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Salamah M, Alradhi A, Alzhrani F, Yousef M. Outcomes of Active Middle Ear Implants: Speech Perception and Quality of Life. J Pers Med 2024; 14:883. [PMID: 39202074 PMCID: PMC11355239 DOI: 10.3390/jpm14080883] [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: 07/18/2024] [Revised: 08/07/2024] [Accepted: 08/12/2024] [Indexed: 09/03/2024] Open
Abstract
OBJECTIVE To evaluate audiological outcomes, quality of life, and complications in patients implanted with Active middle ear implants (AMEI). The secondary objective is to investigate the required duration after implantation to reach satisfactory outcomes. METHODS This retrospective study included 31 patients implanted with Active middle ear implants (AMEI) with different methods of floating mass transducer attachment. Patients with incomplete medical records and those who did not respond to postoperative follow-up were excluded. 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. RESULT There are no significant differences found in PTA and SRT between the 3-, 6-, and 12-month visits. The speech reception threshold (SRT) showed a statistically significant improvement at 3, 6, and 12 months post-operative measures compared to pre-operative. Additionally, the SDS exhibited a significant increase only after 12 months, compared to the 3-month time point. However, satisfaction levels did not significantly differ between the 6-month and 12-month measurements following surgery. CONCLUSION The Vibrant Soundbridge improves subjective satisfaction scores and audiological test scores in patients with different types of hearing loss. AMEI has a low risk of medical or surgical complications, the ease of using a hearing implant, and the social benefits of good hearing and communication.
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Affiliation(s)
- Marzouqi Salamah
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City, King Saud University, Riyadh 11481, Saudi Arabia; (F.A.); (M.Y.)
| | | | - Farid Alzhrani
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City, King Saud University, Riyadh 11481, Saudi Arabia; (F.A.); (M.Y.)
| | - Medhat Yousef
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City, King Saud University, Riyadh 11481, Saudi Arabia; (F.A.); (M.Y.)
- Audiology Unit, ENT Department, Menoufia University, Menoufia 32952, Egypt
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Yam C, Hammer A, Lee E, Shaver T, Thakkar P, Monfared A. Adverse events associated with Vibrant Soundbridge: A MAUDE study. Am J Otolaryngol 2024; 45:104273. [PMID: 38574515 DOI: 10.1016/j.amjoto.2024.104273] [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: 01/15/2024] [Accepted: 03/27/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE To summarize adverse events and their root causes reported to the United States Food and Drug Administration (FDA) on Vibrant Soundbridge (VSB) hearing device (Med-El, Innsbruck, Austria), an active middle ear implant for patients with moderate to severe hearing loss. MATERIALS AND METHODS The FDA's Manufacturer and User Facility Device Experience (MAUDE) database was queried for reports of VSB adverse events from January 1, 2012, to July 27, 2022. RESULTS Six hundred sixty-three total medical device reports were identified, from which 913 adverse events were extracted. Of these, 498 (54.5 %) were adverse events to patients (AEPs), while 415 (45.5 %) were device malfunctions (DMs). The most common AEPs were hearing performance issues 428 (85.9 %). The most common DMs were compromised conductive link 125 (30.1 %). Root causes identified for DMs were iatrogenic 85 (58.6 %), patient-related 28 (19.3 %), and trauma and external causes 32 (22.1 %). The most common iatrogenic root cause 12 (14.1 %) involved damage to the conductive link during revision surgery. The most common patient-related causes of DMs were excessive middle ear tissue growth 16 (57 %), and abrupt body movements 5 (28.6 %). The most common external cause of DM was cleaning of the ear canal or mastoid cavity 20 (62.5 %). CONCLUSIONS Despite its well-known limitations, the MAUDE database provides valuable information on possible complications of VSB as it relates to device malfunction or adverse events for patients. Implementation of standardized reports with relevant and well-defined categories could certainly allow for a more meaningful analysis.
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Affiliation(s)
- Christopher Yam
- Drexel University College of Medicine, Philadelphia, PA, United States of America.
| | - Adam Hammer
- George Washington University School of Medicine and Health Sciences, Division of Otolaryngology-Head and Neck Surgery, Washington, DC, United States of America
| | - Esther Lee
- George Washington University School of Medicine and Health Sciences, Division of Otolaryngology-Head and Neck Surgery, Washington, DC, United States of America
| | - Timothy Shaver
- George Washington University School of Medicine and Health Sciences, Division of Otolaryngology-Head and Neck Surgery, Washington, DC, United States of America
| | - Punam Thakkar
- George Washington University School of Medicine and Health Sciences, Division of Otolaryngology-Head and Neck Surgery, Washington, DC, United States of America
| | - Ashkan Monfared
- George Washington University School of Medicine and Health Sciences, Division of Otolaryngology-Head and Neck Surgery, Washington, DC, United States of America
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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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Bruchhage KL, Lupatsii M, Möllenkolk F, Leffers D, Kurabi A, Jürgens T, Graspeuntner S, Hollfelder D, Leichtle A. Hearing rehabilitation and microbial shift after middle ear surgery with Vibrant Soundbridge in patients with chronic otitis media. Eur Arch Otorhinolaryngol 2023; 280:3107-3118. [PMID: 36662266 DOI: 10.1007/s00405-022-07795-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 12/08/2022] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Patients with otitis media (OM) encounter significant functional hearing impairment with conductive, or a combined hearing loss and long-term sequelae involving impaired speech/language development in children, reduced academic achievement and irreversible disorders of middle and inner ear requiring a long time therapy and/or multiple surgeries. In its persistent chronic form, Otitis media (COM) can often only be treated by undergoing ear surgery for hearing restoration. The persistent inflammatory reaction plays a major role, often caused by multi-resistant pathogens in the ear. Herein, we present outcomes of patients implanted with currently the only FDA approved active Middle Ear Implant Vibrant Soundbridge (VSB), suffering from persistent COM. METHODS The study enrolled 42 patients, treated by performing middle ear (ME) surgery to different extents and implanted with the VSB to various structures in the ME. Included were 17 children and 25 adults that had recurrent and/or persisting OM and significant hearing loss. Preoperative and postoperative patients' audiometric data were evaluated and the benefit with VSB assessed using the Glasgow Benefit Inventory for adults and pediatric cohorts. The microbial spectrum of pathogens was assessed before and after surgery, exploring the colonization of the otopathogens, as well as the intestinal microbiome from individually burdened patients. RESULTS The mean functional gain is 29.7 dB HL (range from 10 to 56.2 dB HL) with a significant improvement in speech intelligibility in quiet. Following VSB implantation, no significant differences in coupling were observed at low complication rates. Postoperatively patients showed significantly increased benefit with VSB compared to the untreated situation, including less otorrhea, pain, medical visits, and medication intake, with no recurrent OM and significant bacterial shift in otopathogens. The analysis of the intestinal microbiome displayed a high abundance of bacterial strains that might be linked to chronic and persistent inflammation. CONCLUSIONS Functional ear surgery including rehabilitation with a VSB in patients suffering from COM present to be safe and effective. The successful acceptance accompanied by the improved audiological performance resulted in significant benefit with VSB, with a shift in the ear pathogens and altered microbiome and thus is a great opportunity to be treated.
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Affiliation(s)
- Karl-Ludwig Bruchhage
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Mariia Lupatsii
- Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Friederike Möllenkolk
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - David Leffers
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Arwa Kurabi
- Division of Otolaryngology, Department of Surgery, UCSD School of Medicine, La Jolla, San Diego, USA
| | - Tim Jürgens
- Institute of Acoustics, University of Applied Sciences Lübeck, Lübeck, Germany
| | - Simon Graspeuntner
- Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein, Lübeck, Germany.,German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Daniela Hollfelder
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Anke Leichtle
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Schleswig-Holstein, Lübeck, Germany.
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Lailach S, Zahnert T. Results and Quality of Life after Implantation of Active Middle Ear Implants. Laryngorhinootologie 2022; 101:S3-S35. [PMID: 35605611 DOI: 10.1055/a-1647-8616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The provision of implantable hearing aids represents an area with high development and innovation potential. On the one hand, this review article provides an overview of current indication criteria for the treatment with active middle ear implants. On the other hand, outcome parameters as well as functional results after implantation of active middle ear implants are demonstrated and discussed. The focus is mainly placed on audiological results as well as the subjective health status. "Patient Reported Outcome Measures" (PROMs) have become an integral part of the evaluation of hearing implant treatment. Due to low evidence level criteria, the study situation regarding audiological as well as subjective outcome parameters is not satisfactory. The lack of an international consensus on accepted outcome parameters makes a meta-analytical analysis of results immensely difficult. In the studies published to date, patients with sensorineural hearing loss and patients with conductive or mixed hearing loss offered better speech recognition after implantation of an active middle ear implant compared to conventional hearing aids. Current analyses show a significant improvement in general as well as hearing-specific quality of life after implantation of an active middle ear implant. To date, no validated, hearing-specific quality-of-life measurement instruments exist for assessing the success of fitting in children. Especially in children with complex malformations of the outer ear and the middle ear, excellent audiological results were shown. However, these results need to be substantiated by quality-of-life measurements in future.
