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Lee S, Motegi M, Koike T. Effectiveness of active middle ear implant placement methods in pathological conditions: basilar membrane vibration simulation. Front Neurol 2024; 15:1417711. [PMID: 39175763 PMCID: PMC11339716 DOI: 10.3389/fneur.2024.1417711] [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: 05/22/2024] [Accepted: 07/24/2024] [Indexed: 08/24/2024] Open
Abstract
Active middle ear implants (AMEI) amplify mechanical vibrations in the middle ear and transmit them to the cochlea. The AMEI includes a floating mass transducer (FMT) that can be placed using two different surgical approaches: "oval window (OW) vibroplasty" and "round window (RW) vibroplasty." The OW and RW are windows located on the cochlea. Normally, sound stimulus is transmitted from the middle ear to cochlea via the OW. RW vibroplasty has been suggested as an alternative method due to the difficulty of applying OW vibroplasty in patients with ossicle dysfunction. Several reports compare the advantages of each approach through pre and postoperative hearing tests. However, quantitatively assessing the treatment effect is challenging due to individual differences in pathologies. This study investigates the vibration transmission efficiency of each surgical approach using a finite-element model of the human cochlea. Vibration of the basilar membrane (BM) of the cochlea is simulated by applying the stimulus through the OW or RW. Pathological conditions, such as impaired stapes mobility, are simulated by increasing the stiffness of the stapedial annular ligament. RW closure due to chronic middle ear diseases is a common clinical occurrence and is simulated by increasing the stiffness of the RW membrane in the model. The results show that the vibration amplitude of the BM is larger when the stimulus is applied to the RW compared to the OW, except for cases of RW membrane ossification. The difference in these amplitudes is particularly significant when stapedial mobility is limited. These results suggest that RW vibroplasty would be advantageous, especially in cases of accompanying stapedial mobility impairment. Additionally, it is suggested that transitioning to OW vibroplasty could still ensure a sufficient level of vibratory transmission efficiency when placing the FMT on the RW membrane is difficult due to anatomical problems in the tympanic cavity or confirmed severe pathological conditions around the RW.
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Affiliation(s)
- Sinyoung Lee
- Department of Mechanical Engineering, Faculty of Engineering, Graduate Faculty of Interdisciplinary Research, University of Yamanashi, Yamanashi, Japan
| | - Masaomi Motegi
- Department of Otolaryngology-Head and Neck Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Takuji Koike
- Department of Mechanical and Intelligent Systems Engineering, Graduate School of Informatics and Engineering, The University of Electro-Communications, Tokyo, Japan
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Maier H, Lenarz T, Busch S. An easy method to determine crucial AMEI performance parameters from clinical routine data in individuals - Part 1: maximum output. Int J Audiol 2024:1-8. [PMID: 38690669 DOI: 10.1080/14992027.2024.2341100] [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: 10/27/2023] [Accepted: 04/01/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE The frequency specific maximum output (MO) of active middle ear implants is the most crucial parameter for speech intelligibility. We determined individual MO from clinical routine data in round window (RW) coupling of the Vibrant Soundbridge (VSB). DESIGN Monocentric, retrospective analysis. STUDY SAMPLE 68 ears implanted with the VSB at the RW were analysed. Using bone conduction and direct threshold, MO was determined for combinations of implants (VORP502, VORP503) and processors (Samba, Amadé). Coupling modes were: (A) without coupler (N = 28), (B) spherical coupler (N = 19), (C) soft coupler (N = 10) or (D) custom-made "Hannover coupler" (N = 11). RESULTS The MO frequency dependence was similar for coupling types (A-D) with a maximum at 1.5 kHz. No differences between groups were observed, although the average MO of the soft coupler was 10 dB lower. The average MO (0.5, 1.0, 2.0, 4.0 kHz) was (A) 77.6 ± 15.0 dB HL, (B) 81.0 ± 11.1 dB HL, (C) 67.6 ± 17.9 dB HL (C), and (D) 79.6 ± 11.7 dB HL (D). CONCLUSION The individual MO can be determined from patients' clinical data. It permits in-depth analyses of patient outcomes and definition of evidence-based indication and decision criteria.
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Affiliation(s)
- Hannes Maier
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
- Cluster of Excellence "Hearing4all", Oldenburg, Germany
| | - Thomas Lenarz
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
- Cluster of Excellence "Hearing4all", Oldenburg, Germany
| | - Susan Busch
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
- Cluster of Excellence "Hearing4all", Oldenburg, Germany
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Morales-Puebla JM, Lassaletta L, Sánchez-Cuadrado I, Calvino M, Gavilán J. Is Age a Limiting Factor for Audiological Results in Active Middle Ear Implants? J Pers Med 2023; 13:1650. [PMID: 38138877 PMCID: PMC10744468 DOI: 10.3390/jpm13121650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 11/24/2023] [Accepted: 11/25/2023] [Indexed: 12/24/2023] Open
Abstract
Active middle ear implants (AMEI) are implantable options for patients with sensorineural, conductive, or mixed hearing loss who are not good candidates for hearing aids. The aim of this study was to compare audiological, surgical, quality of life, and sound quality outcomes in adults <60 and ≥60 years receiving an AMEI. Twenty adult patients who underwent AMEI implantation were divided into two groups, <60 and ≥60 y. Preoperative tests included pure-tone average and speech discrimination score (SDS) at 65 dB for disyllabic words in quiet. Postoperative measures included AMEI-aided bone conduction threshold, free-field warble-tone threshold, and SDS at 65 dB for disyllabic words in quiet 12 months after the AMEI fitting. Subjective benefit was evaluated using the Nijmegen Cochlear Implant Questionnaire (NCIQ), Glasgow Benefit Inventory (GBI), and Hearing Implant Sound Quality Index (HISQUI19). Mean functional gain was 32 and 30 dB, and SDS at 65 dB improved from 19 to 95% and from 31 to 84% in the <60 and ≥60 y groups, respectively. All NCIQ domains improved following surgery, and all patients had a positive overall GBI score. The mean HISQUI19 score was 97 in both age groups. AMEIs are an effective hearing restoration method for older adults suffering from conductive or mixed hearing loss.
