1
|
王 新, 梅 凌, 蒋 璐. [Advances in research on treatment of tympanosclerosis]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2024; 38:86-90. [PMID: 38297857 PMCID: PMC11116161 DOI: 10.13201/j.issn.2096-7993.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 01/10/2023] [Indexed: 02/02/2024]
Abstract
Tympanosclerosis is the hyaline degeneration and calcium deposition of the lamina propria of tympanic membrane and the submucosa of middle ear under long-term chronic inflammatory stimulation. At present, treatment primarily involves the surgical removal of sclerotic foci and reconstruction of auditory ossicular chain. However, excision of sclerotic lesions near critical structures like the facial nerve canal and vestibular window may result in complications like facial paralysis, vertigo, and sensorineural hearing loss. Developing safer and more effective treatments for tympanosclerosis has become an international research focus. Recent years have seen novel explorations in the treatment of tympanosclerosis. Therefore, this article reviews the latest advancements in research on the treatment of tympanosclerosis.
Collapse
Affiliation(s)
- 新 王
- 中南大学湘雅医院耳鼻咽喉头颈外科(长沙,410008)Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Changsha, 410008, China
| | - 凌云 梅
- 中南大学湘雅医院耳鼻咽喉头颈外科(长沙,410008)Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Changsha, 410008, China
- 耳鼻咽喉重大疾病湖南省重点实验室Hunan Province Key Laboratory of Otolaryngology Critical Diseases
| | - 璐 蒋
- 中南大学湘雅医院耳鼻咽喉头颈外科(长沙,410008)Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Changsha, 410008, China
- 耳鼻咽喉重大疾病湖南省重点实验室Hunan Province Key Laboratory of Otolaryngology Critical Diseases
| |
Collapse
|
2
|
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.
Collapse
|
3
|
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]
|
4
|
Dedmon MM, O’Connell BP, Rivas A. Ossiculoplasty for Tympanosclerosis. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00261-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
5
|
Burian A, Gerlinger I, Toth T, Piski Z, Rath G, Bako P. Stapedotomy with incus vibroplasty - A novel surgical solution of advanced otosclerosis and its place among existing therapeutic modalities - Hungarian single institutional experiences. Auris Nasus Larynx 2019; 47:55-64. [PMID: 31079859 DOI: 10.1016/j.anl.2019.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 03/31/2019] [Accepted: 04/18/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To delineate the advantages and steps of stapedotomy with incus vibroplasty, to assess the safety and efficacy of this method via the authors' experiences, and to overview the literature regarding other surgical options in advanced otosclerosis determining the place of stapedotomy with incus vibroplasty in the therapeutic range. METHODS Four patients were enrolled in the study presenting severe mixed hearing loss of at least one side on pure tone audiometry. Based on complementary audiological examinations including stapedial reflex test and multifrequency tympanometry, all cases were suspected as advanced otosclerosis. Stapedotomy with incus vibroplasty - the combination of laser stapedotomy and simultaneous Vibrant Soundbridge implantation - was performed in each patient. Preoperative pure tone average, speech recognition thresholds and word recognition scores were compared to one-year postoperative free-field values with the implant switched on focusing on functional gain. RESULTS Among 4 participants (3 females, 1 male) the mean age (SD) was 66 years (35). In three cases Nitinol, in one case NitiBond piston was inserted. One-year postoperative free-field functional gains were 30 dB, 34 dB, 42 dB and 51 dB, respectively. One-year postoperative free-field speech recognition thresholds were 45 dB, 45 dB, 49 dB and 50 dB, respectively, while word recognition scores were 70%, 70%, 70% and 75%, respectively. CONCLUSION Postoperative results in our serie regarding pure tone average and word recognition score proved to be better than those found in the literature. Stapedotomy with incus vibroplasty - through sufficient air-bone gap closure and simultaneous sensorineural component management - seems to be a promising surgical solution in advanced otosclerosis, requiring further investigation.