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Affiliation(s)
- Susen Lailach
- Universitätsklinikum Dresden Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie (Klinikdirektor: Prof. Dr.med. Dr. h.c. Thomas Zahnert) Dresden
| | - Thomas Zahnert
- Universitätsklinikum Dresden Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie (Klinikdirektor: Prof. Dr.med. Dr. h.c. Thomas Zahnert) Dresden
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Buhl C, Schindler V, Pfiffner F, Veraguth D, Huber A, Röösli C. Subjective Sound Quality Detection (HISQUI) over Time after Vibrant Soundbridge Implantation. J Clin Med 2022; 11:jcm11071811. [PMID: 35407420 PMCID: PMC9000017 DOI: 10.3390/jcm11071811] [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: 02/03/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 02/01/2023] Open
Abstract
Background: To evaluate the long-term audiological outcomes combined with the Hearing Implant Sound Quality Index (HISQUI) after Vibrant Soundbridge (VSB) implantation. Methods: Prospective recall cohort study of patients who received a VSB in a tertiary academic medical center between 1996 and 2017. Air conduction (AC) and bone conduction (BC), sound field thresholds in aided and unaided conditions, and speech discrimination in noise (Oldenburger sentence test) were measured. Postoperative results were compared with preoperative audiograms. Furthermore, the HISQUI was evaluated. Results: Ten patients (eleven implants) were included, the mean follow up period was nine years. The mean AC threshold preoperatively was between 63 and 70 dB, and the BC was between 38 and 49 dB from 500 to 4000 Hz. In the free-field audiogram, the mean threshold was between 61 and 77 dB unaided vs. between 28 and 52 dB in the aided condition. The average signal to noise ratio (SNR) in the Oldenburger sentence test in the unaided condition was 10 dB ± 6.7 dB vs. 2 dB ± 5.4 dB in the aided condition. Three patients reported a good to very good hearing result, four patients a moderate, and three patients a poor hearing result. There was a significant association between the years of implantation and the HISQUI (p = 0.013), as well as a significant decrease by 14 HISQUI points per 10 dB SPL decline (SE 5.2, p = 0.023). There was a significant difference between the change of BC over the years and the HISQUI, as well as the number of years after implantation and the HISQUI. On average, per dB decrease in BC, the HISQUI decreases by 1.4 points, and every year after implantation the HISQUI decreases by 2.7 points. Conclusions: The aided threshold in free field and speech understanding in noise improved significantly with VSB. An increase over time of BC thresholds was observed as well as a decrease in HISQUI score. This decrease in BC thresholds over time may be due to presbycusis. Therefore, monitoring of these patients over time should be considered to discuss alternative hearing rehabilitation measures in a timely manner.
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Affiliation(s)
- Christof Buhl
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (C.B.); (F.P.); (D.V.); (A.H.)
| | - Valeria Schindler
- Department of Gastroenterology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland;
| | - Flurin Pfiffner
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (C.B.); (F.P.); (D.V.); (A.H.)
| | - Dorothe Veraguth
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (C.B.); (F.P.); (D.V.); (A.H.)
| | - Alexander Huber
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (C.B.); (F.P.); (D.V.); (A.H.)
| | - Christof Röösli
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (C.B.); (F.P.); (D.V.); (A.H.)
- Correspondence: ; Tel.: +41-44-255-1111
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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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Edlinger SH, Hasenzagl M, Schoerg P, Muck S, Magele A, Sprinzl GM. Long-Term Safety and Quality of Life after Vibroplasty in Sensorineural Hearing Loss: Short/Long Incus Process Coupler. Audiol Neurootol 2021; 27:175-183. [PMID: 34044387 DOI: 10.1159/000516144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/17/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The study shows the long-term effectiveness, safety, and quality of life after Vibrant Soundbridge (VSB) implantation in sensorineural hearing loss (SNHL) using the short process coupler (SP) or the long process coupler (LP). METHODS This retrospective study evaluated 77 VSB cases. Follow-up (F/U) time-dependent objective measurements (audiological outcomes), subjective data collection (quality-of-life questionnaire), and safety measures are presented. RESULTS Sixty-two ears were included in the analysis with up to 116 months of postsurgical F/U data (mean 32.15 ± 37.97 months LP and SP coupler). Fifty-three ears (13 bilateral cases) received the LP coupler and 9 subjects the SP coupler. The post-operative bone conduction thresholds remained stable and, in both groups, <10 dB. The benefit in word recognition scores measured at 65 dB SPL and 80 dB SPL showed no significant difference between the couplers (p = 0.559 and p = 0.088, respectively). The functional gain was not significantly different (p > 0.05) with a mean of 20.91 ± 9.77 and 17.19 ± 5.75 for LP and SP coupler, respectively. The utility score deciphered from the Assessment of Quality-of-life Questionnaire-8 dimensions revealed a mean score of 0.75 ± 0.16 which is not significantly different to the age- and sex-matched healthy control group with 0.81 ± 0.02 (p = 0.3547). CONCLUSION The Incus Vibroplasty utilizing both couplers is a safe and effective method to treat mild-to-severe SNHL. Both fixation methods of the floating mass transducer exhibit good clinical and audiological outcomes with high patient quality of life. The SP coupling method can be a good alternative when the long process is anatomically inaccessible, or the approach is limited due to anatomical reasons.
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Affiliation(s)
- Stefan Herwig Edlinger
- Department of Otorhinolaryngology, University Hospital St. Pölten, St. Poelten, Austria.,Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Martin Hasenzagl
- Department of Otorhinolaryngology, University Hospital St. Pölten, St. Poelten, Austria
| | - Philipp Schoerg
- Department of Otorhinolaryngology, University Hospital St. Pölten, St. Poelten, Austria.,Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Stefanie Muck
- Department of Otorhinolaryngology, University Hospital St. Pölten, St. Poelten, Austria
| | - Astrid Magele
- Department of Otorhinolaryngology, University Hospital St. Pölten, St. Poelten, Austria.,Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Georg Mathias Sprinzl
- Department of Otorhinolaryngology, University Hospital St. Pölten, St. Poelten, Austria.,Karl Landsteiner University of Health Sciences, Krems, Austria
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Al-Shawi Y, Alsughayer L, Alradhi A, Alzhrani F. Middle Ear Implant in a Patient With Fibrous Dysplasia: An Alternative for Hearing Restoration. EAR, NOSE & THROAT JOURNAL 2020; 100:207S-211S. [PMID: 32986504 DOI: 10.1177/0145561320960542] [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] [Indexed: 11/15/2022] Open
Abstract
We propose middle ear implants (MEI) as alternative hearing restoration option for patients with fibrous dysplasia of the temporal bone (FDTB). A 60-year-old man presented with unilateral right-sided conductive hearing loss (CHL) and FDTB. The Vibrant Soundbridge (VSB) MEI was implanted in the right ear. Preoperatively, the right side had a pure tone average (PTA) threshold of 67 dB, speech reception threshold (SRT) = 75 dB HL, and speech discrimination score (SDS) = 54% at 80 dB HL presentation level. Postoperative aided PTA threshold of the right ear was 28 db, aided SRT = 30 db, and SDS = 96% at 65dB HL. After excluding cholesteatoma, VSB provides an alternative hearing restoration technique for adults with FDTB and CHL due to stenosis of the external auditory canal and/or ossicular crowding.
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Affiliation(s)
- Yazeed Al-Shawi
- King Abdullah Ear Specialist Center (KAESC), 191082College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Luluh Alsughayer
- 191082College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Farid Alzhrani
- King Abdullah Ear Specialist Center (KAESC), 191082College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Zimmermann D, Busch S, Lenarz T, Maier H. Audiological Results with the SAMBA Audio Processor in Comparison to the Amadé for the Vibrant Soundbridge. Audiol Neurootol 2020; 25:164-172. [PMID: 32097930 DOI: 10.1159/000506067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 01/21/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Since its introduction in 1996, the Vibrant Soundbridge (VSB) has been upgraded with several improved generations of processors. As all systems are compatible, implanted patients can benefit from new technologies by upgrading to the newest processor type available. OBJECTIVES The aim of this study was to compare the performance of the new (current) SAMBA processor with the previous Amadé processor. METHODS Twenty subjects monaurally implanted with a VSB and the Amadé processor tested the new SAMBA processor for a trial period of 4 weeks. We measured air conduction and bone conduction thresholds, unaided thresholds, and aided free field thresholds with both devices. Speech performance in quiet using the Freiburg monosyllabic test at 65 dB SPL (S0) was compared. The speech intelligibility in noise was determined using the Oldenburg sentence test measured in different listening conditions (S0NVSB/S0Ncontra) and microphone settings (omni/directional vs. adaptive directivity). RESULTS Word recognition scores in quiet with the SAMBA were still significantly lower than with the Amadé after the 4 weeks trial period but improved over the following year. Speech intelligibility with the SAMBA was significantly better than with the Amadé in omnidirectional mode and comparable with the Amadé in directional mode. Hence, the adaptive directionality provides an advantage in difficult hearing situations such as noisy environments. The subjective benefit was evaluated using the Abbreviated Profile of Hearing Aid Benefit and the Speech, Spatial and Qualities-C questionnaire. Results of the questionnaires demonstrate an overall higher level of satisfaction with the new SAMBA speech processor than with the older processor. CONCLUSION The SAMBA enables similar speech perception in quiet but more flexible adaptation in acoustically challenging environments compared to the previous Amadé processor.
