***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES /HYPOTHESIS To investigate cochlear implantation ( CI ) in patients with unilateral deafness with and without tinnitus . STUDY DESIGN Prospect i ve case series of patients undergoing cochlear implantation for unilateral deafness and tinnitus in a tertiary academic unit . METHODS Nine postlingually deafened subjects with unilateral hearing loss , with and without tinnitus ipsilaterally , and functional hearing in the contralateral ear were implanted with a st and ard electrode .  Speech perception in noise was tested using the Bamford-Kowal-Bench presented at 65 dB SPL . The Speech , Spatial , and Qualities ( SSQ ) of Hearing Scale was used to evaluate the subjective perception of hearing outcomes , and the Tinnitus Reaction Question naire assessed the effect on tinnitus . RESULTS All patients were implanted with the Med-El Flex soft electrode , Innsbruck , Austria . They are regularly wearing the speech processor and find it beneficial in improving their ability to hear , particularly in noise . Decrease of tinnitus perception and an improvement of sound localization sounds were also reported by these patients . CONCLUSION In our case series , CI was successful for all nine patients , with improvement of speech recognition in noise , self-perceived improvement of hearing , and for tinnitus control . Several factors such as deafness duration , age of deafness onset , the presence of residual hearing , patient motivation , and the rehabilitation intensity need to be further investigated in order to underst and their impact on performance after implantation . LEVEL OF EVIDENCE 4 Objective : To longitudinally evaluate short- and long-term subject satisfaction/benefit perception , device usage rates , complication rates , and external device repair rates of bone-anchored hearing aid ( BAHA ) implantation on a cohort of adult subjects with profound unilateral sensorineural hearing loss ( PUSHL ) . Study Design : Prospect i ve clinical trial . Setting : Tertiary referral center . Patients : Fifty-six adults with PUSHL , 21 of which underwent BAHA implantation ( followed for an average of 3.2 years after implantation ; range , 0.8 - 4.6 yr ) . Main Outcome Measures : Short- and long-term satisfaction/benefit perception outcomes consisting of the Glasgow Hearing Aid Benefit Profile , Abbreviated Profile of Hearing Aid Benefit , and Single-Sided Deafness Question naire , including a comparison of results between implanted and nonimplanted subjects . Short- and long-term device usage rates , complications , and device failure issues also were carefully documented . Results : There were statistically significant improvements in nearly all measures of benefit perception documented as well as a high rate of long-term device usage ( 81 % ) . Although satisfaction and benefit perception outcomes generally tended to regress over time when compared with initial short-term outcomes , long-term scores still tended to be significantly improved nevertheless as compared with preoperative levels . Approximately 38 % of implants experienced severe local skin reactions ( Grade 2 and above ) around the implant site at some point throughout the follow-up period , whereas only one ( 4.8 % ) required implant removal . 66.7 % of subjects required repair of their external sound processor . Conclusion : BAHA implantation seems to provide a high level of short- and long-term perceived benefit and satisfaction in subjects with PUSHL and high rate of long-term device usage . Implant site adverse local skin reactions and repairs of the external sound processor were quite common Abstract Conclusion : The bone-anchored hearing aid ( BAHA ) system can offer significant benefits to patients with single-sided deafness ( SSD ) , primarily by lifting the head shadow effect . Objective : To evaluate the efficacy of BAHA for SSD by comparing pre- and postoperative speech , spatial and qualities of hearing scale ( SSQ ) scores . Methods : This was a prospect i ve study conducted within a tertiary auditory implant department . The inclusion criteria were unilateral profound hearing loss with normal or mild high frequency hearing loss in the hearing ear ( pure tone average better than or equal to 25 dBHL measured at 0.5 , 1 , 2 and 3 kHz ) and subjective benefits reported by patients following a home trial with a BAHA Softb and .  Patients who met the above criteria and opted for surgery were asked to complete the SSQ question naire . The postoperative SSQ response was collected after at least 6 months of consistent BAHA usage . Results : This study included 25 adult patients ( mean age at implantation 57.5 years ) . There was a statistically significant improvement in the average SSQ score in all three sections of the question naire with the use of the BAHA . Our patients experienced most marked benefits in speech hearing in challenging listening situations . All patients remain consistent users and there has been no explantation to date To investigate the implication s of duration of deafness in the rehabilitation of unilateral deafness utilizing cochlear implantation . From the ongoing prospect i ve cochlear implantation in unilateral deafness study , we looked at five adults who received a cochlear implant for long-term unilateral deafness .  