilities, and language development are described in 50 patients with...

Baha Attract System: 6-month results of a multicentre, open, prospective clinical investigation - Volume 130 Issue S3 - Peter Monksfield, Piotr Skarzynski, Kevin Green, Christina Runge, Stina Wigren, Johan Ivarsson Blechert, Mark Flynn, Arjan Bosman, Emmanuel Mylanus

Repeated postoperative follow-up diffusion-weighted Magnetic Resonance Imaging to detect residual cholesteatoma - Volume 130 Issue S3 - Emmanuel Mylanus, Stefan Steens, Wulphert Venderink, Dirk Kunst, Anton Meijer

Evaluation of a New Powerful Sound Processor for Bone-Anchored Hearing - Volume 130 Issue S3 - Myrthe Hol, Arjan Bosman, Ivo Kruyt, Emmanuel Mylanus, Ad Snik

Objective: To compare the clinical and audiological outcomes after linear incision with soft-tissue preservation and standard linear incision with soft-tissue reduction for placement of percutaneous bone-anchored hearing implants. Study design: Clinical trial with historical control-group from a previous randomized controlled trial. Setting: T...

Objective: To evaluate the long-term medical and technical results, implant survival, and complications of the semi-implantable vibrant soundbridge (VSB), otologics middle ear transducer (MET), and the otologics fully implantable ossicular stimulator (FIMOS). Study Design: Retrospective cohort study. Patients: Patients with chronic external otitis...

Background: Speech understanding may rely not only on auditory, but also on visual information. Non-invasive functional neuroimaging techniques can expose the neural processes underlying the integration of multisensory processes required for speech understanding in humans. Nevertheless, noise (from functional MRI, fMRI) limits the usefulness in aud...

Objective: In our institution, follow-up diffusion-weighted imaging (DWI) after cholesteatoma surgery is performed at least twice. The aim of this study was to determine the yield of the second follow-up DWI (D-W MRI-2) in patients in whom the first postoperative DWI (D-W MRI-1) was negative for residual or recurrent cholesteatoma. Study design:...

Importance The cost of bilateral cochlear implantation (BCI) is usually not reimbursed by insurance companies because of a lack of well-designed studies reporting the benefits of a second cochlear implant.Objective To determine the benefits of simultaneous BCI compared with unilateral cochlear implantation (UCI) in adults with postlingual deafnes...

OBJECTIVE: To study the cost-utility of simultaneous bilateral cochlear implantation (CI) versus unilateral CI. STUDY DESIGN: Randomized controlled trial (RCT). SETTING: Five tertiary referral centers. PATIENTS: Thirty-eight postlingually deafened adults eligible for cochlear implantation. INTERVENTIONS: A cost-utility analysis was performed from a...

To evaluate the benefit of cochlear implantation in patients with Pendred syndrome. A retrospective study was conducted on patients who underwent cochlear implantation in our tertiary center. Speech perception was measured using a phonetically balanced wordlist at a sound pressure level of 65dB. Post-operative phoneme scores at one year for adults...

Objective: To establish standardization of implant stability measurements in auditory osseointegrated implants by means of resonance frequency analysis (RFA) through reviewing the currently published literature. Methods: Studies reporting on RFA in auditory osseointegrated implants were identified, and the outcomes and the way these were reported w...

The objective of this study was to ascertain the long-term safety of loading osseointegrated implants for bone conduction hearing 3 weeks post-surgery. Thirty consecutive adult patients were implanted with the Baha BI300 (Cochlear Bone Anchored Solutions) in our tertiary referral center. Implants were loaded with the sound processor 3 weeks post-su...

Objectives/HypothesisTo determine the effect of cochlear implantation on tinnitus perception in patients with severe bilateral postlingual sensorineural hearing loss and to demonstrate possible differences between unilateral and bilateral cochlear implantation.Study DesignProspective study.Methods Thirty-eight adult patients were included in this p...

Patients with congenital unilateral conductive hearing loss (UCHL) can either be watchful monitored or treated surgically through the fitting of a percutaneous bone conduction device (BCD) or, in some cases, atresia repair. The current study evaluated the long-term compliance and satisfaction with a percutaneous BCD in this specific population. Fif...

