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Alshalan A, Alzhrani F. Efficacy of vibrant sound bridge in congenital aural atresia: an updated systematic review. Eur Arch Otorhinolaryngol 2024; 281:2849-2859. [PMID: 38647685 DOI: 10.1007/s00405-024-08629-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 03/19/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE The indications of Vibrant Soundbridge (VSB) have been expanded to include patients with conductive and mixed hearing loss due to congenital aural atresia (CAA). However, the current evidence supporting the auditory outcomes of VSB is based mainly on case reports and retrospective chart reviews. Therefore, the present systematic review aims to summarize and critically appraise the current evidence regarding the safety and effectiveness of VSB in children and adult patients with CAA. METHODS A systematic literature search retrieved studies that evaluated the outcomes of unilateral or bilateral implantation of VSB in patients with CAA. The bibliographic search was conducted in PubMed, Scopus, EBSCO, and Cochrane Central Register of Controlled Trials (CENTRAL) databases from January 2000 to December 2022. RESULTS Twenty-seven studies were included in the present systematic review. Overall, the speech perception after VSB was good, with a mean word recognition score (WRS) score ranging from 60 to 96.7%. The mean postoperative speech recognition threshold (SRT) after implantation ranged from 20.8 to 50 dB. The effective gain was reported in 15 studies, ranging from 31.3 to 45.5 dB. In terms of user satisfaction with VSB, the included studies showed significant improvements in the patient-reported outcomes, such as the Speech Spatial and Qualities of Hearing scale and Glasgow Hearing Aid Benefit Profile. The VSB implantation was generally safe with low incidence of postoperative complications. CONCLUSION VSB provides significant benefits to individuals with hearing loss owing to CAA, with very good subjective outcomes and a low risk of complications.
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Affiliation(s)
- Afrah Alshalan
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Jouf University, PO Box 72418, 23235, Skaka, Aljouf, Saudi Arabia.
| | - Farid Alzhrani
- King Abdullah Ear Specialist Center (KAESC), King Saud University, Riyadh, Saudi Arabia
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2
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Bruschini L, Canzi P, Canale A, Covelli E, Laborai A, Monteforte M, Cinquini M, Barbara M, Beltrame MA, Bovo R, Castigliano B, De Filippis C, Della Volpe A, Dispenza F, Marsella P, Mainardi A, Orzan E, Piccirillo E, Ricci G, Quaranta N, Cuda D. Implantable hearing devices in clinical practice. Systematic review and consensus statements. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2024; 44:52-67. [PMID: 38165206 PMCID: PMC10914359 DOI: 10.14639/0392-100x-n2651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/21/2023] [Indexed: 01/03/2024]
Abstract
Objective Implantable hearing devices represent a modern and innovative solution for hearing restoration. Over the years, these high-tech devices have increasingly evolved but their use in clinical practice is not universally agreed in the scientific literature. Congresses, meetings, conferences, and consensus statements to achieve international agreement have been made. This work follows this line and aims to answer unsolved questions regarding examinations, selection criteria and surgery for implantable hearing devices. Materials and methods A Consensus Working Group was established by the Italian Society of Otorhinolaryngology. A method group performed a systematic review for each single question to identify the current best evidence on the topic and to guide a multidisciplinary panel in developing the statements. Results Twenty-nine consensus statements were approved by the Italian Society of Otorhinolaryngology. These were associated with 4 key area subtopics regarding pre-operative tests, otological, audiological and surgical indications. Conclusions This consensus can be considered a further step forward to establish realistic guidelines on the debated topic of implantable hearing devices.
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Affiliation(s)
- Luca Bruschini
- Otolaryngology, ENT Audiology and Phoniatrics Unit, University Hospital of Pisa, Pisa, Italy
| | - Pietro Canzi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Department of Otorhinolaryngology, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Canale
- Division of Otorhinolaryngology, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Edoardo Covelli
- Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Andrea Laborai
- Department of Otolaryngology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Marta Monteforte
- Laboratory of systematic review methodology and guidelines production, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Michela Cinquini
- Laboratory of systematic review methodology and guidelines production, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Maurizio Barbara
- Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Millo Achille Beltrame
- Department of Otorhinolaryngology, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roberto Bovo
- Department of Neuroscience DNS, Otolaryngology Section, Padua University, Padua, Italy
| | - Bruno Castigliano
- Division of Otorhinolaryngology, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Cosimo De Filippis
- Department of Neuroscience, Audiology Section, University of Padua, Treviso, Italy
| | - Antonio Della Volpe
- Otology and Cochlear Implant Unit, Santobono-Pausilipon Children’s Hospital, Naples, Italy
| | - Francesco Dispenza
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, Azienda Ospedaliera Universitaria Policlinico ‘’Paolo Giaccone’’, University of Palermo, Palermo, Italy
| | - Pasquale Marsella
- Audiology and Otosurgery Department, “Bambino Gesù” Children’s Hospital, Rome, Italy
| | - Anna Mainardi
- Department of Otolaryngology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Eva Orzan
- ENT and Audiology Unit, Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, Trieste, Italy
| | | | - Giampietro Ricci
- Department of Surgical and Biomedical Sciences, Section of Otorhinolaryngology, University of Perugia, Perugia, Italy
| | - Nicola Quaranta
- Translational Biomedicine and Neurosciences Department, University of Bari, Bari, Italy
| | - Domenico Cuda
- Department of Otolaryngology, Guglielmo da Saliceto Hospital, Piacenza, Italy
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Gantner S, Epp A, Pollotzek M, Hempel JM. Long-term results and quality of life after vibrant soundbridge implantation (VSBs) in children and adults with aural atresia. Eur Arch Otorhinolaryngol 2024; 281:129-139. [PMID: 37603051 PMCID: PMC10764446 DOI: 10.1007/s00405-023-08100-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/28/2023] [Indexed: 08/22/2023]
