Vibroplasty in mixed and conductive hearing loss: Comparison of different coupling methods

Abstract

Objectives/Hypothesis: To evaluate modified coupling techniques of the Vibrant Soundbridge system in patients with mixed and conductive hearing loss and to compare it with conventional vibroplasty.Study Design: Retrospective study. Methods: Two different groups were evaluated: 1) nine cases of conventional incus vibroplasty in comparison with 2) nine patients with modified coupling of the floating mass transducer. In the modified coupling approach, the vibrant floating mass transducer was attached to 1) the stapes/oval window, 2) the round window, or 3) the drilled promontory bone (promontory fenestration window). In three patients, an additional ossiculoplasty was performed. Preoperative and postoperative aided and unaided pure-tone and free-field audiometry and Freiburg monosyllabic word test were used to assess hearing outcome.Results: Functional hearing gain obtained in patients with mixed and conductive hearing loss who underwent modified coupling was 39 dB. Patients with pure sensorineural hearing loss who received conventional incus coupling showed a functional hearing gain of 25 dB. Average functional gain was 41 dB in the oval window group, 45 dB in the round window group, and 30 dB in the promontory fenestration window group. Word recognition test revealed an average improvement of 51% and 21% in the modified and in the conventional approach, respectively.Conclusions: Modified vibroplasty is a safe and effective treatment for patients with conductive and mixed hearing loss. Coupling the floating mass transducer to the promontory bone (promontory fenestration window) is a viable option in chronically disabled ears if oval and round window coupling is not possible.

Active middle ear implant coupled bilaterally to the round window despite bilateral implanted stapes prostheses

“…These patients do not benefit from conventional hearing aids. The active middle ear implants bypass the middle ear ossicles, thereby providing a reliable hearing restoration strategy . The most advantageous positioning of FMT at the stapes superstructures or the RW include cases of mixed hearing loss, especially in cases where bone‐conduction transducers are insufficient due to the patient's bone conduction power limits.…”

Indication criteria and outcomes with the Bonebridge transcutaneous bone-conduction implant

“…An important group of patients are those with atresia of the external auditory canal. If these patients wanted to avoid a percutaneous solution, the only other implantable solution was an active middle ear implant, for example a Vibrant Soundbridge (MED‐EL, Innsbruck, Austria) . Recently, Frenzel et al have published a useful scoring system to rate the difficulty of such an operation in atretic temporal bones .…”

Long‐Term Outcome of Hearing Rehabilitation With An Active Middle Ear Implant

“…Originally, the floating mass transducer (FMT) was connected the to the long process of the incus . Alternative coupling approaches including the round, the oval window, or even the promontory bone extended the range of indications over recent years. Therefore, patients with mixed/conductive hearing loss could also be treated with this type of active middle ear implant .…”

“…Therefore, patients with mixed/conductive hearing loss could also be treated with this type of active middle ear implant. [1][2][3][4][5][6] To date, a few studies focused on long-term audiological or surgical outcomes. Maier et al 7 reported on audiological outcomes in 104 patients and 122 devices implanted in a single center.…”