Collapse
Affiliation(s)
- Andras Burian
- University of Pécs, Department of Otorhinolaryngology, Pécs, 7621, Munkácsy M Str 2, Hungary.
| | - Imre Gerlinger
- University of Pécs, Department of Otorhinolaryngology, Pécs, 7621, Munkácsy M Str 2, Hungary.
| | - Tamas Toth
- University of Pécs, Department of Otorhinolaryngology, Pécs, 7621, Munkácsy M Str 2, Hungary.
| | - Zalan Piski
- University of Pécs, Department of Otorhinolaryngology, Pécs, 7621, Munkácsy M Str 2, Hungary.
| | - Gabor Rath
- University of Pécs, Department of Paediatrics, 7623, Pécs, József Attila Str 7, Hungary.
| | - Peter Bako
- University of Pécs, Department of Otorhinolaryngology, Pécs, 7621, Munkácsy M Str 2, Hungary.
| |
Collapse
|
6
|
Redesign of the Hannover Coupler: Optimized Vibration Transfer from Floating Mass Transducer to Round Window. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3701954. [PMID: 29862266 PMCID: PMC5976918 DOI: 10.1155/2018/3701954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 03/19/2018] [Indexed: 11/23/2022]
Abstract
Introduction In order to reduce the large variations in clinical outcomes of patients with implanted MED-EL Floating Mass Transducer (FMT) at the round window (RW), several approaches were proposed to optimize FMT-RW coupling. Our previous study showed improved FMT-RW coupling by applying static RW loads utilizing the “Hannover Coupler” (HC) FMT-prosthesis but also demonstrated insufficient low frequency performance. Hence, a redesigned HC version (HCv2) was investigated in this study. Methods Experiments were performed in ASTM F2504-05 compliant fresh human temporal bones. The HCv2 is a FMT-prosthesis redesigned from a previous prototype to specifically improve low frequency performance. Stapes footplate (SFP) displacements in response to acoustic stimulation of the tympanic membrane and to FMT-RW stimulation at varying static force (0–100 mN) were measured by Laser-Doppler vibrometry. Results SFP displacements were highly dependent on the applied RW load and had a global maximum at 15 mN when averaged at speech relevant frequencies (0.5–4 kHz). SFP responses at frequencies ≤ 1 kHz were up to 25 dB higher than responses achieved with the previous HC version. Conclusion Optimizing the HC prosthesis design resulted in improved SFP responses to RW stimulation especially at lower frequencies (≤1 kHz).
Collapse
|
7
|
Acoustic stimulation on the round window for active middle ear implants. Comput Biol Med 2018; 97:171-177. [PMID: 29747060 DOI: 10.1016/j.compbiomed.2018.04.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 04/29/2018] [Accepted: 04/29/2018] [Indexed: 11/24/2022]
Abstract
Many clinical reports have discussed the effectiveness of stimulating the ear's round window (RW) with a tool to mitigate conductive and mixed hearing loss. The RW is one of the two openings from the middle ear into the inner ear. Various methods have been proposed to construct a highly efficient, easily implanted, and reliable RW transducer. Devices, however, such as floating mass transducers, have difficulty establishing proper contact without some degree of bone incision around the RW. Additionally, vibration energy may not be fully transmitted to the cochlea, but instead will be spread through the soft tissue around the transducer. We propose a more direct RW stimulation with very high acoustical impedance using a receiver that is a volume velocity source. We expect this source to overcome large acoustic impedance by maximizing sound pressure in a confined space, the RW niche. To verify the effectiveness of the proposed method, ear canal pressure, RW pressure, and stapes velocity are measured by acoustic RW stimulation of human temporal bones.
Collapse
|
8
|
Müller M, Salcher R, Lenarz T, Maier H. The Hannover Coupler: Controlled Static Prestress in Round Window Stimulation With the Floating Mass Transducer. Otol Neurotol 2018; 38:1186-1192. [PMID: 28657955 DOI: 10.1097/mao.0000000000001484] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Stimulation of the cochlear round window (RW) with the floating mass transducer (FMT) still suffers from large variation in clinical outcomes. Beside the geometric mismatch between RW and FMT diameter that is a known limiting factor in achieving optimal coupling between actuator and RW membrane, the applied static force between FMT and RW is usually undefined. In this study, the feasibility and efficacy of a specially designed FMT coupler permitting application of static preloads to the RW membrane to optimize FMT-RW coupling was investigated. METHODS Experiments were performed in fresh human cadaveric temporal bones. The "Hannover Coupler" FMT-prosthesis has a spherical tip (d=0.5 mm) at the front end and a spring at the prosthesis back that enables the application of static preloads and mobility of the FMT at the same time. Stapes footplate (SFP) displacements in response to acoustic stimulation of the tympanic membrane and to RW stimulation by the FMT were measured by a Laser-Doppler vibrometer. RESULTS Average SFP displacement responses of ASTM standard F2504-05 compliant temporal bones to RW stimulation by the "Hannover Coupler" were dependent on the applied force (∼0-100 mN) and increased by up to 25 dB at frequencies ≥ 1 kHz. When averaged at speech relevant frequencies (0.5, 1, 2, 4 kHz) SFP displacements showed a global maximum at RW preloads of ∼4 mN. CONCLUSION The coupling between FMT and RW membrane was improved by the application of static RW preloads as indicated by increased SFP amplitudes to RW stimulation.
