Hearing rehabilitation and microbial shift after middle ear surgery with Vibrant Soundbridge in patients with chronic otitis media

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.

Comparison of Quality of Life Outcomes for Percutaneous Versus Transcutaneous Implantable Hearing Devices: A Systematic Review and Meta-analysis

“…Full text review of these 290 articles was conducted, and a total of 52 articles were selected for inclusion (Fig. 1) (13–64). Critical appraisal of studies indicated an acceptably low risk of bias for the majority of included studies (Fig.…”

1,8-Cineol Attenuates Checkpoint Molecule PDL-1 and Adhesion Molecule CX3CR1 in Circulating Monocytes in Otitis Media Patients

“…Without sufficient therapy, there is no way out of this descending spiral. This is especially the case in therapy-persistent COM due to antimicrobial resistance; up-to-date, middle ear surgery, with the complete removal of the inflammation foci and appropriate surgical rehabilitation, including the reconstruction of the tympanic membrane, the classic hearing structures or implantable hearing devices, such as an active middle ear implant (VSB), is the only way to treat this disease [ 8 ].…”

“…COM is connected with different inflammatory processes within the middle ear [ 9 , 10 ], whereas infections with Gram-negative bacteria, such as Pseudomonas aeruginosa , are the main cause of COM development [ 8 , 11 ]. In this context, lipopolysaccharide (LPS) is a major component of the cellular envelope of Gram-negative bacteria and it has been shown in mice that LPS-induced COM leads to different inflammatory reactions, such as the infiltration of macrophages and expression of inflammatory cytokines [ 12 ].…”

Anti-inflammatory response to 1,8-Cineol and associated microbial communities in Otitis media patients

“…Chronic otitis media (COM) is a chronic inflammation of the middle ear and in most cases is associated with different bacterial infections of the mastoid cavity. COM is the most widespread clinical pathology that is associated with ear discharge and hearing loss 1 , 2 .…”

“…Without sufficient therapy, there is no way out of this descending spiral. Especially, in antimicrobial-persistent COM, middle ear surgery with complete removal of the inflammation foci and appropriate surgical rehabilitation, including reconstruction of the tympanic membrane, the middle ear ossicles or implantable hearing devices, is the only way to treat this disease 2 .…”