Late changes in hearing results after mastoid obliteration with tympanoplasty

Active middle ear implants: Vibroplasty™ in children and adolescents with acquired or congenital middle ear disorders

CONCLUSION

Active middle ear implant (AMEI) implantation in children and adolescents is safe and provides improved hearing results. No statistical difference in hearing outcomes was shown in the group of patients affected by chronic middle ear diseases versus aural atresia. Also, the transducer location (round window versus oval window placement) did not lead to different outcomes in hearing abilities.

OBJECTIVES

(1) To assess the hearing outcomes with the active implant Vibrant Soundbridge (VSB) in children and adolescents. (2) To evaluate whether functional results of the subjects in the study could depend on the hearing loss etiology (chronic middle ear diseases versus aural atresia) or on transducer location (round window versus oval window placement).

METHODS

The study was carried out with a retrospective, single-subject, repeated measures design, and included 22 children and adolescents with conductive or mixed hearing loss due to aural atresia or chronic middle ear diseases. Preoperative and postoperative pure tone air conduction (AC) and bone conduction (BC) thresholds were measured to demonstrate implantation safety. Free-field warble tone and speech audiometry were performed to assess postoperative hearing abilities with and without the VSB.

RESULTS

No significant changes in mean BC or AC thresholds between preoperative and postoperative conditions were seen in the 22 patients. Mean PTA4 functional gain was 30.7 dB. Averaged over all 22 patients, word recognition at 65 dB SPL changed from an average of 19% in the unaided postoperative condition to 97% in the VSB-aided condition. Functional results were independent of hearing loss etiology and transducer location.

Treatment of mixed hearing losses via implantation of a vibratory transducer on the round window

Early clinical findings are reported for subjects implanted with the Vibrant Med-El Soundbridge (VSB) device. The present criteria for the VSB, limiting its application to patients with normal middle ear function, have been extended to include patients with ossicular chain defects. Seven patients with severe mixed hearing loss were implanted with the transducer placed onto the round window. All had undergone previous surgery: six had multiple ossiculoplasties, and one had the VSB crimped on the incus with unsuccessful results. Round window implantation bypasses the normal conductive path and provides amplified input to the cochlea. Post-operative aided thresholds of 30 dB HL were achieved for most subjects, as compared with unaided thresholds ranging from 60-80 dB HL. Aided speech reception thresholds at 50% intelligibility were 50 dB HL, with most subjects reaching 100% intelligibility at conversational levels, while unaided thresholds averaged 80 dB HL, with only one subject reaching 100% intelligibility. These results suggest that round window implantation may offer a viable treatment option for individuals with severe mixed hearing losses who have undergone unsuccessful ossiculoplasties.

TORP vs round window implant for hearing restoration of patients with extensive ossicular chain defect

CONCLUSIONS

Round window implant (RWI) with a floating mass transducer (FMT) may be suggested as the first choice in hearing rehabilitation for patients with chronic otitis media (COM) and extensive destruction of the ossicular chain.

OBJECTIVE

To investigate the pros and cons of the total ossicular replacement prosthesis (TORP) vs the RWI in restoration of hearing in patients with COM.

PATIENTS AND METHODS

Thirty-eight patients with bilateral moderate to severe mixed or conductive hearing loss from COM without cholesteatoma and bilateral ossicular chain erosion (footplate residual) were alternately assigned to a titanium-TORP (T-TORP) and to RWI with the FMT of the Medel Vibrant Soundbridge (MVBS) located onto the RW niche. The therapeutic efficiency, preoperative vs postoperative air-conduction gain and speech recognition were investigated for the two groups and statistically analyzed at 36 months postoperatively. The following postoperative anatomic conditions were also evaluated for the two groups: 1) recurrence of infection, 2) retraction pocket, 3) extrusion rate, and 4) displacement of the prosthesis.

RESULTS

Good functional results and stability at 36 months were obtained with both procedures. The extrusion rates for T-TORP were low. So far no extrusion has been observed for RWI. Hearing results were statistically much better for RWI vs T-TORP for all investigated parameters.

Role of the mastoid in tympanic membrane reconstruction

Otologists have long debated the importance of the mastoid in determining the success or failure of tympanic membrane reconstruction. The pneumatic spaces within the mastoid represent an "air reservoir" which can be drawn upon during periods of eustachian tube dysfunction and buffer the middle ear against the development of detrimental negative pressures. Mastoid inflammatory disease, if untreated, may result in recurrent suppuration and graft failure. Small mastoid volume, aside from its well known association with chronic infectious middle ear disease, has been shown to effect adversely graft survival following myringoplasty. In 48 patients undergoing myringoplasty with simple mastoidectomy, neither small mastoid size nor inflammatory mastoid disease significantly decreased the rate of graft healing. This suggests that simple mastoidectomy is an effective means of repneumatizing the mastoid and eradicating mastoid sources of infection. The successful surgical creation of a pneumatized mastoid cavity in communication with the middle ear was confirmed by postoperative computerized tomographic (CT) scans. In failed cases, CT scanning predictably identified residual mastoid disease. Simple mastoidectomy is considered to be a safe and useful adjunct to myringoplasty in selected cases of chronic otitis media with perforation.

Tympanomastoidectomy. A 25-year experience

Since 1956, 1,540 tympanomastoidectomy procedures for cholesteatoma or chronic suppurative otitis media with mastoiditis have been performed; 180, done from 1972 through 1980, were reviewed in detail for effectiveness of surgery, control of disease, and hearing results. The majority of the procedures were done for cholesteatoma. Almost all of these had preoperative sclerotic or poorly developed mastoids as judged by x-ray examination. A limited open-cavity technique with one-stage tympanic repair has resulted in long-term control of cholesteatoma in the mastoid segment in almost every case and reasonable success in control of middle ear disease and preservation or improvement in hearing. Properly performed modified radical mastoid cavities seldom cause problems in postoperative care, do not preclude swimming, and do not impair concomitant tympanoplastic repair. Failure to control disease in the middle ear or to improve hearing is the major problem. Revision tympanoplasty can correct some of these remaining problems, but is usually an elective procedure.