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Alshalan A, Alzhrani F. Efficacy of vibrant sound bridge in congenital aural atresia: an updated systematic review. Eur Arch Otorhinolaryngol 2024; 281:2849-2859. [PMID: 38647685 DOI: 10.1007/s00405-024-08629-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 03/19/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE The indications of Vibrant Soundbridge (VSB) have been expanded to include patients with conductive and mixed hearing loss due to congenital aural atresia (CAA). However, the current evidence supporting the auditory outcomes of VSB is based mainly on case reports and retrospective chart reviews. Therefore, the present systematic review aims to summarize and critically appraise the current evidence regarding the safety and effectiveness of VSB in children and adult patients with CAA. METHODS A systematic literature search retrieved studies that evaluated the outcomes of unilateral or bilateral implantation of VSB in patients with CAA. The bibliographic search was conducted in PubMed, Scopus, EBSCO, and Cochrane Central Register of Controlled Trials (CENTRAL) databases from January 2000 to December 2022. RESULTS Twenty-seven studies were included in the present systematic review. Overall, the speech perception after VSB was good, with a mean word recognition score (WRS) score ranging from 60 to 96.7%. The mean postoperative speech recognition threshold (SRT) after implantation ranged from 20.8 to 50 dB. The effective gain was reported in 15 studies, ranging from 31.3 to 45.5 dB. In terms of user satisfaction with VSB, the included studies showed significant improvements in the patient-reported outcomes, such as the Speech Spatial and Qualities of Hearing scale and Glasgow Hearing Aid Benefit Profile. The VSB implantation was generally safe with low incidence of postoperative complications. CONCLUSION VSB provides significant benefits to individuals with hearing loss owing to CAA, with very good subjective outcomes and a low risk of complications.
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Affiliation(s)
- Afrah Alshalan
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Jouf University, PO Box 72418, 23235, Skaka, Aljouf, Saudi Arabia.
| | - Farid Alzhrani
- King Abdullah Ear Specialist Center (KAESC), King Saud University, Riyadh, Saudi Arabia
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Alahmadi A, Yousef M, Ibrahim A, Shahadah N, Hafez A, Abdelsamad Y, Alzhrani F. A novel coupling quality index to estimate the coupling efficiency in Vibrant Soundbridge. Eur Arch Otorhinolaryngol 2024; 281:2333-2340. [PMID: 38070046 DOI: 10.1007/s00405-023-08354-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 11/10/2023] [Indexed: 04/18/2024]
Abstract
BACKGROUND The objective-based methods for intraoperative monitoring have been suggested to assess the coupling and the outcomes of Vibrant Soundbridge (VSB). Although several techniques were proposed, they have not been widely adopted due to their complexity and invasiveness. PURPOSE This study aimed to investigate the accuracy of a new coupling quality index using an intraoperative ABR threshold via AcoustiAP and its correlation with the perioperative measures. METHODS This is a prospective study conducted at a tertiary center. The medical records were retrieved for all patients who underwent VSB implantation and had an intraoperative objective assessment for the coupling efficiency. AcoustiAP was used to evaluate the intraoperative ABR thresholds, which were assessed directly after the floating mass transducer (FMT) placement using acoustic CE-Chirp signals. The Vibrogram was used for the postoperative audiological evaluation. A new coupling quality index was calculated based on the intraoperative ABR thresholds. RESULTS Ten patients were eligible for the present study. The ABR thresholds for good coupling ranged from 35 to 60 dBnHL. The loose coupling thresholds ranged considerably from 40 to 100 dBnHL. Overall, the median intraoperative ABR threshold at good coupling was 42.5 (40-60) dBnHL and 60 (40-100) dBnHL at loose coupling. The analysis showed that there was a significant change in the coupling quality index at the good and loose coupling points (24.3 ± 14 vs 38.8 ± 18.2, respectively, p < 0.001). At a cut-off value of 22.6 dB, the coupling quality index had a sensitivity of 70% and specificity of 90% for discriminating good and loose coupling. CONCLUSION This study provides evidence for the utility of intraoperative ABR measurements in predicting the coupling efficiency in patients with VSB. Our results showed that the coupling quality index had an acceptable accuracy in discriminating between good and poor coupling, which can help clinicians optimize the fitting process for individuals and may ultimately lead to improved patient outcomes.
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Affiliation(s)
- Asma Alahmadi
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, P.O. Box: 245, 11411, Riyadh, Saudi Arabia.
| | - Medhat Yousef
- Audio Vestibular Medicine Unit, ENT Department, Menoufia University, Menoufia, Egypt
- Consultant Audio Vestibular Physician, King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, Riyadh, Saudi Arabia
| | - Anas Ibrahim
- Vibrant Department, MED-EL GmbH, Riyadh, Saudi Arabia
| | - Nourah Shahadah
- Audiology unit, ENT department, College of Medicine, King Abdulaziz University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed Hafez
- Electrophysiology Department, MED-EL GmbH, Riyadh, Saudi Arabia
| | | | - Farid Alzhrani
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, P.O. Box: 245, 11411, Riyadh, Saudi Arabia
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Di Gregorio MF, Der C, Bravo-Torres S, Zernotti ME. Active Bone Conduction Implant and Adhesive Bone Conduction Device: A Comparison of Audiological Performance and Subjective Satisfaction. Int Arch Otorhinolaryngol 2024; 28:e332-e338. [PMID: 38618604 PMCID: PMC11008936 DOI: 10.1055/s-0043-1777416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 11/03/2023] [Indexed: 04/16/2024] Open
Abstract
Introduction Atresia of the external auditory canal affects 1 in every 10 thousand to 20 thousand live births, with a much higher prevalence in Latin America, at 5 to 21 out of every 10 thousand newborns. The treatment involves esthetic and functional aspects. Regarding the functional treatment, there are surgical and nonsurgical alternatives like spectacle frames and rigid and softband systems. Active transcutaneous bone conduction implants (BCIs) achieve good sound transmission and directly stimulate the bone. Objective To assess the audiological performance and subjective satisfaction of children implanted with an active transcutaneous BCI for more than one year and to compare the outcomes with a nonsurgical adhesive bone conduction device (aBCD) in the same users. Methods The present is a prospective, multicentric study. The audiological performance was evaluated at 1, 6, and 12 months postactivation, and after a 1-month trial with the nonsurgical device. Results Ten patients completed all tests. The 4-frequency pure-tone average (4PTA) in the unaided condition was of 65 dB HL, which improved significantly to 20 dB HL after using the BCI for 12 months. The speech recognition in quiet in the unaided condition was of 33% on average, which improved significantly, to 99% with the BCI, and to 91% with the aBCD. Conclusion The aBCD demonstrated sufficient hearing improvement and subjective satisfaction; thus, it is a good solution for hearing rehabilitation if surgery is not desired or not possible. If surgery is an option, the BCI is the superior device in terms of hearing outcomes, particularly background noise and subjective satisfaction.
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Affiliation(s)
| | - Carolina Der
- Department of Otorhinolaryngology, Hospital Dr. Luis Calvo Mackenna, Providencia, Santiago, Chile
| | - Sofia Bravo-Torres
- Department of Audiology, Hospital Dr. Luis Calvo Mackenna, Providencia, Santiago, Chile
| | - Mario Emilio Zernotti
- Department of ENT, Sanatorio Allende, Nueva Córdoba, Córdoba, Argentina
- Speech Therapy School, Faculty of Medical Sciences, Universidad Nacional de Córdoba, Córdoba, Argentina
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Herr C, Stöver T, Baumann U, Weissgerber T. Comparison of hearing performance in patients with borderline indication for active middle ear or cochlear implants: clinical outcomes to guide preoperative counseling and decision making. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08491-6. [PMID: 38324057 DOI: 10.1007/s00405-024-08491-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/17/2024] [Indexed: 02/08/2024]
Abstract
PURPOSE The aim of the presented study was to compare the audiological benefit achieved in cochlear implant (CI) patients who, in principle, could still have been treated with an active middle ear implant (AMEI) with a group of AMEI users. METHODS Results of 20 CI patients with a pure-tone average (PTA) of 70 dB HL prior to surgery were compared with a group of 12 subjects treated with a Vibrant Soundbridge (VSB). Pre-surgical comparison included PTA for air conduction and bone conduction, maximum speech recognition score for monosyllabic words (WRSmax), and aided monosyllabic word recognition at 65 dB SPL. One year after surgery, aided monosyllabic speech recognition score at 65 dB SPL was compared. RESULTS Mean PTA for air conduction in the VSB group was significantly lower than in the CI group (4.8 dB, Z = - 2.011, p < 0.05). Mean PTA for bone conduction in the VSB group was also significantly lower than in the CI group (23.4 dB, Z = - 4.673, p < 0.001). WRSmax in the VSB group was significantly better than in the CI group (40.7%, Z = - 3.705, p < 0.001). One year after treatment, there was no significant difference in aided speech perception in quiet between both subject groups. CONCLUSION Comparison of the two methods showed equivalent results for both treatments in subjects with a borderline indication. Not only pure-tone audiometry results but, particularly, speech perception scores pre-surgery should be taken into account in preoperative counseling.
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Affiliation(s)
- Constanze Herr
- Department of Otorhinolaryngology, Goethe University Frankfurt, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt (Main), Germany
| | - Timo Stöver
- Department of Otorhinolaryngology, Goethe University Frankfurt, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt (Main), Germany
| | - Uwe Baumann
- Department of Otorhinolaryngology, Goethe University Frankfurt, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt (Main), Germany
- Department of Otorhinolaryngology, Audiological Acoustics, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt (Main), Germany
| | - Tobias Weissgerber
- Department of Otorhinolaryngology, Goethe University Frankfurt, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt (Main), Germany.
- Department of Otorhinolaryngology, Audiological Acoustics, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt (Main), Germany.
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Dejaco D, Riedl D, Gottfried TM, Santer M, Runge A, Seebacher J, Zelger P, Lia B, Joachim S. The influence of intraoperative auditory brainstem responses on vibroplasty coupling-quality and analysis of the impact of different fixation steps on the coupling. Eur Arch Otorhinolaryngol 2024; 281:141-151. [PMID: 37442819 PMCID: PMC10764396 DOI: 10.1007/s00405-023-08103-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023]
Abstract
PURPOSE The Vibrant Soundbridge (VSB) is an established active-middle-ear-implant for patients with moderate-to-profound hearing-loss. This surgery is referred to as "Vibroplasty". Sufficient transfer of the VSB's floating-mass-transducers (FMT) energy to the inner ear is a crucial factor influencing the coupling-quality (CQ). However, assessing CQ is hamper by two issues: the method of CQ-assessment itself and the method of FMT-fixation during Vibroplasty. METHODS This prospective study explored the influence of intraoperative auditory-brainstem-response (+ ABR) measurements and various fixation methods on postoperative CQ after Vibroplasty as compared to matched-patients after Vibroplasty without intraoperative ABR (-ABR). Propensity-score-matching was performed based on preoperative bone-conduction-pure-tone-average-3 (BC-PTA3) at 1-, 2- and 4 kHz. Primary outcome parameters were postoperative CQ-PTA3, intraoperative ABR threshold for various fixation methods and postoperative BC-PTA3. RESULTS A total of 28 patients were included, of which 14 were + ABR. Preoperative BC-PTA3, sex, age, and number of previous surgeries did not differ significantly between groups (all p > 0.301). Mean postoperative CQ-PTA3 was significantly better for + ABR (1.8 vs. 12.3 dB-HL; p = 0.006). Mean intraoperative ABR threshold was superior for cartilage-counter-bearing and cartilage-housing compared to additional fixation with injectable-platelet-rich- fibrin (53 vs. 56 & 57 dB-HL, respectively; p = 0.04; η2 = 0.33). Mean postoperative BC-PTA3 did not significantly differ between patients (41.4 vs. 41.8 dB-HL; p = 0.77). A total of 7% of the patients required intraoperative readjustment of the FMT based on unsatisfactory intraoperative ABR threshold. CONCLUSION Intraoperative ABR measurement resulted in significantly better postoperative CQ. Cartilage-counter-bearing and cartilage-housing were observed to have superior CQ. A total of 7% of the patients could be spared revision-Vibroplasty due to intraoperative ABR measurement.
