Treatment of mixed hearing losses via implantation of a vibratory transducer on the round window

Early clinical findings are reported for subjects implanted with the Vibrant Med-El Soundbridge (VSB) device. The present criteria for the VSB, limiting its application to patients with normal middle ear function, have been extended to include patients with ossicular chain defects. Seven patients with severe mixed hearing loss were implanted with the transducer placed onto the round window. All had undergone previous surgery: six had multiple ossiculoplasties, and one had the VSB crimped on the incus with unsuccessful results. Round window implantation bypasses the normal conductive path and provides amplified input to the cochlea. Post-operative aided thresholds of 30 dB HL were achieved for most subjects, as compared with unaided thresholds ranging from 60-80 dB HL. Aided speech reception thresholds at 50% intelligibility were 50 dB HL, with most subjects reaching 100% intelligibility at conversational levels, while unaided thresholds averaged 80 dB HL, with only one subject reaching 100% intelligibility. These results suggest that round window implantation may offer a viable treatment option for individuals with severe mixed hearing losses who have undergone unsuccessful ossiculoplasties.     

振动声桥植入二例

目的 探讨振动声桥(Vibrant Soundbridge,VSB)植入的手术效果.方法 根据VSB植入的手术适应证,分别对1例感音神经性聋患者和1例传导性聋(先天性小耳畸形)患者进行VSB植入.感音神经性聋患者术前纯音测听(0.5、1、2、4 kHz)平均听阈(听力级)为56 dB,小耳畸形患者的平均气导听阈为61 dB.术后7周开机调试.结果 2例患者术后听力均获改善,声场助听听阈(0.5、1、2、4 kHz):感音神经性聋患者为32 dB,获益24 dB;传导性聋(小耳畸形)患者为40 dB,获益21 dB.2例患者术后均无面神经麻痹、眩晕及耳鸣.结论 VSB植入对于感音神经性聋和传导性聋均有效.

Abstract：

Objective To investigate the effect of Vibrant Soundbridge ( VSB) implantation.Methods In accordance with the indications for VSB implantation,surgeries were done for two patients who suffered from either a sensorineural or conductive hearing loss ( microtia).Their preoperative auditory thresholds(0.5,1,2 and 4 kHz) were 56 dB HL and 61 dB HL.The VSB was turned on and adjusted seven weeks after surgery.Results Postoperative auditory thresholds of the two patients were improved.Their pure tone thresholds were 32 dB HL and 40 dB HL,and the respective improvement was 24 dB HL and 21 dB HL.There was no facial paralysis,vertigo and tinnitus.Conclusion Patients with a sensorineural or conductive hearing loss may benefit from VSB implantation.     

振动声桥在中国的临床应用

目的探讨一例中度感音神经性聋患者行振动声桥（MED-EL）植入后的听力变化，进一步了解振动声桥植入的工作原理、手术适应证、手术方法及疗效。方法回顾性分析我国最先开展振动声桥植入的一例患者的临床资料，重点分析其术前和术后听力变化情况，同时结合相关文献，总结振动声桥植入的原理、手术适应证、手术方法及疗效。结果振动声桥植入后短期内听力改善显著，听阈较术前平均下降约20dBHL（言语频率0．5，1，2，4kHz），其中以中高频（1kHz以上）提高为主，无严重的并发症。结论中度一重度感音神经性聋，尤其是高频听力下降为主的患者配戴传统助听器效果不佳时振动声桥植入手术效果良好。振动声桥植入手术是相对安全的，为中国中度一重度感音神经性聋患者提供了一种新的康复办法。     

Our auditory results using the Vibrant Soundbridge on the long process of the incus: 20 years of data

Objective

After 20 years of experience with different types of middle ear implants, we analyzed our database about the Vibrant Soundbridge (VSB) to know the rate of complications, the effect on the residual hearing and the audiometric gain in our center.

