Objective: Our purpose was to evaluate the results of Vibrant Soundbridge (VSB) in conductive or mixed hearing loss. Materials and Methods: Twenty-five adult patients (29 ears) with a mixed or conductive hearing loss and various etiologies were included in this retrospective study. The preoperative ipsilateral pure tone average was 71 ± 3.0 dB, and the average bone conduction threshold was 42 ± 2.8 dB (n = 29). The transducer was placed on the long apophysis of the incus (n = 16), in the round window (n = 10) or on the stapes (n = 3). Results: No complications were noted. The bone conduction threshold remained unchanged. VSB was activated in all cases. The postoperative pure tone average without VSB was 63 ± 3.9 dB (n = 24) and with VSB in free-field condition 24 ± 2.1 dB (n = 22). Conclusions: VSB is safe and efficacious for auditory rehabilitation in conductive and mixed hearing losses.

MEIs started to take form in researchers' mind in the 1930s with the first experiment of Wilska. In the 1970s, several devices, such as the Goode and Perkins', the Maniglia's, or the Hough and Dormer's were created but remained prototypes. It is only in the 1990s the devices that emerged remained on the market. In 1994, Symphonix, Inc. was created and aimed to manufacture and commercialize its semi-implantable MEI, the VSB. The principle of the VSB lies on a direct drive of the sound to a vibratory structure of the middle ear through an electromagnetic transducer, the floating mass transducer (FMT). The particularity of the system VSB is the simplicity of the transducer which is made of both the magnet and the coil; thus, the FMT, fixed on a vibrating middle ear structure, mimics the natural movement of the ossicular chain by moving in the same direction. The goal of the VSB was to give an alternative to patients with mild-to-severe sensorineural hearing loss who could not wear hearing aids (HAs) or who were unsatisfied conventional HA users. Subsequent to Tjellström's experiment in 1997, implantations started to include etiologies such as otosclerosis, radical mastoidectomy, failed ossiculoplasty/tympanoplasty, and atresia. Nowadays, the VSB, with more than 20 years of experience, is the oldest and most used middle ear implant worldwide. It is well acknowledged that the straightforward design and reliability of the transducer have certainly contributed to the success of the device.

The ossified cochlea, although rare, represents a challenge for cochlear implantation. While it is no longer considered an absolute contra-indication to implantation, insertion may be technically difficult and the results may be suboptimal. Techniques which have been employed are reviewed. The new Digisonic™ multi-array implant, which was designed specifically for use in the ossified cochlea is described, along with the technique used for its insertion.In the first patient to be implanted with this new implant, all electrodes lie within the cochlea and are functional. The new Digisonic™ multi-array implant may have advantages over other solutions for the ossified cochlea.

The authors present their experience with cochlear implantation in a 22-year-old patient who had a cardiac pacemaker because of complete atrioventricular block. The question of compatibility between the cochlear implant (multichannel Digisonic DX10AE) and the pacemaker (Biotronik Nanos-01AE) was raised. After consulting the two manufacturers regarding the risk of electrical interference, the authors decided to program the pacemaker in a locked mode (VOO) and then perform cochlear implantation. When the cochlear implant was switched on for the first time, electrocardiograms were obtained to ensure that the two devices were compatible. Absolutely no interference was detected. After a 3-year follow-up, cochlear implant performance remains excellent.

tional hearing aids for a period of 9-24 months, during which time they had used VSB alone; consequently, they were no longer accustomed to wearing conventional hearing aids which would have falsified the comparison with VSB. Todt et al. (2002) have shown that the functional gain in noise of VSB was superior to the one with the preoperatively fitted bilateral conventional hearing aids, in five patients with ski-slope audiograms (hearing loss limited in the high-frequency range).