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Affiliation(s)
- J. Manuel Morales-Puebla
- Department of Otolaryngology, La Paz University Hospital, IdiPAZ Research Institute, 28046 Madrid, Spain; (L.L.); (I.S.-C.); (M.C.); (J.G.)
- Biomedical Research Networking Centre on Rare Diseases (CIBERER), Institute of Health Carlos III, U761, 28029 Madrid, Spain
| | - Luis Lassaletta
- Department of Otolaryngology, La Paz University Hospital, IdiPAZ Research Institute, 28046 Madrid, Spain; (L.L.); (I.S.-C.); (M.C.); (J.G.)
- Biomedical Research Networking Centre on Rare Diseases (CIBERER), Institute of Health Carlos III, U761, 28029 Madrid, Spain
| | - Isabel Sánchez-Cuadrado
- Department of Otolaryngology, La Paz University Hospital, IdiPAZ Research Institute, 28046 Madrid, Spain; (L.L.); (I.S.-C.); (M.C.); (J.G.)
| | - Miryam Calvino
- Department of Otolaryngology, La Paz University Hospital, IdiPAZ Research Institute, 28046 Madrid, Spain; (L.L.); (I.S.-C.); (M.C.); (J.G.)
- Biomedical Research Networking Centre on Rare Diseases (CIBERER), Institute of Health Carlos III, U761, 28029 Madrid, Spain
| | - Javier Gavilán
- Department of Otolaryngology, La Paz University Hospital, IdiPAZ Research Institute, 28046 Madrid, Spain; (L.L.); (I.S.-C.); (M.C.); (J.G.)
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Hundertpfund J, Dejaco T, Meyer JE, Óvári A. Round-Window Vibroplasty: Systematic Review and Meta-Analysis of Audiological Effectiveness With Different Round-Window Coupling Techniques. Otol Neurotol 2023; 44:e549-e559. [PMID: 37504977 DOI: 10.1097/mao.0000000000003958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
OBJECTIVE Active middle ear implants can be directly coupled to the round-window (RW) membrane via RW Vibroplasty. The objectives of this systematic review were to summarize data on different RW coupling techniques and to investigate their effect on audiological and safety outcomes using meta-analyses. DATABASES REVIEWED PubMed (MEDLINE), Cochrane Library, and Embase (DIMDI). METHODS All publications reporting on audiological outcomes in human patients after RW Vibroplasty were included. Two independent reviewers carried out screening and data extraction. Meta-analyses and meta-regression were used to evaluate the potential effects of surgical and demographic parameters on primary audiological outcomes. Adverse events were extracted and tabulated for qualitative analysis. RESULTS Fourteen different combinations of surgical coupling parameters were identified in 61 included publications. Overall, data from 23 publications could be used for meta-analyses. Significantly better aided sound-field thresholds were reported for RW Vibroplasty performed without a dedicated coupler and using fascia as interponate, compared with RW Vibroplasty with an RW coupler or without an interponate. These effects were not found in other outcomes (i.e., functional gain, word recognition score). Reporting of adverse events was relatively heterogeneous, with 32 explicit mentions of revision surgery after the loss of coupling efficacy. CONCLUSION There are numerous publications investigating the effectiveness of coupling active middle ear implants to the RW membrane. However, studies are typically undersampled and of low evidence level. Using meta-analyses, weighted means, and qualitative analyses enabled a summary of the existing literature on audiological and safety outcomes after RW Vibroplasty. Individual selection of the most appropriate coupling modality with standardized intraoperative measurement and careful patient follow-up may be considered key factors for achieving effective RW coupling.
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Round window stimulation with an interface coupler demonstrates proof of concept. Hear Res 2022; 421:108512. [DOI: 10.1016/j.heares.2022.108512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 03/22/2022] [Accepted: 04/27/2022] [Indexed: 11/18/2022]
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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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7
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Jenkins HA, Greene N, Tollin DJ. Round Window Stimulation of the Cochlea. Front Neurol 2022; 12:777010. [PMID: 34970211 PMCID: PMC8712317 DOI: 10.3389/fneur.2021.777010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/11/2021] [Indexed: 11/14/2022] Open
Abstract
Mixed hearing loss associated with a sensorineural component and an impaired conductive mechanism for sound from the external ear canal to the cochlea represents a challenge for rehabilitation using either surgery or traditional hearing amplification. Direct stimulations of the ossicular chain and the round window (RW) membrane have allowed an improved hearing in this population. The authors review the developments in basic and clinical research that have allowed the exploration of new routes for inner ear stimulation. Similar changes occur in the electrophysiological measures in response to auditory stimulation through the traditional route and direct mechanical stimulation of the RW. The latter has proven to be very effective as a means of hearing rehabilitation in a group of patients with significant difficulties with hearing and communication.