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Affiliation(s)
- Daniel Dejaco
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - David Riedl
- Department of Medical Psychology, Medical University of Innsbruck, Schöpfstr. 23a, 6020, Innsbruck, Austria
| | - Timo Maria Gottfried
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Matthias Santer
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Annette Runge
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Josef Seebacher
- Department for Hearing, Speech and Voice Disorders, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Philipp Zelger
- Department for Hearing, Speech and Voice Disorders, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Bicego Lia
- MED-EL Elektromedizinische Geräte G.M.B.H., Fürstenweg 77a, 6020, Innsbruck, Austria
| | - Schmutzhard Joachim
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
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Gantner S, Epp A, Pollotzek M, Hempel JM. Long-term results and quality of life after vibrant soundbridge implantation (VSBs) in children and adults with aural atresia. Eur Arch Otorhinolaryngol 2024; 281:129-139. [PMID: 37603051 PMCID: PMC10764446 DOI: 10.1007/s00405-023-08100-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/28/2023] [Indexed: 08/22/2023]
Abstract
PURPOSE The aim of this study was to evaluate the long-term effectiveness and acceptance of the active middle ear implant system Vibrant Soundbridge (VSB®, MED-EL, Austria) in patients with aural atresia or aplasia (children and adults). METHODS Data from 51 patients (mean age 13.9 ± 11.3 years), 42 (79.2%) children and adolescents, and 11 (20.8%) adults) who received a VSB implant between 2009 and 2019 at the Department of Otolaryngology at LMU Clinic Großhadern, Munich were included in the study. Pure-tone audiometry, speech recognition in a quiet environment and in a noisy environment were performed preoperatively, during the first fitting of the audio processor, after 1-3 years, after 3-5 years, and after 5 years (if possible). The follow-up period ranged from 11 to 157 months with a mean of 58.6 months (4.8 years). Furthermore, the benefit of the VSB was evaluated by self-assessment questionnaires (Speech, Spatial, and Qualities of Hearing Scale, respectively, for parents). RESULTS Significant improvements were observed in hearing and speech comprehension immediately after the initial fitting of the VSB system (mean hearing gain 38.4 ± 9.4 dB HL) and at follow-up intervals (1-3, 3-5 and after 5 years) for children and adults (p < 0.01). The values remained stable over the long-term, indicating a sustained functional gain from the VSB (mean hearing gain 38.9 ± 9.2 dB HL). The results of the self-assessments affirm the positive influence on hearing and speech comprehension with the VSB. With the VSB, there was an improvement of 41.3 ± 13.7% in the Freiburg monosyllable test. CONCLUSION These results (a stable hearing gain over the long term, a good tolerance of the implant and an improvement in quality of life) affirm the recommendation for using the active middle ear implant VSB as early as permitted for aural atresia and aplasia patients. This study represents the audiometric results with the (to date) largest collective of aural atresia patients and with a long follow-up period.
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Affiliation(s)
- Sophia Gantner
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilian University Munich, Munich, Germany.
| | - Alexandra Epp
- Paediatric Hospital, University Hospital, Augsburg, Germany
| | - Marlene Pollotzek
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilian University Munich, Munich, Germany
| | - John Martin Hempel
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilian University Munich, Munich, Germany
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Brandt HH, Bodmer D. [Contemporary diagnosis and management of congenital microtia and aural atresia : Part 2: Overview of therapeutic approaches]. HNO 2024; 72:57-68. [PMID: 38047932 PMCID: PMC10781867 DOI: 10.1007/s00106-023-01386-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 12/05/2023]
Abstract
Congenital malformations of the pinna and aural atresia can result in major aesthetic and functional deficits. Knowledge about embryologic developments and established classification systems is an essential requirement when dealing with affected patients. Early detection of deficiencies and introduction of appropriate diagnostic measures is vital to initiate adequate therapies and prevent long-term disabilities. Treatment for malformations of the pinna-if requested-is mostly surgical, infrequently an epithesis is applied. As in other surgical fields, tissue engineering will likely play a crucial role in the future. Treatment of aural stenosis and atresia aims at improvement of hearing levels and prevention of secondary complications like cholesteatoma and chronic otorrhea. Auditory rehabilitation comprises a spectrum from conventional hearing aids to invasive hearing implants, the latter being favored in recent years.
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Affiliation(s)
- Hannes H Brandt
- Klinische Abteilung für Hals‑, Nasen‑, Ohrenkrankheiten, Universitätsklinikum St. Pölten, Dunant-Platz 1, 3100, St. Pölten, Österreich.
- Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Krems, 3500, Dr. Karl-Dorrek-Straße 30, Österreich.
| | - Daniel Bodmer
- Hals-Nasen-Ohren-Klinik, Universitätsspital Basel, Basel, 4031, Petersgraben 4, Schweiz
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Spahn B, Koestler C, Herrmann D, Voelker J, Engert J, Kurz A, Hagen R, Cebulla M, Rak K. The Stapes Head Coupler-A Flexible and Safe Option for Vibroplasty. Otol Neurotol 2024; 45:11-17. [PMID: 38085759 DOI: 10.1097/mao.0000000000004060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
OBJECTIVE To investigate the surgical approach and the audiological outcome of a stapes head coupler in active middle ear implant surgery. STUDY DESIGN Retrospective data analysis. SETTING Tertiary referral center with a large active middle ear implant program. PATIENTS Twelve patients with active middle ear implant surgery. INTERVENTIONS Therapeutic surgical approach for hearing rehabilitation in human subjects. MAIN OUTCOME MEASURES Auditory brainstem response, sound field thresholds, vibrogram, speech perception in the Freiburger monosyllabic word test. RESULTS The stapes head was attached safely in different coupling situations. Audiological outcomes were similar to the audiological performance of established vibroplasty couplers presented in the literature. CONCLUSION The stapes head coupler is a new and safe tool for vibroplasty with a good audiological outcome.
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Affiliation(s)
- Bjoern Spahn
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Wuerzburg, Wuerzburg, Germany
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Morales-Puebla JM, Lassaletta L, Sánchez-Cuadrado I, Calvino M, Gavilán J. Is Age a Limiting Factor for Audiological Results in Active Middle Ear Implants? J Pers Med 2023; 13:1650. [PMID: 38138877 PMCID: PMC10744468 DOI: 10.3390/jpm13121650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 11/24/2023] [Accepted: 11/25/2023] [Indexed: 12/24/2023] Open
Abstract
Active middle ear implants (AMEI) are implantable options for patients with sensorineural, conductive, or mixed hearing loss who are not good candidates for hearing aids. The aim of this study was to compare audiological, surgical, quality of life, and sound quality outcomes in adults <60 and ≥60 years receiving an AMEI. Twenty adult patients who underwent AMEI implantation were divided into two groups, <60 and ≥60 y. Preoperative tests included pure-tone average and speech discrimination score (SDS) at 65 dB for disyllabic words in quiet. Postoperative measures included AMEI-aided bone conduction threshold, free-field warble-tone threshold, and SDS at 65 dB for disyllabic words in quiet 12 months after the AMEI fitting. Subjective benefit was evaluated using the Nijmegen Cochlear Implant Questionnaire (NCIQ), Glasgow Benefit Inventory (GBI), and Hearing Implant Sound Quality Index (HISQUI19). Mean functional gain was 32 and 30 dB, and SDS at 65 dB improved from 19 to 95% and from 31 to 84% in the <60 and ≥60 y groups, respectively. All NCIQ domains improved following surgery, and all patients had a positive overall GBI score. The mean HISQUI19 score was 97 in both age groups. AMEIs are an effective hearing restoration method for older adults suffering from conductive or mixed hearing loss.
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Affiliation(s)
- J. Manuel Morales-Puebla
- Department of Otolaryngology, La Paz University Hospital, IdiPAZ Research Institute, 28046 Madrid, Spain; (L.L.); (I.S.-C.); (M.C.); (J.G.)
- Biomedical Research Networking Centre on Rare Diseases (CIBERER), Institute of Health Carlos III, U761, 28029 Madrid, Spain
| | - Luis Lassaletta
- Department of Otolaryngology, La Paz University Hospital, IdiPAZ Research Institute, 28046 Madrid, Spain; (L.L.); (I.S.-C.); (M.C.); (J.G.)
- Biomedical Research Networking Centre on Rare Diseases (CIBERER), Institute of Health Carlos III, U761, 28029 Madrid, Spain
| | - Isabel Sánchez-Cuadrado
- Department of Otolaryngology, La Paz University Hospital, IdiPAZ Research Institute, 28046 Madrid, Spain; (L.L.); (I.S.-C.); (M.C.); (J.G.)
| | - Miryam Calvino
- Department of Otolaryngology, La Paz University Hospital, IdiPAZ Research Institute, 28046 Madrid, Spain; (L.L.); (I.S.-C.); (M.C.); (J.G.)
- Biomedical Research Networking Centre on Rare Diseases (CIBERER), Institute of Health Carlos III, U761, 28029 Madrid, Spain
| | - Javier Gavilán
- Department of Otolaryngology, La Paz University Hospital, IdiPAZ Research Institute, 28046 Madrid, Spain; (L.L.); (I.S.-C.); (M.C.); (J.G.)
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Burkhardt V, Hassepaß F, Offergeld C. [Medical examination: Preparation for ENT specialisation : Part 68]. HNO 2023; 71:744-749. [PMID: 37847377 DOI: 10.1007/s00106-023-01373-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 10/18/2023]
Affiliation(s)
- Valentin Burkhardt
- Klinik für Hals- Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland.
| | - Frederike Hassepaß
- Klinik für Hals- Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Christian Offergeld
- Klinik für Hals- Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
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Hundertpfund J, Dejaco T, Meyer JE, Óvári A. Round-Window Vibroplasty: Systematic Review and Meta-Analysis of Audiological Effectiveness With Different Round-Window Coupling Techniques. Otol Neurotol 2023; 44:e549-e559. [PMID: 37504977 DOI: 10.1097/mao.0000000000003958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
OBJECTIVE Active middle ear implants can be directly coupled to the round-window (RW) membrane via RW Vibroplasty. The objectives of this systematic review were to summarize data on different RW coupling techniques and to investigate their effect on audiological and safety outcomes using meta-analyses. DATABASES REVIEWED PubMed (MEDLINE), Cochrane Library, and Embase (DIMDI). METHODS All publications reporting on audiological outcomes in human patients after RW Vibroplasty were included. Two independent reviewers carried out screening and data extraction. Meta-analyses and meta-regression were used to evaluate the potential effects of surgical and demographic parameters on primary audiological outcomes. Adverse events were extracted and tabulated for qualitative analysis. RESULTS Fourteen different combinations of surgical coupling parameters were identified in 61 included publications. Overall, data from 23 publications could be used for meta-analyses. Significantly better aided sound-field thresholds were reported for RW Vibroplasty performed without a dedicated coupler and using fascia as interponate, compared with RW Vibroplasty with an RW coupler or without an interponate. These effects were not found in other outcomes (i.e., functional gain, word recognition score). Reporting of adverse events was relatively heterogeneous, with 32 explicit mentions of revision surgery after the loss of coupling efficacy. CONCLUSION There are numerous publications investigating the effectiveness of coupling active middle ear implants to the RW membrane. However, studies are typically undersampled and of low evidence level. Using meta-analyses, weighted means, and qualitative analyses enabled a summary of the existing literature on audiological and safety outcomes after RW Vibroplasty. Individual selection of the most appropriate coupling modality with standardized intraoperative measurement and careful patient follow-up may be considered key factors for achieving effective RW coupling.
