title: Measurement of skull bone thickness for bone-anchored hearing aids: an experimental study comparing both a novel ultrasound system (SonoPointer) and computed tomographic scanning to mechanical measurements.
abstract: OBJECTIVE
  A-mode ultrasound scanning with coded signals allows bone thickness measurements at the site of bone-anchored hearing aid surgery as compared to computed tomographic scanning and mechanical measurements.
  
  
  BACKGROUND
  Adequate bone thickness is a prerequisite for successful, long-lasting osseointegration of titanium fixtures for bone-anchored hearing aids. Computed tomography can be used to measure bone thickness but has several drawbacks.
  
  
  METHODS
  Bone thickness was measured at the site of bone-anchored hearing aids surgery in 28 formaldehyde-preserved human cadaver temporoparietal bones. Four blinded investigators used a hand-held, A-mode ultrasound system with direct coupling at 2.25 MHz transducer using coded signals (SonoPointer) and repeated the measurements twice. Comparisons were made with high-resolution computed tomographic scanning and mechanical micrometer caliper measurements.
  
  
  RESULTS
  There was significant anatomical variation in the temporoparietal bones. Computed tomography was in good agreement with the mechanical reference. All specimens could be measured by the SonoPointer. The mean difference between the mechanical control and ultrasound scanning averaged for all measurements by all investigators was 0.3 mm (standard deviation, 1.2 mm). Trained ultrasound experts yielded better results (mean difference, 0.3 mm; standard deviation, 1.0 mm). Agreement was best for bone thickness up to 5 mm. Outliers occurred in bones thicker than 7.5 mm.
  
  
  CONCLUSIONS
  The SonoPointer is a promising, noninvasive, hand-held tool for real-time measurement of bone thickness in bone-anchored hearing aid surgery, especially for children. Even disregarding the absolute thickness reading, the SonoPointer could be used to search intraoperatively for a local maximum of bone thickness.
authors.affiliation: University Hospital Heidelberg, Department of Otorhinolaryngology, Heidelberg, Germany. federspil@med.uni-heidelberg.de
authors.forename: Philipp A
authors.initials: PA
authors.lastname: Federspil
authors.forename: Steffen H
authors.initials: SH
authors.lastname: Tretbar
authors.forename: Friederike H
authors.initials: FH
authors.lastname: Böhlen
authors.forename: Stefan
authors.initials: S
authors.lastname: Rohde
authors.forename: Simon
authors.initials: S
authors.lastname: Glaser
authors.forename: Peter K
authors.initials: PK
authors.lastname: Plinkert
mesh_terms: D000328:Adult; D001844:Bone Conduction; D006310:Hearing Aids; D006801:Humans; D007206:Individuality; D010294:Parietal Bone / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D011859:Radiography; D012016:Reference Values; D012044:Regression Analysis; D053441:Suture Anchors; D013701:Temporal Bone / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D014463:Ultrasonography