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Affiliation(s)
- Herman A Jenkins
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, United States
| | - Nathaniel Greene
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, United States
| | - Daniel J Tollin
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, United States.,Department of Physiology and Biophysics, University of Colorado School of Medicine, Aurora, CO, United States
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Evaluation of a New Material From an Allogenic Collagen Scaffold as a Suitable Coupling Option for Round Window Vibroplasty. Otol Neurotol 2021; 42:442-446. [PMID: 33496427 DOI: 10.1097/mao.0000000000002961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION In round window vibroplasty the most efficient coupling technique for contact of the floating mass transducer (FMT) to the round window membrane (RWM) is yet to be determined. Various materials placed between the FMT and the RWM have been proposed to enable better stimulation of the cochlea. Collagenous scaffolds derived from decellularized extracellular cartilage matrices as a commercially available biomaterial are already used for other applications in ear surgery. We aimed to examine the coupling properties of collagen scaffolds compared with commonly used other materials (round window soft coupler, porcine perichondrium, and cartilage) as interponate between the FMT and the RWM in vibroplasty. METHODS A well-established in vitro temporal bone model was used. Volume velocities were measured with collagen scaffold compared with different interponates (round window soft coupler, porcine perichondrium, and cartilage) at 800, 1000, 1250, 1600, 2000, 2500, 3150, and 4000 Hz levels. RESULTS Statistical analysis revealed no superiority of commonly used materials compared with collagen scaffolds at all tested volume velocities (p > 0.05). DISCUSSION We could demonstrate that collagenous scaffolds of decellularized extracellular cartilage matrices have similar vibrational properties as conventional coupling materials of the FMT to the RWM in vibroplasty. Therefore, as a commercially available new material they display a suitable coupling option for round window vibroplasty.
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Schraven SP, Dohr D, Weiss NM, Mlynski R, Dalhoff E. [Laser Doppler vibrometric measurements on human temporal bones]. HNO 2021; 69:491-500. [PMID: 33566127 DOI: 10.1007/s00106-021-00995-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2020] [Indexed: 11/30/2022]
Abstract
Laser Doppler vibrometric (LDV) measurements on human temporal bones represent the standard method for predicting the performance of active middle ear implants (AMEI) and are used as preclinical tests in the development, approval process, and indication expansion of AMEI. The quality of the coupling of the floating mass transducer to the mobile structures of the middle ear is decisive for the performance of the implant and patients' hearing perception. The cochlea can be stimulated via the oval window (forward stimulation) or the round window (reverse stimulation). For forward stimulation, the ASTM standard F2504-05 defines a method to ensure physiologically normal properties of the temporal bones used in the experiments. For reverse stimulation, which depends even more critically on the quality of the temporal bone, a comparable standard method is lacking. Appropriate preparation and storage of the human petrous bone as well as suitable LDV test setups with respect to calibration and reproducibility of measuring positions and angles provide results that allow a comparison of different types of coupling and also correlate well with clinical data.
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Affiliation(s)
- S P Schraven
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Doberaner Straße 137-139, 18057, Rostock, Deutschland.
| | - D Dohr
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Doberaner Straße 137-139, 18057, Rostock, Deutschland
| | - N M Weiss
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Doberaner Straße 137-139, 18057, Rostock, Deutschland
| | - R Mlynski
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Doberaner Straße 137-139, 18057, Rostock, Deutschland
| | - E Dalhoff
- Sektion für Physiologische Akustik und Kommunikation, Universitäts-HNO-Klinik Tübingen, Tübingen, Deutschland
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Rahne T, Skarzynski PH, Hagen R, Radeloff A, Lassaletta L, Barbara M, Plontke SK, Mlynski R. A retrospective European multicenter analysis of the functional outcomes after active middle ear implant surgery using the third generation vibroplasty couplers. Eur Arch Otorhinolaryngol 2020; 278:67-75. [PMID: 32451668 PMCID: PMC7814408 DOI: 10.1007/s00405-020-06064-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 05/15/2020] [Indexed: 11/28/2022]
Abstract
Purpose To evaluate the safety and performance of three novel vibroplasty couplers that allow attachment of the floating mass transducer of a transcutaneous active middle ear implant (AMEI) to the round window (RW) membrane, the long process (LP), or the incus body and the short process (SP) of the incus. Methods Retrospective multicenter cohort study of 25 AMEI users with sensorineural or mixed hearing loss that were among the first implanted with an AMEI vibrating ossicular prosthesis in combination with the third generation of vibroplasty couplers between 2014 and 2016. Main Outcome Measures were bone-conduction pure-tone and vibroplasty thresholds, postoperative aided sound field thresholds and postoperative aided word recognition score (WRS). Results Bone conduction threshold changes of more than 10 dB in 4PTABC were observed in two subjects. A mean improvement of 57.8% in speech recognition was observed with a mean WRS at 65 dB SPL improving from 14.8% (SD 21.9%) preoperatively to a mean aided score of 72.6% (SD 18.6%). Sound field thresholds improved from an average 4PTASF of 64.1 dB HL (SD 9.8 dB HL) to 37.0 dB HL (SD 8.9 dB HL), resulting in a mean functional gain of 27.1 dB. There was no significant difference in WRS or functional gain between the coupler types. Conclusion Initial experience shows that all three third generation vibroplasty couplers represent safe and efficient attachment options for the FMT allowing the surgeon to choose the coupling type based on the present pathology.