Round window vibroplasty: Long-term results

Abstract Conclusions: The round window (RW) approach in the use of the Vibrant Soundbridge? (VSB) is a safe and effective treatment of conductive and mixed hearing losses for a period of more than 3 years of device use. Objective: To investigate the long-term safety and efficacy as well as user satisfaction of patients with conductive and mixed hearing losses implanted with the VSB using RW vibroplasty. Methods: Twelve patients with conductive and mixed hearing losses were evaluated after 40 months of daily VSB use. Safety was assessed by evaluating reports of postoperative medical and surgical complications as well as by changes in bone conduction hearing thresholds. Efficacy outcome measures included aided and unaided hearing thresholds, speech recognition in quiet and in noise and subjective benefit questionnaires. Results: The safety results revealed no significant medical complications. One subject experienced sudden hearing loss after 18-24 months of device use, but still continues to wear the device to her satisfaction. With regard to efficacy, there were no significant changes from short- to long-term results in aided word understanding, functional gain or speech recognition threshold, suggesting that the outcomes are stable over time. Subjective questionnaires revealed either the same or better results compared with the short-term data.     

面神经后入路振动声桥圆窗植入术治疗小耳畸形

目的探讨双侧小耳畸形合并耳道骨性闭锁患者,面神经垂直段后进路振动声桥植入的可行性和术后效果.方法1例双耳先天小耳畸形合并耳道骨性闭锁患者,左耳传导性耳聋,右耳混合性聋,语频区平均骨气导差为55 dB.Jahrsdoerfer评分患者左侧为5分,右侧为4分.双侧面神经后进路开放骨性隧道,一期双耳振动声桥圆窗植入.结果双耳面神经后进路振动声桥圆窗植入,术后2.5个月开机使用,声场测听语频区左耳听阈平均40 dB HL,右耳平均听阈39 dB HL,双耳气导听阈降低15~16 dB HL.开放式汉语单声母、韵母言语识别率为98%.结论面神经后进路开放骨性隧道暴露圆窗行振动声桥圆窗植入术治疗小耳畸形,听力改善较为理想.     

Retrospective audiological analysis of bone conduction versus round window vibratory stimulation in patients with mixed hearing loss

Objective: To compare audiological outcomes in mild-to-moderate mixed hearing loss patients treated with a bone-anchored hearing aid or an active middle-ear implant. Analysis aimed to refine criteria used in preoperative selection of implant type. Design: Retrospective comparative analysis of audiological data. Follow-up time ranged between 0.55 and 8.8 years. Study sample: For detailed comparative analysis, 12 patients (six in each group) with comparable bone conduction thresholds and similar clinical characteristics were selected. A larger cohort of 48 patient files were used to evaluate overall audiological indication criteria (24 per group). Results: In free-field tone audiometry, Baha patients showed mean aided thresholds between 40–48 dB, whereas hearing thresholds for VSB patients were 25–43 dB. Baha and VSB users had mean WRS of 56% and 82%, respectively, at 65 dB. Better speech understanding in noise was seen with the VSB. Conclusion: Analysis of the main cohort (n = 48) showed that treatment with round window vibroplasty leads to better hearing performance than treatment with a bone-anchored hearing device, if the bone conduction pure-tone average (0.5 to 4 kHz) is poorer than 35 dB HL. Audiological analysis in the smaller comparative analysis showed similar findings.     

The active middle ear implant for the rehabilitation of sensorineural, mixed and conductive hearing losses