Abstract
PURPOSE The aim of this study was to evaluate the long-term effectiveness and acceptance of the active middle ear implant system Vibrant Soundbridge (VSB®, MED-EL, Austria) in patients with aural atresia or aplasia (children and adults). METHODS Data from 51 patients (mean age 13.9 ± 11.3 years), 42 (79.2%) children and adolescents, and 11 (20.8%) adults) who received a VSB implant between 2009 and 2019 at the Department of Otolaryngology at LMU Clinic Großhadern, Munich were included in the study. Pure-tone audiometry, speech recognition in a quiet environment and in a noisy environment were performed preoperatively, during the first fitting of the audio processor, after 1-3 years, after 3-5 years, and after 5 years (if possible). The follow-up period ranged from 11 to 157 months with a mean of 58.6 months (4.8 years). Furthermore, the benefit of the VSB was evaluated by self-assessment questionnaires (Speech, Spatial, and Qualities of Hearing Scale, respectively, for parents). RESULTS Significant improvements were observed in hearing and speech comprehension immediately after the initial fitting of the VSB system (mean hearing gain 38.4 ± 9.4 dB HL) and at follow-up intervals (1-3, 3-5 and after 5 years) for children and adults (p < 0.01). The values remained stable over the long-term, indicating a sustained functional gain from the VSB (mean hearing gain 38.9 ± 9.2 dB HL). The results of the self-assessments affirm the positive influence on hearing and speech comprehension with the VSB. With the VSB, there was an improvement of 41.3 ± 13.7% in the Freiburg monosyllable test. CONCLUSION These results (a stable hearing gain over the long term, a good tolerance of the implant and an improvement in quality of life) affirm the recommendation for using the active middle ear implant VSB as early as permitted for aural atresia and aplasia patients. This study represents the audiometric results with the (to date) largest collective of aural atresia patients and with a long follow-up period.
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Affiliation(s)
- Sophia Gantner
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilian University Munich, Munich, Germany.
| | - Alexandra Epp
- Paediatric Hospital, University Hospital, Augsburg, Germany
| | - Marlene Pollotzek
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilian University Munich, Munich, Germany
| | - John Martin Hempel
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilian University Munich, Munich, Germany
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Willenborg K, Lenarz T, Busch S. Surgical and audiological outcomes with a new transcutaneous bone conduction device with reduced transducer thickness in children. Eur Arch Otorhinolaryngol 2023; 280:4381-4389. [PMID: 37000276 PMCID: PMC10477095 DOI: 10.1007/s00405-023-07927-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 03/13/2023] [Indexed: 04/01/2023]
Abstract
PURPOSE Due to smaller bone thickness, young children with conductive or mixed hearing loss or single-sided deafness were previously most commonly treated with a percutaneous osseointegrated bone-anchored hearing aid (BAHA) or an active middle-ear implant. While the BAHA increases the risk of implant infections, skin infection, overgrowth of the screw or involvement of the implant in head trauma, middle-ear implant surgery involves manipulation of the ossicles with possible risk of surgical trauma. These complications can be omitted with transcutaneous bone conduction implant systems like the MED-EL Bonebridge system. The purpose of this study was to analyze whether the second generation of the Bonebridge (BCI 602) that features a decreased implant thickness with a reduced surgical drilling depth can be implanted safely in young children with good postoperative hearing performance. METHODS In this study, 14 patients under 12 years were implanted with the second generation of the Bonebridge. Preoperative workup comprised a CT scan, an MRI scan, pure tone audiometry, or alternatively a BERA (bone conduction, air conduction). Since children under 12 years often have a lower bone thickness, the CT was performed to determine the suitability of the temporal bone for optimal implant placement using the Otoplan software. RESULTS All patients (including three under the age of five) were successfully implanted and showed a good postoperative hearing performance. CONCLUSION With adequate preoperative workup, this device can be safely implanted in children and even children under 5 years of age and allows for an extension of indication criteria toward younger children.
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Affiliation(s)
- Kerstin Willenborg
- Department of Otolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
- Cluster of Excellence H4A, Hannover, Germany.
| | - Thomas Lenarz
- Department of Otolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
- Cluster of Excellence H4A, Hannover, Germany
| | - Susan Busch
- Department of Otolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
- Cluster of Excellence H4A, Hannover, Germany
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Thurnheer S, Müller T, Linder T, Simmen D, Harder M. Congenital aural atresia: hearing rehabilitation using active middle-ear implants. J Laryngol Otol 2023; 137:851-865. [PMID: 36169002 DOI: 10.1017/s0022215122002183] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess hearing rehabilitation in patients with congenital aural atresia using an active middle-ear implant (Vibrant Soundbridge). METHODS Of a cohort of 70 microtia and atresia patients, 10 underwent Vibrant Soundbridge implantation between 2008 and 2021. Two of the 10 patients had binaural implantation, resulting in 12 ears for analysis. Pre- and post-operative audiometry data were analysed, and patient satisfaction was evaluated. Surgical issues regarding coupling sites and outcomes were analysed. RESULTS Pure tone average (0.5, 1, 2 and 4 kHz) improved from a pre-operative mean (standard deviation) of 65.3 (8.7) dB HL to a post-operative mean of 26.8 (4.9) dB HL. This resulted in a mean pure tone average gain of 38.5 dB HL. The results indicate no obvious difference between stapes (n = 8) and incus (n = 4) coupling. The mean effective gain for 0.5, 1, 2 and 4 kHz was -17.8 dB HL (standard deviation = 4.3). Concerning effective gain, Vibrant Soundbridge performed best at 2 kHz. Patients reported high overall satisfaction, good sound quality and strongly improved directional hearing. CONCLUSION An active middle-ear implant (Vibrant Soundbridge) allows hearing rehabilitation in selected atretic ears, and provides long-term hearing stability in children and adults.