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Tollin DJ, Koka K, Peacock J. Using Stapes Velocity to Estimate the Efficacy of Mechanical Stimulation of the Round Window With an Active Middle Ear Implant. Otol Neurotol 2023; 44:e311-e318. [PMID: 36962010 PMCID: PMC10175173 DOI: 10.1097/mao.0000000000003859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Abstract
OBJECTIVE To test a method to measure the efficacy of active middle ear implants when coupled to the round window. METHODS Data previously published in Koka et al. ( Hear Res 2010;263:128-137) were used in this study. Simultaneous measurements of cochlear microphonics (CM) and stapes velocity in response to both acoustic stimulation (forward direction) and round window (RW) stimulation (reverse direction) with an active middle ear implant (AMEI) were made in seven ears in five chinchillas. For each stimulus frequency, the amplitude of the CM was measured separately as a function of intensity (dB SPL or dB mV). Equivalent vibrational input to the cochlea was determined by equating the acoustic and AMEI-generated CM amplitudes for a given intensity. In the condition of equivalent CM amplitude between acoustic and RW stimulation-generated output, we assume that the same vibrational input to the cochlea was present regardless of the route of stimulation. RESULTS The measured stapes velocities for equivalent CM output from the two types of input were not significantly different for low and medium frequencies (0.25-4 kHz); however, the velocities for AMEI-RW drive were significantly lower for higher frequencies (4-14 kHz). Thus, for RM stimulation with an AMEI, stapes velocities can underestimate the mechanical input to the cochlea by ~20 dB for frequencies greater than ~4 kHz. CONCLUSIONS This study confirms that stapes velocity (with the assumption of equivalent stapes velocity for forward and reverse stimulation) cannot be used as a proxy for effective input to the cochlea when it is stimulated in the reverse direction. Future research on application of intraoperative electrophysiological measurements during surgery (CM, compound action potential, or auditory brainstem response) for estimating efficacy and optimizing device coupling and performance is warranted.
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Affiliation(s)
- Daniel J. Tollin
- Department of Physiology and Biophysics, University of Colorado School of Medicine, Aurora, CO 80045
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO 80045
| | - Kanthaiah Koka
- Department of Physiology and Biophysics, University of Colorado School of Medicine, Aurora, CO 80045
| | - John Peacock
- Department of Physiology and Biophysics, University of Colorado School of Medicine, Aurora, CO 80045
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Graf L, Lochner J, Mojallal H, Arnold A, Honegger F, Stieger C. Comparison between incus short process and long process coupling of the vibrant soundbridge in human temporal bones. Int J Audiol 2023; 62:192-198. [PMID: 35174741 DOI: 10.1080/14992027.2022.2031317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The Vibrant Soundbridge (VSB) is one of the most widely used implantable hearing devices. It consists of a vibrating floating mass transducer (FMT) that is connected to a middle ear structure. The standard coupling devices for sensorineural hearing loss are short process (SP) or long process (LP) couplers. DESIGN AND STUDY SAMPLE This study directly compared the electro-mechanical performance of the SP- and LP-coupled FMT of the VSB in the same temporal bone specimen (n = 10). We measured velocity magnitudes and total harmonic distortions (THD) of the stapes (ST) and the round window (RW) using laser Doppler Vibrometry (LDV). RESULTS Comparison shows a maximally 10 dB higher magnitude for the LP coupler at ST and RW for frequencies below 600 Hz, whereas the SP coupler shows a maximally 20 dB higher magnitude at the ST and RW for frequencies above 600 Hz. THD show similar behaviour with less distortion at 500 Hz for the LP coupler and less distortions for the SP coupler in higher frequencies. CONCLUSIONS Our experiments showed that the SP coupling may be mechanically favourable, in terms of magnitude and distortion, for the transmission of FMT vibrations at higher frequencies.
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Affiliation(s)
- Lukas Graf
- ENT Department, University Basel Hospital, Basel, Switzerland
| | | | | | - Andreas Arnold
- ENT Department, Spital Münsingen, Münsingen, Switzerland.,ENT Department, Inselspital, University of Bern, Bern, Switzerland
| | - Flurin Honegger
- ENT Department, University Basel Hospital, Basel, Switzerland
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Dias GFM, Oliveira VVD, Mondelli MFCG. Comparative analysis between effective gain and functional gain in bone-anchored hearing aid users. J Appl Oral Sci 2023; 30:e20220291. [PMID: 36629535 PMCID: PMC9828875 DOI: 10.1590/1678-7757-2022-0291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/25/2022] [Accepted: 11/02/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The cases of ear malformations, conductive, mixed, and single-sided deafness hearing loss are candidates for surgery and use of Bone-Anchored Hearing Aids (BAHA). Commonly, the literature highlights two procedures to assess the benefits and characteristics of amplification in users: functional gain (FG) and effective gain (EG). OBJECTIVE Estimate and compare the EG and the FG to evaluate the benefits obtained by users of BAHA and, later, to compare tests of speech perception in silence and in noise. METHODOLOGY The sample (n=79) was divided into four groups, implanted from February 2014 to February 2021. The following tests were analyzed: pure-tone audiometry by air and bone; research of audiometric thresholds in free field; speech perception tests in silence and in noise. RESULTS EG presented lower values than FG in all frequencies. The positive results of the speech perception tests were correlated with worse FG values. EG is the best method for evaluation, as it allows a proper comparison between devices, as well as a comparison with the prescription of validated rules. CONCLUSIONS A better evaluation of results was observed on the EG values, indicating that it is a relevant method to assess auditory performance. In addition, the FG results were incompatible with the benefits obtained in the speech perception tests, showing that it is not a reliable tool for monitoring the results with the use of BAHA.
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Muacevic A, Adler JR, Chu TSM, Chan J. The 100 Most-Cited Manuscripts in Hearing Implants: A Bibliometrics Analysis. Cureus 2023; 15:e33711. [PMID: 36793822 PMCID: PMC9925031 DOI: 10.7759/cureus.33711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2023] [Indexed: 01/13/2023] Open
Abstract
The aim of the study was to characterise the most frequently cited articles on the topic of hearing implants. A systematic search was carried out using the Thomson Reuters Web of Science Core Collection database. Eligibility criteria restricted the results to primary studies and reviews published from 1970 to 2022 in English dealing primarily with hearing implants. Data including the authors, year of publication, journal, country of origin, number of citations and average number of citations per year were extracted, as well as the impact factors and five-year impact factor of journals publishing the articles. The top 100 papers were published across 23 journals and were cited 23,139 times. The most-cited and influential article describes the first use of the continuous interleaved sampling (CIS) strategy utilised in all modern cochlear implants. More than half of the studies on the list were produced by authors from the United States, and the Ear and Hearing journal had both the greatest number of articles and the greatest number of total citations. To conclude, this research serves as a guide to the most influential articles on the topic of hearing implants, although bibliometric analyses mainly focus on citations. The most-cited article was an influential description of CIS.
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Iwasaki S. Advances in auditory implants. Auris Nasus Larynx 2022; 50:321-326. [PMID: 36114071 DOI: 10.1016/j.anl.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/21/2022] [Accepted: 09/01/2022] [Indexed: 11/30/2022]
Abstract
Auditory implants are classified into bone conduction (BAHA and Bonebridge; BB) and active middle ear implants (Vibrant Soundbridge; VSB) that stimulate cochlear hair cells, and cochlear implants (CIs) that stimulate neural structures. CIs should be performed as early as possible, and bilateral CIs have become popular because sound localization and speech recognition can be improved. CI is also considered a desirable treatment option for patients with single-sided deafness. VSB provides a safe and effective option for patients with conductive or mixed hearing loss and moderate to severe sensorineural hearing loss (SNHL); however, it use in patients with conductive or mixed hearing loss have only been approved in Japan. BAHA and BB implants have been approved by national insurance in Japan as bone conduction implants for patients with conductive or mixed hearing loss. Two fully implantable devices (Cochlear Carina and Envoy Esteem) are provided for patients with SNHL.
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Affiliation(s)
- Satoshi Iwasaki
- Department of Otorhinolaryngology, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo 108-8329, Japan.
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Barbara M, Jiang D. Editorial: The clinical role of auditory implants. Front Neurol 2022; 13:951692. [PMID: 36110389 PMCID: PMC9468972 DOI: 10.3389/fneur.2022.951692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/11/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Maurizio Barbara
- Department of Neuroscience, Mental Health and Sensory Organs, ENT Unit, Sapienza University Sant'Andrea University Hospital, Rome, Italy
- *Correspondence: Maurizio Barbara
| | - Dan Jiang
- Skull Base and Auditory Implants, Guy's and St Thomas NHS Foundation Trust, London, United Kingdom
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Knölke N, Murawski D, Wardenga N, Busch S, Maier H, Lenarz T. The Hannover Coupler V2: Audiological outcomes of a round window coupler for the Vibrant Soundbridge. Laryngoscope Investig Otolaryngol 2022; 7:840-846. [PMID: 35734043 PMCID: PMC9195036 DOI: 10.1002/lio2.812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/08/2022] [Accepted: 04/12/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Nicole Knölke
- Department of Otorhinolaryngology German Hearing Center and Institute of Audioneurotechnology (VIANNA), Hannover Medical School Hannover Germany
| | - Dawid Murawski
- Department of Otorhinolaryngology German Hearing Center and Institute of Audioneurotechnology (VIANNA), Hannover Medical School Hannover Germany
| | - Nina Wardenga
- Department of Otorhinolaryngology German Hearing Center and Institute of Audioneurotechnology (VIANNA), Hannover Medical School Hannover Germany
| | - Susan Busch
- Department of Otorhinolaryngology German Hearing Center and Institute of Audioneurotechnology (VIANNA), Hannover Medical School Hannover Germany
- Cluster of Excellence “Hearing4all” Hannover Germany
| | - Hannes Maier
- Department of Otorhinolaryngology German Hearing Center and Institute of Audioneurotechnology (VIANNA), Hannover Medical School Hannover Germany
- Cluster of Excellence “Hearing4all” Hannover Germany
| | - Thomas Lenarz
- Department of Otorhinolaryngology German Hearing Center and Institute of Audioneurotechnology (VIANNA), Hannover Medical School Hannover Germany
- Cluster of Excellence “Hearing4all” Hannover Germany
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Round window stimulation with an interface coupler demonstrates proof of concept. Hear Res 2022; 421:108512. [DOI: 10.1016/j.heares.2022.108512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 03/22/2022] [Accepted: 04/27/2022] [Indexed: 11/18/2022]
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Dejaco D, Riedl D, Cassar AE, Gottfried T, Rasse T, Fischer N, Kreuzer-Simonyan A, Seebacher J, Riechelmann H, Keintzel T, Schmutzhard J. Modified Power Piston Versus Simultaneous Stapedotomy With Hearing Aids in Otosclerosis: A Follow-Up Study Exploring Speech Recognition, Quality of Life and Usage of Device. Otol Neurotol 2022; 43:429-436. [PMID: 35170556 PMCID: PMC8915993 DOI: 10.1097/mao.0000000000003514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare audiologic outcomes, quality-of-life (QoL) and usage-of-device (UoD) between case-matched, otosclerotic patients with mixed hearing loss (MHL) which received (a) stapedotomy and postoperative amplification with hearing aids (SDT+HA) or (b) short-incudial process coupled active middle ear implant with simultaneous stapedotomy (mPP). STUDY DESIGN, SETTING, AND PATIENTS Prospective, matched case-control, follow-up study conducted at two tertiary otologic referral centers. Eligible were all otosclerotic patients with MHL, which received mPP at either of the two institutions. A case-matched-cohort of SDT+HA-patients was generated from the hospitals database based on preoperative audiologic findings. MAIN OUTCOME MEASURES For sound- and speech perception, primary outcome parameters were the mean postoperative, aided air-conduction pure tone average (mpa-AC-PTA) and word recognition score at 80 dB speech level (mpa-WRS), for QoL the mean Nijmegen-Cochlear-Implant-Questionnaire (NCIQ) total-score, and for UoD the mean score rated on a 10-point Likert-scale. RESULTS A total of 28 patients were included; 14 received mPP; mpa-AC-PTA and mpa-WRS significantly improved from 47.1 dB-HL to 34.3 dB-HL (-12.8 dB-HL; p < 0.001) and from 75.0% to 93.2% (+18.2%; p = 0.002) compared to 46.5 dB-HL to 31.9 dB-HL (-14.8 dB-HL; p < 0.008) and 75.0% to 93.2% (+18.2%; p = 0.002) for SDT+HA. No significant difference between groups was observed (all p > 0.1). NCIQ total-score between groups did not significantly differ (70.4 vs. 69.9; p = 0.93). UoD for mPP was significantly higher (6.1 vs. 3.0; p < 0.001). CONCLUSIONS If medical/technical problems prevent usage of HA in otosclerosis with MHL, mPP can be considered as effective treatment option with similar audiological outcome and QoL. A significantly higher UoD for mPP was observed.