Cochlear implantation is a treatment for deafness and severe sensorineural hearing loss in pediatric and adult patients. Cochlear implants (CIs) bypass damaged or missing hair cells in the cochlea by directly stimulating auditory nerve fibers, allowing for speech perception in most users.Although very successful in most cases, the incidence of medi...

To identify risk factors for complications after bone-anchored hearing implant (BAHI) surgery. Retrospective cohort study. Tertiary referral center. All adult patients who received titanium bone-anchored hearing implants at our clinic between September 1, 1988 and December 31, 2007 were approached to fill out a questionnaire on comorbidity factors....

The objective of this study was to compare the stability, survival, and tolerability of 2 percutaneous osseointegrated titanium implants for bone conduction hearing: a 4.5-mm diameter implant (test) and a 3.75-mm diameter implant (control). Fifty-seven adult patients were included in this randomized controlled clinical trial. Sixty implants were al...

Modulation of a materials surface topography can be used to steer various aspects of adherent cell behaviour, such as cell directional organization. Especially nanometric sized topographies, featuring sizes similar to for instance the axons of the spiral ganglion cells, are interesting for such purpose. Here, we utilized nanosized grooves in the ra...

Image quality of low-dose multi-slice computed tomography (MSCT) after cochlear implantation is comparable to that of cone-beam computed tomography (CBCT). CBCT has been described as a low-dose alternative with superior image quality to MSCT for postoperative cochlear implant (CI) imaging, but to our knowledge, no dose-matched comparisons of image...

Sequential bilateral cochlear implantation in profoundly deaf children often leads to primary advantages in spatial hearing and speech recognition. It is not yet known how these children develop in the long-term and if these primary advantages will also lead to secondary advantages, e.g. in better language skills. The aim of the present longitudina...

Objective: To create a system for the uniform registration and classification of complications and failures in cochlear implant surgery, and apply it to all the patients who underwent implantation in our clinic. Method: The definition of a medical complication was established, and data for all cochlear implantations performed between 1987 and 20...

Objective: To compare the 3-year stability, survival, and tolerability of 2 osseointegrated implants for bone conduction hearing: a wide 4.5-mm-diameter moderately roughened implant with a rounded 6-mm abutment (test) and a 3.75-mm diameter as-machined implant with a conically shaped 5.5-mm abutment (control). Study Design: In this randomized, pros...

To compare amplification options for patients with mixed hearing loss. Devices tested include percutaneous and transcutaneous bone conductors (BCDs) and middle ear implants with their actuator directly coupled to the cochlea. Tertiary academic medical center. Maximum output was studied with simulators. As simulators are lacking for the middle ear i...

To assess the effect of sequential bilateral cochlear implantation on auditory, cortical maturation after various periods of unilateral cochlear implant use. Prospective cohort study. Tertiary academic referral center. Thirty prelingually deaf children, who received their first implant at a mean age of 1.8 years and their second implant at a mean a...

Objectives: To investigate the preservation of residual hearing in subjects who received the Nucleus Hybrid L24 cochlear implant. To investigate the performance benefits up to one year post-implantation in terms of speech recognition, sound quality, and quality of life. Design: Prospective, with sequential enrolment and within-subject comparison...

To confirm the clinical efficacy and safety of a direct acoustic cochlear implant. Prospective multicenter study. The study was performed at 3 university hospitals in Europe (Germany, The Netherlands, and Switzerland). Fifteen patients with severe-to-profound mixed hearing loss because of otosclerosis or previous failed stapes surgery. Implantation...

Background: The recent introduction of digital hearing aid technology for bone-conduction devices employing percutaneous stimulation may be beneficial for patients with conductive and mixed hearing loss and single sided deafness. Purpose: Performance of a recently released sound processor for bone-anchored implants, the Ponto Pro Power from Otic...

OBJECTIVES: Evaluation of a single-channel linear bone conduction implant sound processor (S-BCI) and a multiple-channel nonlinear bone conduction implant sound processor (M-BCI) with objective and subjective measures in patients with mixed hearing loss. STUDY DESIGN: In total, 20 patients with mixed hearing loss were included in the study. For eit...