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Affiliation(s)
- S Thurnheer
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Lucerne Cantonal Hospital, Switzerland
| | - T Müller
- Faculty of Health Sciences and Medicine, University of Lucerne, Switzerland
| | - T Linder
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Lucerne Cantonal Hospital, Switzerland
| | - D Simmen
- Otorhinolaryngology - Center Hirslanden, Zurich, Switzerland
| | - M Harder
- Otorhinolaryngology - Center Hirslanden, Zurich, Switzerland
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Cadre B, Simon F, Célérier C, Coudert C, Flament J, Loundon N, Belhous K, Denoyelle F. Long-term outcomes of retrospective case series of middle ear implantation with Vibrant Soundbridge in children with congenital aural atresia. Eur Arch Otorhinolaryngol 2023; 280:1629-1637. [PMID: 36098862 DOI: 10.1007/s00405-022-07633-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 08/25/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE to assess audiological performance in quiet and noise, quality of life and side effects of Vibrant Soundbridge (VSB) in children with congenital aural atresia (CAA). METHODS A retrospective study including consecutive patients with unilateral or bilateral CAA implanted with VSB from 2009 to 2020 in a tertiary referral centre. RESULTS 18 patients with CAA and a present stapes were included (3 simultaneous bilateral VSB implants) and 21 ears: 17 VSB were attached to the short incus process, and four to the stapes. Age at implantation ranged from 4.7 to 15.8 years. Average follow-up was 6.5 years (± 3.7 years). In unilateral VSB, air conduction pure tone average (ACPTA) thresholds increased from 75.3 ± 15.2 to 32.6 ± 8.3 dB post-operatively (VSB activated) (n = 15; p < 0.01). The speech reception threshold (SRT) and the word recognition score (WRS) were significantly improved from 81.5 ± 10.4 to 43.9 ± 7.6 dB and 0% to 84.8 ± 8.5% postoperatively (n = 15; p < 0.01). The signal to noise ratio (SNR) was significantly improved from 2.1 ± 2.9 dB VSB inactivated to 0.3 ± 2.7 dB VSB activated (n = 15; p < 0.01). There was no significant difference in performance according to floating mass transducer (FMT) placement. 5/15 children were non-users at last follow-up in unilateral VSB and 0/3 in bilateral. CONCLUSIONS CAA ears with VSB activated had a significant improvement of ACPTA, WRS, SRT and SNR. A third of patients with unilateral CAA became non-users at last follow-up. The main challenge is to target the indications for the implantation of the VSB to avoid its discontinuation.
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Affiliation(s)
- Barbara Cadre
- Université Paris Cité, 75006, Paris, France.,Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75015, Paris, France
| | - François Simon
- Université Paris Cité, 75006, Paris, France. .,Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75015, Paris, France.
| | - Charlotte Célérier
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75015, Paris, France
| | - Cyrille Coudert
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75015, Paris, France.,Audika Hearing Expertise Laboratory, 19, avenue des Gobelins, 75005, Paris, France
| | - Jonathan Flament
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75015, Paris, France.,Audika Hearing Expertise Laboratory, 19, avenue des Gobelins, 75005, Paris, France
| | - Natalie Loundon
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75015, Paris, France
| | - Kahina Belhous
- Department of Radiology, AP-HP, Hôpital Necker-Enfants Malades, 75015, Paris, France
| | - Françoise Denoyelle
- Université Paris Cité, 75006, Paris, France.,Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75015, Paris, France
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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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9
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Alzhrani F, Alhabib SF, Yousef M. Speech performance and subjective satisfaction of middle ear implant in congenital aural atresia. ACTA OTORHINOLARYNGOLOGICA ITALICA 2022; 42:182-188. [PMID: 35612511 PMCID: PMC9132001 DOI: 10.14639/0392-100x-n1668] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 02/01/2022] [Indexed: 11/23/2022]
Abstract
Objectives To evaluate the safety, speech performance in noise and subjective satisfaction of patients with congenital aural atresia (CAA) implanted with the active middle ear implant. Methods This retrospective study included 13 patients (15 ears) implanted with middle ear implants with different methods of floating mass transducer attachment. In 6 ears, the floating mass transducer (FMT) was coupled with the short process of incus; in 8 ears, a clip coupler was used; and in one ear, a round window coupler was used. Patients were assessed preoperatively, and at one, three, and six months postoperatively. The assessment included Pure Tone Average (PTA4), Speech Reception Threshold (SRT) and Speech Discrimination Score (SDS). The Speech Spatial and Qualities of Hearing scale (SSQ12) was also used to evaluate levels of satisfaction. Results The mean aided PTA4 using Vibrant Sound Bridge (VSB) was 26.44 4.03 dB HL compared to 61.88 ±1.53 dB HL unaided. The SDS improved significantly (p = 0.002) from 51% (± 9.17%) to 94.60% (± 4.43%). Furthermore, there was a significant improvement in SDS in noise (p = 0.008) and SSQ12 responses (p < 0.0001). Conclusions Patients with hearing loss due to CAA can substantially benefit from VSB, with highly satisfactory subjective results and a negligible rate of complications.
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Yoshimura H, Takahashi M, Iwasaki S, Shinagawa J, Takashimizu I, Nagai F, Yotsuyanagi T, Usami S. Vibrant soundbridge implantation prior to auricular reconstruction with unilateral microtia-atresia. Clin Case Rep 2021; 9:e04408. [PMID: 34429978 PMCID: PMC8365392 DOI: 10.1002/ccr3.4408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/07/2021] [Accepted: 05/18/2021] [Indexed: 11/24/2022] Open
Abstract
We presented the first successful application of VSB implantation prior to auriculoplasty, which can provide hearing improvement in safe conditions and open new strategies for earlier hearing rehabilitation in unilateral microtia-atresia children.
