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Clinical evaluation of cholesteatoma diagnostics and outcomes of bone conduction devices
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.ORCID iD: 0000-0001-9561-9989
2026 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis investigates the diagnostic accuracy of non-echo-planar diffusion-weighted magnetic resonance imaging (non-EPI DW MRI) for cholesteatoma detection in routine clinical practice. It also evaluates the audiological and patient-reported outcomes of active transcutaneous bone-conduction devices (active transcutaneous BCDs) in otologic care.The thesis focuses on cholesteatoma diagnostics and hearing rehabilitation in individuals with conductive hearing loss, mixed hearing loss, and single-sided deafness.

The first paper evaluated the diagnostic accuracy of non-EPI DW MRI for the detection of cholesteatoma in routine clinical practice. Overall, diagnostic accuracy was moderate in routine clinical practice but improved when examinations were interpreted by experienced radiologists and when standardised EAONO/JOS diagnostic criteria were applied.

The subsequent papers assessed audiological and patient-reported outcome measures following implantation of active transcutaneous BCDs. The second paper evaluated the short-term outcomes of an active transcutaneous BCD and included an assessment of postoperative complications. The results demonstrated substantial short-term improvements in audiological performance and in quality of life among individuals with conductive and mixed hearing loss, while the complications rate was low. Participants with single-sided deafness generally experienced less benefit from the active transcutaneous BCD. However, the observed outcomes were in line with those reported for alternative rehabilitation options in this population.

The third paper examined the long-term efficacy and safety of active transcutaneous BCDs. Hearing improvements and patient-reported outcomes were maintained over time, with a low incidence of adverseevents.

The fourth paper expanded the evidence base by comparing the audiological performance of two commercially available active transcutaneous BCDs in participants with conductive and mixed hearing loss. The results showed that both systems produced substantial improvements in audiological performance. However, one system achieved significantly lower aided sound-field thresholds at several frequencies, indicating more efficient sound transmission. Both devices led to significant improvements in speech recognition in noise, with comparable gains across groups.

Overall, the findings indicate that non-EPI DW MRI has limitations in routine clinical practice, but diagnostic accuracy improves when examinations are interpreted by experienced radiologists using standardised assessment criteria. Active transcutaneous BCDs represent a safe and effective rehabilitation option for individuals with conductiveand mixed hearing loss and single-sided deafness.

Place, publisher, year, edition, pages
Umeå: Umeå University, 2026. , p. 76
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2408
Keywords [en]
Active transcutaneous bone-conduction devices, audiology, patient-reported outcome measures, non-echo-planar diffusion-weighted magnetic resonance imaging, diagnostic accuracy, cholesteatoma.
National Category
Oto-rhino-laryngology
Identifiers
URN: urn:nbn:se:umu:diva-251788ISBN: 978-91-8070-936-1 (electronic)ISBN: 978-91-8070-935-4 (print)OAI: oai:DiVA.org:umu-251788DiVA, id: diva2:2051751
Public defence
2026-05-08, Triple Helix, Samverkanshuset, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Note

Link to participate via Zoom: https://umu.zoom.us/s/67288228854

Available from: 2026-04-17 Created: 2026-04-09 Last updated: 2026-04-14Bibliographically approved
List of papers
1. Evaluation of magnetic resonance imaging to detect cholesteatoma in clinical healthcare
Open this publication in new window or tab >>Evaluation of magnetic resonance imaging to detect cholesteatoma in clinical healthcare
2024 (English)In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 144, no 3, p. 193-197Article in journal (Refereed) Published
Abstract [en]

Background: Non-Echo-Planar Diffusion Weighed Magnetic Resonance Imaging (non-EPI DW MRI) plays a role in the planning of cholesteatoma surgery.

Objectives: To outline the usage of Non-EPI DW MRI in cholesteatoma diagnostics and to determine its accuracy, using otosurgery diagnostics as reference standard. Material and

Methods: A retrospective descriptive study. All subjects operated, with suspicion of cholesteatoma as indication, that had a preceding examination with non-EPI DW MRI, between October 2010 and March 2019. Calculating sensitivity, specificity, predicative values, and likelihood ratios, using non-EPI DW MRI as index test and diagnosis from otosurgery as reference standard.

Results: Fifty-two subject episodes were included. Non-EPI DW MRI had a sensitivity of 0.50, specificity of 0.75, positive and negative predictive values of 0.74 and 0.52 and, positive and negative likelihood ratios of 2.0 and 0.67 respectively.

Conclusions and Significance: There is a clear annual trend with increased numbers of executed examinations during the study period. The diagnostic accuracy of non-EPI DW MRI does not reach acceptable levels in the existing everyday routine practice conditions. The accuracy of the examination increases when interpreted by an experienced radiologist and when using the definition of cholesteatoma recommended by EAONO/JOS.

