Fully Implantable Active Middle Ear Implants After Subtotal Petrosectomy With Fat Obliteration: Preliminary Clinical Results

Abstract

Objectives: In patients with chronic middle ear disease, especially after revision surgery for ventilation problems and mixed hearing loss, active middle ear implants may provide an alternative treatment option. The fully implantable active middle-ear implant (FI-AMEI) is designed for implantation in a ventilated mastoid with an intact posterior canal wall. Until now, there have been no reports on audiometric results after implantation of a FI-AMEI in a fat-obliterated cavity after subtotal petrosectomy (SPE). Study Design: Retrospective case review. Setting: Tertiary referral center. Patients: Twelve patients were included after numerous previous tympanoplasty surgeries for severe mixed hearing loss and FI-AMEI implantation. Intervention: In five patients, the FI-AMEI was implanted in a cavity, with fat obliteration, after SPE. Seven patients received FI-AMEI implantation after intact canal wall (ICW) surgery. Main Outcome Measure(s): Audiometric results (pure-tone audiometry, Freiburger monosyllables) are demonstrated for 12 patients after an observation period of 3 months. Results: The improvement in monosyllable score was 40 to 85% for the 12 patients. Free-field-aided thresholds showed high heterogeneity. Conclusion: FI-AMEI implantation combined with SPE provides an alternative approach to hearing rehabilitation to non-FI-AMEI implantation. Studies with a high number of patients and long-term observation periods are necessary to statistically verify these results.

Ergebnisse und Lebensqualität nach Implantation aktiver Mittelohrimplantate

“…The hearing improvement after implantation of an active middle ear implant compared to the unaided hearing constellation has been confirmed in several trials ( Table 1 ) and presented in systematic review articles 34 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 . In a meta-analysis, Ernst et al could quantify for patients with MHL/CHL who had been treated with a Vibrant Soundbridge (VSB, MED-EL Company, Innsbruck, Austria) an average functional gain of 29.6 dB (range: 12.5–43.4 dB) 88 .…”

“…The speech perception was comparable in both patient groups (77.9 ± 20.8 % versus 83.3 ± 13.6 %) [172]. After Carina implantation and simultaneous belly fat obliteration, a small patient group revealed a speech perception that did not significantly deviate from the one of patients with intact posterior canal wall (50-85 % versus 50-100 %) [79].…”

“…Der Hörgewinn nach der Implantation eines aktiven Mittelohrimplantates gegenüber der unversorgten Hörkonstellation ist vielfach in Studien nachgewiesen ( Tab. 1 ) und in systematischen Übersichtsarbeiten dargestellt 34 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 . Ernst et al konnten für Patienten mit MHL/CHL, welche mit einer Vibrant Soundbridge (VSB, Firma MED-EL, Innsbruck, Österreich) versorgt wurden, in einer metaanalytischen Auswertung einen mittleren Functional Gain von 29,6 dB (Range: 12,5–43,4 dB) ermitteln 88 .…”

“…In einer vergleichenden Untersuchung wurde in der Patientengruppe mit Obliteration sogar ein besserer Effective Gain ermittelt (−15,1±21,2 dB) als in der Patientengruppe ohne Obliteration und erhaltener hinterer Gehörgangswand (−7,2±11,4 dB), das Sprachverstehen war in beiden Patientengruppen vergleichbar (77,9±20,8 vs. 83,3±13,6%) 172 . Auch nach Carina-Implantation und simultaner Bauchfettobliteration konnte in einer kleinen Patientengruppe ein Sprachverstehen, welches nicht wesentlich von dem bei Patienten mit intakter hinterer Gehörgangswand abwich (50–85 vs. 50–100%), ermittelt werden 79 .…”