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Affiliation(s)
- Denise Zimmermann
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
| | - Susan Busch
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany.,Cluster of Excellence EXC 1077/1 "Hearing4all", Hannover, Germany
| | - Thomas Lenarz
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany.,Cluster of Excellence EXC 1077/1 "Hearing4all", Hannover, Germany
| | - Hannes Maier
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany, .,Cluster of Excellence EXC 1077/1 "Hearing4all", Hannover, Germany,
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Geiger U, Radeloff A, Hagen R, Cebulla M. Intraoperative Estimation of the Coupling Efficiency and Clinical Outcomes of the Vibrant Soundbridge Active Middle Ear Implant Using Auditory Brainstem Response Measurements. Am J Audiol 2019; 28:553-559. [PMID: 31318578 DOI: 10.1044/2019_aja-18-0066] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose This study intraoperatively measured the coupling efficiency of the Vibrant Soundbridge (VSB), with the aim of avoiding revision surgery due to insufficient outcome. This method can also be used to test the integrity of the implant at the end of the implantation surgery and to evaluate aided thresholds. In addition, this method makes it possible to objectively test how well the VSB has been fitted, provide assistance in fitting handicapped patients or children, evaluate hearing degradation, or test for a drop in coupling efficiency before revision surgeries. In order to analyze the feasibility of these new VSB-aided auditory brainstem response (ABR) thresholds, they were compared to behavioral thresholds from the Vibrogram and the preoperative bone conduction thresholds. Method The study included 30 patients with mild-to-severe hearing loss implanted with a VSB (VORP503). Intraoperative ABR thresholds during the VSB implantation were recorded using a VSB-optimized chirp stimulus. The new method is compared to the bone conduction threshold of the study sample and the aided Vibrogram thresholds. Speech intelligibility results up to 24 months after surgery are also presented. Results A reliable correlation between the bone conduction thresholds and the intraoperative ABRs was found and was higher in comparison to the Vibrogram. Furthermore, speech intelligibility outcomes were stable over time. Conclusion ABR measurements can be used intraoperatively to estimate the coupling efficiency of the VSB and test the integrity of the implant at the end of surgery.
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Affiliation(s)
- Ute Geiger
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital of Würzburg, Germany
| | - Andreas Radeloff
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital of Würzburg, Germany
| | - Rudolf Hagen
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital of Würzburg, Germany
| | - Mario Cebulla
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital of Würzburg, Germany
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Pegan A, Ries M, Ajduk J, Bedeković V, Ivkić M, Trotić R. ACTIVE MIDDLE EAR VIBRANT SOUNDBRIDGE SOUND IMPLANT. Acta Clin Croat 2019; 58:348-353. [PMID: 31819333 PMCID: PMC6884373 DOI: 10.20471/acc.2019.58.02.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The Vibrant Soundbridge represents a new approach to hearing improvement in the form of active implantable middle ear hearing device. Unlike conventional acoustic hearing aids, which increase the volume of sound that goes to the eardrum, the Vibrant Soundbridge bypasses the ear canal and eardrum by directly vibrating the small bones in the middle ear. Because of its design, no portion of the device is placed in the ear canal itself. The Vibrant Soundbridge has been approved by the FDA as a safe and effective treatment option for adults with moderate to severe sensorineural, conductive or mixed hearing losses who desire an alternative to the acoustic hearing aids, for better hearing. The paper presents a review of the active middle ear implant Vibrant Soundbridge, which has been also implanted at the Department of Otorhinolaryngology and Head and Neck Surgery, Sestre milosrdnice University Hospital Center, which is the Referral Center for Cochlear Implantation and Surgery of Hearing Impairment and Deafness of the Ministry of Health, Republic of Croatia.
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Affiliation(s)
| | - Mihael Ries
- Department of Otorhinolaryngology and Head and Neck Surgery, Sestre milosrdnice University Hospital Centre, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Jakov Ajduk
- Department of Otorhinolaryngology and Head and Neck Surgery, Sestre milosrdnice University Hospital Centre, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Vladimir Bedeković
- Department of Otorhinolaryngology and Head and Neck Surgery, Sestre milosrdnice University Hospital Centre, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Mirko Ivkić
- Department of Otorhinolaryngology and Head and Neck Surgery, Sestre milosrdnice University Hospital Centre, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Robert Trotić
- Department of Otorhinolaryngology and Head and Neck Surgery, Sestre milosrdnice University Hospital Centre, School of Medicine, University of Zagreb, Zagreb, Croatia
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Pitiot V, Hermann R, Coudert A, Truy E. Lysis of the long process of the incus secondary to Vibrant SounBridge® middle ear implants, treated with hydroxyapatite bone cement. Auris Nasus Larynx 2019; 46:952-955. [PMID: 30878164 DOI: 10.1016/j.anl.2019.02.011] [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: 10/05/2018] [Revised: 02/08/2019] [Accepted: 02/28/2019] [Indexed: 11/28/2022]
Abstract
We report two patients presenting with delayed complicationsafter Vibrant SounBridge® middle ear implant surgery: in both cases, a revision surgery was performed and lysis of the long process of the incus was highlighted. A re-assembly of the clip around the remaining long process of the incus was performed, associated with hydroxyapatite bone cement application, on the clip and the incudo-stapedial joint. Both patients had a satisfying result, with a mean follow up of 12 months.
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Affiliation(s)
- Vincent Pitiot
- ENT Department, Hôpital Edouard Herriot, Hospices Civils de Lyon, Place d'Arsonval, 69437 Lyon Cedex 03, France; Infirmerie Protestante, 1-3 Chemin du Penthod, 69300 Caluire-et-Cuire, France.
| | - Ruben Hermann
- ENT Department, Hôpital Edouard Herriot, Hospices Civils de Lyon, Place d'Arsonval, 69437 Lyon Cedex 03, France; Claude Bernard Lyon 1 University, 8, Avenue Rockefeller, 69008 Lyon, France
| | - Aurélie Coudert
- ENT Department, Hôpital Edouard Herriot, Hospices Civils de Lyon, Place d'Arsonval, 69437 Lyon Cedex 03, France; Claude Bernard Lyon 1 University, 8, Avenue Rockefeller, 69008 Lyon, France
| | - Eric Truy
- ENT Department, Hôpital Edouard Herriot, Hospices Civils de Lyon, Place d'Arsonval, 69437 Lyon Cedex 03, France; Claude Bernard Lyon 1 University, 8, Avenue Rockefeller, 69008 Lyon, France
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Abstract
The Vibrant Soundbridge is a semi-implantable, active middle ear implant that is a safe and effective treatment for patients with sensorineural hearing loss. Since Food and Drug Administration approval for this indication, many international investigators have expanded its use for conductive and mixed hearing losses. This article reviews the author's experience and the international uses of this versatile device.
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Brkic FF, Riss D, Auinger A, Zoerner B, Arnoldner C, Baumgartner WD, Gstoettner W, Vyskocil E. Long-Term Outcome of Hearing Rehabilitation With An Active Middle Ear Implant. Laryngoscope 2018; 129:477-481. [PMID: 30284273 PMCID: PMC6585801 DOI: 10.1002/lary.27513] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2018] [Indexed: 11/29/2022]
Abstract
Objective To assess the audiological and long‐term medical and technical follow‐up outcomes of an active middle ear implant. Methods This was a retrospective medical chart analysis of all patients provided with an active middle ear implant in a tertiary academic medical referral center between September 1, 1998, and July 31, 2015. Main outcome measures were medical and technical complications, revisions, reimplantations, explantations, coupling approaches, mean time of use, pre‐ and postoperative hearing thresholds, functional hearing gain across frequencies (250–4,000 Hz), and Freiburg monosyllablic word test at 65 dB. Results One hundred and three patients were identified. Fifteen were implanted bilaterally (n = 118 Vibrant Soundbridge devices [MED‐EL, Innsbruck, Austria]). Seventy‐seven devices were implanted for sensorineural and 41 for mixed and conductive hearing loss. Patients used the implant for 6.7 years (range 0.7 months–17.9 years) on average. Ninety‐one patients (77.12%) were using the device at the end of the observation period. An overall complication rate of 16.1% was observed. The revision and explantation rates were higher for devices implanted between 2004 and 2006. The device failure rate was 3.4%. Audiological evaluation showed significant hearing gains for both hearing loss patient groups. Conclusion This long‐term follow‐up reveals the reliability of the active middle ear implant in a single center. Overall complication rate and device failure rate are acceptable. The complication rate was higher during implementation of alternative coupling approaches. The audiological benefit was satisfactory in patients with all hearing loss types. The majority of implanted patients used the implant at the end of the observation period. Level of Evidence 4 Laryngoscope, 129:477–481, 2019
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Affiliation(s)
- Faris F Brkic
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Dominik Riss
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Alice Auinger
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Barbara Zoerner
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Christoph Arnoldner
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Wolf-Dieter Baumgartner
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Gstoettner
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Erich Vyskocil
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
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Lee JM, Jeon JH, Moon IS, Choi JY. Benefits of active middle ear implants over hearing aids in patients with sloping high tone hearing loss: comparison with hearing aids. ACTA OTORHINOLARYNGOLOGICA ITALICA 2018; 37:218-223. [PMID: 28516965 PMCID: PMC5463512 DOI: 10.14639/0392-100x-1146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 01/15/2017] [Indexed: 11/24/2022]
Abstract
In this retrospective chart review we compared the subjective and objective benefits of active middle ear implants (AMEIs) with conventional hearing aids (HAs) in patients with sloping high tone hearing loss. Thirty-four patients with sensorineural hearing loss were treated with AMEIs. Of these, six had sloping high tone hearing loss and had worn an HA for more than 6 months. Objective assessments, a pure-tone audiogram, as well as a word recognition test, and the Korean version of the Hearing in Noise Test (K-HINT), and a subjective assessment, the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire, were performed. Tests were conducted under three circumstances: 1) the unaided state before surgery; 2) the HA-aided state before surgery; and 3) the AMEI-aided state 3 months after surgery. The average high-frequency hearing gain (≥ 2 kHz) was significantly better with AMEIs than with HAs. Although the result had no statistical significance, AMEIs showed a superior word recognition score (WRS) compared to HAs. However, the most comfortable hearing level at which the WRS was tested was significantly decreased with an AMEI compared to an HA. In the K-HINT, patients with an AMEI showed greater recognition than those fitted with an HA under both quiet and noisy conditions. The APAHB scores revealed that patients were more satisfied with an AMEI rather than an HA on all subscales. The use of vibroplasty in patients with sloping high tone loss resulted in positive hearing outcomes when compared to conventional HAs. Based on the data from this study, AMEIs provided better objective and subjective results and could, therefore, be a better alternative for the treatment of sloping hearing loss.
