Endonasal ballon dilatation of the Eustachian tube (BET) is a promising treatment for Eustachian tube dysfunction with encouraging results over the last years in adults. In addition, in children, single studies demonstrated promising results, but revealed the necessity for broader and additional studies. Our retrospective analysis presents outcomes with BET in children with chronic obstructive dysfunction of the Eustachian tube, showing resistance to the conventional therapy after adenotomy with paracentesis or grommets (ventilation tubes). The data of 52 children, having undergone BET from April 2011 to April 2016, were retrospectively evaluated. Most children in our study presented middle ear effusion (47%), adhesive (21%), chronic otitis media (13%), or recurrent acute otitis media (11%). In 24 (37%) children, we combined BET with a paracentesis, in 5 (8%) patients with a tympanoplasty type I and in 3 (5%) patients with a type III. All children were assessed using an audiogram, tympanometry, and tubomanometry (50 mbar) before and after BET. In addition, we evaluated the results of the Lübecker questionnaire, which we performed before and after BET. The childrens' ear-related and quality of life-related symptoms, such as pressure equalization, ear pressure, hearing loss, pain and limitation in daily life, and satisfaction pre- and postoperatively, were analyzed. In the majority of patients, we could see an improvement in the ear pressure, hearing loss, limitation in daily life, and satisfaction with recurrent inflammations, underlined by better outcomes in the tubomanometry and the tympanogram. BET in children is a safe, efficient, and promising method to treat chronic tube dysfunction, especially as a second line treatment, when adenotomy, paracentesis, or grommets failed before.

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.

No 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.

Zusammenfassung Hintergrund und Ziel der Arbeit Neben dem Sprachverstehen ist die empfundene Höranstrengung im Alltag ein wichtiger Indikator für den Erfolg einer Hörhilfe und deren Signalverarbeitung. Diese Studie hat zum Ziel, die subjektive Höranstrengung für Sprache im Störgeräusch bei Patienten mit dem aktiven Mittelohrimplantat Vibrant Soundbridge (VSB) für omnidirektionale und direktionale Richtwirkung und für einseitiges und beidseitiges Hören zu ermitteln. Material und Methoden Bei 15 VSB-Trägern wurde die subjektive Höranstrengung in einem Lautsprecherring im reflexionsarmen Raum mit der adaptiven Skalierungsmethode ACALES (Adaptive CAtegorical Listening Effort Scaling) erfasst. Verschiedene Hintergrund-Störgeräusche aus unterschiedlichen Richtungen und gleichzeitig dargebotene Sätze aus dem Oldenburger Satztest wurden zu vier alltagsnahen akustischen Szenen kombiniert. Ergebnisse Direktionale Richtwirkung verringerte die Höranstrengung bei VSB-Trägern im Median nur numerisch, insbesondere bei räumlich verteilten Störquellen und niedrigem Signal-Rausch-Verhältnis, allerdings ohne signifikanten Unterschied zur omnidirektionalen Einstellung. Einseitiges Hören mit VSB (bei Verschluss des kontralateralen Ohrs) führte dazu, dass im Probandenmittel alle untersuchten Höranstrengungskategorien bei signifikant höheren Signal-Rausch-Verhältnissen gemessen wurden als bei beidseitigem Hören. Schlussfolgerung Insgesamt konnte keine statistisch signifikant niedrigere Höranstrengung bei Verwendung des Richtmikrofonprogramms nachgewiesen werden, daher liefert diese Studie keine Empfehlung für oder gegen das Richtmikrofonprogramm. Allerdings konnte eine geringere Höranstrengung bei beidseitigem Hören im Gegensatz zu einseitigem Hören gezeigt werden. Patienten sollten daher ermutigt werden, immer mit beiden Ohren bestmöglich versorgt zu hören.