Collapse
Affiliation(s)
- Mathias Müller
- Cluster of Excellence Hearing4all, Department of Otolaryngology and Institute of Audioneurotechnology (VIANNA), Hannover Medical School, Hannover, Germany
| | | | | | | |
Collapse
|
9
|
Gostian AO, Otte MS, Pazen D, Ortmann M, Schwarz D, Hüttenbrink KB, Beutner D. Influence of backside loading on the floating mass transducer: An in vitro experimental study. Clin Otolaryngol 2017; 43:538-543. [PMID: 29054109 DOI: 10.1111/coa.13017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 11/30/2022]
Abstract
HYPOTHESIS The vibration of the floating mass transducer (FMT) of a single active middle-ear implant (AMEI) is distinctly influenced by the properties of the material coupled to its back side. BACKGROUND In round window vibroplasty, the FMT needs to be padded against the surrounding bone opposite from the round window membrane. This represents one factor influencing its performance as a round window driver. Therefore, we examined the effects of different materials linked to the back side of an FMT on its vibration range. METHODS The back side of an FMT was glued to a silicone cylinder 1.0 mm in diameter and 1.0 mm - 1.5 mm in length and of 40A, 50A or 70A Shore hardness; to cartilage of equivalent size; or to a round window soft coupler (RWSC), all firmly fixed on a steel plate. The vibrations were determined by a laser Doppler vibrometer (LDV) measuring the velocity of the centre point on the front side of the FMT. RESULTS The materials on the back side of the FMT significantly influenced the vibration range of the FMT. The RWSC and silicone of 40A Shore hardness allowed for the highest detected velocities, while cartilage led to a distinct reduction similarly to 70A silicone. CONCLUSION The coupling on the back side of an FMT distinctly affects its vibration range. In this regard, the RWSC and silicone of 40A Shore hardness yield the least impairment of vibration. Thus, the RWSC may be a feasible option in round window vibroplasty when additionally connected to the FMT opposite from the round window membrane.
Collapse
Affiliation(s)
- A-O Gostian
- Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
| | - M S Otte
- Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
| | - D Pazen
- Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
| | - M Ortmann
- Jean Uhrmacher-Institute for Clinical, ENT-Research, University of Cologne, Cologne, Germany
| | - D Schwarz
- Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
| | - K B Hüttenbrink
- Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
| | - D Beutner
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Göttingen, Göttingen, Germany
| |
Collapse
|
10
|
Zahnert T, Löwenheim H, Beutner D, Hagen R, Ernst A, Pau HW, Zehlicke T, Kühne H, Friese N, Tropitzsch A, Lüers JC, Mlynski R, Todt I, Hüttenbrink KB. Multicenter Clinical Trial of Vibroplasty Couplers to Treat Mixed/Conductive Hearing Loss: First Results. Audiol Neurootol 2016; 21:212-222. [DOI: 10.1159/000444616] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 02/08/2016] [Indexed: 11/19/2022] Open
Abstract
Objective: To evaluate the safety and effectiveness of round window (RW), oval window (OW), CliP and Bell couplers for use with an active middle ear implant. Methods: This is a multicenter, long-term, prospective trial with consecutive enrollment, involving 6 university hospitals in Germany. Bone conduction, air conduction, implant-aided warble-tone thresholds and Freiburger monosyllable word recognition scores were compared with unaided preimplantation results in 28 moderate-to-profound hearing-impaired patients after 12 months of follow-up. All patients had previously undergone failed reconstruction surgeries (up to 5 or more). In a subset of patients, additional speech tests at 12 months postoperatively were used to compare the aided with the unaided condition after implantation with the processor switched off. An established quality-of-life questionnaire for hearing aids was used to determine patient satisfaction. Results: Postoperative bone conduction remained stable. Mean functional gain for all couplers was 37 dB HL (RW = 42 dB, OW = 35 dB, Bell = 38 dB, CliP = 27 dB). The mean postoperative Freiburger monosyllable score was 71% at 65 dB SPL. The postimplantation mean SRT50 (speech reception in quiet for 50% understanding of words in sentences) improved on average by 23 dB over unaided testing and signal-to-noise ratios also improved in all patients. The International Outcome Inventory for Hearing Aids (IOI-HA)quality-of-life questionnaire was scored very positively by all patients. Conclusion: A significant improvement was seen with all couplers, and patients were satisfied with the device at 12 months postoperatively. These results demonstrate that an active implant is an advantage in achieving good hearing benefit in patients with prior failed reconstruction surgery.