Place, publisher, year, edition, pages
Taylor & Francis, 2024
Keywords
Cholesteatoma, data accuracy, ear, magnetic resonance imaging, middle, non-epi diffusion weighted imaging, sensitivity and specificity, temporal bone
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-223954 (URN)10.1080/00016489.2024.2344820 (DOI)001208216000001 ()38662877 (PubMedID)2-s2.0-85191260879 (Scopus ID)
Funder
Region Västernorrland, LVNFOU92905The Kempe FoundationsUmeå University, FS 2.1.6-2408-18Umeå University, KV00-1.3-20-151
Available from: 2024-05-02 Created: 2024-05-02 Last updated: 2026-04-09Bibliographically approved
2. Outcomes after Application of Active Bone Conducting Implants
Open this publication in new window or tab >>Outcomes after Application of Active Bone Conducting Implants
2019 (English)In: Audiology & neuro-otology, ISSN 1420-3030, E-ISSN 1421-9700, Vol. 24, no 4, p. 197-205Article in journal (Refereed) Published
Abstract [en]

Background: A bone conducting implant is a treatment option for individuals with conductive or mixed hearing loss (CHL, MHL) who do not tolerate regular hearing aids, and for individuals with single-sided deafness (SSD). An active bone conducting implant (ABCI) was introduced in 2012 with indication in CHL, MHL, and SSD, and it is still the only ABCI available. With complete implantation of the active transducer and consequent intact skin, a decrease in infections, skin overgrowth, and implant losses, all common disadvantages with earlier passive bone conducting implants, could be expected. Our Ear, Nose and Throat Department, a secondary care center for otosurgery that covers a population of approximately 365,000 inhabitants, was approved to implant ABCIs in 2012.

Objectives: Our aim was to conduct an evaluation of audiological and subjective outcomes after ABCIs.

Method: A cohort study with retrospective and prospective data collection was performed.The first 20 consecutive patients operated with an ABCI were asked for informed consent. The main outcome measures werepure tone and speech audiometry and the Glasgow Benefit Inventory (GBI).

Results: Seventeen patients accepted to participate and 15 were able to complete all parts. Six patients had CHL or MHL. In this group the pure tone audiometry tests are comparable with an average functional hearing gain of 29.8 dB HL. With bilateral hearing, the mean Word Recognition Score (WRS) in noise was 35.7% unaided and 62.7% aided. Ten patients had the indication SSD. With the hearing ear blocked, the pure tone average was >101 dB HL, compared to 29.3 dB HL in sound field aided. With bilateral hearing, the mean WRS in noise was 59.7% unaided and 72.8% aided. The mean of the total GBI score was 42.1 in the group with CHL or MHL and 20.6 in the group with SSD.

Conclusions: The patients benefit from their implants in terms of quality of life, and there is a substantial hearing gain from the implant for patients with conductive or MHL. Patients with SSD benefit less from the implant than other diagnoses but the positive outcomes are comparable to other options for this group.

Place, publisher, year, edition, pages
S. Karger, 2019
Keywords
Active hearing implant, Audiometry, Bone conducting implant, Questionnaires, Single-sided deafness
National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:umu:diva-169636 (URN)10.1159/000502052 (DOI)000539022300006 ()31499490 (PubMedID)2-s2.0-85072233314 (Scopus ID)
Available from: 2020-04-14 Created: 2020-04-14 Last updated: 2026-04-09Bibliographically approved
3. Long-term follow-up in active transcutaneous bone conduction implants
Open this publication in new window or tab >>Long-term follow-up in active transcutaneous bone conduction implants
2024 (English)In: Otology and Neurotology, ISSN 1531-7129, E-ISSN 1537-4505, Vol. 45, no 1, p. 58-64Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate long-term outcomes of active transcutaneous bone conduction implants (atBCIs) regarding safety, hearing, and quality of life.

Study design: A clinical study with retrospective medical record analysis combined with prospective audiometry and quality of life questionnaires.

Setting: Three secondary to tertiary care hospitals.

Patients: All subjects operated with an atBCI in three regions in Sweden were asked for informed consent. Indications for atBCI were single-sided deafness (SSD) and conductive or mixed hearing loss (CMHL).

Intervention: Evaluation of atBCI.

Main Outcome Measures: Pure tone and speech audiometry and Glasgow Benefit Inventory (GBI).

Result: Thirty-three subjects were included and 29 completed all parts. The total follow-up time was 124.1 subject-years. Nineteen subjects had CMHL and in this group, pure tone averages (PTA4) were 56.6 dB HL unaided and 29.6 dB HL aided, comparable with a functional gain of 26.0 dB. Effective gain (EG) was −12.7 dB. With bilateral hearing, Word Recognition Scores (WRS) in noise were 36.5% unaided and 59.1% aided. Fourteen subjects had SSD or asymmetric hearing loss (AHL) and in this group, PTA4 were >100 dB HL unaided and 32.1 dB HL aided with the contralateral ear blocked. EG was −9.1 dB. With bilateral hearing, WRSs were 53.2% unaided and 67.9% aided. The means of the total GBI scores were 31.7 for CMHL and 23.6 for SSD/AHL.

Conclusion: Few complications occurred during the study. The atBCI is concluded to provide a safe and effective long-term hearing rehabilitation.

Place, publisher, year, edition, pages
Wolters Kluwer, 2024
Keywords
Bone conduction hearing device, Hearing loss, conductive/surgery, Hearing loss, mixed conductive-sensorineural, Hearing loss, unilateral, Implantable hearing, device
National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:umu:diva-218680 (URN)10.1097/MAO.0000000000004057 (DOI)001124019600007 ()38085764 (PubMedID)2-s2.0-85179639429 (Scopus ID)
Funder
Region VästernorrlandThe Kempe FoundationsUmeå University
Available from: 2023-12-27 Created: 2023-12-27 Last updated: 2026-04-09Bibliographically approved
4. A comparative study of audiological outcomes in two types of active transcutaneous bone conduction implants
Open this publication in new window or tab >>A comparative study of audiological outcomes in two types of active transcutaneous bone conduction implants
(English)Manuscript (preprint) (Other (popular science, discussion, etc.))
National Category
Oto-rhino-laryngology
Identifiers
urn:nbn:se:umu:diva-251787 (URN)
Available from: 2026-04-09 Created: 2026-04-09 Last updated: 2026-04-09

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