Speech perception in noise and subjective evaluation of the benefits of cochlear implantation  were measured at 3 , 6 , and 12 months after implantation . The results were analyzed and compared with published data from normal hearing individuals and adults using cochlear implants bilaterally .  Analysis of speech perception in noise showed significant improvement for three spatial configurations : speech and noise from the front ( S0/N0 ; P=0.003 ) , speech from the front and noise from the normal hearing ear ( S0/NHE ; P=0.001 ) , speech from the implanted ear , and noise from the normal hearing ear ( SCI/NHE ; P<0.001 ) . The scores obtained at 12 months after surgery improved to values similar to those obtained by individuals with normal hearing . The results of subjective measures showed significant improvement in hearing over time to the scores obtained by individuals with a bilateral cochlear implants and those with normal hearing . In this study , older adults with more than 25 years of unilateral deafness obtained scores in speech perception testing and in subjective evaluation that are similar to those attained by individuals with normal hearing and /or those with bilateral cochlear implants . Therefore , patients with postlingual unilateral deafness should not be excluded as cochlear implant c and i date s on the basis of a long duration of deafness The objective of the present pilot study is to evaluate the effectiveness of three conventional contralateral routing of sound ( CROS ) hearing aids in adults with unilateral inner ear deafness . The study included tertiary referral center . Ten patients with unilateral inner ear deafness and normal hearing in the contralateral ear were selected to evaluate three different methods of amplification : the CROS hearing aid , the completely in the canal hearing aid and the bone-anchored hearing aid CROS ( BAHA ) . Each of the three hearing aids was tried in a r and om order for a period of 8 weeks . Audiometric performance , including speech-in-noise , directional hearing and subjective benefit were measured after each trial period , using the APHAB , SSQ and single-sided deafness question naire . Sound localization performance was essentially at chance level in all four conditions . Mixed results were seen on the other patient outcome measures that alternated in favor of one of the three CROS devices . After the trial , three patients chose to be fitted with the BAHA CROS and one with the conventional CROS . In conclusion , most of the patients experienced some degree of benefit with each of the three hearing aids . Preference for one of the three hearing aids was independent of the order in which they were tried . It would be worthwhile to formulate selection criteria ; still , we recommend that all patients with unilateral inner ear deafness should be offered a trial with at least the BAHA CROS Objective Monaural hearing imposes constraints under many listening conditions . The authors compared the effects of a semi-implantable bone conductor , the Entific bone anchored hearing aid , with conventional contralateral routing of offside signal amplification to assess rehabilitative benefit in adults with unilateral deafness . Design Prospect i ve trials of subjects with unilateral deafness using benefit surveys , source identification testing , and hearing in noise testing . Setting Tertiary referral center , outpatient surgical and audiologic services . Patients Adults with unilateral deafness ( pure tone average > 90 dB , SD < 20 % ) after acoustic neuroma excision ( n = 7 ) , meningitis ( n = 1 ) , sudden sensorineural hearing loss ( n = 1 ) , and sudden sensorineural hearing loss with chronic suppurative otitis media ( n = 1 ) . Entry criteria included normal hearing in the contralateral ear ( pure tone average < 25 dB , SD > 80 % ) . Intervention Subjects were fitted with contralateral routing of offside signal amplification devices for 1 month and tested with contralateral routing of offside signal before mastoid implantation of the deaf ear , fitting , and testing for bone anchored hearing aid . Outcome measures Subjects ' assessment of experience with their devices and patterns of use , 2 ) source azimuth identification in noise test , and 3 ) speech discrimination in quiet and in noise under conditions of noise-front , noise-to-normal-ear , and noise-to-deaf-ear . Results There was consistent satisfaction with bone anchored hearing aid implantation and amplification , and poor acceptance of contralateral routing of offside signal amplification . Sound localization was poor at baseline and with both bone anchored hearing aid and contralateral routing of offside signal . Relative to baseline , contralateral routing of offside