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Affiliation(s)
- Torsten Rahne
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle (Saale), Halle (Saale), Germany.
| | - Piotr Henryk Skarzynski
- Department of Teleaudiology and Screening, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw, Poland.,Heart Failure and Cardiac Rehabilitation Department, 2nd Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland.,Institute of Sensory Organs, Kajetany, Poland
| | - Rudolf Hagen
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Andreas Radeloff
- Department of Otorhinolaryngology, University of Oldenburg, Oldenburg, Germany
| | - Luis Lassaletta
- Department of Otolaryngology, La Paz University Hospital, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER-U761), Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Maurizio Barbara
- NESMOS Department, Otorhinolaryngology Clinic, University Hospital Sant'Andrea, Sapienza University, Rome, Italy
| | - Stefan K Plontke
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle (Saale), Halle (Saale), Germany
| | - Robert Mlynski
- Department of Otorhinolaryngology, Head and Neck Surgery "Otto Körner", University Medical Center Rostock, Rostock, Germany
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Zhang J, Tian J, Ta N, Rao Z. Finite element analysis of round-window stimulation of the cochlea in patients with stapedial otosclerosis. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2019; 146:4122. [PMID: 31893738 DOI: 10.1121/1.5134770] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 10/30/2019] [Indexed: 06/10/2023]
Abstract
An active actuator coupled to the round window (RW) can transmit mechanical vibrations into the cochlea and has become a therapeutic option of hearing rehabilitation for patients with stapedial otosclerosis. A finite-element model of the human ear that includes sound transmission effects of the vestibular and cochlear aqueducts of the inner ear is adopted in this study for investigating the cochlear response to RW stimulation under stapes fixation. There are two effects due to otosclerosis of the stapes: the fixation of the stapedial annular ligament (SAL) and the increase of the stapes mass. The frequency responses of the middle ear and cochlea with normal and otosclerotic stapes are calculated under sound and RW stimulations. The results show that changes in the material property of the stapes have different effects on the cochlear responses under sound and RW stimulations. Because of the vestibuli aqueduct, the reduction in the low-frequency magnitude of the pressure difference across the cochlear partition due to SAL fixation is much smaller under RW stimulation than under sound stimulation. The results of this study help understand sound transmission during RW stimulation in patients with stapedial otosclerosis.
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Affiliation(s)
- Jing Zhang
- Institute of Vibration, Shock and Noise, State Key Laboratory of Mechanical System and Vibration, Shanghai Jiao Tong University, Shanghai 200240, People's Republic of China
| | - Jiabin Tian
- Wuhan Second Ship Design and Research Institute, Wuhan 403205, People's Republic of China
| | - Na Ta
- Institute of Vibration, Shock and Noise, State Key Laboratory of Mechanical System and Vibration, Shanghai Jiao Tong University, Shanghai 200240, People's Republic of China
| | - Zhushi Rao
- Institute of Vibration, Shock and Noise, State Key Laboratory of Mechanical System and Vibration, Shanghai Jiao Tong University, Shanghai 200240, People's Republic of China
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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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13
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Chang CJ, Wen YH, Sun CH, Beltrame MA, Wu HP. Treatment of moderate-to-severe otosclerosis with simultaneous piston surgery and incus vibroplasty. Tzu Chi Med J 2019; 31:96-101. [PMID: 31007489 PMCID: PMC6450152 DOI: 10.4103/tcmj.tcmj_176_17] [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
Objective: Whereas the nature of otosclerosis has been extensively investigated, treatment modalities in advanced otosclerosis with the sensorineural hearing loss (SNHL) are relatively unexplored. Materials and Methods: This article presents a retrospective case series study of nine patients who received a one-stage piston coupled with Vibrant Soundbridge® vibroplasty in treating otosclerosis with moderate-to-severe SNHL. Results: The findings suggest that hearing loss could be restored across frequencies and no significant change in the bone-conduction threshold were measured. Conclusion: One-stage piston surgery coupled with incus vibroplasty is a safe procedure and has sufficient efficacy to restore hearing loss in patients with otosclerosis with moderate-to-severe SNHL.
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Affiliation(s)
- Chan-Jung Chang
- Department of Otolaryngology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Yu-Hsuan Wen
- Department of Otolaryngology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chuan-Hung Sun
- Department of Otolaryngology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | | | - Hung-Pin Wu
- School of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Otolaryngology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
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Svrakic M, Vambutas A. Medical and Audiological Indications for Implantable Auditory Devices. Otolaryngol Clin North Am 2019; 52:195-210. [DOI: 10.1016/j.otc.2018.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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YAO WENJUAN, TANG DUTIN, CHEN YIQIANG, LI BINGTAI. STUDY ON VIBRATION CHARACTERISTICS AND TRANSMISSION PERFORMANCE OF ROUND WINDOW MEMBRANE UNDER INVERSE EXCITATION. J MECH MED BIOL 2018. [DOI: 10.1142/s0219519418500331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
According to the vibration characteristics of the round window membrane, a mechanical model that contains round window membrane and the soft tissue is established. The Euler equation of the whole of round window membrane and the soft tissue and the complementary boundary conditions are derived by the variational principle. Combined with the Bessel function, the analytical solution of the total displacement of round window membrane and the soft tissue is obtained by using Mathematica. The results are in good agreement with experimental data, which confirms the validity of the analytical solution of the model. At the same time, the effect of different thicknesses and different elastic modulus of soft tissue on the total displacement of round window membrane and soft tissue is studied by analytical method. The results show that with the thickening of the soft tissue, the total displacement of round window membrane and the soft tissue decreased gradually. However, with the decrease of elastic modulus of the soft tissue, the total displacement of round window membrane and the soft tissue increased gradually. Furthermore, the relationship between thickness and elastic modulus of the soft tissue and the corresponding range selection is achieved, which can evaluate the transmission performance of round window membrane efficiently and provide theoretical basis for the reverse excitation of artificial prosthesis.