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Affiliation(s)
- J M Lee
- Department of Otorhinolaryngology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - J H Jeon
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - I S Moon
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - J Y Choi
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
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Our auditory results using the Vibrant Soundbridge on the long process of the incus: 20 years of data. Auris Nasus Larynx 2018; 45:66-72. [DOI: 10.1016/j.anl.2017.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 02/09/2017] [Accepted: 02/16/2017] [Indexed: 11/18/2022]
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Round Window Application of an Active Middle Ear Implant: A Comparison With Hearing Aid Usage in Japan. Otol Neurotol 2018; 38:e145-e151. [PMID: 28481780 PMCID: PMC5470858 DOI: 10.1097/mao.0000000000001438] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Objective: To report on the safety and efficacy of an investigational active middle ear implant (AMEI) in Japan, and to compare results to preoperative results with a hearing aid. Design: Prospective study conducted in Japan in which 23 Japanese-speaking adults suffering from conductive or mixed hearing loss received a VIBRANT SOUNDBRIDGE with implantation at the round window. Postoperative thresholds, speech perception results (word recognition scores, speech reception thresholds, signal-to-noise ratio [SNR]), and quality of life questionnaires at 20 weeks were compared with preoperative results with all patients receiving the same, best available hearing aid (HA). Results: Statistically significant improvements in postoperative AMEI-aided thresholds (1, 2, 4, and 8 kHz) and on the speech reception thresholds and word recognition scores tests, compared with preoperative HA-aided results, were observed. On the SNR, the subjects’ mean values showed statistically significant improvement, with −5.7 dB SNR for the AMEI-aided mean and −2.1 dB SNR for the preoperative HA-assisted mean. The APHAB quality of life questionnaire also showed statistically significant improvement with the AMEI. Conclusion: Results with the AMEI applied to the round window exceeded those of the best available hearing aid in speech perception as well as quality of life questionnaires. There were minimal adverse events or changes to patients’ residual hearing.
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Han JJ, Rhee J, Song JJ, Koo JW, Choi BY. Clinical predictors for satisfaction with incus vibroplasty: a preliminary study. Eur Arch Otorhinolaryngol 2017; 275:371-378. [DOI: 10.1007/s00405-017-4823-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 11/23/2017] [Indexed: 11/25/2022]
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Active Middle Ear Implantation: Long-term Medical and Technical Follow-up, Implant Survival, and Complications. Otol Neurotol 2017; 37:513-9. [PMID: 27023016 DOI: 10.1097/mao.0000000000001015] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the long-term medical and technical results, implant survival, and complications of the semi-implantable vibrant soundbridge (VSB), otologics middle ear transducer (MET), and the otologics fully implantable ossicular stimulator (FIMOS). STUDY DESIGN Retrospective cohort study. PATIENTS Patients with chronic external otitis and either moderate to severe sensorineural or conductive/mixed hearing loss. SETTING Tertiary referral center. INTERVENTION Implantation with the VSB, MET, or FIMOS. MAIN OUTCOME MEASURES Medical complications, number of reimplantations, and explantations. RESULTS Ninety-four patients were implanted, 12 patients with a round window or stapes application. 28 patients were lost to follow-up. The average follow-up duration was 4.4 years (range, 1 month-15 years). 128 devices were evaluated: (92 VSB, 32 MET, 4 FIMOS). 36 devices (28%) have been explanted or replaced (18 VSB, 14 MET, 4 FIMOS). Device failure was 7% for VSB, 28% for MET, and 100% for FIMOS. In 16 patients (17%) revision surgery (n = 20) was performed. Twenty patients (21%) suffered any medical complication. CONCLUSION Medical and technical complications and device failures have mostly occurred in the initial period of active middle ear implants (AMEI) implementation and during clinical trials or experimental procedures. All four FIMOS had technical difficulties. An important decrease in the occurrence of both medical and technical complications was observed. Application in more recent years did not show any complications and the recent device failure rates are acceptable. Magnetic resonance imaging (MRI) incompatibility should be taken into account when indicating AMEI.
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Kosaner Kliess M, Kluibenschaedl M, Zoehrer R, Schlick B, Scandurra F, Urban M. Cost-Utility of Partially Implantable Active Middle Ear Implants for Sensorineural Hearing Loss: A Decision Analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:1092-1099. [PMID: 28964441 DOI: 10.1016/j.jval.2017.04.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 04/05/2017] [Accepted: 04/26/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Partially implantable active middle ear implants (aMEIs) offer a solution for individuals who have mild to severe sensorineural hearing loss and an outer ear medical condition that precludes the use of hearing aids. When otherwise left untreated, individuals report a lower quality of life, which may further decrease with increasing disability. In the lack of cost-effectiveness studies and long-term data, there is a need for decision modeling. OBJECTIVE To explore individual-level variance in resource utilization patterns following aMEI implantation. METHODS A Markov model was developed and analyzed as microsimulation to estimate the incremental cost utility ratio (ICUR) of partially implantable aMEIs compared with no (surgical) intervention in individuals with sensorineural hearing loss and an outer ear medical condition in Australia. Cost data were derived mostly from the Medicare Benefit Schedule and effectiveness data from published literature. A third-party payer perspective was adopted, and a 5% discount rate was applied over a 10-year time horizon. RESULTS Compared with baseline strategy, aMEIs yielded an incremental cost of Australian dollars (AUD) 13,339.18, incremental quality-adjusted life-year (QALY) of 1.35, and an ICUR of AUD 9,913.72/QALY. Of the respective number of simulated patients who visited each health state, 75.73% never had a minor adverse event, 99.82% did not experience device failure, and 97.75% did not cease to use their aMEIs. Probabilistic sensitivity analyses showed the ICUR to differ by only 0.95%. CONCLUSIONS In the Australian setting, partially implantable aMEIs offer a safe and cost-effective solution compared with no intervention and are also well accepted by users.
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Affiliation(s)
| | | | - Ruth Zoehrer
- MED-EL Medical Electronics Ges.m.b.H., Innsbruck, Austria
| | | | | | - Michael Urban
- MED-EL Medical Electronics Ges.m.b.H., Innsbruck, Austria.
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Importance of adhesiolysis in revision surgery for vibrant soundbridge device failures at the short incus process. Eur Arch Otorhinolaryngol 2017; 274:3867-3873. [DOI: 10.1007/s00405-017-4715-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 08/11/2017] [Indexed: 12/16/2022]
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Labassi S, Beliaeff M, Péan V, Van de Heyning P. The Vibrant Soundbridge ® middle ear implant: A historical overview. Cochlear Implants Int 2017; 18:314-323. [PMID: 28784040 DOI: 10.1080/14670100.2017.1358913] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To present a historical overview of the Vibrant Soundbridge® (VSB) middle ear implant (MEI), since its beginning in the 1990s to date and to describe its course and contemplate what it might become in the future. HISTORY MEIs started to take form in researchers' mind in the 1930s with the first experiment of Wilska. In the 1970s, several devices, such as the Goode and Perkins', the Maniglia's, or the Hough and Dormer's were created but remained prototypes. It is only in the 1990s the devices that emerged remained on the market. In 1994, Symphonix, Inc. was created and aimed to manufacture and commercialize its semi-implantable MEI, the VSB. The principle of the VSB lies on a direct drive of the sound to a vibratory structure of the middle ear through an electromagnetic transducer, the floating mass transducer (FMT). The particularity of the system VSB is the simplicity of the transducer which is made of both the magnet and the coil; thus, the FMT, fixed on a vibrating middle ear structure, mimics the natural movement of the ossicular chain by moving in the same direction. The goal of the VSB was to give an alternative to patients with mild-to-severe sensorineural hearing loss who could not wear hearing aids (HAs) or who were unsatisfied conventional HA users. Subsequent to Tjellström's experiment in 1997, implantations started to include etiologies such as otosclerosis, radical mastoidectomy, failed ossiculoplasty/tympanoplasty, and atresia. Nowadays, the VSB, with more than 20 years of experience, is the oldest and most used middle ear implant worldwide. It is well acknowledged that the straightforward design and reliability of the transducer have certainly contributed to the success of the device.