Collapse
|
11
|
Loads and Coupling Modalities Influence the Performance of the Floating Mass Transducer as a Round Window Driver. Otol Neurotol 2016; 37:524-32. [DOI: 10.1097/mao.0000000000001028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
12
|
Performance of the round window soft coupler for the backward stimulation of the cochlea in a temporal bone model. Eur Arch Otorhinolaryngol 2016; 273:3651-3661. [DOI: 10.1007/s00405-016-3997-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 03/18/2016] [Indexed: 10/22/2022]
|
13
|
Zhao S, Gong S, Han D, Zhang H, Ma X, Li Y, Chen X, Ren R, Li Y. Round window application of an active middle ear implant (AMEI) system in congenital oval window atresia. Acta Otolaryngol 2015; 136:23-33. [PMID: 26493073 DOI: 10.3109/00016489.2014.1003091] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Application of the Vibrant Soundbridge to the round window (RW) membrane can be utilized as an efficient therapy for congenital oval window (OW) atresia. OBJECTIVE To report the surgical technique and auditory outcome of an active middle ear implant (AMEI) system used in patients with congenital OW atresia. METHODS Nine subjects with congenital OW atresia (six males and three females, ranging in age from 5.5 to 25 years, average 12.5 years) were implanted with an AMEI (Vibrant Soundbridge) at the round window (RW-Vibroplasty). Five cases were diagnosed as having isolated congenital OW atresia while four patients presented with combined external/middle ear malformation. RESULTS An improvement of 30 dB in average pure-tone air conduction thresholds (0.5-4 kHz) was achieved, with the high frequencies showing greater results. The subjects achieved postoperative speech recognition scores of 80-100% on the Computerized Mandarin Speech Test System (CMSTS) sentence test. Bone conduction thresholds were confirmed as stable in all subjects postoperatively. Decline in auditory benefit was noticed in two subjects, who then underwent revision surgery. One of these revision surgery patients then experienced stable hearing recovery, while the other patient's hearing declined.
Collapse
Affiliation(s)
- Shouqin Zhao
- a Department of Otolaryngology Head and Neck Surgery , Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education , Beijing , China
| | - Shusheng Gong
- a Department of Otolaryngology Head and Neck Surgery , Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education , Beijing , China
| | - Demin Han
- a Department of Otolaryngology Head and Neck Surgery , Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education , Beijing , China
| | - Hua Zhang
- b Beijing Institute of Otolaryngology , Beijing , China
| | - Xiaobo Ma
- a Department of Otolaryngology Head and Neck Surgery , Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education , Beijing , China
| | - Yi Li
- a Department of Otolaryngology Head and Neck Surgery , Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education , Beijing , China
| | - Xueqing Chen
- b Beijing Institute of Otolaryngology , Beijing , China
| | - Ran Ren
- a Department of Otolaryngology Head and Neck Surgery , Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education , Beijing , China
| | - Yuling Li
- b Beijing Institute of Otolaryngology , Beijing , China
| |
Collapse
|
14
|
Impact of Coupling Techniques of an Active Middle Ear Device to the Round Window Membrane for the Backward Stimulation of the Cochlea. Otol Neurotol 2015; 36:111-7. [DOI: 10.1097/mao.0000000000000655] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
15
|
Beltrame AM, Todt I, Sprinzl G, Profant M, Schwab B. Consensus statement on round window vibroplasty. Ann Otol Rhinol Laryngol 2014; 123:734-40. [PMID: 24842869 DOI: 10.1177/0003489414534013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study aimed to review current knowledge regarding implantation of the Vibrant Soundbridge floating mass transducer (FMT) at the round window (round window vibroplasty) as well as to form a consensus on steps for a reliable, stable surgical procedure. DATA SOURCES Review of the literature and experimental observations by the authors. CONCLUSION Round window (RW) vibroplasty has been established as a reliable procedure that produces good and stable results for patients with conductive or mixed hearing loss. The experience gained over the past few years of the authors' more than 200 implantations has led to consensus on several key points: (1) a wide and bloodless access to the middle ear with facial nerve monitoring, (2) the careful and correct identification and exposure of the round window membrane, (3) a good setup for efficient energy transition of the FMT, namely, perpendicular placement of the FMT with no contact to bone and the placement of cartilage behind the FMT to create a preloaded "spring" function, and (4) 4 points of FMT fixation: a rim of the round window bony overhang left intact both anterior and posterior to the FMT, conductor link stabilization, and cartilage behind the FMT. In addition, the FMT should be covered with soft tissue.