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Affiliation(s)
- WENJUAN YAO
- Shanghai Institute of Applied Mathematics and Mechanics, Shanghai University, Shanghai 200040, P. R.China
| | - DUTIN TANG
- Department of Civil Engineering, Shanghai University, Shanghai 200444, P. R. China
| | - YIQIANG CHEN
- Shanghai Waterway Engineering Design and Consulting Co., Ltd, Shanghai 200120, P. R. China
| | - BINGTAI LI
- Department of Civil Engineering, Shanghai University, Shanghai 200444, P. R. China
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Round and Oval Window Anatomic Variability: Its Implication for the Vibroplasty Technique. Otol Neurotol 2018; 38:e50-e57. [PMID: 28346291 DOI: 10.1097/mao.0000000000001385] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study is to evaluate the anatomical variability of round and oval window regions and its relationship with their closest structures, to determine its implication on the fitting and stabilization of the middle ear implant Vibrant Soundbridge. METHODS Variations of the anatomy of round and oval window regions were assessed in a total of 85 human dissected temporal bones. Afterward, we evaluated the adaptation and subsequent stabilization of the floating mass transducer (FMT) of the Vibrant Soundbridge in 67 cases in round window (RW) and in 22 cases in oval window (OW), and the influence that the variability of the different anatomical features examined had on this stabilization. We also assessed access and surgeon's view of the RW niche through the facial recess approach. RESULTS Stabilization of the FMT in the RW was achieved in 53 (79%) of the 67 cases; we found that the less favorable anatomical conditions for stabilization were: membrane smaller than 1.5 mm, presence of a high jugular bulb and a narrow or very narrow RW niche. Frequently, two or more of these conditions happened simultaneously. In seven cases (22%) access to the RW through facial recess approach did not allow positioning the FMT in place. OW stabilization succeeded in 18 (82%) of the 22 cases. CONCLUSION Round and oval window vibroplasty are difficult surgical techniques. To place the FMT directly on the OW may be easier as we do not have to drill the niche. In both regions there are some anatomical conditions that hinder fitting the FMT and even make it impossible. Once fitted, the main problem is to achieve good stabilization of the device.
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Gostian AO, Otte MS, Pazen D, Ortmann M, Schwarz D, Hüttenbrink KB, Beutner D. Influence of backside loading on the floating mass transducer: An in vitro experimental study. Clin Otolaryngol 2017; 43:538-543. [PMID: 29054109 DOI: 10.1111/coa.13017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 11/30/2022]
Abstract
HYPOTHESIS The vibration of the floating mass transducer (FMT) of a single active middle-ear implant (AMEI) is distinctly influenced by the properties of the material coupled to its back side. BACKGROUND In round window vibroplasty, the FMT needs to be padded against the surrounding bone opposite from the round window membrane. This represents one factor influencing its performance as a round window driver. Therefore, we examined the effects of different materials linked to the back side of an FMT on its vibration range. METHODS The back side of an FMT was glued to a silicone cylinder 1.0 mm in diameter and 1.0 mm - 1.5 mm in length and of 40A, 50A or 70A Shore hardness; to cartilage of equivalent size; or to a round window soft coupler (RWSC), all firmly fixed on a steel plate. The vibrations were determined by a laser Doppler vibrometer (LDV) measuring the velocity of the centre point on the front side of the FMT. RESULTS The materials on the back side of the FMT significantly influenced the vibration range of the FMT. The RWSC and silicone of 40A Shore hardness allowed for the highest detected velocities, while cartilage led to a distinct reduction similarly to 70A silicone. CONCLUSION The coupling on the back side of an FMT distinctly affects its vibration range. In this regard, the RWSC and silicone of 40A Shore hardness yield the least impairment of vibration. Thus, the RWSC may be a feasible option in round window vibroplasty when additionally connected to the FMT opposite from the round window membrane.
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Affiliation(s)
- A-O Gostian
- Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
| | - M S Otte
- Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
| | - D Pazen
- Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
| | - M Ortmann
- Jean Uhrmacher-Institute for Clinical, ENT-Research, University of Cologne, Cologne, Germany
| | - D Schwarz
- Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
| | - K B Hüttenbrink
- Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
| | - D Beutner
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Göttingen, Göttingen, Germany
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Influence of Floating-Mass Transducer Coupling Efficiency for Active Middle-Ear Implants on Speech Recognition. Otol Neurotol 2017; 38:809-814. [DOI: 10.1097/mao.0000000000001412] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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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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Loads and Coupling Modalities Influence the Performance of the Floating Mass Transducer as a Round Window Driver. Otol Neurotol 2016; 37:524-32. [DOI: 10.1097/mao.0000000000001028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Performance of the round window soft coupler for the backward stimulation of the cochlea in a temporal bone model. Eur Arch Otorhinolaryngol 2016; 273:3651-3661. [DOI: 10.1007/s00405-016-3997-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 03/18/2016] [Indexed: 10/22/2022]
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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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Abstract
OBJECTIVE Vibroplasty has offered a new modality of hearing rehabilitation in patients with mixed, conductive, and sensorineural hearing loss who cannot wear hearing aids. Potentially, the positioning of the floating mass transducer (FMT) in vibroplasty surgery has a critical effect on hearing outputs. In this study, the impact on hearing outputs and coupling efficiency are evaluated by comparing various vibroplasty applications in the middle ear. No other study to date has examined the coupling efficiency of round window (RW) versus an ossicular vibroplasty application. STUDY DESIGN Prospective cohort study of patients with underlying ear pathologies who were not able to wear hearing aids. METHODS This is an ongoing prospective study of 16 patients. All patients had a standard audiological test battery. Direct drive transfer function analysis results were correlated with bone conduction thresholds to assess the efficiency of the FMT coupling. Speech perception in quiet and quality of life measure questionnaires were used to assess outcomes. Nine patients had round window vibroplasty, six patients had stapes vibroplasty, and one patient had traditional incus vibroplasty. RESULTS Patients with a soft tissue coupler between the FMT and the RW had significantly reduced coupling efficiency. Patients who had direct RW contact had significantly improved coupling efficiency. Patients who underwent stapes or incus vibroplasty had the greatest coupling efficiency. CONCLUSION This study demonstrates that attachment to the stapes or incus provides the best coupling when compared to round window vibroplasty. When applicable, stapes or incus coupling should be the first choice when implementing vibroplasty.