Active middle ear implants, such as the Vibrant Soundbridge, are used as an important part in the rehabilitation of sensorineural, conductive hearing, or mixed hearing loss. The attachment of the Vibrant Soundbridge at the round window and the usage of the Vibroplasty couplers strongly expanded the application of the Vibrant Soundbridge.The Vibrant Soundbridge is developed for patients who have an intolerance to hearing aids and a moderate to profound sensorineural hearing loss. The VSB also provides an optimal solution for patients with failed middle ear reconstructions or patients with atresia. To capture the improvement with the VSB Implant with different hearing losses a literature analysis was conducted. The functional gain was analyzed for 107 patients with conductive hearing loss and for 214 patients with sensorineural hearing loss out of 14 studies.Patients with conductive and mixed hearing loss resulted in a functional gain from 30 to 58?dB with the VSB. Patients with a pure sensorineural hearing loss showed a functional gain of 23-30?dB. The VSB bone conduction threshold shift was analyzed for all studies conducted in the years between 2000 and 2009. In 11 of the 16 studies there was no significant (p=0.05) change found. In 5 studies, the pre- to post-surgical bone conduction threshold shift was less than 10?dB. None of these studies measured a threshold shift of more than 10?dB.The flexible attachment at either the long process of the incus with sensorineural hearing loss, with an conductive hearing loss at the round window or the use of Vibroplasty couplers at the oval window, head of the stapes or round window makes the VSB an extremely versatile instrument. If patients can't wear conventional hearing aids, had failed middle ear reconstructions or atresia the VSB presents, due to the significant hearing improvement in any type of hearing loss, an ideal solution.     

Results of Active Middle Ear Implantation in Patients With Mixed Hearing Loss After Middle Ear Surgery: A Prospective Multicenter Study (the ROMEO Study)

ObjectivesThis study was conducted to evaluate the user satisfaction, efficacy, and safety of round window (RW) vibroplasty using the Vibrant Soundbridge (VSB) in patients with persistent mixed hearing loss after mastoidectomy.Methods The study included 27 patients (mean age, 58.7 years; age range, 28–76 years; 11 men and 16 women) with mixed hearing loss after mastoidectomy from 15 tertiary referral centers in Korea. The VSB was implanted at the RW. The Korean translation of the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire and the Korean version of the International Outcome Inventory for Hearing Aids (K-IOI-HA) questionnaire were used to evaluate user satisfaction as the primary outcome. The secondary outcome measures were audiological test results and complication rates.ResultsThe mean scores for ease of communication (61.3% to 29.7% to 30.2%), reverberation (62.1% to 43.1% to 37.4%), and background noise (63.3% to 37.7% to 34.3%) subscales of the APHAB questionnaire significantly decreased after VSB surgery. The mean K-IOI-HA scores at 3 and 6 months after surgery were significantly higher than the mean preoperative score (18.6 to 27.2 to 28.1). The postoperative VSB-aided thresholds were significantly lower than the preoperative unaided and hearing aid (HA)-aided thresholds. There was no significant difference between preoperative unaided, preoperative HA-aided, and postoperative VSB-aided maximum phonetically balanced word-recognition scores. None of the 27 patients experienced a change in postoperative bone conduction pure tone average. One patient developed temporary facial palsy and two developed surgical wound infections.ConclusionRW vibroplasty resulted in improved satisfaction and audiological test results in patients with mixed hearing loss after mastoidectomy, and the complication rate was tolerable.     

索菲康骨导助听器助听效果的多中心研究

目的 评估软带或头带佩戴新型经皮传导索菲康骨导助听器对传导性聋或混合性聋、单侧聋患者的助听效果.方法 以来自国内4家三级甲等医院的109例传导性或混合性聋患者及11例单侧聋(single-sided deafness,SSD)患者为研究对象,均以纯音测听(≥6岁患者)或听性脑干反应(ABR)(<6岁患者)评估裸耳听阈后予以头带或软带佩戴索菲康Alpha 2 MPO骨导助听器;并在声场下进行未助听、佩戴当日及佩戴2周后的助听听阈(0.5~4 kHz)测试;≥6岁患者进行未助听、佩戴当日及佩戴2周助听下的言语识别阈(speech recognition threshold, SRT)测试,并记录患者佩戴后的不良反应.结果 传导性或混合性聋患者中≥6岁患者助听耳裸耳骨导及气导平均听阈均值分别为18.55±8.99、71.45±10.25 dB HL,<6岁组助听耳裸耳骨导及气导ABR阈值均值分别为18.33±8.36、70.80±8.24 dB HL;SSD患者助听耳裸耳听阈不能测出;佩戴2周后,三组助听后纯音听阈均值分别为32.21±10.00、37.33±14.15、34.38±10.76 dB HL,较未助听时明显改善,差异有统计学意义(P<0.05);≥6岁传导性或混合性聋组和SSD组患者佩戴2周后助听下各方向SRT较未助听时均显著降低,差异有统计学意义(P<0.05);各组患者均无与佩戴助听器相关的不良皮肤反应等.结论 使用软带、头带佩戴索菲康骨导助听器,可有效改善传导性或混合性聋、SSD患者听阈和安静环境下言语识别阈.     