To investigate the quality of life of people with an auricular prosthesis. A retrospective case series study was conducted. Quality of life was evaluated by an open-ended question form and 3 questionnaires: the Glasgow Benefit Inventory, the Rosenberg Self-Esteem scale, and the standard Medical Outcome Study Short-Form 12. The occurrence of peri-im...

Assessment of the clinical effectiveness of bilateral cochlear implantation compared with unilateral cochlear implantation or bimodal stimulation, in adults with severe-to-profound hearing loss. In 2007, the National Institute for Health and Clinical Excellence (NICE) in the U.K. conducted a systematic review on cochlear implantation. This study fo...

This report provides the first short-term follow-up data on the Ponto bone-anchored hearing implant from our tertiary referral centre. Thirty-one consecutive patients with a mean age of 51 years who received the implant between October 2010 and December 2011 were included retrospectively in this study. Implant loss, skin reactions around the implan...

OBJECTIVE: To clinically evaluate the performance of a titanium percutaneous bone-anchored hearing implant (BAHI) using a 3-week healing period. Short-term implant survival, stability changes, and skin reactions are evaluated from the initial implantation to 6 months postimplantation. METHODS: Thirty patients eligible for a BAHI were included in an...

Background: Congenital cytomegalovirus (CMV) infection is the leading cause of non-genetic congenital hearing loss. The contribution of congenital CMV to prelingual deafness and the pathophysiology is largely unknown. Objective: (1) To analyze the prevalence of congenital CMV among cochlear implant (CI) recipients with prelingual deafness. (2) T...

To develop a transmastoid-posterior tympanotomy approach for the implantation of a penetrating auditory prosthesis in the most distal portion of the cochlear nerve. Animal studies suggest that penetrating cochlear nerve implants may overcome limitations of current cochlear implant systems. One step toward human implantation is the development of a...

Cochleaire implantatie (CI) heeft de afgelopen decennia een enorme ontwikkeling doorgemaakt. We weten dat de resultaten met CI variëren naargelang de voorgeschiedenis van de patiënt. De patiënt doorloopt binnen een multidisciplinaire setting een uitvoerige indicatiefase alvorens een uitspraak over de mogelijke meerwaarde van een CI kan worden gedaa...

This study assesses soft tissue reactions and implant stability of 1,132 percutaneous titanium implants (970 patients) for bone conduction devices (BCDs). In addition, it examines BCD usage and comparisons between different patient groups. Retrospective survey. Mean follow-up time of 4.6 years. Tertiary care referral center. The surveyed cohort was...

To assess the effect of sequential bilateral cochlear implantation in children on their quality of life (QoL). Prospective cohort-control study. Tertiary academic referral center. Thirty children with prelingual deafness underwent sequential bilateral cochlear implantation (mean age at first implant, 1.8 years; mean age at second implant, 5.3 years...

The purpose of this study was (1) to measure parental expectations before surgery of a sequentially placed second cochlear implant and compare these results with parental observations postoperatively and (2) to measure device use of the second cochlear implant and compare to unilateral implant use. Thirty prelingually deaf children with a unilatera...

Determination of the difference in implant stability between a novel Baha implant system (test) and the previous-generation implant system (control). In an open, randomized, prospective multicenter clinical investigation, 77 adult patients with Baha implants were included. Test and control implants were randomly assigned in proportions of 2:1. Impl...

Objectives We present indications and clinical outcomes of fitting an 8.5-mm abutment for bone conduction devices. Methods In 39 cases with a follow-up time of more than 12 months after fitting of an 8.5-mm abutment, the preintervention and postintervention courses were retrospectively evaluated. The outcome measures were indications for fitting a...

An important aspect of binaural hearing is the proper detection of interaural sound level differences and interaural timing differences. Assessments of binaural hearing were made in patients with acquired unilateral conductive hearing loss (UCHL, n = 11) or congenital UCHL (n = 10) after unilateral application of a bone conduction device (BCD), and...

To evaluate the benefits of a bone-anchored hearing aid (BAHA) in the daily lives of hearing-impaired children. Retrospective questionnaire study. Nijmegen Medical Centre, Nijmegen, the Netherlands. Thirty-eight BAHA users with a minimum age of 4 years at BAHA fitting and 1 to 4 years of use, divided into groups with bilateral conductive or mixed h...