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Ernst A, Todt I, Wagner J. Safety and effectiveness of the Vibrant Soundbridge in treating conductive and mixed hearing loss: A systematic review. Laryngoscope 2015; 126:1451-7. [DOI: 10.1002/lary.25670] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2015] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Jan Wagner
- Department of Otolaryngology at UKB; Hospital of the University of Berlin; Berlin Germany
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TIAN JIABIN, HUANG XINSHENG, RAO ZHUSHI, TA NA, XU LIFU. FINITE ELEMENT ANALYSIS OF THE EFFECT OF ACTUATOR COUPLING CONDITIONS ON ROUND WINDOW STIMULATION. J MECH MED BIOL 2015. [DOI: 10.1142/s0219519415500487] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The finite element (FE) method was used to analyze the effect of coupling conditions between the actuator and the round window membrane (RWM) on the performance of round window (RW) stimulation. A FE model of the human ear consisting of the external ear canal, middle ear and cochlea was firstly developed, and then validation of this model was accomplished through comparison between analytical results and experimental data in the literature. Intracochlear pressure were derived from the model under normal forward sound stimulation and reverse RW stimulation. The equivalent sound pressure of RW stimulation was then calculated via comparing the differential intracochlear pressure produced by the actuator and normal ear canal sound stimulus. The actuator was simulated as a floating mass and placed onto the middle ear cavity side of RWM. Two aspects about the actuator coupling conditions were considered in this study: (1) the cross-section area of the actuator relative to the RWM; (2) the coupling layer between the actuator and the RWM. The results show that smaller actuator size can improve the implant performance of RW stimulation, and size requirements of the actuator can also be reduced by introducing a coupling layer between the actuator and RWM, which will benefit the manufacture of the actuator.
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Affiliation(s)
- JIABIN TIAN
- Institute of Vibration, Shock and Noise, State Key Laboratory of Mechanical System and Vibration, Shanghai Jiao Tong University, Shanghai 200240, P. R. China
| | - XINSHENG HUANG
- Department of Otorhinolaryngology-Head and Neck Surgery, Shanghai Zhongshan Hospital Affiliated to Fudan University, Shanghai 200032, P. R. China
| | - ZHUSHI RAO
- Institute of Vibration, Shock and Noise, State Key Laboratory of Mechanical System and Vibration, Shanghai Jiao Tong University, Shanghai 200240, P. R. China
| | - NA TA
- Institute of Vibration, Shock and Noise, State Key Laboratory of Mechanical System and Vibration, Shanghai Jiao Tong University, Shanghai 200240, P. R. China
| | - LIFU XU
- Institute of Vibration, Shock and Noise, State Key Laboratory of Mechanical System and Vibration, Shanghai Jiao Tong University, Shanghai 200240, P. R. China
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Impact of Coupling Techniques of an Active Middle Ear Device to the Round Window Membrane for the Backward Stimulation of the Cochlea. Otol Neurotol 2015; 36:111-7. [DOI: 10.1097/mao.0000000000000655] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Implantable hearing aids are gaining importance for the treatment of sensorineural hearing loss and also for mixed hearing loss. The various hearing aid systems, combined with different middle ear situations, give rise to a wide range of different reconstructions. This article attempts to summarize the current knowledge concerning the mechanical interaction between active middle ear implants (AMEIs) and the normal or reconstructed middle ear. Some basic characteristics of the different AMEIs are provided in conjunction with the middle ear mechanics. The interaction of AMEIs and middle ear and the influence of various boundary conditions are discussed in more detail.
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Measurement of basilar membrane motion during round window stimulation in guinea pigs. J Assoc Res Otolaryngol 2014; 15:933-43. [PMID: 25080894 DOI: 10.1007/s10162-014-0477-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 07/01/2014] [Indexed: 10/25/2022] Open
Abstract
Driving the cochlea in reverse via the round window membrane (RWM) is an alternative treatment option for the hearing rehabilitation of a nonfunctional or malformed middle ear. However, cochlear stimulation from the RWM side is not a normal sound transmission pathway. The basilar membrane (BM) motion elicited by mechanical stimulation of the RWM is unknown. In this study, the BM movement at the basal turn was investigated in both reverse via RWM drive and acoustic stimulation in the ear canal or forward drive in postmortem isolated temporal bone preparations of guinea pigs. During reverse drive, a magnet-coil was coupled on RWM, and the BM vibration at the basal turn and the movement of the incus tip were measured with laser Doppler vibrometry. During forward drive, the vibration of the incus tip induced by sound pressure in the ear canal resulted in BM vibration and the BM movement at the same location as that in the reverse stimulation was measured. The displacement ratio of the BM to RWM in reverse drive and the ratio of the BM to incus in forward drive were compared. The results demonstrated that the BM response measured in both situations was similar in nature between forward and reverse drives. This study provides new knowledge for an understanding of BM movement induced by reverse drive via the RWM stimulation.
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Salcher R, Schwab B, Lenarz T, Maier H. Round window stimulation with the floating mass transducer at constant pretension. Hear Res 2014; 314:1-9. [DOI: 10.1016/j.heares.2014.04.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 03/24/2014] [Accepted: 04/01/2014] [Indexed: 10/25/2022]
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Beltrame AM, Todt I, Sprinzl G, Profant M, Schwab B. Consensus statement on round window vibroplasty. Ann Otol Rhinol Laryngol 2014; 123:734-40. [PMID: 24842869 DOI: 10.1177/0003489414534013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study aimed to review current knowledge regarding implantation of the Vibrant Soundbridge floating mass transducer (FMT) at the round window (round window vibroplasty) as well as to form a consensus on steps for a reliable, stable surgical procedure. DATA SOURCES Review of the literature and experimental observations by the authors. CONCLUSION Round window (RW) vibroplasty has been established as a reliable procedure that produces good and stable results for patients with conductive or mixed hearing loss. The experience gained over the past few years of the authors' more than 200 implantations has led to consensus on several key points: (1) a wide and bloodless access to the middle ear with facial nerve monitoring, (2) the careful and correct identification and exposure of the round window membrane, (3) a good setup for efficient energy transition of the FMT, namely, perpendicular placement of the FMT with no contact to bone and the placement of cartilage behind the FMT to create a preloaded "spring" function, and (4) 4 points of FMT fixation: a rim of the round window bony overhang left intact both anterior and posterior to the FMT, conductor link stabilization, and cartilage behind the FMT. In addition, the FMT should be covered with soft tissue.
