The Desired Sensation Level bone conduction device prescriptive formula: new adaptations and applications for skin-driven bone conduction fittings

This manuscript describes the computational workflow and normative data used within the newly released Version 2 of the Desired Sensation Level (DSL) Bone Conduction Device (BCD) Prescription. The previous version 1.1 of the DSL BCD prescription was an innovation in the field, allowing for the prescription of output levels from direct drive BCDs worn percutaneously on an osseointegrated abutment. Verification of these prescriptions has been possible using a clinically-available skull simulator. Version 2 of the DSL BCD prescription extends upon version 1.1 and now allows for the fitting and verification of some skin-drive BCDs, which is the primary coupling method used for infants and young children. DSL BCD 2 introduces a new age-specific audiometric-to-dial-level (ADL) correction to predict in-situ BCD thresholds from audiometric bone conduction thresholds, as well as other transforms that allow target generation for skin-worn devices. This implementation provides the option to base the output prescription on audiometric thresholds for patients who may not yet be capable of performing in-situ BCD audiometry, computational support for a wider range of device types and couplings, and prescriptive targets for use with either skull simulators or verification of on-head force levels.