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Short-term safety and effectiveness of the mCLIP partial prosthesis

PURPOSE

This multicentric, retrospective study aimed to analyze the short-term safety and effectiveness of the mCLIP Partial Prosthesis.

METHODS

Patients underwent tympanoplasty with implantation of a mCLIP Partial Prosthesis. Follow-up examination included ear microscopy and pure-tone audiometry to determine the post-operative pure tone average of the frequencies 0.5, 1, 2 and 3 kHz (PTA4). The post-operative PTA4 air bone gap (ABG) was used to evaluate the audiological outcome. A post-operative minimum and maximum follow-up period was not defined. Thus, the follow-up times of each study center were different, which resulted in different follow-up times for the audiological analysis and for adverse events (AE).

RESULTS

72 (66 adults, 6 children) patients were implanted with the mCLIP Partial Prosthesis. 68 (62 adults, 6 children) patients underwent audiological examination; all 72 patients were examined for adverse events. All patients (N = 68): 72.1% of the patients showed a PTA4 ABG of ≤ 20 dB. Individual post-operative bone conduction (BC) PTA4 thresholds were stable in 67 patients. The mean post-operative follow-up time was 78 ± 46 days. Children (N = 6): 5 out of 6 children showed a PTA4 ABG of ≤ 20 dB. None of the children reported a BC PTA4 deterioration of > 10 dB HL after the implantation. The mean post-operative follow-up time was 101 ± 45 days. Adverse events (all patients, N = 72): 15 (14 adults, 1 child) patients had AEs (27 AEs and 2 Follow-Ups). The mean post-operative follow-up time was 375 days.

CONCLUSION

Clinical data show satisfactory audiological parameters after implantation of the mCLIP Partial Prosthesis. The prosthesis is safe and effective for implantation in children and adults.

TRIAL REGISTRATION NUMBER

NCT05565339, 09 September 2022, retrospectively registered.

Evaluation on the possibility of sound conduction independent of tympanic air cavity for severe tympanic adhesion patients by finite element analysis

Background: For patients with severe tympanic adhesion, reconstructing the tympanic air cavity is often challenging, resulting in poor hearing reconstruction outcomes. Therefore, establishing a sound conduction pathway independent of the tympanic air cavity may be a viable method for reconstructing hearing in these patients. Purpose: The objective of this study was to evaluate the feasibility of sound conduction independent of the tympanic air cavity (i.e., replacing the original cavity with a tympanic vibrating material) using finite element analysis. Methods: We established a sound-structure coupling finite element model of the tympanum vibration conduction system, which included the tympanic membrane (TM), ossicular prosthesis, and tympanic vibrating material. This model was used to simulate middle ear vibrations under sound pressure, and we extracted the frequency response curve of the ossicular prosthesis' vibration displacement amplitude to evaluate the sound conduction effect of the middle ear. Next, we adjusted the structural and mechanical parameters of the tympanic vibrating material to analyze its impact on the sound conduction effect of the middle ear. Finally, we compared the frequency response curve of the stapes footplate in normal subjects to evaluate the feasibility of sound conduction independent of the tympanic air cavity. Results: The Shell tympanic vibrating material had a better vibration conduction effect compared to solid or porous tympanic vibrating material. The vibration amplitude decreases with the increasing elastic modulus of the tympanic vibrating material. Implantation of 40 kPa-shell tympanic vibrating material had the lowest hearing loss less than 5 dB, and the hearing loss with 1 MPa-porous tympanic vibrating material was largest and less than 25 dB. Conclusion: Our study suggests that replacing the tympanic air cavity with a tympanic vibrating material is feasible. The establishment of a sound conduction pathway independent of the tympanic air cavity could potentially provide a method for hearing reconstruction in patients with severe tympanic adhesion.

Hearing outcome after tympanoplasty type III

Purpose

We assessed overall hearing outcome after tympanoplasty type III in chronically infected ears with cholesteatoma (CH) and without cholesteatoma: otitis media chronica mesotympanalis, tympanosclerosis, and adhesive process (COM_T_AP).