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Affiliation(s)
- S Labassi
- a MED-EL France , Sophia Antipolis , France
| | - M Beliaeff
- a MED-EL France , Sophia Antipolis , France
| | - V Péan
- a MED-EL France , Sophia Antipolis , France
| | - P Van de Heyning
- b Department of Otorhinolaryngology, Antwerp University Hospital , University of Antwerp , Antwerp , Belgium
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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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Monini S, Bianchi A, Talamonti R, Atturo F, Filippi C, Barbara M. Patient satisfaction after auditory implant surgery: ten-year experience from a single implanting unit center. Acta Otolaryngol 2017; 137:389-397. [PMID: 27918233 DOI: 10.1080/00016489.2016.1258733] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
CONCLUSIONS The satisfaction rate of the subjects with an auditory implant appears strictly related to the resulting auditory improvement, and the surgical variables would play a prevailing role in respect to the esthetic factors. OBJECTIVES To assess the rate of satisfaction in subjects who underwent the surgical application of an auditory device at a single Implanting Center Unit. METHOD A series of validated questionnaires has been administered to subjects who underwent the surgical application of different auditory devices. The Glasgow Benefit Inventory (GBI), the Visual Analog Scale (VAS), and the Abbreviated Profile of Hearing Aid Benefit (APHAB) have been used to compare the implanted situation with the hearing-aided one; a percutaneous bone conductive implant (pBCI) with an active middle ear implant (AMEI) on the round window in mixed hearing loss; and an invisible, fully-implantable device with a frankly and bulky semi-implantable device. RESULTS The mean GBI scores were higher in Vibrant Soundbridge (VSB)® and Bonebridge® subjects, without significant differences among the various devices. The mean VAS score increased for all the devices in comparison with the conventional hearing aid. The mean APHAB score was similarly better in the implanted condition as total and partial scores.
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Affiliation(s)
- Simonetta Monini
- NESMOS Department, ENT Clinic, Medicine and Psychology, Sapienza University, Rome, Italy
| | - Alessandra Bianchi
- NESMOS Department, ENT Clinic, Medicine and Psychology, Sapienza University, Rome, Italy
| | - Rita Talamonti
- NESMOS Department, ENT Clinic, Medicine and Psychology, Sapienza University, Rome, Italy
| | - Francesca Atturo
- NESMOS Department, ENT Clinic, Medicine and Psychology, Sapienza University, Rome, Italy
| | - Chiara Filippi
- NESMOS Department, ENT Clinic, Medicine and Psychology, Sapienza University, Rome, Italy
| | - Maurizio Barbara
- NESMOS Department, ENT Clinic, Medicine and Psychology, Sapienza University, Rome, Italy
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Busch S, Lenarz T, Maier H. Comparison of Alternative Coupling Methods of the Vibrant Soundbridge Floating Mass Transducer. Audiol Neurootol 2017; 21:347-355. [DOI: 10.1159/000453354] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 11/08/2016] [Indexed: 11/19/2022] Open
Abstract
The active middle ear implant Vibrant Soundbridge© provides a variety of coupling modalities of the floating mass transducer (FMT) to various structures of the ossicular chain and the round window. A retrospective analysis was performed on 125 subjects (n = 137 ears) (1) to compare the efficacy of the different FMT coupling modalities with increasing degree of hearing loss, (2) to compare the performance in speech outcome and the effective gain between the coupling types, and (3) to evaluate the risk of additional hearing loss of each coupling procedure. The patients were grouped according to their type of FMT coupling into incus vibroplasty (incus group, n = 59), round window vibroplasty with coupler (RWC group, n = 23), round window vibroplasty without coupler (RW group, n = 22), and oval window vibroplasty with coupler (OWC group, n = 33). For each coupling group, pre- and postoperative thresholds, the results of the Freiburg monosyllable test at 65 dB SPL, and the effective gain across frequencies (0.5-6 kHz) were evaluated. A logistic regression function was used to describe the relationship between word recognition scores (WRS, in % correct) and the mean bone conduction (BC) hearing loss. The surgical procedure had no clinically relevant effect on BC thresholds of patients in each coupling group. The BC pure tone average (PTA4) for 50% WRS predicted by the model function was similar for the incus (48.2 dB nHL), RW (47.8 dB nHL), and OWC (49.0 dB nHL) groups, but higher for the RWC group (67.9 dB nHL). However, the median WRS was 80% or better with no significant differences in speech perception between coupling types (Kruskal-Wallis test, p = 0.229). The effective gain shows an advantage for the incus coupling between 0.5 and 2 kHz over the other coupling types. The performance of the FMT coupling modalities is equally good for patients with a mild-to-moderate hearing loss, but the efficacy of coupling types differs for patients with greater hearing loss (>48 dB BC HL).
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Systematic review to evaluate the safety, efficacy and economical outcomes of the Vibrant Soundbridge for the treatment of sensorineural hearing loss. Eur Arch Otorhinolaryngol 2016; 274:1797-1806. [PMID: 27796557 DOI: 10.1007/s00405-016-4361-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 10/24/2016] [Indexed: 11/27/2022]
Abstract
Introduced in the late 90s, the active middle ear implant Vibrant Soundbridge (VSB) is nowadays used for hearing rehabilitation in patients with mild to severe sensorineural hearing loss (SNHL) unable to tolerate conventional hearing aids. In experienced hands, the surgical implantation is fast done, safe and highly standardized. Here, we present a systematic review, after more than 15 years of application, to determine the efficacy/effectiveness and cost-effectiveness, as well as patient satisfaction with the VSB active middle ear implant in the treatment of mild to severe SNHL. A systematic search of electronic databases, investigating the safety and effectiveness of the VSB in SNHL plus medical condition resulted in a total of 1640 papers. After removing duplicates, unrelated articles, screening against inclusion criteria and after in-depth screening, the number decreased to 37 articles. 13 articles were further excluded due to insufficient outcome data. 24 studies remained to be systematically reviewed. Data was searched on safety, efficacy and economical outcomes with the VSB. Safety-oriented outcomes included complication/adverse event rates, damage to the middle/inner ear, revision surgery/explant rate/device failure and mortality. Efficacy outcomes were divided into audiological outcomes, including hearing thresholds, functional gain, speech perception in quiet and noise, speech recognition thresholds, real ear insertion gain and subjective outcomes determined by questionnaires and patient-oriented scales. Data related to quality of life (QALY, ICER) were considered under economical outcomes. The VSB turns out to be a highly reliable and a safe device which significantly improves perception of speech in noisy situations with a high sound quality. In addition, the subjective benefit of the VSB was found to be mostly significant in all studies. Finally, implantation with the VSB proved to be a cost-effective and justified health care intervention.
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Long-term Stability of the Active Middle-ear Implant with Floating-mass Transducer Technology: A Single-center Study. Otol Neurotol 2016; 37:252-66. [PMID: 26796211 DOI: 10.1097/mao.0000000000000943] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the long-term results of an active middle-ear implant (AMEI) with floating-mass transducer (FMT) technology. STUDY DESIGN Prospective cohort study of German-speaking patients implanted with an AMEI between 2006 and 2013. SETTING Single-center study. PATIENTS Eighty-three patients. INTERVENTION AMEI with FMT technology implantation. MAIN OUTCOME MEASURES Long-term outcome (27 mo; range, 12-84 mo) for FMT position in correlation with pure-tone audiometry, auditory thresholds for frequency-modulated (warble) tones, vibroplasty thresholds for pure tones, and speech audiometry in quiet and noise. RESULTS In 15.6% of patients, a revision surgery was necessary to improve functional performance of the AMEI, and the highest revision rate was found with FMT coupling to the round window not using couplers. A peak number of revision surgeries were observed 3 years after the initial surgery. Stable audiological results (pure-tone audiometry and speech audiometry in quiet and noise) were observed up to 84-month post-surgery. Incus vibroplasty (classic indication) showed a significantly lower functional gain compared with oval and round window vibroplasty. Vibroplasty in combined or conductive hearing loss showed no functional difference between forward and reverse stimulation of the cochlea; however, significantly lower vibroplasty thresholds were detected when using a coupler. CONCLUSIONS The AMEI with FMT technology can be safely used in treatment of patients with mild-to-severe sensorineural, conductive, or mixed hearing loss. Optimized coupling, especially in incus vibroplasty, has to be developed to achieve enhanced audiological results.