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Affiliation(s)
- Hidekane Yoshimura
- Department of OtorhinolaryngologyShinshu University School of MedicineMatsumotoJapan
| | - Masahiro Takahashi
- Department of OtorhinolaryngologyInternational University of Health and Welfare Mita HospitalTokyoJapan
| | - Satoshi Iwasaki
- Department of OtorhinolaryngologyInternational University of Health and Welfare Mita HospitalTokyoJapan
| | - Jun Shinagawa
- Department of OtorhinolaryngologyShinshu University School of MedicineMatsumotoJapan
| | - Ikkei Takashimizu
- Department of Plastic and Reconstructive SurgeryShinshu University School of MedicineMatsumotoJapan
| | - Fumio Nagai
- Department of Plastic and Reconstructive SurgeryShinshu University School of MedicineMatsumotoJapan
| | - Takatoshi Yotsuyanagi
- Department of Plastic and Reconstructive SurgerySapporo Medical University School of MedicineSapporoJapan
| | - Shin‐ichi Usami
- Department of Hearing Implant SciencesShinshu University School of MedicineMatsumotoJapan
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11
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Asp F, Stokroos RJ, Agterberg MJH. Toward Optimal Care for Children With Congenital Unilateral Aural Atresia. Front Neurol 2021; 12:687070. [PMID: 34305795 PMCID: PMC8298319 DOI: 10.3389/fneur.2021.687070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/14/2021] [Indexed: 11/21/2022] Open
Affiliation(s)
- Filip Asp
- Scientific Center for Advanced Pediatric Audiology, Division of Ear, Nose, and Throat Diseases, Department of Clinical Science, Intervention and Technology Karolinska Institute, Stockholm, Sweden
| | - Robert J Stokroos
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands.,University Medical Center (UMC) Utrecht Brain Center, Utrecht, Netherlands
| | - Martijn J H Agterberg
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre Nijmegen, Nijmegen, Netherlands.,Department of Biophysics, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Nijmegen, Nijmegen, Netherlands
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12
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Feasibility and Efficacy of Vibrant Soundbridge Short Process Coupler in Patients With Aural Atresia. Otol Neurotol 2021; 41:e1219-e1223. [PMID: 32810015 DOI: 10.1097/mao.0000000000002801] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Different options are available for hearing restoration in patients with aural atresia. Middle ear implantation with the Vibrant Soundbridge (VSB) has been used successfully in many patients with aural atresia with conductive or mixed hearing loss. The aim of the current study was to assess the safety and the efficiency of VSBs coupled to the short process of the incus in patients with aural atresia with conductive or mixed hearing loss. METHODS The study was a retrospective chart review conducted at a tertiary university hospital. Audiological and surgical data from six ears with aural atresia implanted with VSBs coupled to the short process of the incus were analyzed. The audiological results were compared with previously reported results obtained after the utilization of different coupling techniques. RESULTS All six atretic ears were successfully implanted using the short process coupler, and there were no major complications. Postoperative bone conduction thresholds did not differ substantially from preoperative thresholds. The respective mean preoperative pure-tone average 4, speech reception threshold, and word recognition score values were 56.7 dB, 61.7 dB, and 44%. Postoperative pure-tone average 4 thresholds (25 ± 3.5 dB) and speech reception thresholds (20.8 ± 8 dB) were significantly improved. The maximum postoperative word recognition score achieved was 100%. The audiological outcomes obtained were similar to previously reported outcomes after classic stapes placement. CONCLUSION Coupling of the floating mass transducer to the short process of the incus in patients with aural atresia resulted in significant audiological improvements that were comparable to previously reported improvements after placement via other methods.
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Hempel JM, Epp A, Volgger V. [Hearing rehabilitation with the Vibrant Soundbridge in patients with congenital middle ear malformation]. HNO 2021:10.1007/s00106-021-01004-5. [PMID: 33599810 DOI: 10.1007/s00106-021-01004-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Congenital aural atresia, which is usually unilateral, causes hearing loss and aesthetic impairment. Besides tympanoplasty with/without canalplasty and bone conduction devices, active middle ear implants are also available for functional rehabilitation. OBJECTIVE This article aims to present a contemporary review on the treatment possibilities for middle ear malformations, with a focus on audiological rehabilitation with the Vibrant Soundbridge. MATERIALS AND METHODS A selective literature search for treatment possibilities was performed in PubMed up to October 2020, and personal clinical experiences are reported. RESULTS The Vibrant Soundbridge, which is approved for children ≥ 5 years, is suitable for treatment of middle ear malformations with a Jahrsdoerfer score ≥ 5. Although implantation of a Vibrant Soundbridge is surgically more demanding than implantation of a bone conduction device, the method is safe, delivers good auditory results (superior to bone conduction devices in terms of speech understanding and spatial hearing), does not involve intensive postsurgical care, and rarely requires revision surgery. The Vibrant Soundbridge can be coupled to (remnants of) the ossicular chain or the round window. CONCLUSION The Vibrant Soundbridge is an appropriate treatment method in patients with middle ear malformations who have suitable anatomical preconditions.