Results of Cochlear Implantation in Patients with Severe to Profound Hearing Loss—Implications for Patient Selection

In patients with some residual hearing and minor benefit from conventional hearing aids, the benefits of cochlear implantation have to be weighed carefully against eventual adverse effects. In this study, pre- and post-operative thresholds as well as functional results after cochlear implantation are reported; 17 of 44 implanted adults had residual hearing pre-operatively (mean threshold(_{250 to 4000 Hz}): 106 dB HL) in the implanted ear. Residual hearing in the implanted ear could not, in general, be preserved post-operatively.

Seventeen of 44 implanted children had some amount of residual hearing in the implanted ear pre-operatively (implanted ear: 114 dB HL; contralateral ear: 109.9 dB HL; mean thresholds(_{250 to 4000 Hz)})).

Contrary to the results in adults, residual hearing in the implanted ear remained statistically unchanged. Hearing in the contralateral ear increased significantly from 109.9 to 101.9 dB HL post-operatively. This increase was mainly attributed to maturation of the central auditory pathway. In adults with residual hearing, the monosyllable word recognition scores increased significantly from 9 per cent pre-operatively to 42 per cent post-operatively. Children with residual hearing tended to perform better on speech-related test material compared to children without prior auditory experience. Cochlear implantation is indicated in adults and children with residual hearing and minor benefit from conventional amplification. The contralateral ear in children should be considered for additional acoustical stimulation.     

振动声桥在先天性耳畸形耳道再闭锁患者中的应用

目的:探讨外耳道再闭锁患者振动声桥植入效果。方法:曾行外耳道成形和鼓室成形术的耳畸形患者3例,其中男2例,女1例;年龄15～18岁,平均17岁。3例患者均为传导性聋,骨气导差51.6～65.0dB HL,平均为56.3dB HL。3例均行振动声桥植入,手术方式为:镫骨振动成形术2例,圆窗振动成形术1例。结果:3例患者术后听力改善21.6～52.5dB HL,平均32.2dB HL。无眩晕、耳鸣及面瘫等并发症发生。结论:外耳道成形和鼓室成形术后再闭锁的耳畸形患者,振动声桥植入后听力改善效果明显。     

A novel implantable hearing system with direct acoustic cochlear stimulation

A new implantable hearing system, the direct acoustic cochlear stimulator (DACS) is presented. This system is based on the principle of a power-driven stapes prosthesis and intended for the treatment of severe mixed hearing loss due to advanced otosclerosis. It consists of an implantable electromagnetic transducer, which transfers acoustic energy directly to the inner ear, and an audio processor worn externally behind the implanted ear. The device is implanted using a specially developed retromeatal microsurgical approach. After removal of the stapes, a conventional stapes prosthesis is attached to the transducer and placed in the oval window to allow direct acoustical coupling to the perilymph of the inner ear. In order to restore the natural sound transmission of the ossicular chain, a second stapes prosthesis is placed in parallel to the first one into the oval window and attached to the patient's own incus, as in a conventional stapedectomy. Four patients were implanted with an investigational DACS device. The hearing threshold of the implanted ears before implantation ranged from 78 to 101 dB (air conduction, pure tone average, 0.5-4 kHz) with air-bone gaps of 33-44 dB in the same frequency range. Postoperatively, substantial improvements in sound field thresholds, speech intelligibility as well as in the subjective assessment of everyday situations were found in all patients. Two years after the implantations, monosyllabic word recognition scores in quiet at 75 dB improved by 45-100 percent points when using the DACS. Furthermore, hearing thresholds were already improved by the second stapes prosthesis alone by 14-28 dB (pure tone average 0.5-4 kHz, DACS switched off). No device-related serious medical complications occurred and all patients have continued to use their device on a daily basis for over 2 years.     

