Oval window membrane vibroplasty for direct acoustic cochlear stimulation:  treating severe mixed hearing loss in challenging middle ears.
OBJECTIVE
To date, all the Vibrant Soundbridge (VSB) applications have managed to stimulate the inner ear indirectly. Our objective was to present a new VSB application for direct inner ear stimulation.


METHODS
Prospective cohort study.


METHODS
Tertiary, referral center


METHODS
Three patients with previous middle ear surgery and moderate-to-severe ipsilateral, mixed hearing loss.


METHODS
Oval window membrane vibroplasty (OWMV) for direct acoustic cochlear stimulation. A total ossicular replacement prosthesis (TORP) was attached to the floating mass transducer (FMT). Then, the stapes footplate was perforated, and the tip of the FMT-TORP assembly was advanced approximately 1 mm into the inner ear. A silicon ring was placed around the TORP's tip to prevent it from slipping deeper into the inner ear.


METHODS
Audiologic assessment involving pure-tone audiometry, aided and unaided free-field audiometry, Freiburg monosyllabic word test, and registration of any complications.


RESULTS
OWMV resulted in an average functional hearing gain of 36.1 dB (range, 24.2-47.5 dB). Although the greatest amplification was observed in the higher frequencies, there also was a significant improvement in the lower frequencies. The surgery was not related to any difficulties; vertigo, inner ear trauma, or further complications did not occur.


CONCLUSIONS
We present a new method for direct acoustic cochlear stimulation using an active middle ear implant. The preliminary results show that OWMV is a promising and safe option for treating moderate and severe hearing loss, even in challenging cases with previous middle ear operations or fixed stapes footplate.
Department of Otolaryngology, Hanover Medical School, Hanover, Germany.
Burkard
B
Schwab
Rolf Benedict
RB
Salcher
Hannes
H
Maier
Georgios
G
Kontorinis
D000161:Acoustic Stimulation; D001299:Audiometry; D004432:Ear, Middle / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006314:Hearing Loss, Conductive / Q000503:physiopathology / Q000601:surgery*; D046089:Hearing Loss, Mixed Conductive-Sensorineural / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009998:Ossicular Prosthesis; D019933:Ossicular Replacement; D010046:Oval Window, Ear / Q000601:surgery*; D011446:Prospective Studies; D013199:Stapes / Q000503:physiopathology; D013201:Stapes Surgery; D016896:Treatment Outcome