Ankopplung aktiver Mittelohrimplantate – biomechanische Aspekte

Bornitz, Matthias; Lasurashvili, Nikoloz; Neudert, Marcus; Beleites, Thomas; Zahnert, Thomas

doi:10.1007/s00106-021-00994-6

Cited by 4 publications

(12 citation statements)

References 34 publications

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“…Right, The amplitude differences of the transfer function of the SP coupler with reference to the LP coupler are depicted compared to current literature data. The data of Bornitz (Bornitz et al 2010; Bornitz 2011; Bornitz et al 2021) have been generated by means of a finite-element model, all other data (Mlynski et al 2015b; Schraven et al 2016b; Raphael 2021) have been obtained from human TB experiments. The recent literature displays a high level of inhomogeneity.…”

Section: Resultsmentioning

confidence: 99%

Influence of the Coupling on the Hearing Outcome After Implantation of an Active Middle Ear Implant: Comparison of the Transmission Behavior in Temporal Bone Experiments With Clinical Data

et al. 2022

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Objectives: The active middle ear implant, Vibrant Soundbridge (VSB), can be implanted with a variety of couplers. Hearing outcome after implantation has been investigated in both temporal bone (TB) experiments and patient studies, but the relationship between experimental and clinical data is still weak in the literature. Therefore, experimental data from TB experiments should be compared with patient data in a retrospective study, in which the floating mass transducer is used with couplers of the third generation. Actuator coupling structures included the long (LP coupler) and short (SP coupler) incus process, the stapes head (Clip coupler), and the round window membrane (RW soft coupler). Methods: In the TB experiments, the sound transmission after vibroplasty on the above-mentioned actuator coupling structures was determined in 32 specimens by means of laser Doppler vibrometry on the stapes footplate. Data of 69 patients were analyzed. The main target audiometric parameters were the postoperative aided word recognition score (WRS) in the free field at 65 dB SPL (WRS 65 dB in %), the preoperative and postoperative pure-tone average (PTA4, including the frequencies 0.5, 1, 2, and 4 kHz) of the bone conduction hearing threshold (PTA4BC), the aided postoperative air conduction hearing threshold in the free field (PTA4FF) and the direct threshold (Vibrogram) at least 6 months postoperatively. The coupling efficiency of the actuator (Vibrogram—PTA4BC) as well as the effective hearing gain (PTA4FF—PTA4BC) was compared between the couplers. Results: The analysis in the main speech range (0.5–4 kHz) indicated that in the TB experiments, the LP coupler tends to have the best coupling quality at low frequencies (500–1000 Hz). This was up to 15 dB above the worst actuator (RW soft coupler). However, the results missed the significance level (p > 0.05). In the high frequencies (2000–4000 Hz), the Clip coupler showed the best coupling quality. This was 15 dB above the worst actuator (SP coupler). However, the results missed the significance level (p > 0.05), too. The postoperative WRS at 65 dB SPL and the postoperative PTA4FF were independent of the actuator coupling structure. The PTA4BC was stable at 6 months postoperatively. For the PTA4 of the coupling efficiency, there were no significant differences between the actuator coupling structures (LP 8.9 dB ± 12.9; SP 9.5 ± 6.5 dB; Clip 5.2 ± 10.5 dB; RW 12.7 ± 11.0 dB). However, the tendential inferiority of the RW soft coupler with regard to transmission in the low-frequency range and the tendential superiority of the Clip coupler in the high-frequency range that have already been displayed experimentally could be confirmed in the clinical results. However, the clinical results missed the significance level, too (p > 0.05). Conclusions: In vivo, there are no significant differences in the postoperative outcome stratified according to coupling the target structure. The differences known from the experimental setting were repressed by individual biasing factors. Howe...

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Section: Resultsmentioning

confidence: 99%

Influence of the Coupling on the Hearing Outcome After Implantation of an Active Middle Ear Implant: Comparison of the Transmission Behavior in Temporal Bone Experiments With Clinical Data

et al. 2022

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“…Based on the knowledge gained from LDV (laser doppler vibrometry) measurements of the temporal bone and simulated calculations regarding an optimal coupling of the FMT it is easy to understand the wish for a measurement method for intraoperative evaluation of the coupling efficiency 128 129 130 131 .…”