Preservation of residual hearing with cochlear implantation: how and why

CONCLUSIONS: Hearing may be conserved in adults after implantation with the Nucleus Contour Advance perimodiolar electrode array. The degree of hearing preservation and the maximum insertion depth of the electrode array can vary considerably despite a defined surgical protocol. Residual hearing combined with electrical stimulation in the same ear can provide additional benefits even for conventional candidates for cochlear implantation. OBJECTIVES: We present preliminary results from a prospective multicentre study investigating the conservation of residual hearing after implantation with a standard-length Nucleus Contour Advance perimodiolar electrode array and the benefits of combined electrical and acoustic stimulation. MATERIAL AND METHODS: The subjects were 12 adult candidates for cochlear implantation recruited according to national selection criteria. A "soft" surgery protocol was defined, as follows: 1-1.2-mm cochleostomy hole anterior and inferior to the round window; Nucleus Contour Advance electrode array inserted using the "Advance-off-stylet" technique; and insertion depth controlled by means of three square marker ribs left outside the cochleostomy hole. These procedures had been shown to reduce insertion forces in temporal bone preparations. Variations in surgical techniques were monitored using a questionnaire. Pure-tone thresholds were measured pre- and postoperatively. Patients who still retained thresholds <90 dB HL for frequencies up to 500 Hz were re-fitted with an in-the-ear (ITE) hearing aid. Word recognition was tested in quiet and sentence perception in noise for the cochlear implant alone and in combination with an ipsilateral hearing aid. RESULTS: Hearing threshold level data were available for 12 patients recruited from 6 of the centres. Median increases in hearing threshold levels were 23, 27 and 33 dB for the frequencies 125, 250 and 500 Hz, respectively. These median increases include the data for two patients who had total loss of residual hearing due to difficulties encountered during surgery. "Cochlear view" X-ray images indicated that the depth of insertion varied between 300 and 430 degrees, despite modest variations in the length of the electrode inserted (17-19 mm). The insertion angle had some influence on the preservation of residual hearing at frequencies of 250-500 Hz. Six of the 12 patients retained sufficient hearing for effective use of an ipsilateral ITE hearing aid (< or = 80 dB HL at 125 and 250 Hz; < or = 90 dB HL at 500 Hz). Word recognition scores in quiet were improved from 10% to 30% with the cochlear implant plus ipsilateral hearing aid in 3 patients who had at least 3 months postoperative experience. Signal:noise ratio thresholds for sentence recognition were improved by up to 3 dB. Patients reported that they experienced greatly improved sound quality and preferred to use the two devices together.     

两种不同长度的人工耳蜗电极对不同频率残余听力的影响

目的探讨植入两种不同长度的人工耳蜗电极对患者不同频率残余听力的影响。方法以中耳、内耳无明显异常的15例单侧植入Nucleus 24型人工耳蜗(A组,电极长度17mm)患儿与15例单侧植入Medel C40+15型(B组,电极长度29.2mm)人工耳蜗患儿为对象,两组对象于手术前后分别进行听性稳态反应(ASSR)测试,比较不同长度的人工耳蜗电极植入对不同频率听力的影响。结果①人工耳蜗植入后一月开机经耳蜗电刺激后,有51.67%患者植入耳保留残余听力;②手术前0.5、1、2、4kHz ASSR反应阈A组分别为98.93±6.28、107.80±8.16、104.07±8.83及104.73±5.93dB HL,B组分别为99.67±4.20、110.87±8.17、109.93±7.51及106.93±4.35dB HL;手术后一月上述各频率ASSR反应阈A组分别为101.60±4.64、112.60±6.11、106.13±5.19及106.60±6.25dB HL;B组分别为101.40±3.96、116.33±2.58、113.13±3.84及108.46±3.76dB HL;③术后B组0.5、1kHz的残余听力损伤明显,2、4kHz处残余听力损伤程度与A组差异无统计学意义;④A组术后残余听力损失以1kHz最显著,B组术后残余听力损失以500Hz最显著。结论人工耳蜗植入及耳蜗电极电刺激对植入耳的残余听力并非完全破坏,电极长短对不同频率残余听力会造成不同程度的损害,植入电极越长,植入耳蜗的部位越深,对低频残余听力损伤越明显。     