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Affiliation(s)
| | - Ingo Todt
- Department of Otolaryngology at UKB, Hospital of the University of Berlin (Charité Medical School), Berlin, Germany
| | | | - Milan Profant
- Department of Otorhinolaryngology, Slovak Medical University, Bratislava, Slovak Republic
| | - Burkhard Schwab
- Department of Otorhinolaryngology, Hannover Medical University, Hannover, Germany
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Lenarz T, Verhaert N, Desloovere C, Desmet J, D'hondt C, González JCF, Kludt E, Macías AR, Skarżyński H, Van de Heyning P, Vyncke C, Wasowski A. A Comparative Study on Speech in Noise Understanding with a Direct Acoustic Cochlear Implant in Subjects with Severe to Profound Mixed Hearing Loss. Audiol Neurootol 2014; 19:164-74. [DOI: 10.1159/000358004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 12/13/2013] [Indexed: 11/19/2022] Open
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Luers JC, Hüttenbrink KB, Zahnert T, Bornitz M, Beutner D. Vibroplasty for mixed and conductive hearing loss. Otol Neurotol 2014; 34:1005-12. [PMID: 23820796 DOI: 10.1097/mao.0b013e3182990d2b] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To summarize new application methods of an active middle ear implant (Vibrant Soundbridge) in patients with conductive or mixed hearing loss. DATA SOURCES Publications listed in the Medline/PubMed database. STUDY SELECTION All publications published in English language; search term Vibrant Soundbridge AND floating mass transducer in all fields. DATA EXTRACTION Structured analysis of all publications. DATA SYNTHESIS Extraction of significant findings and conclusions and audiometric data. CONCLUSION Modern application methods of an active middle ear implant (VSB) open new therapeutic options for patients with various outer and middle ear diseases resulting in conductive or mixed hearing loss. Titanium couplers can help to couple the active middle ear implant in a standardized way to remnants of the ossicular chain or to the round window. Thus, the active middle ear implant has been established as an alternative treatment option for patients with mixed and conductive hearing. However, the heterogeneity of the studies published so far complicates the analysis of the audiometric results, and thus, the functional hearing gain after VSB implantation varies a lot.
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Affiliation(s)
- Jan Christoffer Luers
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
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Edfeldt L, Strömbäck K, Grendin J, Bunne M, Harder H, Peebo M, Eeg-Olofsson M, Petersson CM, Konradsson K. Evaluation of cost-utility in middle ear implantation in the 'Nordic School': a multicenter study in Sweden and Norway. Acta Otolaryngol 2014; 134:19-25. [PMID: 24256038 DOI: 10.3109/00016489.2013.834459] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Hearing restoration using an active middle ear implant (AMEI) is a highly cost-effective treatment for a selected group of patients with no other possibilities for auditory rehabilitation. OBJECTIVES To evaluate the cost-utility of using an AMEI for hearing rehabilitation. METHODS This was a prospective, multicenter, single-subject repeated study in six tertiary referral centers. Twenty-four patients with sensorineural (SNHL), conductive (CHL), and mixed hearing loss (MHL) were implanted with the AMEI Vibrant Soundbridge® (VSB) for medical reasons. All patients were previously rehabilitated with conventional hearing aids. Multiple validated quality of life patient questionnaires, Health Utilities Index (HUI 2 and 3), and Glasgow Hearing Aid Benefit Profile (GHABP) were used to determine the utility gain and quality adjusted life years (QALY). Directly related treatment costs for the implantation were calculated and related to utility gain and QALY. RESULTS The cost/QALY for patients with SNHL was estimated at €7260/QALY, and for patients with C/MHL at €12 503/QALY.
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Affiliation(s)
- Lennart Edfeldt
- Department of Surgical Sciences, Section of Otolaryngology, Uppsala University Hospital , Uppsala , Sweden
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Edfeldt L, Rask-Andersen H. Round window vibroplasty in chronic ear surgery: comparison with conventional hearing rehabilitation. Acta Otolaryngol 2013; 133:814-25. [PMID: 23627989 DOI: 10.3109/00016489.2013.780294] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Functional hearing results with round window vibroplasty in chronically disabled middle ears were comparable and, at high frequencies, superior to the results achieved with previously used conventional hearing aids even after extended surgery. Soft tissue transfer appears to be more important than floating mass transducer (FMT) alignment with the round window membrane (RWM) for efficient coupling or sonoinversion. OBJECTIVES To evaluate the functional hearing results of an active middle ear implant (AMEI) to the round window niche (RWN). The results were compared with previously used conventional hearing aids. The position of the FMT was determined by cone-beam computed tomography (CBCT). METHODS This was a prospective cohort study carried out in a tertiary referral center. Seven patients with severe middle ear disease were implanted with an AMEI with round window application. The postoperative hearing outcome was compared with preoperative hearing using unaided and conventionally aided conditions. The results were correlated with the physical/geometric relation of the FMT to the RWM as determined with CBCT. RESULTS Dislocation of the FMT was not observed. One patient was re-implanted due to accidental damage to the electrode. In all patients, the pertinent functional hearing results were achieved and were comparable to previous rehabilitation results.