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Affiliation(s)
- Daniel Dejaco
- Department of Otorhinolaryngology – Head and Neck Surgery, Medical University of Innsbruck
| | - David Riedl
- Department of Medical Psychology, Medical University of Innsbruck, Innsbruck
| | - Anna Elisabeth Cassar
- Department of Otorhinolaryngology – Head and Neck Surgery, Medical University of Innsbruck
| | - Timo Gottfried
- Department of Otorhinolaryngology – Head and Neck Surgery, Medical University of Innsbruck
| | - Thomas Rasse
- Department of Otorhinolaryngology – Klinikum Wels-Grieskirchen, Wels
| | - Natalie Fischer
- Department of Otorhinolaryngology – Head and Neck Surgery, Medical University of Innsbruck
| | - Armina Kreuzer-Simonyan
- Department for Hearing, Speech and Voice Disorders, Medical University of Innsbruck, Innsbruck, Austria
| | - Josef Seebacher
- Department for Hearing, Speech and Voice Disorders, Medical University of Innsbruck, Innsbruck, Austria
| | - Herbert Riechelmann
- Department of Otorhinolaryngology – Head and Neck Surgery, Medical University of Innsbruck
| | - Thomas Keintzel
- Department of Otorhinolaryngology – Klinikum Wels-Grieskirchen, Wels
| | - Joachim Schmutzhard
- Department of Otorhinolaryngology – Head and Neck Surgery, Medical University of Innsbruck
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Alzhrani F, Alhabib SF, Yousef M. Speech performance and subjective satisfaction of middle ear implant in congenital aural atresia. ACTA OTORHINOLARYNGOLOGICA ITALICA 2022; 42:182-188. [PMID: 35612511 PMCID: PMC9132001 DOI: 10.14639/0392-100x-n1668] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 02/01/2022] [Indexed: 11/23/2022]
Abstract
Objectives To evaluate the safety, speech performance in noise and subjective satisfaction of patients with congenital aural atresia (CAA) implanted with the active middle ear implant. Methods This retrospective study included 13 patients (15 ears) implanted with middle ear implants with different methods of floating mass transducer attachment. In 6 ears, the floating mass transducer (FMT) was coupled with the short process of incus; in 8 ears, a clip coupler was used; and in one ear, a round window coupler was used. Patients were assessed preoperatively, and at one, three, and six months postoperatively. The assessment included Pure Tone Average (PTA4), Speech Reception Threshold (SRT) and Speech Discrimination Score (SDS). The Speech Spatial and Qualities of Hearing scale (SSQ12) was also used to evaluate levels of satisfaction. Results The mean aided PTA4 using Vibrant Sound Bridge (VSB) was 26.44 4.03 dB HL compared to 61.88 ±1.53 dB HL unaided. The SDS improved significantly (p = 0.002) from 51% (± 9.17%) to 94.60% (± 4.43%). Furthermore, there was a significant improvement in SDS in noise (p = 0.008) and SSQ12 responses (p < 0.0001). Conclusions Patients with hearing loss due to CAA can substantially benefit from VSB, with highly satisfactory subjective results and a negligible rate of complications.
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Brkic FF, Baumgartner WD, Riss D, Thurner T, Liu DT, Gstöttner W, Vyskocil E. Progressive Sensorineural Hearing Loss in Vibrant Soundbridge Users Requiring Cochlear Implantation. J Pers Med 2022; 12:jpm12020191. [PMID: 35207679 PMCID: PMC8878649 DOI: 10.3390/jpm12020191] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/22/2022] [Accepted: 01/25/2022] [Indexed: 02/04/2023] Open
Abstract
Less than 20% of patients with sensorineural hearing loss (HL) provided with the Vibrant Soundbridge (VSB) experience a progressive HL and warrant cochlear implantation (CI). The aim of this study was to identify possible predictors of progressive HL prior to VSB implantation. This retrospective study included all consecutive ears with sensorineural HL provided with the VSB between 1998 and 2016. The patient cohort was divided in a study group comprising patients who underwent CI (CI group) after years of VSB usage and those who did not require VSB replacement during the observational time (control group). Pre- and postoperative pure-tone audiometry thresholds were compared among the two groups. Fifteen out of 81 VSB devices (18.5%) required a CI. The CI group had higher preoperative air-conduction (AC) thresholds than the control group (64.3 ± 8.9 dB vs. 56.3 ± 12.9 dB; p = 0.007) at the time of the VSB implantation. On average, the CI group was significantly younger (39.1 ± 12.3 years vs. 52.6 ± 16.2 years; p = 0.003). In conclusion, VSB users with higher preoperative AC thresholds and younger age at the time of VSB implantation might be at risk for progressive HL within the upcoming eight years and need a further CI surgery. Preoperative counseling is particularly advisable in this patient group.
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Fröhlich L, Müller A, Kropp MH, Mir-Salim P, Dziemba O, Oberhoffner T, Plontke SK, Rahne T. Active Middle Ear Implant Evoked Auditory Brainstem Response Intensity-Latency Characteristics. Front Neurol 2022; 12:739906. [PMID: 35126279 PMCID: PMC8810535 DOI: 10.3389/fneur.2021.739906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/16/2021] [Indexed: 11/21/2022] Open
Abstract
Objective To analyze intensity-latency functions of intraoperative auditory evoked brainstem responses (ABRs) to stimulation by the Vibrant Soundbridge (VSB) active middle ear implant with respect to coupling efficiency, VSB evoked ABR thresholds, and coupling modality [oval window (OW) placement vs. Incus placement and vs. round window (RW) placement]. Study Design Exploratory study. Setting Bi-centric study at tertiary referral centers. Patients Twenty-four patients (10 female, 14 male, mean age: 58 years) who received a VSB. Outcome Measures Wave-V intensity-latency functions of intraoperative VSB evoked ABRs using a modified audio processor programmed to preoperative bone conduction thresholds for stimulation. Threshold level correction to coupling efficiency and ABR thresholds. Individual plots and exponential function fits. Results After ABR threshold level correction, the latency functions could be aligned. A large variance of latencies was observed at individual threshold level. Wave-V latency was longest in the Incus placement subgroup (9.73 ms, SD: 1.04) as compared to OW placement subgroup (9.47 ms, SD: 1.05), with the shortest latency in the RW placement subgroup (8.99 ms, SD: 0.68). For increasing stimulation levels, the variance decreased with intensity-latency function slopes converging toward a steady-state (saturation) latency caused by saturation of audio processor (stimulation) gain. Latency saturation was reached at a stimulation level of 50 dB nHL for the OW placement subgroup, 35 dB nHL for the Incus placement subgroup, and 30 dB nHL for the RW placement subgroup. The latency and saturation results indicated decreased dynamic range for RW placement, i.e., reverse stimulation. Conclusions VSB evoked ABR wave-V intensity-latency function slopes were similar to acoustic stimulation at high stimulation levels with a shift toward longer latencies caused by audio processor signal delay. Saturation of latencies occurred for higher stimulation levels due to saturation of audio processor gain. Thus, the analysis of VSB evoked intensity-latency functions appears to allow for the objective assessment of a patient's individual dynamic range. This can further improve diagnostics as well as intraoperative and postoperative quality control.
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Affiliation(s)
- Laura Fröhlich
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Halle, Germany
- *Correspondence: Laura Fröhlich
| | - Alexander Müller
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrichshain Clinic, Vivantes Hearing Center, Berlin, Germany
| | - Miriam H. Kropp
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrichshain Clinic, Vivantes Hearing Center, Berlin, Germany
| | - Parwis Mir-Salim
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrichshain Clinic, Vivantes Hearing Center, Berlin, Germany
| | - Oliver Dziemba
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine of Greifswald, Greifswald, Germany
| | - Tobias Oberhoffner
- Department of Otorhinolaryngology, Head and Neck Surgery “Otto Körner”, Rostock University Medical Center, Rostock, Germany
| | - Stefan K. Plontke
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Torsten Rahne
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Halle, Germany
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Liu Z, Liu H, Wang J, Yang J, Hao J, Yang S. Analysis of design parameters of round-window stimulating type electromagnetic transducer by a nonlinear lumped parameter model of implanted human ear. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2022; 19:2453-2470. [PMID: 35240792 DOI: 10.3934/mbe.2022113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Round-window stimulating transducer is a new solution to treat mixed hearing loss. To uncover the factors affecting the round-window stimulation's performance, we investigated the influence of four main design parameters of round-window stimulating type electromagnetic transducer. Firstly, we constructed a human ear nonlinear lumped parameter model and confirmed its validity by comparing the stapes responses predicted by the model with the experimental data. Following this, an electromagnetic transducer's mechanical model, which simulates the floating mass transducer, was built and coupled to the human ear model; thereby, we established a nonlinear lumped parameter model of implanted human ear under round-window stimulation and verified its reliability. Finally, based on this model, the influences of the four main design parameters, i.e., the excitation voltage, the electromechanical coupling coefficient, the support stiffness, and the preload force, were analyzed. The results show that the change of excitation voltage does not alter the system's natural frequency. Chaotic motion occurs when the electromechanical coupling coefficient is small. Meanwhile, the stapes displacement appears to increase firstly and then decrease with the increase of the electromechanical coupling coefficient. The increase of the support stiffness enlarges the resonance frequency of the stapes displacement and reduces the stapes displacement near the resonance frequency, deteriorating the transducer's hearing compensation at low frequency. The preload force can improve the transducer's hearing compensation performance in mid-high frequency region.
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Affiliation(s)
- Zhaohai Liu
- School of Mechatronic Engineering, China University of Mining and Technology, Xuzhou 221116, China
| | - Houguang Liu
- School of Mechatronic Engineering, China University of Mining and Technology, Xuzhou 221116, China
| | - Jie Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
- Beijing Engineering Research Center of Hearing Technology, Beijing 100730, China
| | - Jianhua Yang
- School of Mechatronic Engineering, China University of Mining and Technology, Xuzhou 221116, China
| | - Jingbin Hao
- School of Mechatronic Engineering, China University of Mining and Technology, Xuzhou 221116, China
| | - Shanguo Yang
- School of Mechatronic Engineering, China University of Mining and Technology, Xuzhou 221116, China
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Jenkins HA, Greene N, Tollin DJ. Round Window Stimulation of the Cochlea. Front Neurol 2022; 12:777010. [PMID: 34970211 PMCID: PMC8712317 DOI: 10.3389/fneur.2021.777010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/11/2021] [Indexed: 11/14/2022] Open
Abstract
Mixed hearing loss associated with a sensorineural component and an impaired conductive mechanism for sound from the external ear canal to the cochlea represents a challenge for rehabilitation using either surgery or traditional hearing amplification. Direct stimulations of the ossicular chain and the round window (RW) membrane have allowed an improved hearing in this population. The authors review the developments in basic and clinical research that have allowed the exploration of new routes for inner ear stimulation. Similar changes occur in the electrophysiological measures in response to auditory stimulation through the traditional route and direct mechanical stimulation of the RW. The latter has proven to be very effective as a means of hearing rehabilitation in a group of patients with significant difficulties with hearing and communication.