一例神经纤维瘤患者植入人工耳蜗的效果观察

目的：探讨神经纤维瘤听力下降患者人工耳蜗植入手术可行性及疗效。方法对一例多发性神经纤维瘤伽马刀术后患者带瘤行CS-10A人工耳蜗植入,术前和术后3个月分别进行裸耳/助听听阈评估、单音节和双音节言语识别测试。结果患者术前右侧重度、左侧极重度感音神经性聋,术前言语识别率左耳最大声输出患者无反应,右耳最大单音节词言语识别率为12%,双耳双音节词言语识别率均为0%。听觉行为分级量表为2级。患者右侧成功植入人工耳蜗。术后3个月助听后声场评估右耳（人工耳蜗植入耳）平均听力42.5 dB HL,单音节词最大言语识别率为64%,双音节词最大言语识别率为47%,听觉行为分级量表为7级。结论在影像学证明听神经完整的情况下,神经纤维瘤伽马刀术后重度聋患者可植入人工耳蜗,以提升听力水平。     

Preservation of residual hearing with cochlear implantation: How and why

Conclusions Hearing may be conserved in adults after implantation with the Nucleus Contour Advance perimodiolar electrode array. The degree of hearing preservation and the maximum insertion depth of the electrode array can vary considerably despite a defined surgical protocol. Residual hearing combined with electrical stimulation in the same ear can provide additional benefits even for conventional candidates for cochlear implantation.

Objectives We present preliminary results from a prospective multicentre study investigating the conservation of residual hearing after implantation with a standard-length Nucleus Contour Advance perimodiolar electrode array and the benefits of combined electrical and acoustic stimulation.

Material and methods The subjects were 12 adult candidates for cochlear implantation recruited according to national selection criteria. A “soft” surgery protocol was defined, as follows: 1–1.2-mm cochleostomy hole anterior and inferior to the round window; Nucleus Contour Advance electrode array inserted using the “Advance-off-stylet” technique; and insertion depth controlled by means of three square marker ribs left outside the cochleostomy hole. These procedures had been shown to reduce insertion forces in temporal bone preparations. Variations in surgical techniques were monitored using a questionnaire. Pure-tone thresholds were measured pre- and postoperatively. Patients who still retained thresholds <90 dB HL for frequencies up to 500 Hz were re-fitted with an in-the-ear (ITE) hearing aid. Word recognition was tested in quiet and sentence perception in noise for the cochlear implant alone and in combination with an ipsilateral hearing aid.

Results Hearing threshold level data were available for 12 patients recruited from 6 of the centres. Median increases in hearing threshold levels were 23, 27 and 33 dB for the frequencies 125, 250 and 500 Hz, respectively. These median increases include the data for two patients who had total loss of residual hearing due to difficulties encountered during surgery. “Cochlear view” X-ray images indicated that the depth of insertion varied between 300 and 430°, despite modest variations in the length of the electrode inserted (17–19 mm). The insertion angle had some influence on the preservation of residual hearing at frequencies of 250–500 Hz. Six of the 12 patients retained sufficient hearing for effective use of an ipsilateral ITE hearing aid (≤80 dB HL at 125 and 250 Hz; ≤90 dB HL at 500 Hz). Word recognition scores in quiet were improved from 10% to 30% with the cochlear implant plus ipsilateral hearing aid in 3 patients who had at least 3 months postoperative experience. Signal:noise ratio thresholds for sentence recognition were improved by up to 3 dB. Patients reported that they experienced greatly improved sound quality and preferred to use the two devices together.     