Collapse
Affiliation(s)
| | - Ingo Todt
- Department of Otolaryngology at UKB, Hospital of the University of Berlin (Charité Medical School), Berlin, Germany
| | | | - Milan Profant
- Department of Otorhinolaryngology, Slovak Medical University, Bratislava, Slovak Republic
| | - Burkhard Schwab
- Department of Otorhinolaryngology, Hannover Medical University, Hannover, Germany
| |
Collapse
|
16
|
Vyskocil E, Riss D, Honeder C, Arnoldner C, Hamzavi J, Baumgartner W, Flak S, Gstoettner W. Vibroplasty in mixed and conductive hearing loss: Comparison of different coupling methods. Laryngoscope 2013; 124:1436-43. [DOI: 10.1002/lary.24474] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 08/22/2013] [Accepted: 10/10/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Erich Vyskocil
- Department of OtorhinolaryngologyMedical University of ViennaVienna Austria
| | - Dominik Riss
- Department of OtorhinolaryngologyMedical University of ViennaVienna Austria
| | - Clemens Honeder
- Department of OtorhinolaryngologyMedical University of ViennaVienna Austria
| | | | | | | | - Stefan Flak
- Department of OtorhinolaryngologyMedical University of ViennaVienna Austria
| | | |
Collapse
|
17
|
Stieger C, Rosowski JJ, Nakajima HH. Comparison of forward (ear-canal) and reverse (round-window) sound stimulation of the cochlea. Hear Res 2012; 301:105-14. [PMID: 23159918 DOI: 10.1016/j.heares.2012.11.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 10/26/2012] [Accepted: 11/05/2012] [Indexed: 11/29/2022]
Abstract
The cochlea is normally driven with "forward" stimulation, in which sound is introduced to the ear canal. Alternatively, the cochlea can be stimulated at the round window (RW) using an actuator. During RW "reverse" stimulation, the acoustic flow starting at the RW does not necessarily take the same path as during forward stimulation. To understand the differences between forward and reverse stimulation, we measured ear-canal pressure, stapes velocity, RW velocity, and intracochlear pressures in scala vestibuli (SV) and scala tympani (ST) of fresh human temporal bones. During forward stimulation, the cochlear drive (differential pressure across the partition) results from the large difference in magnitude between the pressures of SV and ST, which occurs due to the high compliance of the RW. During reverse stimulation, the relatively high impedance of the middle ear causes the pressures of SV and ST to have similar magnitudes, and the differential pressure results primarily from the difference in phase of the pressures. Furthermore, the sound path differs between forward and reverse stimulation, such that motion through a third window is more significant during reverse stimulation. Additionally, we determined that although stapes velocity is a good estimate of cochlear drive during forward stimulation, it is not a good measure during reverse stimulation. This article is part of a special issue entitled "MEMRO 2012".
Collapse
Affiliation(s)
- Christof Stieger
- Department of Otology and Laryngology, Harvard Medical School, Eaton Peabody Laboratory, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA
| | | | | |
Collapse
|