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Affiliation(s)
- Herman A Jenkins
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, United States
| | - Nathaniel Greene
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, United States
| | - Daniel J Tollin
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, United States.,Department of Physiology and Biophysics, University of Colorado School of Medicine, Aurora, CO, United States
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Zhao Y, Liu H, Yang J, Yang S, Liu W, Huang X. Effects of design and coupling parameters on the performance of electromagnetic transducers in round-window stimulation. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2022; 151:609. [PMID: 35105032 DOI: 10.1121/10.0009313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 12/24/2021] [Indexed: 06/14/2023]
Abstract
Many studies have investigated factors contributing to large variations in the outcomes of round-window (RW) stimulation but most have focused on the floating mass transducer (FMT). To determine whether results for the FMT hold for a fixed-type transducer (FTT), this study constructs two coupled finite element models of the transducer and the human ear that incorporate the cochlear third windows and inner structures of these two electromagnetic transducers. We use these FE models of the human ear and transducers to investigate the influence of four design parameters and coupling conditions for the transducers, i.e., the support's Young's modulus, the coupling layer's cross sectional area and Young's modulus, and the transducer's cross sectional area. The results show that an increase in the support's Young's modulus reduces the output of the FMT but increases that of the FTT. Reducing the cross sectional area and Young's modulus of the coupling layer significantly increases the low-frequency response of the FMT but slightly reduces that of the FTT. Reducing the cross sectional area of the transducer increases the output of the FMT but reduces that of the FTT. This shows that inner structures of electromagnetic transducers should be considered in the optimal design parameters and coupling conditions for RW stimulation.
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Affiliation(s)
- Yu Zhao
- School of Mechatronic Engineering, China University of Mining and Technology, Xuzhou 221116, People's Republic of China
| | - Houguang Liu
- School of Mechatronic Engineering, China University of Mining and Technology, Xuzhou 221116, People's Republic of China
| | - Jianhua Yang
- School of Mechatronic Engineering, China University of Mining and Technology, Xuzhou 221116, People's Republic of China
| | - Shanguo Yang
- School of Mechatronic Engineering, China University of Mining and Technology, Xuzhou 221116, People's Republic of China
| | - Wen Liu
- Department of Otolaryngology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221006, People's Republic of China
| | - Xinsheng Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, Zhongshan Hospital affiliated to Fudan University, Shanghai, 200032, People's Republic of China
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Systematic and audiological indication criteria for bone conduction devices and active middle ear implants. Hear Res 2021; 421:108424. [PMID: 34987018 DOI: 10.1016/j.heares.2021.108424] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 12/02/2021] [Accepted: 12/22/2021] [Indexed: 01/11/2023]
Abstract
Certain patients with conductive or mixed hearing loss can benefit from bone-conduction hearing devices or active middle ear implants. Available devices differ in coupling site, energy transfer from the sound processor to the implant, and the active or passive actuator technology. The audiological benefit of those devices depends on the maximum stable power output and the noise floor of the device, the degree and expected stability of the sensorineural hearing loss and the coupling efficiency with the aim on achieving a minumum of 30-35 dB effective dynamic range. The choice of the device is often a trade-off between the optimal audiological solution with respect to the hearing loss, technical device-related parameters and the expected coupling efficiency, the optimal surgical solution with respect to patho-anatomical aspects, device dimensions and the coupling site, invasiveness or surgical risks, and other patient factors with respect to the patients' wish and expectations, social aspects, device usability and connectivity. This review article lists all currently available implantable and conventional bone-conduction hearing devices and active middle ear implants with respect to technical features like maximum power output, market availability, and the expected effective output dynamic range.
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Long-Term Outcome With an Active Middle Ear Implant in Patients to Bilateral Aural Atresia. Otol Neurotol 2021; 42:1527-1533. [PMID: 34619727 DOI: 10.1097/mao.0000000000003315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe the audiological results and complications following active middle ear implant (AMEI) surgery in users with bilateral ear atresia. STUDY DESIGN Observational and retrospective longitudinal follow-up. SETTING A tertiary referral hospital for hearing rehabilitation and craniofacial malformations. PATIENTS Medical records of 27 patients with bilateral congenital aural atresia (34 ears) who underwent surgery for AMEI were reviewed. Data were analyzed using descriptive and inferential statistics. The alpha error was assumed to be 5%. OUTCOME MEASURES Medical and technical complications and audiological results were observed during follow-up. RESULTS The median postoperative follow-up was 37.5 months (27.7-75.5 mo). Medical or technical complications occurred in 35.3% (n = 12) of patients during follow-up, 14.7% (n = 5) required surgical revision. The auditory thresholds in the free field improved from 53.75 dB (46.87-56.25) to 25 dB (21.25-32.5) after 6 months using the AMEI (p < 0.001) and remained stable till the last audiological evaluation (22.5: 21.25 26.25). Compared with the preoperative results, all speech perception tests also showed the benefits of AMEI at 6 months postoperatively and in the last audiological evaluation. CONCLUSIONS Monitoring the use of AMEI in this sample demonstrated the safety of these implants compared with data available in the literature. The rates of medical and technical complications were consistent with data published by other groups. Finally, the audiological results remained stable during follow-up.
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Kostevich IV, Kuzovkov VE, Lilenko AS, Sugarova SB. [The significance of microanatomy of the round window in terms of cochlear implantation]. Vestn Otorinolaringol 2021; 86:42-47. [PMID: 34783472 DOI: 10.17116/otorino20218605142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sensoneural hearing loss is a polyetiological disease, which is often a secondary reflection of systemic pathology and is associated with damage of the cochlea and auditory nerve receptors. An important point in the surgical stage of cochlear implantation is the introduction of an implant active electrode into the cochleostomy spiral channel through the cochleostoma or round window. However, the issue of intra-cochlear structures surgical trauma in such surgical intervention seems to be very important, as it may reduce the success of subsequent rehabilitation. Therefore, the study of the anatomy of the round window and adjuscent areas was the objective of this work.
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Affiliation(s)
- I V Kostevich
- St. Petersburg Research Institute of Ear, Throat, Nose and Speech, St. Petersburg, Russia
| | - V E Kuzovkov
- St. Petersburg Research Institute of Ear, Throat, Nose and Speech, St. Petersburg, Russia
| | - A S Lilenko
- St. Petersburg Research Institute of Ear, Throat, Nose and Speech, St. Petersburg, Russia
| | - S B Sugarova
- St. Petersburg Research Institute of Ear, Throat, Nose and Speech, St. Petersburg, Russia
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Machine Learning Technique Reveals Prognostic Factors of Vibrant Soundbridge for Conductive or Mixed Hearing Loss Patients. Otol Neurotol 2021; 42:e1286-e1292. [PMID: 34528923 DOI: 10.1097/mao.0000000000003271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Vibrant Soundbridge (VSB) was developed for treatment of hearing loss, but clinical outcomes vary and prognostic factors predicting the success of the treatment remain unknown. We examined clinical outcomes of VSB for conductive or mixed hearing loss, prognostic factors by analyzing prediction models, and cut-off values to predict the outcomes. STUDY DESIGN Retrospective chart review. SETTING Tertiary care hospital. PATIENTS Thirty patients who underwent VSB surgery from January 2017 to December 2019 at our hospital. INTERVENTION Audiological tests were performed prior to and 3 months after surgery; patients completed questionnaires 3 months after surgery. MAIN OUTCOME MEASURES We used a multiregression and the random forest algorithm for predictions. Mean absolute errors and coefficient of determinations were calculated to estimate prediction accuracies. Coefficient values in the multiregression model and the importance of features in the random forest model were calculated to clarify prognostic factors. Receiver operation characteristic curves were plotted. RESULTS All audiological outcomes improved after surgery. The random forest model (mean absolute error: 0.06) recorded more accuracy than the multiregression model (mean absolute error: 0.12). Speech discrimination score in a silent context in patients with hearing aids was the most influential factor (coefficient value: 0.51, featured value: 0.71). The candidate cut-off value was 36% (sensitivity: 89%, specificity: 75%). CONCLUSIONS VSB is an effective treatment for conductive or mixed hearing loss. Machine learning demonstrated more precise predictions, and speech discrimination scores in a silent context in patients with hearing aids were the most important factor in predicting clinical outcomes.
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Shin DH, Kim JH, Gottlieb P, Vaisbuch Y, Puria S, Cho JH, Seong KW. Comparative study of efficiency and characteristics of FMT and DRT installed in human cadavers for round-window stimulation. Sci Rep 2021; 11:16775. [PMID: 34408166 PMCID: PMC8373861 DOI: 10.1038/s41598-021-95456-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 07/22/2021] [Indexed: 11/09/2022] Open
Abstract
Acoustic hearing aids generate amplified sound in the ear canal, and they are the standard of care for patients with mild to moderate sensorineural hearing loss. However, because of their limited frequency bandwidth, gain, and feedback, there is substantial room for improvement. Active middle ear implants, which directly vibrate the middle ear and cochlea, are an alternative approach to conventional acoustic hearing aids. They provide an opportunity to improve sound quality and speech understanding with amplification rehabilitation. For floating-mass type and direct-rod type (DRT) middle ear transducers, a differential floating-mass transducer (DFMT) and a tri-coil bellows transducer (TCBT), respectively, were fabricated to measure the output characteristics in four human temporal bones. Both were fabricated to have similar output forces per unit input and were placed in four human temporal bones to measure their output performances. The TCBT resulted in higher output than did the DFMT throughout the audible frequency range, and the output was more prominent at lower frequency ranges. In this study, we showed that DRT was a more effective method for round window stimulation. Because of its frequency characteristics and vibration efficiency, this implantation method can be utilized as a driving solution for middle ear implants.
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Affiliation(s)
- Dong Ho Shin
- Institute of Biomedical Engineering Research, Kyungpook National University, Daegu, 41944, Korea
| | - Jong Hoon Kim
- Institute of Biomedical Engineering Research, Kyungpook National University, Daegu, 41944, Korea
| | - Peter Gottlieb
- Department of Mechanical Engineering, Stanford University, Stanford, CA, 94305, USA
| | - Yona Vaisbuch
- Otolaryngology Head and Neck Department, Rambam Medical Center, 31096, Haifa, Israel
| | - Sunil Puria
- Department of Mechanical Engineering, Stanford University, Stanford, CA, 94305, USA.,Otolaryngology Head and Neck Department, Rambam Medical Center, 31096, Haifa, Israel.,Eaton Peabody Laboratory, Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, 02114, USA
| | - Jin-Ho Cho
- Institute of Biomedical Engineering Research, Kyungpook National University, Daegu, 41944, Korea
| | - Ki Woong Seong
- Department of Biomedical Engineering, Kyungpook National University Hospital, Daegu, 41944, Korea.
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Grueninger I, Canis M, Spiegel JL, Müller J. Combination of Direct Oval Window Vibroplasty With Customized Partial Ossicular Replacement Prosthesis (PORP): A Novel Reconstruction Technique to Rehabilitate Mixed Hearing Loss. Otol Neurotol 2021; 42:1507-1514. [PMID: 34267101 DOI: 10.1097/mao.0000000000003278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Hearing rehabilitation with an active middle ear implant (AMEI) in patients with mixed hearing loss (MHL) after multiple ear surgeries is surgically challenging and requires individual solutions in some cases. Our objective was to introduce a feasible novel technique for direct oval window vibroplasty (OW vibroplasty) using a partial ossicular replacement prosthesis (PORP) to ensure stability and enable active and passive sound transmission. DESIGN Four patients with MHL following multiple middle ear surgeries and indication for an AMEI received direct OW vibroplasty in combination with a customized PORP between the enwrapped actuator and reconstructed tympanic membrane (TM). RESULTS Postoperative bone conduction was stable in all patients. All patients benefitted from the AMEI in combination with PORP with a mean functional gain of 31.5 ± 17.0 dB. Mean aided postoperative pure tone average was 27.3 ± 2.6 dB. Speech discrimination in quiet at 65 dB with the German Language Freiburg Monosyllabic Test improved for all patients to 68.8 ± 6.3% and in noise with the German Language Oldenburger Sentence Test to -10.4 ± 3.3 dB SNR. No complications were observed. CONCLUSIONS This novel technique of direct OW vibroplasty extends the portfolio of reconstructive middle ear procedures by combining an intraoperatively customized "off-the-shelf" PORP as a coupler between floating mass transducer (FMT) and a cartilage TM. We found satisfying functional hearing results. Benefits of the reported technique comprise 1) stabilization and optimized coupling of the reconstruction, 2) possibility of passive sound transmission, 3) general feasibility due to great availability of a regular PORP, and 4) flexibility in bridging of large gaps between TM and actuator.
