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Warnholtz B, Schär M, Cuny P, Sonntag K, Beutner D, Dobrev I, Röösli C, Sim JH. A New Stapes-Head Coupler for the Vibrant Soundbridge System. Audiol Neurootol 2021; 26:287-294. [PMID: 33647905 DOI: 10.1159/000512600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 10/12/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The Vibrant Soundbridge (MED-EL Medical Electronics, Austria) is an active middle ear implant with a floating mass transducer (FMT) for patients with conductive, sensorineural, or mixed hearing loss. While the FMT is vertically aligned above the stapes head (SH) with the current Vibroplasty Clip coupler (MED-EL Medical Electronics), the new SH coupler was developed to mount the FMT on the inferior side of the stapes and to fit in the reduced middle ear space after canal-wall-down mastoidectomy. METHODS Using 11 human cadaveric temporal bones (TBs), placements of the new SH couplers on the stapes were examined, and effective stimuli to the cochlea were evaluated by measuring piston-like motion of the stapes footplate with a current of 1 mA on the FMT. The results were assessed in comparison with the Vibroplasty Clip coupler. RESULTS The new SH coupler showed perfect coupling on the stapes in 9 out of 11 TBs. A small gap between the SH and the plate of the connection link part was unavoidable in 2 TBs but had negligible effect on vibrational motion of the stapes. Vibrational motion of the stapes with the new SH coupler was reduced at frequencies above 3 kHz compared to the corresponding motion with the current Vibroplasty Clip coupler, but the relative attenuation over all 11 cadaveric temporal bones was <10 dB. CONCLUSIONS The new SH coupler provides an alternative with more stable fixation when placement of the current Vibroplasty Clip coupler is limited due to insufficient space after canal-wall-down mastoidectomy, while still delivering effective stimuli to the cochlea.
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Affiliation(s)
- Birthe Warnholtz
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Zürich, Zürich, Switzerland.,Department of Otolaryngology, Head and Neck Surgery, University of Zürich, Zürich, Switzerland
| | - Merlin Schär
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Zürich, Zürich, Switzerland.,Department of Otolaryngology, Head and Neck Surgery, University of Zürich, Zürich, Switzerland
| | - Pascale Cuny
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Zürich, Zürich, Switzerland.,Department of Otolaryngology, Head and Neck Surgery, University of Zürich, Zürich, Switzerland
| | | | - Dirk Beutner
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Göttingen, Göttingen, Germany
| | - Ivo Dobrev
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Zürich, Zürich, Switzerland.,Department of Otolaryngology, Head and Neck Surgery, University of Zürich, Zürich, Switzerland
| | - Christof Röösli
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Zürich, Zürich, Switzerland.,Department of Otolaryngology, Head and Neck Surgery, University of Zürich, Zürich, Switzerland
| | - Jae Hoon Sim
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Zürich, Zürich, Switzerland, .,Department of Otolaryngology, Head and Neck Surgery, University of Zürich, Zürich, Switzerland,
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Chen T, Ren LJ, Yin DM, Li J, Yang L, Dai PD, Zhang TY. A comparative study of MED-EL FMT attachment to the long process of the incus in intact middle ears and its attachment to disarticulated stapes head. Hear Res 2017; 353:97-103. [PMID: 28666703 DOI: 10.1016/j.heares.2017.06.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 06/11/2017] [Accepted: 06/13/2017] [Indexed: 01/10/2023]
Abstract
The Vibrant Soundbridge© (VSB) active middle-ear implant provides an effective treatment for mild-to-severe sensorineural hearing loss in the case of normal middle ear anatomy and mixed hearing loss in middle ear malformation. The VSB floating mass transducer (FMT), with proper couplers, can be installed on various structures of the ossicular chain, e.g., the short and long process of the incus, the stapes head, and the stapes footplate. A long process (LP) coupler is most commonly used for FMT attachment to the long process of the incus with intact ossicular chain, while CliP and Bell couplers are two standardized and reliable methods for FMT attachment to the stapes head with missing incus and malleus. However, the difference and relationship of the vibration properties among these three FMT couplers remain unclear. In the present study, the stapes footplate velocity responses of the LP, CliP, and Bell couplers have been investigated in eight fresh temporal bones (TBs) to evaluate the vibration properties of these three couplers. Normal and reconstructed middle ear transfer functions (METFs) were determined from laser Doppler vibrometer (LDV) measurements. A mastoidectomy and a posterior tympanotomy were performed to expose the ossicular chain. The METFs of the normal middle ear and middle ear with LP-FMT-coupler were compared under acoustic stimulation, thus the mass effect of the FMT with LP coupler was evaluated. Additional comparisons were made between the stapes footplate vibrations of the LP-FMT-coupler (with the intact ossicular chain at the long process of the incus), CliP-FMT-coupler and Bell-FMT-coupler on the stapes head (after incus and malleus removed) under active electromechanical stimulation. After the installation of CliP-FMT-coupler and Bell-FMT-coupler to the middle ear, the average velocity amplitude of the stapes footplate, comparing to the LP-FMT-coupler, was about 15 dB higher between 1 and 6 kHz, and 10 dB lower at about 0.5 kHz. Quantitatively, there was no significant difference between the CliP-FMT-coupler and Bell-FMT-coupler. According to our study, installation of CliP-FMT-coupler or Bell-FMT-coupler on the stapes head provides considerable improvement of the middle ear mechanical and functional responses, comparing with the LP-FMT-coupler in the temporal bone experiments. Moreover, the installation of the Bell-FMT-coupler to the stapes head produces essentially the same footplate velocity responses in comparison to the CliP-FMT-coupler.
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Affiliation(s)
- Tao Chen
- Eye & ENT Hospital of Fudan University, Fenyang Road 83, Shanghai 200031, China
| | - Liu-Jie Ren
- Eye & ENT Hospital of Fudan University, Fenyang Road 83, Shanghai 200031, China
| | - Dong-Ming Yin
- Eye & ENT Hospital of Fudan University, Fenyang Road 83, Shanghai 200031, China
| | - Jia Li
- Eye & ENT Hospital of Fudan University, Fenyang Road 83, Shanghai 200031, China; Department of Aeronautics and Astronautics, Fudan University, Handan Road 220, Shanghai 200433, China
| | - Lin Yang
- Eye & ENT Hospital of Fudan University, Fenyang Road 83, Shanghai 200031, China; ENT Institute, Eye & ENT Hospital of Fudan University, Fenyang Road 83, Shanghai 200031, China
| | - Pei-Dong Dai
- Eye & ENT Hospital of Fudan University, Fenyang Road 83, Shanghai 200031, China; ENT Institute, Eye & ENT Hospital of Fudan University, Fenyang Road 83, Shanghai 200031, China
| | - Tian-Yu Zhang
- Eye & ENT Hospital of Fudan University, Fenyang Road 83, Shanghai 200031, China; ENT Institute, Eye & ENT Hospital of Fudan University, Fenyang Road 83, Shanghai 200031, China.
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