title: Results of VSB implantation at the short process of the incus in children with ear atresia.
abstract: OBJECTIVE
  To describe a new and more simple surgical procedure for implanting the Vibrant Soundbridge (VSB) on the short process of the incus in children with ear atresia and atretic plate and present the audiometric results.
  
  
  METHODS
  Since 2014, pre- and post-operative audiometric tests with tonal and vocal audiometryat the maximal follow up, respectively 33, 22 and 12 months were performed after VSB implantation at the ENT department, Necker Enfants Malades Hospital, Paris, France. 3 children aged 11, 9 and 15 years with conductive hearing loss due to high grade ear atresia and absent ear canal were implanted. The malformed and fused malleus-incus complex was found to be immobile in two of the subjects, who then underwent a superior tympanotomy to carefully remobilize the malleus. Stapes were mobile in all cases. The FMT clip was customized and crimped on the short process, stabilized by the metallic wire.
  
  
  RESULTS
  At the maximum follow-up time, the bone conduction was unchanged, and the mean aided ACPTA was 21 dB, 29 dB and 30 dB, compared to 66 dB, 63 dB and 68 dB unaided, respectively. The word recognition score (WRS) at 65 dB SPL increased from 10%, 10% and 70% (unaided) respectively to 100% (aided).
  
  
  CONCLUSIONS
  The long process of the incus is usually very hypoplastic in patients with ear atresia with a fused malleus-incus complex lateral to the stapes. VSB coupling to the long process of the incus or the stapes may be challenging in small mastoids. Coupling to the short process of the incus is comparatively a simple procedure, since there is no need for posterior tympanotomy and has no proximity to the facial nerve. The results of this study are similar to other ear atresia cases in the literature with classic FMT placement on the stapes or long process of the incus. Outcomes should be confirmed in a larger number of patients.
authors.affiliation: ENT Department, Necker-Enfants Malades Hospital, Paris-Descartes University, Paris, France. Electronic address: Charlotte.celerier@aphp.fr.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Célérier
authors.affiliation: ENT Department, Necker-Enfants Malades Hospital, Paris-Descartes University, Paris, France.
authors.forename: Briac
authors.initials: B
authors.lastname: Thierry
authors.affiliation: ENT Department, Necker-Enfants Malades Hospital, Paris-Descartes University, Paris, France.
authors.forename: Cyrille
authors.initials: C
authors.lastname: Coudert
authors.affiliation: ENT Department, Necker-Enfants Malades Hospital, Paris-Descartes University, Paris, France.
authors.forename: Marion
authors.initials: M
authors.lastname: Blanchard
authors.affiliation: ENT Department, Necker-Enfants Malades Hospital, Paris-Descartes University, Paris, France.
authors.forename: Natalie
authors.initials: N
authors.lastname: Loundon
authors.affiliation: ENT Department, Necker-Enfants Malades Hospital, Paris-Descartes University, Paris, France.
authors.forename: Erea Noel
authors.initials: EN
authors.lastname: Garabédian
authors.affiliation: ENT Department, Necker-Enfants Malades Hospital, Paris-Descartes University, Paris, France. Electronic address: f.denoyelle@nck.aphp.fr.
authors.forename: Françoise
authors.initials: F
authors.lastname: Denoyelle
mesh_terms: D000293:Adolescent; D002648:Child; D005500:Follow-Up Studies; D005602:France; D006314:Hearing Loss, Conductive / Q000151:congenital* / Q000601:surgery*; D006801:Humans; D007188:Incus / Q000002:abnormalities* / Q000601:surgery*; D009998:Ossicular Prosthesis; D019933:Ossicular Replacement / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Children; Ear atresia; Surgery; VSB implantation