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Affiliation(s)
- Ivo Grueninger
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany
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Xie Y, Chen K, Yin D, Zhang T, Dai P. Anatomic Measurements of Distances from Lateral Surface of Cranium to Cochlea in Congenital Aural Atresia and Stenosis Patients. ORL J Otorhinolaryngol Relat Spec 2021; 83:319-326. [PMID: 34237740 DOI: 10.1159/000511598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 09/06/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Studies have shown that higher response levels can be obtained when the bone conduction stimulation position is closer to the cochlea. However, the morphological characteristics of round window niche and posterior tympanum in congenital aural atresia (CAA) and stenosis (CAS) patients were different from the normal. These affected the position of the cochlea at the cranial base. It was still unknown whether the distances from the cranium of CAA and CAS patients to the cochlea were the same as those of normal patients or not. OBJECTIVE To measure distances from various points on the lateral surface of the cranium to the cochlea and the cranium thickness on these points among a CAA group, CAS group and normal control group, which may provide valuable information for the better position of bone conduction stimulation. METHODS CT images of CAA, CAS patients and these patients' healthy sides were analyzed. Firstly, the Frankfurt horizontal plane (Pfrkt) was established. Secondly, a model of part of the cranium was three-dimensionally reconstructed. Then, the Pfrkt plane was rotated down 20, 30 and 40° according to the superior margin of the external auditory canal. At every angle, points 25, 30, 35 and 40 mm away from the superior margin of the external auditory canal were marked out on the surface of the model and recorded as P20A, P30A, P40A, P20B, etc. The spatial distances between the cranium and ipsilateral cochlea were defined as lengths of points on the surface of the model to the cochlea apex (CA), cochlear base (CB) and modiolus midpoint (MM), respectively, recorded as P20A/CA, P20A/CB, P20A/MM, P30A/CA, etc. Results and Conclusions: In all groups, the length of P20D/CA was the shortest compared to P30D/CA and P40D/CA (p < 0.05). The P20A/CB and P20A/MM were also the shortest (p < 0.05). When the Pfrkt plane was rotated down 30 and 40°, the results were the same as at 20° (p < 0.05). However, P20D, P30D and P40D were almost on the mastoid air cells. We suggest that the bone conduction stimulation position is placed closer to the ear, while avoiding the mastoid air cells in the CAA and CAS patients.
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Affiliation(s)
- Youzhou Xie
- ENT Institute, Eye and ENT Hospital of Fudan University, Shanghai, China.,NHC Hearing Medicine Key Laboratory, Shanghai, China.,Department of Facial Plastic and Reconstructive Surgery, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Keguang Chen
- Department of Otolaryngology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Dongming Yin
- ENT Institute, Eye and ENT Hospital of Fudan University, Shanghai, China.,NHC Hearing Medicine Key Laboratory, Shanghai, China.,Department of Otolaryngology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tianyu Zhang
- ENT Institute, Eye and ENT Hospital of Fudan University, Shanghai, China.,NHC Hearing Medicine Key Laboratory, Shanghai, China.,Department of Facial Plastic and Reconstructive Surgery, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Peidong Dai
- ENT Institute, Eye and ENT Hospital of Fudan University, Shanghai, China.,NHC Hearing Medicine Key Laboratory, Shanghai, China
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Liu H, Xue L, Yang J, Cheng G, Zhou L, Huang X. Effect of ossicular chain deformity on reverse stimulation considering the overflow characteristics of third windows. Comput Methods Biomech Biomed Engin 2021; 25:257-272. [PMID: 34229548 DOI: 10.1080/10255842.2021.1948023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Stimulating the round window membrane via an active actuator of the middle ear implant, named the reverse stimulation, has become an option to help patients with ossicular chain deformity (OCD) to restore hearing. However, there is still no concise description of how OCD affects reverse stimulation considering the overflow characteristics of third windows. In the present study, an impedance model considering the vestibular and cochlear aqueducts was used to investigate the dynamic response of the cochlea to reverse stimulation under OCD. First, a finite-element (FE) model of the middle ear and the ear canal was used to estimate the changes in reverse middle-ear impedance caused by ossicular chain fixation and ossicular chain interruption. Then, the impedance model was used to predict the reverse transfer function, which characterizes the effect of OCD on the dynamic response of the cochlea. The results show that ossicular chain fixation reduces the reverse stimulation's performance. Moreover, the existence of the third windows complicates the effect of ossicular chain fixation on the reverse stimulation and boosts obviously the reverse stimulation's performance at low frequencies. In contrast, regardless of the existence of third windows, ossicular chain interruption enhances the effect of reverse stimulation.
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Affiliation(s)
- Houguang Liu
- School of Mechatronic Engineering, China University of Mining and Technology, Xuzhou, China
| | - Lin Xue
- School of Mechatronic Engineering, China University of Mining and Technology, Xuzhou, China
| | - Jianhua Yang
- School of Mechatronic Engineering, China University of Mining and Technology, Xuzhou, China
| | - Gang Cheng
- School of Mechatronic Engineering, China University of Mining and Technology, Xuzhou, China
| | - Lei Zhou
- Department of Otorhinolaryngology-Head and Neck Surgery, Shanghai Zhongshan Hospital affiliated to Fudan University, Shanghai, China
| | - Xinsheng Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, Shanghai Zhongshan Hospital affiliated to Fudan University, Shanghai, China
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Lailach S, Müller C, Lasurashvili N, Seidler H, Zahnert T. [Active hearing implants in chronic otitis media]. HNO 2021; 69:447-463. [PMID: 31712875 DOI: 10.1007/s00106-019-00775-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In patients with inadequate hearing improvement after tympanoplasty and failure of conventional hearing aid fitting, active hearing implants provide an alternative treatment option. Active middle ear implants function as a vibromechanical bypass of the stiffness and damping effect of a poorly oscillating tympanic membrane and the (reconstructed) ossicular chain. The selection of the hearing system depends on the maximum output levels of the hearing system and the anatomical conditions in mostly multiply operated ears. The development of variable coupling elements for active middle ear implants led to an extension of the indications to include not only purely sensorineural hearing loss but also mixed and conductive hearing loss in patients, as the transducer can now be coupled to the (mobile) stapes or the round window membrane. The article provides an overview of current clinical study results and recommendations on the indications for active hearing implants in patients with chronic otitis media.
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Affiliation(s)
- S Lailach
- Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf-Hals-Chirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - C Müller
- Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf-Hals-Chirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - N Lasurashvili
- Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf-Hals-Chirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - H Seidler
- Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf-Hals-Chirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - T Zahnert
- Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf-Hals-Chirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
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Evaluation of a New Material From an Allogenic Collagen Scaffold as a Suitable Coupling Option for Round Window Vibroplasty. Otol Neurotol 2021; 42:442-446. [PMID: 33496427 DOI: 10.1097/mao.0000000000002961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION In round window vibroplasty the most efficient coupling technique for contact of the floating mass transducer (FMT) to the round window membrane (RWM) is yet to be determined. Various materials placed between the FMT and the RWM have been proposed to enable better stimulation of the cochlea. Collagenous scaffolds derived from decellularized extracellular cartilage matrices as a commercially available biomaterial are already used for other applications in ear surgery. We aimed to examine the coupling properties of collagen scaffolds compared with commonly used other materials (round window soft coupler, porcine perichondrium, and cartilage) as interponate between the FMT and the RWM in vibroplasty. METHODS A well-established in vitro temporal bone model was used. Volume velocities were measured with collagen scaffold compared with different interponates (round window soft coupler, porcine perichondrium, and cartilage) at 800, 1000, 1250, 1600, 2000, 2500, 3150, and 4000 Hz levels. RESULTS Statistical analysis revealed no superiority of commonly used materials compared with collagen scaffolds at all tested volume velocities (p > 0.05). DISCUSSION We could demonstrate that collagenous scaffolds of decellularized extracellular cartilage matrices have similar vibrational properties as conventional coupling materials of the FMT to the RWM in vibroplasty. Therefore, as a commercially available new material they display a suitable coupling option for round window vibroplasty.
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Dalgic A, Atsal G, Olgun L, Kirazli T. Long term results and evaluation of device satisfaction in patients used the vibrant sound bridge (VSB). Acta Otolaryngol 2021; 141:256-260. [PMID: 33528309 DOI: 10.1080/00016489.2020.1843708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Patients' satisfaction with the device is as important as the audiological gains in patients using these devices. OBJECTIVE In this study, we aimed to evaluate the hearing aid satisfaction of individuals using The Vibrant Sound Bridge (VSB) (Vibrant Med-El, Innsbruck, Austria) and to compare this result with audiologic results with and without devices. MATERIAL AND METHODS Patients who were using VSB were included in the study. Preoperative and postoperative pure tone averages and demographic datas of the patients to be included in the study were recorded. A shortened version of Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire, was used to evaluate patients' device satisfaction. RESULTS Fifteen patients with VSB were included in the study. The mean follow-up was 9.13 years. The preoperative air conduction threshold and the air-bone gap in all frequencies were significantly higher than postoperative values (p < .05). The functional gain was found as 28 dB. In the APHAB questionnaire, there was a significant difference between total score results and EC, BN, RV subscales in the patients using the device (p < .01). CONCLUSION AND SIGNIFICANCE Patients with VSB give satisfactory results in auditory gains. In particular, good indication and long-term use of the device increases the suitability and satisfaction of the patients.
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Affiliation(s)
- Abdullah Dalgic
- Department of Otolaryngology, University of Health Sciences Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Gorkem Atsal
- Department of Otolaryngology, University of Health Sciences Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Levent Olgun
- Department of Otorhinolaryngology, Izmir Baskent Zubeyde Hanım Training and Research Hospital, Izmir, Turkey
| | - Tayfun Kirazli
- Department of Otolaryngology, Ege University School of Medicine, Izmir, Turkey
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Hempel JM, Epp A, Volgger V. [Hearing rehabilitation with the Vibrant Soundbridge in patients with congenital middle ear malformation]. HNO 2021:10.1007/s00106-021-01004-5. [PMID: 33599810 DOI: 10.1007/s00106-021-01004-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Congenital aural atresia, which is usually unilateral, causes hearing loss and aesthetic impairment. Besides tympanoplasty with/without canalplasty and bone conduction devices, active middle ear implants are also available for functional rehabilitation. OBJECTIVE This article aims to present a contemporary review on the treatment possibilities for middle ear malformations, with a focus on audiological rehabilitation with the Vibrant Soundbridge. MATERIALS AND METHODS A selective literature search for treatment possibilities was performed in PubMed up to October 2020, and personal clinical experiences are reported. RESULTS The Vibrant Soundbridge, which is approved for children ≥ 5 years, is suitable for treatment of middle ear malformations with a Jahrsdoerfer score ≥ 5. Although implantation of a Vibrant Soundbridge is surgically more demanding than implantation of a bone conduction device, the method is safe, delivers good auditory results (superior to bone conduction devices in terms of speech understanding and spatial hearing), does not involve intensive postsurgical care, and rarely requires revision surgery. The Vibrant Soundbridge can be coupled to (remnants of) the ossicular chain or the round window. CONCLUSION The Vibrant Soundbridge is an appropriate treatment method in patients with middle ear malformations who have suitable anatomical preconditions.