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Affiliation(s)
- J M Hempel
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, LMU Klinikum Großhadern, Marchioninistr. 15, 81377, München, Deutschland.
| | - A Epp
- Kinderklinik, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - V Volgger
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, LMU Klinikum Großhadern, Marchioninistr. 15, 81377, München, Deutschland
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14
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A Transcutaneous Active Middle Ear Implant (AMEI) in Children and Adolescents: Long-term, Multicenter Results. Otol Neurotol 2020; 40:1059-1067. [PMID: 31356489 DOI: 10.1097/mao.0000000000002340] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Evaluation of the long-term safety and performance of an active middle ear implant (AMEI) in the treatment of hearing loss in children and adolescents with a primary focus on improvement in speech discrimination. STUDY DESIGN Prospective, multicentric, single-subject repeated-measures design in which each subject serves as his or her own control. SUBJECTS Thirty-one pediatric subjects aged 5 to 17 years. INTERVENTION Implantation of an active middle ear implant. METHODS Improvement in word recognition scores, speech reception thresholds (SRT) in quiet and noise, in addition to air conduction, bone conduction, and sound field thresholds were evaluated in two age groups. RESULTS Residual hearing did not change over time and speech intelligibility significantly improved and remained stable after 36 months. Children aged 5 to 9 improved in WRS from 21.92 to 95.38% and in SRT in quiet and in noise respectively from 62.45 dB SPL (sound pressure level) and +1.14 dB SNR to 42.07 dB SPL and -4.45 dB SNR. Adolescents aged 10 to 17 improved in WRS from 12.78 to 84.71% and in SRT in quiet and in noise respectively from 63.96 dB SPL and +3.32 dB SNR to 35.31 dB SPL and -4.55 dB SNR. CONCLUSIONS The AMEI, under investigation, is a safe treatment for children and adolescents, and significantly improved audiological performance that remains stable on the long-term scale (up to 36 mo postimplantation). In general, all adult-related issues and questions regarding safety and performance can also be applied to the pediatric population, as no apparent specific issues developed.
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15
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Zhao C, Yang J, Liu Y, Gao M, Chen P, Zhao S. Long-term Outcomes of Clip Coupler Implantation in Patients with Unilateral Congenital Aural Atresia. Ann Otol Rhinol Laryngol 2020; 129:1221-1228. [PMID: 32500728 DOI: 10.1177/0003489420924058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the long-term safety and efficacy of the Clip coupler attached to the stapes head in patients with unilateral congenital aural atresia (CAA). METHODS This single-center retrospective study included 16 Mandarin-speaking patients who had unilateral microtia accompanied by CAA. All patients were divided into two groups: the short-term follow-up group (n = 9) and the long-term follow-up group (n = 7). The floating mass transducer of the Vibrant Soundbridge (VSB) was positioned in the stapes head by the Clip coupler. The safety of the VSB was investigated by comparing preoperative and postoperative bone-conduction (BC) thresholds as well as by complications. The effectiveness was evaluated by functional gain (FG), word recognition score (WRS), speech reception threshold (SRT) and signal-to-noise ratio (SNR). RESULTS Pre- and post-operative BC thresholds were no different in all patients. And no complications developed. VSB-aided thresholds in the free-field had improved significantly in both short- and long-term follow-up groups. The improvements of WRS were observed in two groups. The monosyllabic VSB-aided WRS in the long-term follow-up group was significantly higher than that in the short-term follow-up group. When speech was from the impaired ear and noise presented to the side of normal ear (SVSBNCL), lower SNRs were found in two groups after VSB implantation. However, there was no statistical difference in aided SNR between the two groups at SVSBNCL status. CONCLUSIONS Our results show that the FMT connected to the stapes head is a secure and useful device for patients with unilateral CHL/MHL, not only in terms of improved hearing thresholds, but also improved speech intelligibility in quiet and noisy environments.
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Affiliation(s)
- Chunli Zhao
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jinsong Yang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yujie Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Mengdie Gao
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Peiwei Chen
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Shouqin Zhao
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Alanazi Y, Halawani R, Alzhrani F. Vibrant Soundbridge implant in a patient with Fanconi anemia. ACTA OTO-LARYNGOLOGICA CASE REPORTS 2020. [DOI: 10.1080/23772484.2020.1756295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Yara Alanazi
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Roa Halawani
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Farid Alzhrani
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Vogt K, Wasmann JW, Van Opstal AJ, Snik AFM, Agterberg MJH. Contribution of spectral pinna cues for sound localization in children with congenital unilateral conductive hearing loss after hearing rehabilitation. Hear Res 2019; 385:107847. [PMID: 31786443 DOI: 10.1016/j.heares.2019.107847] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 11/01/2019] [Accepted: 11/12/2019] [Indexed: 12/27/2022]
Abstract
Congenital unilateral conductive hearing loss (UCHL) jeopardizes directional hearing and speech perception in noisy conditions. Potentially, children with congenital UCHL can benefit from fitting a hearing device, such as a bone-conduction device (BCD). However, the literature reports limited benefit from fitting a BCD, and often, surprisingly, relatively good sound localization in the unaided condition is reported. In this study, we hypothesized that the limited benefit with a BCD is related to (i) insufficient access to binaural cues and (ii) relying on monaural spectral pinna cues for sound localization in the horizontal plane. Directional hearing was tested in seventeen children with congenital UCHL (age 6-19) using a percutaneous BCD. Additionally, a mold was placed in the pinna of the normal-hearing ear to diminish direction-dependent spectral pinna cues. Relatively good localization in azimuth was found in the unaided hearing condition in the majority of the children. Sound localization improved when listening with a BCD, and no correlation between age of implantation and aided localization performance was found. When the mold was inserted, the unaided and aided localization abilities of most children deteriorated. Interestingly, in the children with poor localization performance in the unaided condition, sound localization improved significantly with the BCD, and was hardly affected by molding the pinna of the normal-hearing ear. These observations indicate that the majority of these children rely on spectral pinna cues to localize sounds, independent of listening with or without their device. In conclusion, an important reason for the limited benefit of BCD fitting in children with congenital UCHL might be ascribed to an effective coping strategy (use of spectral pinna cues) that still plays a dominant role after BCD fitting.
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Affiliation(s)
- Katharina Vogt
- Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, the Netherlands
| | - Jan-Willem Wasmann
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre Nijmegen, the Netherlands
| | - A John Van Opstal
- Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, the Netherlands
| | - Ad F M Snik
- Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, the Netherlands
| | - Martijn J H Agterberg
- Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, the Netherlands; Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre Nijmegen, the Netherlands.