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Affiliation(s)
- Lennart Edfeldt
- Department of Surgical Sciences, Section of Otorhinolaryngology, Head & Neck Surgery, Uppsala University, Uppsala, Sweden.
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Skarzynski H, Olszewski L, Skarzynski PH, Lorens A, Piotrowska A, Porowski M, Mrowka M, Pilka A. Direct round window stimulation with the Med-El Vibrant Soundbridge: 5 years of experience using a technique without interposed fascia. Eur Arch Otorhinolaryngol 2013; 271:477-82. [PMID: 23512431 PMCID: PMC3927063 DOI: 10.1007/s00405-013-2432-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 03/02/2013] [Indexed: 11/29/2022]
Abstract
The objective of this study was to present 5 years of surgical experience, and the extended results of hearing preservation (based on 3-year follow-up), with the Med-El Vibrant Soundbridge (VSB) in which the floating mass transducer (FMT) is placed directly against the round window membrane, and the fascia is used only as covering tissue to keep it in position. A retrospective survey of surgical and audiological data was conducted to evaluate the performance and stability of patient hearing, with audiometric measurements performed over fixed time intervals up to 36 months. 21 patients, aged 19–62 years (mean 48.4), with mixed or conductive, bilateral or unilateral hearing loss were included in this study. Surgical intervention involved monaural implantation of the Med-El VSB between 2006 and 2009. The results were assessed using pure tone audiometry. In 5 years of experience with the technique, no significant complications or device extrusion were observed except for two revision surgeries requiring FMT repositioning. In the 3-year follow-up, we observed stable hearing in the implanted ear. It is concluded that direct round window stimulation without interposed fascia is an alternative for patients with hearing impairment caused by chronic otitis media and/or lack of ossicles, especially after modified radical mastoidectomy. It allows good results in a selected group of patients, although further observation on a larger population is needed to confirm long-term validity and effectiveness.
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Affiliation(s)
- Henryk Skarzynski
- Institute of Physiology and Pathology of Hearing, ul Mochnackiego 10, 02-042, Warsaw, Poland,
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Stieger C, Rosowski JJ, Nakajima HH. Comparison of forward (ear-canal) and reverse (round-window) sound stimulation of the cochlea. Hear Res 2012; 301:105-14. [PMID: 23159918 DOI: 10.1016/j.heares.2012.11.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 10/26/2012] [Accepted: 11/05/2012] [Indexed: 11/29/2022]
Abstract
The cochlea is normally driven with "forward" stimulation, in which sound is introduced to the ear canal. Alternatively, the cochlea can be stimulated at the round window (RW) using an actuator. During RW "reverse" stimulation, the acoustic flow starting at the RW does not necessarily take the same path as during forward stimulation. To understand the differences between forward and reverse stimulation, we measured ear-canal pressure, stapes velocity, RW velocity, and intracochlear pressures in scala vestibuli (SV) and scala tympani (ST) of fresh human temporal bones. During forward stimulation, the cochlear drive (differential pressure across the partition) results from the large difference in magnitude between the pressures of SV and ST, which occurs due to the high compliance of the RW. During reverse stimulation, the relatively high impedance of the middle ear causes the pressures of SV and ST to have similar magnitudes, and the differential pressure results primarily from the difference in phase of the pressures. Furthermore, the sound path differs between forward and reverse stimulation, such that motion through a third window is more significant during reverse stimulation. Additionally, we determined that although stapes velocity is a good estimate of cochlear drive during forward stimulation, it is not a good measure during reverse stimulation. This article is part of a special issue entitled "MEMRO 2012".
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Affiliation(s)
- Christof Stieger
- Department of Otology and Laryngology, Harvard Medical School, Eaton Peabody Laboratory, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA
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Iwasaki S, Suzuki H, Moteki H, Miyagawa M, Takumi Y, Usami SI. Experience with the Vibrant Soundbridge RW-Coupler for round window Vibroplasty with tympanosclerosis. Acta Otolaryngol 2012; 132:676-82. [PMID: 22385350 PMCID: PMC3490479 DOI: 10.3109/00016489.2011.649492] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Usage of the Vibrant Soundbridge (VSB) with round window (RW)-Coupler placement at the RW has been shown to successfully treat mixed hearing loss. Coupling between the VSB's floating mass transducer (FMT) and the RW membrane is difficult in the case of sclerosis in the RW and drilling down the bony lip until the RW membrane can be seen completely can possibly induce a perilymphatic fistula. A 68-year-old woman who had bilateral mixed hearing loss with sclerosis in the RW due to tympanosclerosis underwent a RW-Vibroplasty with a RW-Coupler. Speech discrimination scores in quiet and noise and functional gain with the VSB with RW-Coupler were better than those using a conventional hearing aid. The results of the present case have shown the feasibility of implanting a VSB with RW-Coupler in patients with mixed hearing loss due to tympanosclerosis.
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Affiliation(s)
| | - Hiroaki Suzuki
- Department of Otolaryngology, Shinshu University School of Medicine, Matsumoto city, Japan
| | - Hideaki Moteki
- Department of Hearing Implant Sciences
- Department of Otolaryngology, Shinshu University School of Medicine, Matsumoto city, Japan
| | - Maiko Miyagawa
- Department of Otolaryngology, Shinshu University School of Medicine, Matsumoto city, Japan
| | - Yutaka Takumi
- Department of Hearing Implant Sciences
- Department of Otolaryngology, Shinshu University School of Medicine, Matsumoto city, Japan
| | - Shin-ichi Usami
- Department of Otolaryngology, Shinshu University School of Medicine, Matsumoto city, Japan
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