Section: Resultsmentioning

confidence: 99%

Ergebnisse und Lebensqualität nach Implantation aktiver Mittelohrimplantate

Lailach

Zahnert

2022

Laryngorhinootologie

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ZusammenfassungDie Versorgung mit implantierbaren Hörgeräten stellt einen Bereich mit hohem Entwicklungs- und Innovationspotenzial dar. Der vorliegende Übersichtsartikel gibt einerseits einen Überblick über derzeitige Indikationskriterien für die Versorgung mit aktiven Mittelohrimplantaten. Andererseits werden Zielparameter sowie Ergebnisse nach der Versorgung mit aktiven Mittelohrimplantaten beleuchtet. Hierbei liegt der Fokus auf audiologischen Ergebnissen sowie dem vom Patienten bewerteten Gesundheitszustand. Sogenannte „Patient Reported Outcome Measures“ (PROMs) nehmen mittlerweile auch in der Hörimplantatversorgung einen festen Stellenwert in der Evaluierung des Versorgungserfolges ein. Bisher ist die Studienlage sowohl hinsichtlich audiologischer als auch subjektiver Erfolgsparameter gemessen an den Evidenz-Level-Kriterien nicht befriedigend. Ein bislang fehlender internationaler Konsens über akzeptierte Outcomeparameter erschwert eine metaanalytische Aufarbeitung der Ergebnisse immens. In den bislang publizierten Untersuchungen konnte sowohl für Patienten mit einer Schallempfindungsschwerhörigkeit als auch für Patienten mit einer Schallleitungs- oder kombinierten Schwerhörigkeit ein besseres Sprachverstehen mit dem aktiven Mittelohrimplantat im Vergleich zur konventionellen Hörsystemversorgung ermittelt werden. Aktuelle Analysen zeigen eine signifikante Verbesserung der allgemeinen sowie der hörspezifischen Lebensqualität nach Versorgung mit einem aktiven Mittelohrimplantat. Zur Beurteilung des Versorgungserfolges bei Kindern existieren bislang keine validierten, hörspezifischen Lebensqualitätsmessinstrumente. Insbesondere bei Kindern mit komplexen Fehlbildungen des äußeren Ohres sowie des Mittelohres zeigen sich audiologisch zufriedenstellende Ergebnisse, welche zukünftig jedoch durch Lebensqualitätsmessungen untermauert werden müssen.

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“…Comparison between acoustic stimulation and electromechanical stimulation by an FMT has only been performed in experimental studies using Laser-Doppler vibrometry so far. These studies provided objective evidence that acoustic stimulation is mechanically different from electromechanical stimulation by the VSB (9,10). However, normative data on the characteristics of VSB evoked ABRs as a new objective method were not available in the literature so far.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, there is a risk of ineffective Abbreviations: AMEI, active middle ear implant; VSB, Vibrant Soundbridge; FMT, floating mass transducer; LP, long process (of the incus); SP, short process (of the incus); OW, oval window; RW, round window; VIB, vibrogram (thresholds); BC, bone conduction (thresholds); ASSR, auditory steady state response; CAP, compound action potential; ABR, auditory brainstem response; 3PTA coupling , pure tone average of coupling efficiency at 1, 2, and 4 kHz; AC, air conduction; 4PTA AC , pure tone average of air conduction thresholds at 0.5, 1, 2, and 4 kHz; 4PTA BC , pure tone average of bone conduction thresholds at 0.5, 1, 2, and 4 kHz; 4PTA VIB, pure tone average of vibrogram conduction thresholds at 0.5, 1, 2, and 4 kHz; L ABR, VSB evoked ABR thresholds; SD, standard deviation. movements with FMT resulting in a reduction of the transfer function (9). However, this was not visible in experimental Laser-Doppler vibrometry measurements with the SP-Coupler (5).…”

Section: Introductionmentioning

confidence: 90%

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Active Middle Ear Implant Evoked Auditory Brainstem Response Intensity-Latency Characteristics

et al. 2022

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ObjectiveTo analyze intensity-latency functions of intraoperative auditory evoked brainstem responses (ABRs) to stimulation by the Vibrant Soundbridge (VSB) active middle ear implant with respect to coupling efficiency, VSB evoked ABR thresholds, and coupling modality [oval window (OW) placement vs. Incus placement and vs. round window (RW) placement].Study DesignExploratory study.SettingBi-centric study at tertiary referral centers.PatientsTwenty-four patients (10 female, 14 male, mean age: 58 years) who received a VSB.Outcome MeasuresWave-V intensity-latency functions of intraoperative VSB evoked ABRs using a modified audio processor programmed to preoperative bone conduction thresholds for stimulation. Threshold level correction to coupling efficiency and ABR thresholds. Individual plots and exponential function fits.ResultsAfter ABR threshold level correction, the latency functions could be aligned. A large variance of latencies was observed at individual threshold level. Wave-V latency was longest in the Incus placement subgroup (9.73 ms, SD: 1.04) as compared to OW placement subgroup (9.47 ms, SD: 1.05), with the shortest latency in the RW placement subgroup (8.99 ms, SD: 0.68). For increasing stimulation levels, the variance decreased with intensity-latency function slopes converging toward a steady-state (saturation) latency caused by saturation of audio processor (stimulation) gain. Latency saturation was reached at a stimulation level of 50 dB nHL for the OW placement subgroup, 35 dB nHL for the Incus placement subgroup, and 30 dB nHL for the RW placement subgroup. The latency and saturation results indicated decreased dynamic range for RW placement, i.e., reverse stimulation.ConclusionsVSB evoked ABR wave-V intensity-latency function slopes were similar to acoustic stimulation at high stimulation levels with a shift toward longer latencies caused by audio processor signal delay. Saturation of latencies occurred for higher stimulation levels due to saturation of audio processor gain. Thus, the analysis of VSB evoked intensity-latency functions appears to allow for the objective assessment of a patient's individual dynamic range. This can further improve diagnostics as well as intraoperative and postoperative quality control.

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Ankopplung aktiver Mittelohrimplantate – biomechanische Aspekte

Cited by 4 publications

References 34 publications

Influence of the Coupling on the Hearing Outcome After Implantation of an Active Middle Ear Implant: Comparison of the Transmission Behavior in Temporal Bone Experiments With Clinical Data

Influence of the Coupling on the Hearing Outcome After Implantation of an Active Middle Ear Implant: Comparison of the Transmission Behavior in Temporal Bone Experiments With Clinical Data

Ergebnisse und Lebensqualität nach Implantation aktiver Mittelohrimplantate

Active Middle Ear Implant Evoked Auditory Brainstem Response Intensity-Latency Characteristics

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