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18
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The vibrating ossicular prosthesis in children and adolescents: a retrospective study. Eur Arch Otorhinolaryngol 2019; 277:55-60. [PMID: 31570983 DOI: 10.1007/s00405-019-05667-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 09/21/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The primary objective of the retrospective study was to collect speech intelligibility data on children and adolescents implanted with the vibrating ossicular prosthesis (VORP) 503. METHODS This was a retrospective, multicentre study on 55 children and adolescents from 6 German clinics aged between 5 and 17 years suffering from mixed or conductive hearing loss implanted with a VORP 503. Pre- and postoperative bone-conduction pure tone thresholds were measured at 0.5, 1, 2 and 4 kHz, and word recognition scores in the unaided and VORP 503-aided conditions using monosyllabic speech intelligibility tests measured at 65-dB sound pressure level (SPL) were determined. RESULTS Mean pre- and postoperative bone-conduction thresholds remained unchanged, showing the preservation of inner ear hearing. Speech intelligibility assessed in quiet at 65-dB SPL improved on average from 24.5% (SD ± 25.4) unaided to 86.4% (SD ± 13.4) aided. The average improvement of 61.9% (SD ± 25.3) was clinically and statistically significant. A total of three complications were found in the medical records of 55 subjects. The responsible investigators judged these events as procedure related. CONCLUSION The treatment of children suffering from conductive or mixed hearing loss with the VORP 503 implant demonstrates excellent aided benefit in terms of speech understanding and only minor complications.
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Burian A, Gerlinger I, Toth T, Piski Z, Rath G, Bako P. Stapedotomy with incus vibroplasty - A novel surgical solution of advanced otosclerosis and its place among existing therapeutic modalities - Hungarian single institutional experiences. Auris Nasus Larynx 2019; 47:55-64. [PMID: 31079859 DOI: 10.1016/j.anl.2019.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 03/31/2019] [Accepted: 04/18/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To delineate the advantages and steps of stapedotomy with incus vibroplasty, to assess the safety and efficacy of this method via the authors' experiences, and to overview the literature regarding other surgical options in advanced otosclerosis determining the place of stapedotomy with incus vibroplasty in the therapeutic range. METHODS Four patients were enrolled in the study presenting severe mixed hearing loss of at least one side on pure tone audiometry. Based on complementary audiological examinations including stapedial reflex test and multifrequency tympanometry, all cases were suspected as advanced otosclerosis. Stapedotomy with incus vibroplasty - the combination of laser stapedotomy and simultaneous Vibrant Soundbridge implantation - was performed in each patient. Preoperative pure tone average, speech recognition thresholds and word recognition scores were compared to one-year postoperative free-field values with the implant switched on focusing on functional gain. RESULTS Among 4 participants (3 females, 1 male) the mean age (SD) was 66 years (35). In three cases Nitinol, in one case NitiBond piston was inserted. One-year postoperative free-field functional gains were 30 dB, 34 dB, 42 dB and 51 dB, respectively. One-year postoperative free-field speech recognition thresholds were 45 dB, 45 dB, 49 dB and 50 dB, respectively, while word recognition scores were 70%, 70%, 70% and 75%, respectively. CONCLUSION Postoperative results in our serie regarding pure tone average and word recognition score proved to be better than those found in the literature. Stapedotomy with incus vibroplasty - through sufficient air-bone gap closure and simultaneous sensorineural component management - seems to be a promising surgical solution in advanced otosclerosis, requiring further investigation.
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Affiliation(s)
- Andras Burian
- University of Pécs, Department of Otorhinolaryngology, Pécs, 7621, Munkácsy M Str 2, Hungary.
| | - Imre Gerlinger
- University of Pécs, Department of Otorhinolaryngology, Pécs, 7621, Munkácsy M Str 2, Hungary.
| | - Tamas Toth
- University of Pécs, Department of Otorhinolaryngology, Pécs, 7621, Munkácsy M Str 2, Hungary.
| | - Zalan Piski
- University of Pécs, Department of Otorhinolaryngology, Pécs, 7621, Munkácsy M Str 2, Hungary.
| | - Gabor Rath
- University of Pécs, Department of Paediatrics, 7623, Pécs, József Attila Str 7, Hungary.
| | - Peter Bako
- University of Pécs, Department of Otorhinolaryngology, Pécs, 7621, Munkácsy M Str 2, Hungary.
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Lin J, Chen S, Zhang H, Xiong H, Zhang Z, Liang M, Zhang X, Ye H, Zheng Y. Application of Implantable Hearing Aids and Bone Conduction Implant System in patients with bilateral congenital deformation of the external and middle ear. Int J Pediatr Otorhinolaryngol 2019; 119:89-95. [PMID: 30690308 DOI: 10.1016/j.ijporl.2018.12.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 12/18/2018] [Accepted: 12/19/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To determine the efficacy of the application of the Implantable Hearing Aids and Bone Conduction Implant System in patients with bilateral congenital deformation of the external and middle ear. METHODS twenty patients with bilateral congenital malformation of the external and middle ear were included in the study. Implantable Hearing Aids implantation was performed in ten patients, and Bone Conduction Implant System implantation was performed in ten patients. Audiometric tests, including pure-tone audiometry and speech discrimination in the free field were performed pre-operatively and post-operatively. RESULTS Implantable Hearing Aids and Bone Conduction Implant System implantation were performed successfully in all patients. The mean pure-tone threshold improvement with Implantable Hearing Aids or Bone Conduction Implant System activation in the free filed pure tone audiometry was 25 dB and ranged from 0.25 to 4 kHz. Mean free field speech discrimination in quiet was 80% at 65 dB compared to 18% pre-operatively. The mean pure-tone threshold improvement with Bone Conduction Implant System was 25.5 dB better than 18.2 dB with Implantable Hearing Aids. The mean free filed speech discrimination in quite improvement with Bone Conduction Implant System was 66% better than 58% with Implantable Hearing Aids. CONCLUSION Implantable Hearing Aids or Bone Conduction Implant System are effective options for improving hearing in patients with bilateral congenital deformation of the external and middle ear. The procedure is safe and effective, and its indications are wider than those of tympanoplasty for such cases. Furthermore, the Bone Conduction Implant System is better than Implantable Hearing Aids, tympanoplasty and hearing aids.