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Affiliation(s)
- J M Hempel
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, LMU Klinikum Großhadern, Marchioninistr. 15, 81377, München, Deutschland.
| | - A Epp
- Kinderklinik, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - V Volgger
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, LMU Klinikum Großhadern, Marchioninistr. 15, 81377, München, Deutschland
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Wickert E, Kurz A, Voelker J, Hagen R, Kaulitz S, Rak K. [Simultaneous implantation of epithesis anchors and Bonebridge to treat severe ear malformations]. Laryngorhinootologie 2021; 100:882-888. [PMID: 33572001 DOI: 10.1055/a-1369-9530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Surgical treatment with bone conduction hearing implants and epitheses for ear malformations offer the right combination of hearing rehabilitation and cosmetic reconstruction. The surgical procedure is often performed in two-stage surgical steps. This project aimed to gain experience with a procedure in which the hearing implant and the epithesis anchors are inserted simultaneously. MATERIAL AND METHODS Four ears of three patients (nf = 1, nm = 2) with severe ear malformations (type III, according to Weerda) received a Bonebridge and an epithesis anchor with three base posts in one operation each. Previously, the indication for the use of a bone conduction implant using the active middle ear implant (aMEI) score, according to Frenzel (2013), had been established. RESULTS All patients scored 4 points each in the aMEI score, indicating an unfavorable prognosis for successful implantation of an active middle ear implant. The treatment with a Bonebridge and an epithesis anchor was performed without complications. Postoperatively, the initial audiological fitting and the application of the magnetic abutment were performed after 4 weeks. Audiometry showed a functional gain of up to 30 dB and an improved speech comprehension. The epithesis was shaped like the contralateral ear. After treatment, patients were satisfied with the audiological and cosmetic results. CONCLUSIONS The simultaneous surgical procedure with a bone conduction hearing implant and epithesis anchor is a good option for the treatment of ear malformations. The aMEI-score was a helpful instrument for the indication. The procedure reduced the surgical risk and the time and effort required for treatment.
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Affiliation(s)
- Eva Wickert
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Direktor: Prof. Dr. med. Dr. h. c. R. Hagen, Univ.-Klinik Würzburg, Würzburg, Germany
| | - Anja Kurz
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Direktor: Prof. Dr. med. Dr. h. c. R. Hagen, Univ.-Klinik Würzburg, Würzburg, Germany
| | - Johannes Voelker
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Direktor: Prof. Dr. med. Dr. h. c. R. Hagen, Univ.-Klinik Würzburg, Würzburg, Germany
| | - Rudolf Hagen
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Direktor: Prof. Dr. med. Dr. h. c. R. Hagen, Univ.-Klinik Würzburg, Würzburg, Germany
| | - Stefan Kaulitz
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Direktor: Prof. Dr. med. Dr. h. c. R. Hagen, Univ.-Klinik Würzburg, Würzburg, Germany
| | - Kristen Rak
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Direktor: Prof. Dr. med. Dr. h. c. R. Hagen, Univ.-Klinik Würzburg, Würzburg, Germany
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Schraven SP, Dohr D, Weiss NM, Mlynski R, Dalhoff E. [Laser Doppler vibrometric measurements on human temporal bones]. HNO 2021; 69:491-500. [PMID: 33566127 DOI: 10.1007/s00106-021-00995-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2020] [Indexed: 11/30/2022]
Abstract
Laser Doppler vibrometric (LDV) measurements on human temporal bones represent the standard method for predicting the performance of active middle ear implants (AMEI) and are used as preclinical tests in the development, approval process, and indication expansion of AMEI. The quality of the coupling of the floating mass transducer to the mobile structures of the middle ear is decisive for the performance of the implant and patients' hearing perception. The cochlea can be stimulated via the oval window (forward stimulation) or the round window (reverse stimulation). For forward stimulation, the ASTM standard F2504-05 defines a method to ensure physiologically normal properties of the temporal bones used in the experiments. For reverse stimulation, which depends even more critically on the quality of the temporal bone, a comparable standard method is lacking. Appropriate preparation and storage of the human petrous bone as well as suitable LDV test setups with respect to calibration and reproducibility of measuring positions and angles provide results that allow a comparison of different types of coupling and also correlate well with clinical data.
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Affiliation(s)
- S P Schraven
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Doberaner Straße 137-139, 18057, Rostock, Deutschland.
| | - D Dohr
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Doberaner Straße 137-139, 18057, Rostock, Deutschland
| | - N M Weiss
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Doberaner Straße 137-139, 18057, Rostock, Deutschland
| | - R Mlynski
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Doberaner Straße 137-139, 18057, Rostock, Deutschland
| | - E Dalhoff
- Sektion für Physiologische Akustik und Kommunikation, Universitäts-HNO-Klinik Tübingen, Tübingen, Deutschland
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Xue L, Liu H, Yang J, Liu S, Zhao Y, Huang X. Research on coupling effects of actuator and round window membrane on reverse stimulation of human cochlea. Proc Inst Mech Eng H 2021; 235:447-458. [PMID: 33427056 DOI: 10.1177/0954411920987960] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An active actuator of a middle-ear implant coupled to the round window membrane (RWM), which transmits vibration to the cochlea, has been used to compensate for hearing loss in patients. However, various factors affect the coupling condition between the actuator and the RWM, resulting in coupling leakage. In this study, a coupling impedance model of the human ear and the actuator was used to investigate the effect of inefficient coupling during reverse stimulation. First, the three-port circuit network model of the actuator was coupled with the acoustic impedance model of human ear reverse sound transmission. Meanwhile, the inefficient coupling impedance was estimated. Then, the effect of the actuator's coupling on reverse stimulation was studied by comparing the reverse pressure transfer function. Furthermore, the inefficient coupling's influence in the ear with middle-ear disorder was also investigated by simulating two typical forms of middle-ear disorder: otosclerosis and ossicular chain disarticulation. The results show that the change of the inefficient coupling impedance plays a significant role during reverse stimulation. Inefficient coupling of the actuator and the RWM deteriorates the cochlear response of reverse stimulation over the entire frequency range. Additionally, the coupling effect of the actuator does not change the influence tendency of middle-ear disorder on reverse stimulation's performance, but changes the response amplitude of the reverse stimulation.
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Affiliation(s)
- Lin Xue
- School of Mechatronic Engineering, China University of Mining and Technology, Xuzhou, Jiangsu Province, China
| | - Houguang Liu
- School of Mechatronic Engineering, China University of Mining and Technology, Xuzhou, Jiangsu Province, China
| | - Jianhua Yang
- School of Mechatronic Engineering, China University of Mining and Technology, Xuzhou, Jiangsu Province, China
| | - Songyong Liu
- School of Mechatronic Engineering, China University of Mining and Technology, Xuzhou, Jiangsu Province, China
| | - Yu Zhao
- School of Mechatronic Engineering, China University of Mining and Technology, Xuzhou, Jiangsu Province, China
| | - Xinsheng Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, Shanghai Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
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Takahashi M, Iwasaki S, Furutate S, Oka S, Oyamada S, Yasumura K. Active middle ear implant (vibrant soundbridge) in children with unilateral congenital aural atresia. Acta Otolaryngol 2021; 141:34-38. [PMID: 33043753 DOI: 10.1080/00016489.2020.1823471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Detailed studies have not been conducted on sound localization and speech perception in noise in patients with unilateral congenital aural atresia (UCAA). AIMS/OBJECTIVES To evaluate the benefits of the use of the Vibrant Soundbridge (VSB) for UCAA by performing audiometric and sound localization tests. MATERIALS AND METHODS Four children with UCAA underwent VSB (VORP 503) implantation from 2018 to 2019. Speech perception tests in noise were conducted using the Japanese monosyllable test. The spatial configuration for speech testing consisted of speech presented from the front and noise presented into the normal ear (S0N90). The sound localization test was conducted using nine loudspeakers equally distributed in a semicircle. RESULTS The children's speech perception in noise 6 months after VSB activation was significantly better than before activation (p < .05). Additionally, the children's sound localization ability after VSB activation was significantly better than before VSB activation. CONCLUSION AND SIGNIFICANCE The benefits of VSB use in children with UCAA were revealed using audiometric and sound localization tests.
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Affiliation(s)
- Masahiro Takahashi
- Department of Otorhinolaryngology, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Satoshi Iwasaki
- Department of Otorhinolaryngology, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Sakiko Furutate
- Department of Otorhinolaryngology, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Shinichiro Oka
- Department of Otorhinolaryngology, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Shogo Oyamada
- Department of Otorhinolaryngology, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Kazunori Yasumura
- Department of Plastic and Reconstructive Surgery, Kanagawa Children’s Medical Center, Kanagawa, Japan
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Speech Segregation in Active Middle Ear Stimulation: Masking Release With Changing Fundamental Frequency. Ear Hear 2020; 42:709-717. [PMID: 33369941 DOI: 10.1097/aud.0000000000000973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Temporal fine structure information such as low-frequency sounds including the fundamental frequency (F0) is important to separate different talkers in noisy environments. Speech perception in noise is negatively affected by reduced temporal fine structure resolution in cochlear hearing loss. It has been shown that normal-hearing (NH) people as well as cochlear implant patients with preserved acoustic low-frequency hearing benefit from different F0 between concurrent talkers. Though patients with an active middle ear implant (AMEI) report better sound quality compared with hearing aids, they often struggle when listening in noise. The primary objective was to evaluate whether or not patients with a Vibrant Soundbridge AMEI were able to benefit from F0 differences in a concurrent talker situation and if the effect was comparable to NH individuals. DESIGN A total of 13 AMEI listeners and 13 NH individuals were included. A modified variant of the Oldenburg sentence test was used to emulate a concurrent talker scenario. One sentence from the test corpus served as the masker and the remaining sentences as target speech. The F0 of the masker sentence was shifted upward by 4, 8, and 12 semitones. The target and masker sentences were presented simultaneously to the study subjects and the speech reception threshold was assessed by adaptively varying the masker level. To evaluate any impact of the occlusion effect on speech perception, AMEI listeners were tested in two configurations: with a plugged ear-canal contralateral to the implant side, indicated as AMEIcontra, or with both ears plugged, indicated as AMEIboth. RESULTS In both study groups, speech perception improved when the F0 difference between target and masker increased. This was significant when the difference was at least 8 semitones; the F0-based release from masking was 3.0 dB in AMEIcontra (p = 0.009) and 2.9 dB in AMEIboth (p = 0.015), compared with 5.6 dB in NH listeners (p < 0.001). A difference of 12 semitones revealed a F0-based release from masking of 3.5 dB in the AMEIcontra (p = 0.002) and 3.4 dB in the AMEIboth (p = 0.003) condition, compared with 5.0 dB in NH individuals (p < 0.001). CONCLUSIONS Though AMEI users deal with problems resulting from cochlear damage, hearing amplification with the implant enables a masking release based on F0 differences when F0 between a target and masker sentence was at least 8 semitones. Additional occlusion of the ear canal on the implant side did not affect speech performance. The current results complement the knowledge about the benefit of F0 within the acoustic low-frequency hearing.
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Fröhlich L, Rahne T, Plontke SK, Oberhoffner T, Dahl R, Mlynski R, Dziemba O, Aristeidou A, Gadyuchko M, Koscielny S, Hoth S, Kropp MH, Mir-Salim P, Müller A. Intraoperative quantification of floating mass transducer coupling quality in active middle ear implants: a multicenter study. Eur Arch Otorhinolaryngol 2020; 278:2277-2288. [PMID: 32880736 PMCID: PMC8165065 DOI: 10.1007/s00405-020-06313-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 08/19/2020] [Indexed: 11/28/2022]
Abstract
Purpose Evaluating the effectiveness of intraoperative auditory brainstem responses (ABRs) to stimulation by the Vibrant Soundbridge (VSB) active middle ear implant for quantifying the implant’s floating mass transducer (FMT) coupling quality. Methods In a diagnostic multicentric study, patients (> 18 years) who received a VSB with different coupling modalities were included. Pre- and postoperative bone conduction thresholds, intraoperative VSB-evoked ABR thresholds (VSB-ABR) using a modified audio processor programmed to preoperative bone conduction thresholds, postoperative vibrogram thresholds, and postoperative VSB-ABR thresholds were measured. Coupling quality was calculated from the difference between the pure tone average at 1000, 2000, and 4000 Hz (3PTA) vibrogram and postoperative 3PTA bone conduction thresholds. Results Twenty-three patients (13 males, 10 females, mean age 56.6 (± 12.5) years) were included in the study. Intraoperative VSB-ABR response thresholds could be obtained in all except one patient where the threshold was > 30 dB nHL. Postoperatively, an insufficient coupling of 36.7 dB was confirmed in this patient. In a Bland–Altman analysis of the intraoperative VSB-ABRs and coupling quality, the limits of agreement exceeded ± 10 dB, i.e., the maximum allowed difference considered as not clinically important but the variation was within the general precision of auditory brainstem responses to predict behavioral thresholds. Five outliers were identified. In two patients, the postoperative VSB-ABR thresholds were in agreement with the coupling quality, indicating a change of coupling before the postoperative testing. Conclusion The response thresholds recorded in this set-up have the potential to predict the VSB coupling quality and optimize postoperative audiological results.
