title: Programmable shunt valve interactions with osseointegrated hearing devices.
abstract: OBJECTIVE Patients with ventriculoperitoneal (VP) shunts with programmable valves who would benefit from osseointegrated hearing devices (OIHDs) represent a unique population. The aim of this study was to evaluate the magnetic field strengths of 4 OIHDs and their interactions with 5 programmable VP shunt valves. METHODS Magnetic field strength was measured as a function of distance for each hearing device (Cochlear Baha 5, Cochlear Baha BP110, Oticon Ponto Plus Power, and Medtronic Sophono) in the following modes: inactive, active in quiet, and active in 60 decibels of background noise in the sound booth. The hearing devices were introduced to each shunt valve (Aesculap proGAV, Aesculap proGAV 2.0, Codman Hakim, Codman Certas, and Medtronic Strata II) also as a function of distance in these identical 3 settings. Each trial was repeated 5 times. Between each trial, the valves were assessed for a change in setting. Finally, using a skull model, the devices were introduced to each other in standard anatomical locations and the valves were assessed for a change in settings. RESULTS The maximum magnetic field strengths generated by the Cochlear Baha 5, BP110, and Oticon OIHDs were 1.1, 36.2, and 48.7 gauss (G), respectively. The maximum strength generated by the Sophono device was > 800 G. The magnetic field strength of the hearing devices decreased markedly with increasing distance from the device. The strength of the Sophono's magnetic attachment decreased to 34.8 G at 5 mm. The Codman Hakim, Codman Certas, and Medtronic Strata II valve settings changed when rotating the valves next to the Sophono abutment. No other changes in valve settings occurred in the distance or anatomical models for any other trials. CONCLUSIONS This is the first study evaluating the interaction between OIHDs and programmable VP shunt valves. The findings suggest that it is safe to use these devices together without having to switch to a nonprogrammable valve or move the shunt valve to a more distant location. Still, care should be taken if the Sophono device is used to ensure that the valve is ≥ 5 mm away from the magnetic attachment.
mesh_terms: D000162:Acoustics / Q000295:instrumentation*; D000704:Analysis of Variance; D004867:Equipment Design; D006320:Hearing Tests; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery; D066298:In Vitro Techniques; D060526:Magnetic Fields / Q000009:adverse effects; D008953:Models, Anatomic; D013813:Therapy, Computer-Assisted / Q000295:instrumentation; D017287:Ventriculoperitoneal Shunt / Q000295:instrumentation* / Q000379:methods*
keywords: CI = cochlear implant; G = gauss; OIHD = osseointegrated hearing device; VP = ventriculoperitoneal; dB = decibel; hydrocephalus; osseointegrated hearing device, magnetic field strength; programmable shunt valve; surgical technique