Monosyllable speech perception of Japanese hearing aid users with prelingual hearing loss: implications for surgical indication of cochlear implant

OBJECTIVE: The monosyllable speech perception ability after years of educational intervention was compared between prelingually deafened pediatric hearing aid users and their cochlear implant counterparts. DESIGN: An open-set monosyllabic speech perception test was conducted on all subjects. The test required subjects to indicate a corresponding Japanese character to that spoken by the examiner. Fifty-two subjects with prelingual hearing impairment (47 hearing aid users and 5 cochlear implant users) were examined. RESULTS: Hearing aid users with average pure-tone thresholds less than 90 dB HL demonstrated generally better monosyllable perception than 70%, which was equivalent or better performance than that of the cochlear implant group. Widely dispersed speech perception was observed within the 90-99 dB HL hearing-aid user group with most subjects demonstrating less than 50% speech perception. In the cluster of >100 dB HL, few cases demonstrated more than 50% in speech perception. The perception ability of the vowel part of each mora within the cochlear implant group was 100% and corresponding to that of hearing aid users with moderate and severe hearing loss. CONCLUSION: Hearing ability among cochlear implant users can be comparable with that of hearing aid users with average unaided pure-tone thresholds of 90 dB HL, after monosyllabic speech perception testing was performed.     

UTILITY OF VIBRANT SOUNDBRIDGE IN PATIENTS WITH CONGENITAL MIDDLE AND OUTER EAR DEFORMITIES

Objective To report use of the Vibrant Soundbridge (VSB) in patients with congenital deformation of the middle and outer ears and investigate its utility in this patient population.Method Four patients with congenital deformation of middle and outer ears underwent VSB implantation. All were male (aged 3-18 years,average 13.5 years) and operated on the left side.Malformation was bilateral in 3 patients and unilateral in 1 patient. Surgical techniques were modified to accommodate each patient’s unique conditions and needs.The implant site was approached via the facial recess in 3 patients and through a retro-facial nerve route in 1 patient. The VSB implant was connected to either the stapes (2 cases) or the round window (2 cases).Pure tone and speech audiometry results and daily communication capabilities before and after VSB activation were compared.Results The operations were successful in all patients, with no complications. The patient communication level improved significantly after VSB activation. Average air conduction pure tone threshold or conditioned reflex audiometry threshold improved by 35 dB in the 0.25-4 kHz range,from 69 dB HL before VSB activation to 34 dB HL after.The sentence recognition rate in quiet at 65 dB SPL went up to 86% from 0% without VSB for patients with bilateral deformation and remained at 100% for the patient with unilateral deformity. However, for the latter patient, the rate improved to 20% from 0% without VSB in noise (-8 dB SNR).Conclusion VSB is an excellent solution for improving hearing in patients with congenital deformation of middle and outer ears.Operation can be completed and good results can be achieved even in patients with unique conditions and needs.     

Combined electroacoustic stimulation in conventional candidates for cochlear implantation

Objective:To report on combined ipsilateral electrical and acoustic stimulation in a subset of conventional candidates for cochlear implantation where preoperative pure tone thresholds were 85-110 dB HL, 250-500 Hz). In the remaining 7 cases, residual hearing was maintained up to at least 6 months after operation with minor changes. Insertion depth angles in these cases ranged from 285 to 420 degrees . For these subjects, the mean preoperative score for words presented at 65 dB SPL was 22%. Mean postoperative scores were 56% for CI alone, and 68% for CI plus ipsilateral hearing aid (p < 0.05, paired t). For sentences presented in multitalker babble noise at 5 dB SNR, mean scores were 61% CI alone, and 75% CI+IpsiHA (p < 0.01, paired t). Conclusions: Hearing was conserved during surgery and over time in 70% of conventional candidates implanted with the Nucleus 24 Contour Advance CI who had significant levels of preoperative low-frequency residual hearing (相似文献