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Leinung M, Zaretsky E, Lange BP, Hoffmann V, Stöver T, Hey C. Vibrant Soundbridge® in preschool children with unilateral aural atresia: acceptance and benefit. Eur Arch Otorhinolaryngol 2016; 274:159-165. [DOI: 10.1007/s00405-016-4265-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 08/11/2016] [Indexed: 10/21/2022]
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Kim HH, Barrs DM. Hearing Aids: A Review of What's New. Otolaryngol Head Neck Surg 2016; 134:1043-50. [PMID: 16730553 DOI: 10.1016/j.otohns.2006.03.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Accepted: 03/08/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE: To review the recent innovations in hearing aid technology. STUDY DESIGN: Review of the literature. SETTING: Private tertiary referral otology/neurotology practice. RESULTS: Recent innovations including digital signal processing (DSP), directional microphone technology, and open mold hearing aid fitting have resulted in improved satisfaction with current hearing aids. CONCLUSION: Current hearing aid technology with its innovations better meet needs of individuals who are hard of hearing. SIGNIFICANCE: The image commonly held of hearing aids by the general public is a negative one that can be improved with greater education.
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Mlynski R, Dalhoff E, Heyd A, Wildenstein D, Rak K, Radeloff A, Hagen R, Gummer AW, Schraven SP. Standardized Active Middle-Ear Implant Coupling to the Short Incus Process. Otol Neurotol 2016; 36:1390-8. [PMID: 26247138 DOI: 10.1097/mao.0000000000000822] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Active middle-ear implants with floating-mass transducer (FMT) technology are used to treat mild-to-severe sensorineural hearing losses. The standard surgical approach for incus vibroplasty is a mastoidectomy and a posterior tympanotomy, crimping the FMT to the long incus process. An alternative fixation side with less surgical trauma might be the short incus process and incus body.The aim of this study was to develop and test a short incus process coupling device for its functional properties in temporal bone preparations and clinical practice. MATERIALS AND METHODS An extended antrotomy and a posterior tympanotomy were performed in 10 fresh human temporal bones. As a control for normal middle-ear function, the tympanic membrane was stimulated acoustically, and the vibration of the stapes footplate was measured using laser Doppler vibrometry. FMT-induced vibration responses of the stapes were then measured for standard attachment at the long process and for 2 types of couplers designed for attachment at the short process of the incus (SP1 and SP2 coupler). Additionally, the functional outcome in 2 patients provided with an SP2 coupler was assessed postoperatively at 2 weeks, 3 months, and then 11 months, using pure-tone audiometry, auditory thresholds for frequency-modulated (warble) tones, vibroplasty thresholds, and speech audiometry in quiet and noise. RESULTS For the SP2 coupler, velocity-amplitude responses in temporal-bone preparations showed generally similar mean amplitudes as compared with the standard coupling of the FMT to the long process but with clearly increased mean amplitudes between 0.7 and 1.5 kHz and with reduced interindividual variation between 0.5 and 3 kHz. The clinical data of 2 patients with mild-to-severe sensory hearing loss showed good vibroplasty thresholds and convincing results for speech audiometry in quiet (Freiburger monosyllables at 65 dB SPL, 23 ± 31% unaided versus 83 ± 4% aided) and noise (Hochmair-Schulz-Moser-test at 65 dB SPL at 10 dB SNR, 32 ± 45% unaided and 42 ± 29% aided). CONCLUSION The attachment of the FMT to the short incus process with the SP2 coupler leads to good mechanical and functional coupling in an experimental setup and clinical practice.
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Affiliation(s)
- Robert Mlynski
- *Department of Otorhinolaryngology, Head and Neck Surgery "Otto Koerner" University Medical Center Rostock, Rostock; †Department of Otolaryngology, Section of Physiological Acoustics and Communication, University of Tübingen, Tübingen; and ‡Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Comprehensive Hearing Center, University of Würzburg, Würzburg, Germany
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Hendry J, Chin A, Swan IRC, Akeroyd MA, Browning GG. The Glasgow Benefit Inventory: a systematic review of the use and value of an otorhinolaryngological generic patient-recorded outcome measure. Clin Otolaryngol 2016; 41:259-75. [PMID: 26264703 PMCID: PMC5912499 DOI: 10.1111/coa.12518] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Glasgow Benefit Inventory (GBI) is a validated, generic patient-recorded outcome measure widely used in otolaryngology to report change in quality of life post-intervention. OBJECTIVES OF REVIEW To date, no systematic review has made (i) a quality assessment of reporting of Glasgow Benefit Inventory outcomes; (ii) a comparison between Glasgow Benefit Inventory outcomes for different interventions and objectives; (iii) an evaluation of subscales in describing the area of benefit; (iv) commented on its value in clinical practice and research. TYPE OF REVIEW Systematic review. SEARCH STRATEGY 'Glasgow Benefit Inventory' and 'GBI' were used as keywords to search for published, unpublished and ongoing trials in PubMed, EMBASE, CINAHL and Google in addition to an ISI citation search for the original validating Glasgow Benefit Inventory paper between 1996 and January 2015. EVALUATION METHOD Papers were assessed for study type and quality graded by a predesigned scale, by two authors independently. Papers with sufficient quality Glasgow Benefit Inventory data were identified for statistical comparisons. Papers with <50% follow-up were excluded. RESULTS A total of 118 eligible papers were identified for inclusion. A national audit paper (n = 4325) showed that the Glasgow Benefit Inventory gave a range of scores across the specialty, being greater for surgical intervention than medical intervention or 'reassurance'. Fourteen papers compared one form of surgery versus another form of surgery. In all but one study, there was no difference between the Glasgow Benefit Inventory scores (or of any other outcome). The most likely reason was lack of power. Two papers took an epidemiological approach and used the Glasgow Benefit Inventory scores to predict benefit. One was for tonsillectomy where duration of sore throat episodes and days with fever were identified on multivariate analysis to predict benefit albeit the precision was low. However, the traditional factor of number of episodes of sore throat was not predictive. The other was surgery for chronic rhinosinusitis where those with polyps on univariate analysis had greater benefit than those without. Forty-three papers had a response rate of >50% and gave sufficient Glasgow Benefit Inventory total and subscales for meta-analysis. For five of the 11 operation categories (vestibular schwannoma, tonsillectomy, cochlear implant, middle ear implant and stapes surgery) that were most likely to have a single clear clinical objective, score data had low-to-moderate heterogeneity. The value in the Glasgow Benefit Inventory having both positive and negative scores was shown by an overall negative score for the management of vestibular schwannoma. The other six operations gave considerable heterogeneity with rhinoplasty and septoplasty giving the greatest percentages (98% and 99%) most likely because of the considerable variations in patient selection. The data from these operations should not be used for comparative purposes. Five papers also reported the number of patients that had no or negative benefit, a potentially a more clinically useful outcome to report. Glasgow Benefit Inventory subscores for tonsillectomy were significantly different from ear surgery suggesting different areas of benefit CONCLUSIONS The Glasgow Benefit Inventory has been shown to differentiate the benefit between surgical and medical otolaryngology interventions as well as 'reassurance'. Reporting benefit as percentages with negative, no and positive benefit would enable better comparisons between different interventions with varying objectives and pathology. This could also allow easier evaluation of factors that predict benefit. Meta-analysis data are now available for comparison purposes for vestibular schwannoma, tonsillectomy, cochlear implant, middle ear implant and stapes surgery. Fuller report of the Glasgow Benefit Inventory outcomes for non-surgical otolaryngology interventions is encouraged.
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Affiliation(s)
- J Hendry
- Department of Otolaryngology Head and Neck Surgery, Glasgow Royal Infirmary, Glasgow, UK
| | - A Chin
- Department of Otolaryngology Head and Neck Surgery, Monklands Hospital, Airdrie, UK
| | - I R C Swan
- MRC/CEO Institute of Hearing Research (Scottish Section), Glasgow Royal Infirmary, Glasgow, UK
| | - M A Akeroyd
- MRC Institute of Hearing Research, Nottingham University, Nottingham, UK
| | - G G Browning
- MRC/CEO Institute of Hearing Research (Scottish Section), Glasgow Royal Infirmary, Glasgow, UK
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Jung J, Roh KJ, Moon IS, Kim SH, Hwang KR, Lee JM, Hou JH, Choi JY. Audiologic limitations of Vibrant Soundbridge device: Is the contralateral hearing aid fitting indispensable? Laryngoscope 2016; 126:2116-23. [PMID: 26774568 DOI: 10.1002/lary.25856] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 11/18/2015] [Accepted: 12/07/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS The purpose of this study was to evaluate the audiologic limitations of the Vibrant Soundbridge (VSB) implant and the benefits of contralateral hearing aid (HA) fitting in VSB recipients. STUDY DESIGN Retrospective study. METHODS Twenty-three patients with symmetrical sensorineural or mixed hearing loss were enrolled in this study. The patients underwent VSB implantation in one ear and HA fitting in the other. Aided pure-tone audiometry was performed to measure the functional gains of each device. The Korean version of the Hearing in Noise Test (K-HINT) was used to determine the sentence speech perception in a quiet environment and the signal-to-noise ratio (SNR) in a noisy environment. RESULTS VSB implantation resulted in hearing gains comparable to that of conventional HAs at high frequencies, whereas the functional gains at low frequencies were not satisfactory in the mixed hearing loss group. In these patients, the contralateral HA sufficiently amplified the low frequencies. The results of the K-HINT of the SNR in the VSB-aided ear were not significantly improved when compared to HA-aided contralateral ear. However, binaural fitting of a VSB and HA resulted in substantially improved SNR when compared to the unaided condition. This improvement of the SNR strongly correlated with functional gains at low frequencies in the contralateral HA-aided ear. CONCLUSIONS Although unilateral VSB implantation is limited in terms of low-tone enhancement and speech perception in noisy environments, contralateral HA fitting can overcome these limitations and increase the efficacy of hearing rehabilitation. LEVEL OF EVIDENCE 4 Laryngoscope, 126:2116-2123, 2016.