signal and bone anchored hearing aid produced significantly better speech recognition in noise under most conditions . The bone anchored hearing aid enabled significantly better speech recognition than contralateral routing of offside signal in quiet and in a composite of noise conditions . The advantages may relate to averting the interference of speech signals delivered to the better ear , as occurs with conventional contralateral routing of offside signal amplification . Conclusions Preliminary data in subjects with normal monaural hearing indicate that vibromechanical stimulation with the bone anchored hearing aid overcomes some of the negative head shadow effects in unilateral deafness . The bone anchored hearing aid system , when placed on the side of a deaf ear , yields greater benefit in subjects with normal monaural hearing than does contralateral routing of offside signal amplification . It seems that this rehabilitative approach can exp and the sound field of monaural listeners in further enhancing speech underst and ing . Observations suggest that further underst and ing of bone conduction as implemented in transcranial stimulation will guide further options for patients with monaural hearing . Longer follow-up will help to determine whether communicative skill improvements with the bone anchored hearing aid outweigh the disadvantages of implantation surgery , costs , and device maintenance Objective : Vibromechanical stimulation with a semi-implantable bone conductor ( Entific BAHA device ) overcomes some of the head-shadow effects in unilateral deafness . What specific rehabilitative benefits are observed when the functional ear exhibits normal hearing versus moderate sensorineural hearing loss ( SNHL ) ? Design : The authors conducted a prospect i ve trial of subjects with unilateral deafness in a tertiary care center . Patients : This study comprised adults with unilateral deafness ( pure-tone average [ PTA ] > 90 dB ; Sp . D. < 20 % ) and either normal monaural hearing ( n = 18 ) or moderate SNHL ( PTA = 25 - 50 dB : Sp . D. > 75 % ) in the contralateral functional ear ( n = 5 ) . Interventions : Subjects were fit with contralateral routing of signal ( CROS ) devices for 1 month and tested before ( mastoid ) implantation , fitting , and testing with a bone-anchored hearing aid ( BAHA ) . Outcome Measures : Outcome measures were : 1 ) subjective benefit ; 2 ) source localization tests ( Source Azimuth Identification in Noise Test [ SAINT ] ) ; 3 ) speech discrimination in quiet and in noise assessed with Hearing In Noise Test ( HINT ) protocol s. Results : There was consistent satisfaction with BAHA amplification and poor acceptance of CROS amplification .  General directional hearing decreased with CROS use and was unchanged by BAHA and directional microphone aids . Relative to baseline and CROS , BAHA produced significantly better speech recognition in noise .  Twenty-two of 23 subjects followed up in this study continue to use their BAHA device over an average follow-up period of 30.24 months ( range , 51 - 12 months ) . Conclusion : BAHA amplification on the side of a deaf ear yields greater benefit in subjects with monaural hearing than does CROS amplification . Advantages likely related to averting the interference of speech signals delivered to the better ear , as occurs with conventional CROS amplification , while alleviating the negative head-shadow effects of unilateral deafness . The advantages of head-shadow reduction in enhancing speech recognition with noise in the hearing ear outweigh disadvantages inherent in head-shadow reduction that can occur by introducing noise from the deaf side . The level of hearing impairment correlates with incremental benefit provided by the BAHA .  Patients with a moderate SNHL in the functioning ear perceived greater increments in benefit , especially in background noise , and demonstrated greater improvements in speech underst and ing with BAHA amplification Objectives : The objectives of this study were to distinguish the equivalent-effectiveness , health-economic , and actuarial approaches to specifying criteria of c and idacy for medical interventions ; to apply the equivalent-effectiveness approach to unilateral cochlear implantation for postlingually deafened adults ; and to determine whether the criterion should take age at implantation and duration of profound deafness into account . Design : The study was design ed as a prospect i ve cohort study in 13 hospitals with four groups of severely-profoundly hearing-impaired subjects distinguished by their preoperative ability to identify words in sentences when aided acoustically . 
    Output:
    
A mixed-effect meta- analysis of disease-specific measures suggested that hearing-assistive devices have a small-to-medium impact on HRQoL. The Speech , Spatial and Qualities of Hearing Scale and the Health Utilities Index Mark 3 ( HUI3 ) were identified as instruments that are sensitive to device-related changes in disease-specific and generic HRQoL , respectively