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Affiliation(s)
- Laura Fröhlich
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.
| | - Torsten Rahne
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Stefan K Plontke
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Tobias Oberhoffner
- Department of Otorhinolaryngology, Head and Neck Surgery "Otto Körner", Rostock University Medical Center, Rostock, Germany
| | - Rüdiger Dahl
- Department of Otorhinolaryngology, Head and Neck Surgery "Otto Körner", Rostock University Medical Center, Rostock, Germany
| | - Robert Mlynski
- Department of Otorhinolaryngology, Head and Neck Surgery "Otto Körner", Rostock University Medical Center, Rostock, Germany
| | - Oliver Dziemba
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine of Greifswald, Greifswald, Germany
| | - Aristotelis Aristeidou
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine of Greifswald, Greifswald, Germany
| | - Maria Gadyuchko
- Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany.,Department of Otorhinolaryngology, Helios Clinic, Erfurt, Germany
| | - Sven Koscielny
- Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Sebastian Hoth
- Department of ENT, University of Heidelberg, Heidelberg, Germany
| | - Miriam H Kropp
- ORL Department Friedrichshain Clinic, Vivantes Hearing Center, Berlin, Germany
| | - Parwis Mir-Salim
- ORL Department Friedrichshain Clinic, Vivantes Hearing Center, Berlin, Germany
| | - Alexander Müller
- ORL Department Friedrichshain Clinic, Vivantes Hearing Center, Berlin, Germany
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Vorbereitung zur Facharztprüfung HNO. HNO 2020; 68:616-622. [DOI: 10.1007/s00106-020-00894-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Zhao C, Yang J, Liu Y, Gao M, Chen P, Zhao S. Long-term Outcomes of Clip Coupler Implantation in Patients with Unilateral Congenital Aural Atresia. Ann Otol Rhinol Laryngol 2020; 129:1221-1228. [PMID: 32500728 DOI: 10.1177/0003489420924058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the long-term safety and efficacy of the Clip coupler attached to the stapes head in patients with unilateral congenital aural atresia (CAA). METHODS This single-center retrospective study included 16 Mandarin-speaking patients who had unilateral microtia accompanied by CAA. All patients were divided into two groups: the short-term follow-up group (n = 9) and the long-term follow-up group (n = 7). The floating mass transducer of the Vibrant Soundbridge (VSB) was positioned in the stapes head by the Clip coupler. The safety of the VSB was investigated by comparing preoperative and postoperative bone-conduction (BC) thresholds as well as by complications. The effectiveness was evaluated by functional gain (FG), word recognition score (WRS), speech reception threshold (SRT) and signal-to-noise ratio (SNR). RESULTS Pre- and post-operative BC thresholds were no different in all patients. And no complications developed. VSB-aided thresholds in the free-field had improved significantly in both short- and long-term follow-up groups. The improvements of WRS were observed in two groups. The monosyllabic VSB-aided WRS in the long-term follow-up group was significantly higher than that in the short-term follow-up group. When speech was from the impaired ear and noise presented to the side of normal ear (SVSBNCL), lower SNRs were found in two groups after VSB implantation. However, there was no statistical difference in aided SNR between the two groups at SVSBNCL status. CONCLUSIONS Our results show that the FMT connected to the stapes head is a secure and useful device for patients with unilateral CHL/MHL, not only in terms of improved hearing thresholds, but also improved speech intelligibility in quiet and noisy environments.
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Affiliation(s)
- Chunli Zhao
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jinsong Yang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yujie Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Mengdie Gao
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Peiwei Chen
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Shouqin Zhao
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Rahne T, Skarzynski PH, Hagen R, Radeloff A, Lassaletta L, Barbara M, Plontke SK, Mlynski R. A retrospective European multicenter analysis of the functional outcomes after active middle ear implant surgery using the third generation vibroplasty couplers. Eur Arch Otorhinolaryngol 2020; 278:67-75. [PMID: 32451668 PMCID: PMC7814408 DOI: 10.1007/s00405-020-06064-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 05/15/2020] [Indexed: 11/28/2022]
Abstract
Purpose To evaluate the safety and performance of three novel vibroplasty couplers that allow attachment of the floating mass transducer of a transcutaneous active middle ear implant (AMEI) to the round window (RW) membrane, the long process (LP), or the incus body and the short process (SP) of the incus. Methods Retrospective multicenter cohort study of 25 AMEI users with sensorineural or mixed hearing loss that were among the first implanted with an AMEI vibrating ossicular prosthesis in combination with the third generation of vibroplasty couplers between 2014 and 2016. Main Outcome Measures were bone-conduction pure-tone and vibroplasty thresholds, postoperative aided sound field thresholds and postoperative aided word recognition score (WRS). Results Bone conduction threshold changes of more than 10 dB in 4PTABC were observed in two subjects. A mean improvement of 57.8% in speech recognition was observed with a mean WRS at 65 dB SPL improving from 14.8% (SD 21.9%) preoperatively to a mean aided score of 72.6% (SD 18.6%). Sound field thresholds improved from an average 4PTASF of 64.1 dB HL (SD 9.8 dB HL) to 37.0 dB HL (SD 8.9 dB HL), resulting in a mean functional gain of 27.1 dB. There was no significant difference in WRS or functional gain between the coupler types. Conclusion Initial experience shows that all three third generation vibroplasty couplers represent safe and efficient attachment options for the FMT allowing the surgeon to choose the coupling type based on the present pathology.
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Affiliation(s)
- Torsten Rahne
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle (Saale), Halle (Saale), Germany.
| | - Piotr Henryk Skarzynski
- Department of Teleaudiology and Screening, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw, Poland.,Heart Failure and Cardiac Rehabilitation Department, 2nd Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland.,Institute of Sensory Organs, Kajetany, Poland
| | - Rudolf Hagen
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Andreas Radeloff
- Department of Otorhinolaryngology, University of Oldenburg, Oldenburg, Germany
| | - Luis Lassaletta
- Department of Otolaryngology, La Paz University Hospital, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER-U761), Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Maurizio Barbara
- NESMOS Department, Otorhinolaryngology Clinic, University Hospital Sant'Andrea, Sapienza University, Rome, Italy
| | - Stefan K Plontke
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle (Saale), Halle (Saale), Germany
| | - Robert Mlynski
- Department of Otorhinolaryngology, Head and Neck Surgery "Otto Körner", University Medical Center Rostock, Rostock, Germany
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Efficacy of Auditory Implants for Patients With Conductive and Mixed Hearing Loss Depends on Implant Center. Otol Neurotol 2020; 40:430-435. [PMID: 30870349 DOI: 10.1097/mao.0000000000002183] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Although from a technological point of view, progress is impressive, most implantable hearing devices for conductive or mixed hearing loss have a limited capacity. These devices all bypass the impaired middle ear; therefore, the desired amplification (gain) should be based on the cochlear hearing loss (component) only. The aim of the study is to review the literature with regard to accomplished gain with current implantable devices. METHOD Thirty-one articles could be included. Aided thresholds were compared with prescribed values, based on cochlear hearing loss (bone-conduction thresholds), according to the well-validated NAL rule. RESULTS For the majority of the studies, NAL targets were not met. Variation in accomplished gain between implant teams was unacceptably large, largely independent of the type of device that was used. NAL targets were best met at 2 kHz, with worse results at the other frequencies. CONCLUSION Large variations in reported results were found, which primarily depended on implant center. Based on the analyses, a pragmatic fitting procedure is proposed which should minimize the differences between implant centres.
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Direct Drive Simulation-Preoperative Sound Simulation of "Vibroplasty-Hearing" in Patients With Mixed Hearing Loss. Otol Neurotol 2020; 41:494-503. [PMID: 32176137 DOI: 10.1097/mao.0000000000002572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Validation of the preoperative sound simulation test for vibroplasty-hearing so-called "Direct Drive Simulation" (DDS) in case of mixed hearing loss. STUDY DESIGN Retrospective data analysis. SETTING Tertiary referral center with a large hearing implant program. MAIN OUTCOME MEASURE Comparison of sound impression during preoperative Direct Drive Simulation, and postoperative testing with the activated active middle ear implant (AMEI) under free-field condition and in daily routine. PATIENTS Fifty-four data sets from 18 patients with mixed hearing loss with a mean age of 60.78 ± 3.18 were included. RESULTS Comparing the sound impression during DDS preoperatively versus free-field testing with the implanted AMEI, no significant differences were found. DDS offers a slightly better sound quality than the AMEI in daily routine, fitting well to the ideal listening situation in DDS versus some background noise in daily routine. CONCLUSION The DDS offers the possibility of a realistic preoperative sound simulation of the "vibroplasty-hearing" in cases of mixed hearing loss. This probably facilitates patient's decision towards a vibroplasty. The audiologist as well as the surgeon get additional information regarding the indication especially when audiologic inclusion criteria are critical. Thus, the DDS is a useful extension of preoperative diagnostics before vibroplasty.
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Xue L, Liu H, Wang W, Yang J, Zhao Y, Huang X. The role of third windows on human sound transmission of forward and reverse stimulations: A lumped-parameter approach. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2020; 147:1478. [PMID: 32237813 DOI: 10.1121/10.0000846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 02/14/2020] [Indexed: 06/11/2023]
Abstract
The vestibular and cochlear aqueducts serve as additional sound transmission paths and produce different degrees of volume velocity shunt flow in cochlear sound transmission. To investigate its effect on forward and reverse stimulations, a lumped-parameter model of the human ear, which incorporates the third windows, was developed. The model combines a transmission-line ear-canal model, a middle-ear model, and an inner-ear model, which were developed previously by different investigators. The model is verified by comparison with experiments. The intracochlear differential-pressure transfer functions, which reflect the input force to the organ of Corti, were calculated. The results show that middle-ear gain for forward sound transmission is greater than the gain for reverse sound transmission. Changes in the cochlear aqueduct impedance have little effect on forward and reverse stimulations. The vestibular aqueduct has little effect on forward stimulation, but increasing its impedance causes deterioration on reverse stimulation below 300 Hz. Decreasing its impedance increases the excitation effect during reverse stimulation over the entire frequency, especially below 1000 Hz. Moreover, compared with the case without the third windows, the presence of the third windows has little effect on forward stimulation. Whereas, it boosts the reverse stimulation's performance below 300 Hz.
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Affiliation(s)
- Lin Xue
- School of Mechatronic Engineering, China University of Mining and Technology, Xuzhou, 221116, China
| | - Houguang Liu
- School of Mechatronic Engineering, China University of Mining and Technology, Xuzhou, 221116, China
| | - Wenbo Wang
- School of Mechatronic Engineering, China University of Mining and Technology, Xuzhou, 221116, China
| | - Jianhua Yang
- School of Mechatronic Engineering, China University of Mining and Technology, Xuzhou, 221116, China
| | - Yu Zhao
- School of Mechatronic Engineering, China University of Mining and Technology, Xuzhou, 221116, China
| | - Xinsheng Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, Shanghai Zhongshan Hospital Affiliated to Fudan University, Shanghai, 200032, China
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