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Affiliation(s)
- Junfeng Lin
- Departments of a Otolaryngology, Sun Yat-sen Memorial Hospital, Xinhua College, Sun Yat-Sen University, Guangzhou, China
| | - Suijun Chen
- Departments of a Otolaryngology, Sun Yat-sen Memorial Hospital, Xinhua College, Sun Yat-Sen University, Guangzhou, China; Institute of Hearing and Speech-Language Science, Xinhua College, Sun Yat-Sen University, Guangzhou, China; Department of Hearing and Speech Science, Xinhua College, Sun Yat-Sen University, Guangzhou, China.
| | - Huasong Zhang
- Departments of a Otolaryngology, Sun Yat-sen Memorial Hospital, Xinhua College, Sun Yat-Sen University, Guangzhou, China
| | - Hao Xiong
- Departments of a Otolaryngology, Sun Yat-sen Memorial Hospital, Xinhua College, Sun Yat-Sen University, Guangzhou, China; Department of Hearing and Speech Science, Xinhua College, Sun Yat-Sen University, Guangzhou, China
| | - Zhigang Zhang
- Departments of a Otolaryngology, Sun Yat-sen Memorial Hospital, Xinhua College, Sun Yat-Sen University, Guangzhou, China
| | - Maojin Liang
- Departments of a Otolaryngology, Sun Yat-sen Memorial Hospital, Xinhua College, Sun Yat-Sen University, Guangzhou, China
| | - Xueyuan Zhang
- Departments of a Otolaryngology, Sun Yat-sen Memorial Hospital, Xinhua College, Sun Yat-Sen University, Guangzhou, China
| | - Haiwen Ye
- Departments of a Otolaryngology, Sun Yat-sen Memorial Hospital, Xinhua College, Sun Yat-Sen University, Guangzhou, China
| | - Yiqing Zheng
- Departments of a Otolaryngology, Sun Yat-sen Memorial Hospital, Xinhua College, Sun Yat-Sen University, Guangzhou, China; Institute of Hearing and Speech-Language Science, Xinhua College, Sun Yat-Sen University, Guangzhou, China; Department of Hearing and Speech Science, Xinhua College, Sun Yat-Sen University, Guangzhou, China.
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Abstract
"Hearing loss in the pediatric population can have significant social and developmental implications. Early auditory rehabilitation by at least 6 months of age is imperative. Although traditional hearing aids are often a first-line treatment option, there is a wide array of implantable auditory devices available. This article describes the indications for such devices as they pertain to the pediatric population, including osseointegrated bone-conduction devices, middle ear implants, cochlear implants, and auditory brainstem implants."
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Zahnert T, Mlynski R, Löwenheim H, Beutner D, Hagen R, Ernst A, Zehlicke T, Kühne H, Friese N, Tropitzsch A, Luers J, Todt I, Hüttenbrink KB. Long-Term Outcomes of Vibroplasty Coupler Implantations to Treat Mixed/Conductive Hearing Loss. Audiol Neurootol 2019; 23:316-325. [DOI: 10.1159/000495560] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 11/15/2018] [Indexed: 11/19/2022] Open
Abstract
Objective: To evaluate the long-term safety and performance of four different vibroplasty couplers (round window, oval window, CliP and Bell coupler) in combination with an active middle ear implant. Methods: This was a multicentre, prospective, long-term study including 5 German hospitals. Thirty adult subjects suffering from conductive or mixed hearing loss were initially enrolled for the study, 24 of these were included in the final analysis with up to 36 months of postsurgical follow-up data. Bone conduction and air conduction were measured pre- and postoperatively to evalu ate safety. Postoperative aided sound field thresholds and Freiburger monosyllable word recognition scores were compared to unaided pre-implantation results to confirm performance. Additional speech tests compared postoperative unaided with aided results. To determine patient satisfaction, an established quality-of-life questionnaire developed for conventional hearing aid usage was administered to all subjects. Results: Mean postoperative bone conduction thresholds remained stable throughout the whole study period. Mean functional gain for all couplers investigated was 38.5 ± 11.4 dB HL (12 months) and 38.8 ± 12.5 dB HL (36 months). Mean word recognition scores at 65 dB SPL increased from 2.9% in the unaided by 64.2% to 67.1% in the aided situation. The mean postoperative speech reception in quiet (or 50% understanding of words in sentences) shows a speech intelligibility improvement at 36 months of 17.8 ± 12.4 dB SPL over the unaided condition. The signal-to-noise ratio (SNR) improved by 5.9 ± 7.2 dB SNR over the unaided condition. High subjective device satisfaction was reflected by the International Inventory for Hearing Aids scored very positively. Conclusion: A significant improvement was seen with all couplers, and audiological performance did not significantly differ between 12 and 36 months after surgery.