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Affiliation(s)
- Jinsei Jung
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung Jin Roh
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - In Seok Moon
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Huhn Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyu Rin Hwang
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeon Mi Lee
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jee Hay Hou
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Young Choi
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
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Roh KJ, Lee EJ, Choi BI, Son EJ. A Case of Incus Vibroplasty: Postoperative Changes in Residual Hearing. J Audiol Otol 2015; 19:54-7. [PMID: 26185793 PMCID: PMC4491948 DOI: 10.7874/jao.2015.19.1.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 11/01/2014] [Accepted: 11/23/2014] [Indexed: 11/22/2022] Open
Abstract
In patients with mild to severe hearing loss, conventional hearing aids offer limited benefits and several problems with feedback and cosmesis. Middle ear implants are a feasible option for patients with moderate to severe hearing loss who are unable to achieve adequate benefit from or cannot tolerate hearing aids for various reasons. Here we present a case of middle ear implant surgery using Vibrant Soundbridge with incus vibroplasty technique, and describe the hearing changes during postoperative follow-up.
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Affiliation(s)
- Kyung Jin Roh
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Jung Lee
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Il Choi
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Jin Son
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
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Schwab B, Kludt E, Maier H, Lenarz T, Teschner M. Subtotal petrosectomy and Codacs™: new possibilities in ears with chronic infection. Eur Arch Otorhinolaryngol 2015; 273:1387-91. [PMID: 26092235 DOI: 10.1007/s00405-015-3688-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 06/10/2015] [Indexed: 10/23/2022]
Abstract
Subtotal petrosectomy combined with obliteration of the tympanomastoid is a standard procedure to treat temporal bones in patients with radical cavity and chronic infections. Currently, patients with profound-to-severe sensorineural hearing loss are often fitted with cochlear implants. In the case of profound mixed hearing loss, active middle ear implants have been used successfully. The new Codacs™ system provides an effective treatment for patients with severe-to-profound mixed hearing loss; however, only aerated middle ears have been treated with this device. The question arises whether the Codacs™ can be implanted in patients with radical cavity or ears with chronic otorrhea. Of the 41 patients who were implanted with the Codacs™ at the department, 4 received the device after subtotal petrosectomy and obliteration with abdominal fat. Clinical and audiological results were assessed. The device was implanted without any complications in the obliterated subtotal petrosectomy. The preliminary results of the first two patients showed stable bone conduction thresholds and indicated improved speech intelligibility in quiet and noise. Implanting the Codacs™ device after subtotal petrosectomy and obliteration with abdominal fat has been proven to be a feasible and suitable procedure for patients with radical cavity or chronic otorrhea. The speech intelligibility outcome directly after activation was comparable to patients with aerated middle ears.
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Affiliation(s)
- Burkard Schwab
- Department of Otolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Eugen Kludt
- Department of Otolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Hannes Maier
- Department of Otolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Thomas Lenarz
- Department of Otolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Magnus Teschner
- Department of Otolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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Debeaupte M, Decullier E, Tringali S, Devèze A, Mom T, Darrouzet V, Truy E. Evolution of the Reliability of the Fully Implantable Middle Ear Transducer Over Successive Generations. Otol Neurotol 2015; 36:625-30. [DOI: 10.1097/mao.0000000000000718] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Maier H, Hinze AL, Gerdes T, Busch S, Salcher R, Schwab B, Lenarz T. Long-Term Results of Incus Vibroplasty in Patients with Moderate-to-Severe Sensorineural Hearing Loss. Audiol Neurootol 2015; 20:136-146. [DOI: 10.1159/000368387] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 09/15/2014] [Indexed: 11/19/2022] Open
Abstract
Objectives: The principal aim of this study was to assess the safety and effectiveness of the middle ear implant Vibrant Soundbridge (VSB) in patients with moderate-to-severe sensorineural hearing loss up to a mean (± standard deviation) duration of 11.1 ± 2.1 years (min. = 8.2, max. = 13.9, n = 16) after the intervention. Design: This was a retrospective, single-subject repeated-measurements study over a long-term period. A total of 104 German-speaking adults (for 122 implants) were included in this study (54 male, 50 female). The mean age at implantation was 54.5 years (min. = 19.0, max. = 80.4). Audiological outcome and speech intelligibility were assessed in all VSB patients at different time points in non-overlapping groups. Results: Bone conduction (BC) thresholds were preserved after the implantation and no indication was found of an increase over time of the small air-bone gaps introduced by the implantation. BC and air conduction thresholds worsened similarly in both implanted and non-implanted ears over time. The decrease in audiological benefit provided by the VSB was moderate and the Word Recognition Score in quiet conditions at 65 dB SPL was still largely improved with the VSB in the longest observed group. Conclusions: These results confirm that the VSB does not affect the integrity of the inner/middle ear and is still beneficial in long-term follow-up.
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Khan A, Hillman T, Chen D. Vibrant Soundbridge Rehabilitation of Sensorineural Hearing Loss. Otolaryngol Clin North Am 2014; 47:927-39. [DOI: 10.1016/j.otc.2014.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
OBJECTIVE To compare surgical methods, functional gain, and speech discrimination using two different coupling methods for an active middle ear implant. Of several couplers enabling placement of the active element at various locations, two function directly at a cochlear membrane, bypassing a missing or malformed ossicular chain. This study evaluates whether either of these methods is more beneficial. STUDY DESIGN Retrospective case review. SETTING ENT surgical clinic. PATIENTS Forty-seven German-speaking patients with moderate to severe mixed hearing loss. INTERVENTIONS Records of patients implanted with either a round window (RW) or oval window (OW) coupler and active implant were examined. Preoperative and postoperative bone and air-conduction thresholds, auditory gain, and speech perception were compared. MAIN OUTCOME MEASURES Functional gain, Freiburger monosyllables in quiet. RESULTS The range of hearing benefit shown by functional gain in patients implanted with the RW coupler (median) was between 22.5 dB (at 0.25 kHz) and 52.5 dB (2 and 3 kHz). In the OW group, improvement was similar, ranging from 21 dB (at 8 kHz) to 50 dB (1 and 2 kHz). Patients in both groups showed a similar improvement in speech recognition. Median preoperative unaided word recognition was 0% at 60 dB HL for both patient groups, improved postoperatively in both groups to median 85% correct at 65 dB HL and 95% at 80 dB HL. CONCLUSION Placement of an active middle ear implant using the RW and the OW coupler was found to be safe, although the surgical methods differ. Safety and efficacy of both couplers present no significant differences.
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Bittencourt AG, Burke PR, Jardim IDS, Brito RD, Tsuji RK, Fonseca ACDO, Bento RF. Implantable and semi-implantable hearing AIDS: a review of history, indications, and surgery. Int Arch Otorhinolaryngol 2014; 18:303-10. [PMID: 25992110 PMCID: PMC4297020 DOI: 10.1055/s-0033-1363463] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 09/17/2013] [Indexed: 10/28/2022] Open
Abstract
Introduction The complaints associated with the use of conventional amplifying hearing aids prompted research at several centers worldwide that ultimately led to the development of implantable devices for aural rehabilitation. Objectives To review the history, indications, and surgical aspects of the implantable middle ear hearing devices. Data Synthesis Implantable hearing aids, such as the Vibrant Soundbridge system (Med-El Corporation, Innsbruck, Austria), the Maxum system (Ototronix LLC, Houston, Texas, United States), the fourth-generation of Carina prosthesis (Otologics LLC, Boulder, Colorado, United States), and the Esteem device (Envoy Medical Corporation - Minnesota, United States), have their own peculiarities on candidacy and surgical procedure. Conclusion Implantable hearing aids, which are currently in the early stages of development, will unquestionably be the major drivers of advancement in otologic practice in the 21st century, improving the quality of life of an increasingly aged population, which will consequently require increased levels of hearing support.