Methods

303 surgeries were evaluated: 229 CH-group and 74 COM_T_AP-group. Air-bone gaps (PTA-ABG) with pure-tone averages (PTA-4) at four frequencies (0.5, 1, 2 and 4 kHz) were compared preoperatively, early postoperatively (< 40 days) and late postoperatively (40–400 days). Hearing outcome was compared in various types of middle-ear reconstruction and in smokers and non-smokers. Correlations between hearing outcome and predictive staging indices were evaluated: Middle Ear Risk-Index (MER-I) and Ossiculoplasty Outcome Parameter Staging-Index (OOPS-I).

Results

Mean PTA-ABG in the CH-group increased from 20.9 ± 11.3 dB to 22.3 ± 10.4 dB early postoperatively and decreased significantly to 19.2 ± 10.1 dB late postoperatively. Mean PTA-ABG in the COM_T_AP-group decreased significantly from 27.3 ± 10.9 dB to 20.6 ± 10.9 dB early postoperatively and decreased to 20.0 ± 12.2 dB late postoperatively. No significant difference was seen between PTA-ABG-closures of partial or total ossicular replacement prosthesis (PORP/TORP) and cartilage ossiculoplasty in the CH-group. Patients receiving TORP showed a significantly higher preoperative PTA-ABG. All reconstruction types exhibited postoperative PTA-ABG around 20 dB. In the COM_T_AP-group, smokers had a significantly higher mean PTA-ABG early postoperatively; this equalized with that of non-smokers late postoperatively. PTA-ABG-closures and MER-I or OOPS-I were not significantly correlated.

Conclusion

Tympanoplasty type III maintains hearing in patients with cholesteatoma and significantly improves hearing in chronically inflamed ears without cholesteatoma. All investigated ossicular replacement prostheses are equally beneficial. Healing postoperatively takes longer in smokers, but they eventually catch up with non-smokers.

Evaluation of cochlear implant electrode scalar position by 3 Tesla magnet resonance imaging

The estimation of scalar electrode position is a central point of quality control during the cochlear implant procedure. Ionic radiation is a disadvantage of commonly used radiologic estimation of electrode position. Recent developments in the field of cochlear implant magnets, implant receiver magnet position, and MRI sequence usage allow the postoperative evaluation of inner ear changes after cochlear implantation. The aim of the present study was to evaluate the position of lateral wall and modiolar cochlear implant electrodes using 3 T MRI scanning. In a prospective study, we evaluated 20 patients (10× Med-El Flex 28; 5× HFMS AB and 5× SlimJ AB) with a 3 T MRI and a T2 2D Drive MS sequence (voxel size: 0.3 × 0.3 × 0.9 mm) for the estimation of the intracochlear position of the cochlear implant electrode. In all cases, MRI allowed a determination of the electrode position in relation to the basilar membrane. This observation made the estimation of 19 scala tympani electrode positions and a single case of electrode translocation possible. 3 T MRI scanning allows the estimation of lateral wall and modiolar electrode intracochlear scalar positions.

[Modern ideas about the professional suitability of employees of regulated professions with middle ear pathology and the possibility of their return to work (analytical review of the literature)]

Fitness for work in persons with middle ear disease who are exposed to harmful work environment and their possible return to work was analyzed. Fitness for work expertise procedure in the Russian Federation is disclosed in detail. A list of medical contraindications to work in harmful and/or dangerous work environment according to hearing condition is given. Clinical aspects of middle ear diseases in the industry workers are presented and modern ideas about middle ear surgical treatment, it's functional results, documenting technique and outcome calculation are described in detail. Possibility of returning the employee to work is discussed based on all the analyzed materials.

Minimal Reporting Standards for Active Middle Ear Hearing Implants

There is currently no standardized method for reporting audiological, surgical and subjective outcome measures in clinical trials with active middle ear implants (AMEIs). It is often difficult to compare studies due to data incompatibility and to perform meta-analyses across different centres is almost impossible. A committee of ENT and audiological experts from Germany, Austria and Switzerland decided to address this issue by developing new minimal standards for reporting the outcomes of AMEI clinical trials. The consensus presented here aims to provide a recommendation to enable better inter-study comparability.