title: [Integration of the active middle ear implant Vibrant Soundbridge in total auricular reconstruction].
abstract: BACKGROUND
  Patients with high-grade microtia and atresia require a sophisticated and specific treatment. Apart from the plastic reconstruction of the auricle, in some cases hearing rehabilitation is medically indicated or is desired by the patients. The long-term results of simultaneous middle ear reconstruction with tympanoplasty are often inadequate owing to a persisting air-bone gap, and new techniques in hearing rehabilitation are needed for these patients.
  
  
  METHODS
  We present three cases of unilateral atresia to illustrate a combined approach integrating hearing rehabilitation using the active middle ear implant Vibrant Soundbridge (VSB) into plastic auricular reconstruction. The VSB was attached to the stapes suprastructure via the titanium clip in two of these cases and in the third case a subfacial approach was used to attach it directly to the membrane of the round window.
  
  
  RESULTS
  The air-bone gap was reduced to 17 dB, 14 dB and 0.25 dB HL. In free-field speech recognition tests at 65 dB SPL the patients achieved 100%, 90% and 100% recognition with the activated implant. No postoperative complications such as facial nerve paresis, vertigo or inner ear damage were found.
  
  
  CONCLUSIONS
  The integration of active middle ear implants in auricular reconstruction opens up a new approach in complete hearing rehabilitation. The additional implantation of the VSB does not have any negative effect on the healing process or the cosmetic outcome of the auricular reconstruction.
authors.affiliation: Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde & Plastische Operationen, Universitätsklinikum Schleswig-Holstein-Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck,. barbara.wollenberg@hno.uni-luebeck.de
authors.forename: B
authors.initials: B
authors.lastname: Wollenberg
authors.forename: M
authors.initials: M
authors.lastname: Beltrame
authors.forename: R
authors.initials: R
authors.lastname: Schönweiler
authors.forename: E
authors.initials: E
authors.lastname: Gehrking
authors.forename: S
authors.initials: S
authors.lastname: Nitsch
authors.forename: A
authors.initials: A
authors.lastname: Steffen
authors.forename: H
authors.initials: H
authors.lastname: Frenzel
mesh_terms: D019929:Cochlear Implantation / Q000379:methods*; D003054:Cochlear Implants; D003131:Combined Modality Therapy; D004432:Ear, Middle / Q000002:abnormalities* / Q000601:surgery*; D006314:Hearing Loss, Conductive / Q000151:congenital / Q000534:rehabilitation* / Q000601:surgery*; D006801:Humans; D011474:Prosthesis Design; D019651:Plastic Surgery Procedures / Q000379:methods; D016896:Treatment Outcome; D014433:Tympanoplasty / Q000379:methods*