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Affiliation(s)
| | | | | | - Rubens de Brito
- Department of Otolaryngology, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Robinson Koji Tsuji
- Department of Otolaryngology, Universidade de São Paulo, São Paulo, São Paulo, Brazil
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Active middle ear implantation for patients with sensorineural hearing loss and external otitis: long-term outcome in patient satisfaction. Otol Neurotol 2014; 34:855-61. [PMID: 23739560 DOI: 10.1097/mao.0b013e31828f47c2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To study long-term subjective benefit of patients with sensorineural hearing loss and chronic external otitis who use active middle ear implants. DESIGN Single-subject repeated measures in a preintervention and postintervention design with multiple postintervention measurements (questionnaires). SETTING Tertiary academic center. PATIENTS Moderate-to-severe sensorineural hearing loss (n = 56) with severe chronic external otitis who use the Vibrant Soundbridge (VSB) or Otologics MET middle ear implant systems. MAIN OUTCOME MEASURE Changes in hearing disability and handicap as evaluated using the Abbreviated Profile of Hearing Aid Benefit (APHAB), the Nijmegen Cochlear Implant Questionnaire (NCIQ), and the Glasgow Benefit Inventory (GBI). RESULTS Data of 33 patients (mean postoperative duration of 7.5 yr) were available. No difference in subjective results was found between the VSB and Otologics MET patient groups. Total percentage of nonuse was 13%. Long-term APHAB results show a significant decrease in disability for 43% of the patients compared with 54% at 1-year postoperative. NCIQ results show a significant benefit for all subdomains with a negative trend over time. The GBI results show a significant long-term increase in quality of life with positive scores for 82% of the assessed patients. CONCLUSION Long-term postoperative patient satisfaction and quality of life results show a significant difference compared with preoperative measurements, with conventional hearing aids. A negative trend over time is found on all questionnaires, which might reflect patient aging (increase of hearing loss) or habituation to a situation with fewer concerns regarding a patient's external otitis.
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Labassi S, Beliaeff M. Retrospective of 1000 patients implanted with a Vibrant Soundbridge middle-ear implant. Cochlear Implants Int 2013; 6 Suppl 1:74-7. [DOI: 10.1179/cim.2005.6.supplement-1.74] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Long-term functional outcome and satisfaction of patients with an active middle ear implant for sensorineural hearing loss compared to a matched population with conventional hearing aids. Eur Arch Otorhinolaryngol 2013; 271:3161-9. [DOI: 10.1007/s00405-013-2811-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 11/03/2013] [Indexed: 10/26/2022]
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Schraven SP, Dalhoff E, Wildenstein D, Hagen R, Gummer AW, Mlynski R. Alternative fixation of an active middle ear implant at the short incus process. Audiol Neurootol 2013; 19:1-11. [PMID: 24192762 DOI: 10.1159/000354981] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 08/12/2013] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Since 1996, the preferred approach for positioning the active middle-ear implant Vibrant Soundbridge© is a mastoidectomy and a posterior tympanotomy. With this device, placement of the floating mass transducer (FMT) on the long incus process is the standard method for treatment of mild-to-severe sensorineural hearing loss in the case of normal middle-ear anatomy. The aim of this study was to determine the vibrational effectiveness of FMT placement at the short incus process. MATERIALS AND METHODS An extended antrotomy and a posterior tympanotomy were performed in 5 fresh human temporal bones. As a control for normal middle-ear function, the tympanic membrane was stimulated acoustically and the vibration of the stapes footplate and the round-window (RW) membrane were (sequentially) measured by laser Doppler vibrometry. Vibration responses for coupling of an FMT to the long incus process (standard coupling) were compared to those for coupling to the short incus process. RESULTS Apart from narrow frequency bands near 3 and 9 kHz for the stapes footplate and RW membrane, respectively, the velocity responses presented no significant differences between standard coupling of the FMT and coupling to the short incus process. CONCLUSION Coupling the FMT to the short incus process may be a viable alternative in cases where the surgical approach is limited to an extended antrotomy. A reliable technique for attachment to the short incus process has yet to be developed.
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Affiliation(s)
- Sebastian P Schraven
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Comprehensive Hearing Center, University of Würzburg, Würzburg, Germany
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Experience With the Active Middle Ear Implant in Patients With Moderate-to-Severe Mixed Hearing Loss. Otol Neurotol 2013; 34:1373-9. [DOI: 10.1097/mao.0b013e3182a0044e] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Marino R, Linton N, Eikelboom RH, Statham E, Rajan GP. A comparative study of hearing aids and round window application of the vibrant sound bridge (VSB) for patients with mixed or conductive hearing loss. Int J Audiol 2013; 52:209-18. [PMID: 23527900 DOI: 10.3109/14992027.2012.750431] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study was undertaken to determine the efficacy of the round window (RW) application of the vibrant soundbridge (VSB) in patients with mixed or conductive hearing loss. DESIGN Speech in quiet and in noise were compared to preoperative data attained with conventional hearing aids so that each subject served as his or her own control in a single test protocol. STUDY SAMPLE Eighteen adults implanted monaurally with the VSB in the poorer hearing ear. Experience with the VSB ranged from nine to 25 months. RESULTS Sixteen of the 18 subjects were successful VSB users, wearing their device all waking hours. There was no significant deterioration in the averaged bone conduction results preoperatively versus post-operatively (p>0.05). Speech recognition in quiet results were not significantly different to performance attained whilst wearing hearing aids (p>0.05). Speech recognition in noise performance was substantially improved with use of the VSB in most test conditions. CONCLUSIONS For the majority of the subjects, the VSB was an effective method of hearing restoration for their mixed and conductive hearing loss.
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Ihler F, Köhler S, Meyer AC, Blum J, Strenzke N, Matthias C, Canis M. Mastoid cavity obliteration and Vibrant Soundbridge implantation for patients with mixed hearing loss. Laryngoscope 2013; 124:531-7. [PMID: 23918587 DOI: 10.1002/lary.24180] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 03/04/2013] [Accepted: 04/03/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To review the results of obliteration of a preexisting mastoid cavity with abdominal fat and Vibrant Soundbridge implantation in patients with mixed hearing loss (MHL) and to compare the data with results of Vibrant Soundbridge implantation in patients with MHL without mastoid cavity and with pure sensorineural hearing loss (SNHL). STUDY DESIGN Retrospective chart analysis of 10 patients (10 ears) with MHL and preexisting mastoid cavity, 18 patients (19 ears) with MHL alone and nine patients (10 ears) with SNHL treated in one tertiary referral center. METHODS Vibrant Soundbridge implantation and obliteration in case a mastoid cavity existed previously. Pure tone audiometry (average air-bone gap, average functional gain), speech audiometry (Freiburg Monosyllabic Test) and complication rate were main outcome measures. RESULTS Postoperative average air-bone gap was -15.1 ± 21.2 dB in patients with MHL with mastoid cavity obliteration, -7.2 ± 11.4 dB in patients with MHL without mastoid cavity, and -5.7 ± 11.2 dB in patients with SNHL. Average functional gain was 40.0 ± 23.5 dB, 39.7 ± 12.1 dB, and 9.5 ± 10.6 dB. Postoperative speech discrimination rate was 77.9 ± 20.8%, 83.3 ± 13.6%, and 83.6 ± 6.3%. No severe intraoperative or postoperative complications were noted. CONCLUSIONS Mastoid cavity obliteration during Vibrant Soundbridge implantation in patients with MHL and preexisting mastoid cavity is a safe procedure. The audiometric results are satisfying and comparable to those of other patient groups implanted with the same device. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Friedrich Ihler
- Department for Otolaryngology, University of Göttingen Medical Center, Germany
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Techniques to improve the efficiency of a middle ear implant: effect of different methods of coupling to the ossicular chain. Otol Neurotol 2013. [PMID: 23196747 DOI: 10.1097/mao.0b013e3182785261] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
HYPOTHESIS Coupling and placement of actuators onto the ossicular chain have a significant influence on active middle ear implant (AMEI) performance. BACKGROUND AMEIs have proved to be effective in treating moderate-to-severe sensorineural hearing loss as well as mixed and conductive loss. Here, we assess the effect on performance of an AMEI prosthesis using 5 different methods of coupling to the ossicular chain in 6 temporal bones. METHODS The AMEI provided direct vibratory stimuli to the incus using the following methods: 1) tip of the transducer in contact with incus body (baseline condition), 2) tip of the transducer placed in a laser-drilled hole in the incus body, 3) the àWengen clips (straight and articulated) crimped to the transducer and attached to the incus long process, 4) a 0.5-mm diameter cylinder placed in contact with the incus long process, and 5) a bell-shaped prosthesis in contact with the head of the stapes. Performance in each condition was assessed by measuring the resultant stapes velocities (HEV) from which the maximum equivalent ear canal sound pressure levels (L(Emax)) were computed. RESULTS Relative to the baseline condition, which produced L(Emax) of 112 to 126 dB SPL for frequencies of 0.25 to 8 kHz, the other coupling methods produced similar or substantially improved (increased L(Emax)) performance. Best performance was achieved by providing vibratory stimulation to the head of the stapes directly with the bell-shaped tip where performance improved significantly by 16 to 22 dB. CONCLUSION Stapes velocities produced by AMEI transducers may be increased depending on the tip used to couple the transducer to the ossicular chain and the placement of the stimulating tip along the incus. Improvement in coupling the transducer to the incus and stapes produced significant improvements in the transfer of vibratory stimuli to the ossicular chain.
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Vibrant sound bridge application to middle ear windows versus conventional hearing aids: a comparative study based on international outcome inventory for hearing aids. Eur Arch Otorhinolaryngol 2013; 271:35-40. [DOI: 10.1007/s00405-013-2387-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Accepted: 01/28/2013] [Indexed: 10/27/2022]
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