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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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Vogt K, Frenzel H, Ausili SA, Hollfelder D, Wollenberg B, Snik AFM, Agterberg MJH. Improved directional hearing of children with congenital unilateral conductive hearing loss implanted with an active bone-conduction implant or an active middle ear implant. Hear Res 2018; 370:238-247. [PMID: 30174182 DOI: 10.1016/j.heares.2018.08.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 07/18/2018] [Accepted: 08/20/2018] [Indexed: 11/19/2022]
Abstract
Different amplification options are available for listeners with congenital unilateral conductive hearing loss (UCHL). For example, bone-conduction devices (BCDs) and middle ear implants. The present study investigated whether intervention with an active BCD, the Bonebridge, or a middle ear implant, the Vibrant Soundbridge (VSB), affected sound-localization performance of listeners with congenital UCHL. Listening with a Bonebridge or VSB might provide access to binaural cues. However, when fitted with the Bonebridge, but not with a VSB, binaural processing might be affected through cross stimulation of the contralateral normal hearing ear, and could interfere with processing of binaural cues. In the present study twenty-three listeners with congenital UCHL were included. To assess processing of binaural cues, we investigated localization abilities of broadband (BB, 0.5-20 kHz) filtered noise presented at varying sound levels. Sound localization abilities were analyzed separately for stimuli presented at the side of the normal-hearing ear, and for stimuli presented at the side of the hearing-impaired ear. Twenty-six normal hearing children and young adults were tested as control listeners. Sound localization abilities were measured under open-loop conditions by recording head-movement responses. We demonstrate improved sound localization abilities of children with congenital UCHL, when listening with a Bonebridge or VSB, predominantly for stimuli presented at the impaired (aided) side. Our results suggest that the improvement is not related to accurate processing of binaural cues. When listening with the Bonebridge, despite cross stimulation of the contralateral cochlea, localization performance was not deteriorated compared to listening with a VSB.
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Affiliation(s)
- K Vogt
- Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands.
| | - H Frenzel
- University of Lübeck and HNO-Praxis-Lübeck, Lübeck, Germany
| | - S A Ausili
- Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - D Hollfelder
- Department of Otorhinolaryngology and Plastic Operations, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - B Wollenberg
- Department of Otorhinolaryngology and Plastic Operations, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - A F M Snik
- Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - M J H Agterberg
- Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands; Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
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Active Transcutaneous Bone Conduction Implant: Middle Fossa Placement Technique in Children With Bilateral Microtia and External Auditory Canal Atresia. Otol Neurotol 2018; 39:e342-e348. [DOI: 10.1097/mao.0000000000001809] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Simon F, Hempel JM. [Extended applications for cochlear implantation]. MMW Fortschr Med 2018; 160:51-53. [PMID: 29721870 DOI: 10.1007/s15006-018-0485-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Florian Simon
- Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Klinikum der Universität München, Marchioninistr. 15, D-81377, München, Deutschland.
| | - John-Martin Hempel
- Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Klinikum der Universität München, Marchioninistr. 15, D-81377, München, Deutschland
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Vibroplasty in Severe Congenital or Acquired Meatal Stenosis by Coupling an Active Middle Ear Implant to the Short Process of the Incus. Otol Neurotol 2017; 38:996-1004. [DOI: 10.1097/mao.0000000000001459] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Célérier C, Thierry B, Coudert C, Blanchard M, Loundon N, Garabédian EN, Denoyelle F. Results of VSB implantation at the short process of the incus in children with ear atresia. Int J Pediatr Otorhinolaryngol 2017; 93:83-87. [PMID: 28109505 DOI: 10.1016/j.ijporl.2016.12.038] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 11/26/2016] [Accepted: 12/27/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE(S) To describe a new and more simple surgical procedure for implanting the Vibrant Soundbridge (VSB) on the short process of the incus in children with ear atresia and atretic plate and present the audiometric results. METHODS Since 2014, pre- and post-operative audiometric tests with tonal and vocal audiometryat the maximal follow up, respectively 33, 22 and 12 months were performed after VSB implantation at the ENT department, Necker Enfants Malades Hospital, Paris, France. 3 children aged 11, 9 and 15 years with conductive hearing loss due to high grade ear atresia and absent ear canal were implanted. The malformed and fused malleus-incus complex was found to be immobile in two of the subjects, who then underwent a superior tympanotomy to carefully remobilize the malleus. Stapes were mobile in all cases. The FMT clip was customized and crimped on the short process, stabilized by the metallic wire. RESULTS At the maximum follow-up time, the bone conduction was unchanged, and the mean aided ACPTA was 21 dB, 29 dB and 30 dB, compared to 66 dB, 63 dB and 68 dB unaided, respectively. The word recognition score (WRS) at 65 dB SPL increased from 10%, 10% and 70% (unaided) respectively to 100% (aided). CONCLUSIONS The long process of the incus is usually very hypoplastic in patients with ear atresia with a fused malleus-incus complex lateral to the stapes. VSB coupling to the long process of the incus or the stapes may be challenging in small mastoids. Coupling to the short process of the incus is comparatively a simple procedure, since there is no need for posterior tympanotomy and has no proximity to the facial nerve. The results of this study are similar to other ear atresia cases in the literature with classic FMT placement on the stapes or long process of the incus. Outcomes should be confirmed in a larger number of patients.
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Affiliation(s)
- Charlotte Célérier
- ENT Department, Necker-Enfants Malades Hospital, Paris-Descartes University, Paris, France.
| | - Briac Thierry
- ENT Department, Necker-Enfants Malades Hospital, Paris-Descartes University, Paris, France
| | - Cyrille Coudert
- ENT Department, Necker-Enfants Malades Hospital, Paris-Descartes University, Paris, France
| | - Marion Blanchard
- ENT Department, Necker-Enfants Malades Hospital, Paris-Descartes University, Paris, France
| | - Natalie Loundon
- ENT Department, Necker-Enfants Malades Hospital, Paris-Descartes University, Paris, France
| | - Erea Noel Garabédian
- ENT Department, Necker-Enfants Malades Hospital, Paris-Descartes University, Paris, France
| | - Françoise Denoyelle
- ENT Department, Necker-Enfants Malades Hospital, Paris-Descartes University, Paris, France.
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