Vibroplasty combined with tympanic membrane reconstruction in middle ear ventilation disorders

Müller, Christoph; Zahnert, Thomas; Ossmann, Steffen; Neudert, Marcus; Bornitz, Matthias

doi:10.1016/j.heares.2019.02.012

Cited by 7 publications

(10 citation statements)

References 34 publications

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“…The METFs were obtained in the frequency domain as complex averages of mostly 20 single measurement frames. METFs were either obtained as stapes displacement with reference to the sound pressure at the TM or as stapes displacement with reference to the driving voltage of the FMT (Müller et al 2019).…”

Section: Methodsmentioning

confidence: 99%

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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: Methodsmentioning

confidence: 99%

“…See Table 1 for details on the specimens and the distribution within the individual target structure subgroups. Details on TB preparation have already been presented by Müller et al (2019). Important details are described below.…”

Section: Methodsmentioning

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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“…The differences amounted to less than 5 dB in the frequencies below 1 kHz. In contrast, it is meanwhile known for the VSB that negative pressure situations in the middle ear lead to a poorer transmission behavior for stapes coupling in low frequencies due to an increased pretension of the annular ligament [148,165]. In this context, it is obvious that patients with ventilation disorders benefit from the necessity of safe tympanic membrane reconstruction with thick cartilage because it carries most of the charge and consecutively leads to a lesser charge of the annular ligament.…”

Section: Clinical Aspects Of Coupling In Cases Of Defective Ossicular...mentioning

confidence: 99%

“…In this context, it is obvious that patients with ventilation disorders benefit from the necessity of safe tympanic membrane reconstruction with thick cartilage because it carries most of the charge and consecutively leads to a lesser charge of the annular ligament. On the average, the transmission losses amount to less than 5 dB in cases of ventilation disorder and thick cartilage reconstruction of the tympanic membrane (thickness of about 300 µm) [165]. In the clinical setting, the influ-ence of the ventilation disorder on the audiological outcome cannot be verified because of the important heterogeneity of the patient populations.…”

Section: Clinical Aspects Of Coupling In Cases Of Defective Ossicular...mentioning

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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“…It is the leading cause for hearing disorders and potentially life threatening chronic inflammatory processes such as cholesteatoma, which commonly leads to middle ear surgery (Magnuson, 1981). Another crucial point is balanced middle ear pressure after ear surgery, as maintaining the physiological function of the middle ear and the overall rate of healing and hearing rehabilitation success is determined by a balanced middle ear pressure (Takahashi et al, 2007;Müller et al, 2019). Currently, only indirect pressure measurement methods are established.…”

Section: Introductionmentioning

confidence: 99%

Bio-Compatible Sensor for Middle Ear Pressure Monitoring on a Bio-Degradable Substrate

Mosshammer¹,

Lüdke²,

Spitzner³

et al. 2021

Front.Electron.

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Hypotension in the middle ear can cause serious diseases and hearing disorders. Until now, pressure in the middle ear is measured indirectly by using the impedance of the tympanic membrane (tympanometry). Direct methods are just described in scientific studies and would be harmful in clinical routine. Here, we demonstrate a bio-compatible pressure sensor, which can resolve pressure changes in the range of −7.5 kPa up to +7.5 kPa, and due to its compact design (area of 2 × 4 mm2), can be directly implanted in the human middle ear. Furthermore, the read-out of the pressure sensor can be conveniently done using wireless data communication technologies employing a plate capacitor with an elastic dielectric for pressure monitoring and a planar coil. Thus, our sensor allows for direct pressure measurements in the middle ear, avoiding additional surgeries after device implantation.

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Vibroplasty combined with tympanic membrane reconstruction in middle ear ventilation disorders

Cited by 7 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

Bio-Compatible Sensor for Middle Ear Pressure Monitoring on a Bio-Degradable Substrate

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