McKinnon B J, Dumon T, Hagen R, Lesinskas E, Mlynski R, Profant M, Spindel J, Van Beek-King J, Zernotti M
Otology/Neurotology, Shea Ear Clinic, 6133 Poplar Pike, Memphis, TN, 38119, USA.
Eur Arch Otorhinolaryngol. 2014 Jul;271(7):1917-21. doi: 10.1007/s00405-013-2680-0. Epub 2013 Sep 13.
Congenital aural atresia (CAA) poses significant challenges to surgical remediation. Both bone anchored hearing aids (BAHA) and the Vibrant Soundbridge (VSB) have been considered as alternatives or adjuncts to conventional atresiaplasty. A consensus statement on VSB implantation in children and adolescents recommended against implantation when the Jahrsdoerfer score was less than 8. More recent publications suggest that patients with Jahrsdoerfer scores between three and seven may benefit from VSB implantation. The purpose of this study was to further investigate the outcomes of VSB implantation in CAA. The study was a multi-center, retrospective review. A retrospective review of data (patient's demographic, clinical, implant and audiological information) from four collaborating centers that have performed VSB implantation in CAA was performed. Outcomes based on severity of the atresia using the Jahrsdoerfer and Yellon-Branstetter scoring systems were also evaluated. Data from 28 patients from the four centers revealed no iatrogenic facial nerve injuries or change in bone thresholds. Post-operative speech threshold and speech recognition was, respectively, 39 dB and 94%. Jahrsdoerfer and Yellon scores ranged from 4 to 9 and 4 to 12, respectively. The scores did not correlate to or predict outcomes. Three individual elements of the scores did correlate to initial, but not long-term outcomes. Atresiaplasty and BAHA in the management of CAA are not complete solutions. VSB may offer an alternative in these surgically complex patients for achieving amplification, though better metrics for patient selection need to be developed. LEVEL OF EVIDENCE : IV.
先天性耳道闭锁（CAA）给手术修复带来了重大挑战。骨锚式助听器（BAHA）和振动声桥（VSB）都被视为传统耳道成形术的替代方案或辅助手段。一份关于儿童和青少年VSB植入的共识声明建议，当雅尔斯多费尔评分低于8分时，不建议植入。最近的出版物表明，雅尔斯多费尔评分为3至7分的患者可能从VSB植入中获益。本研究的目的是进一步调查VSB植入治疗CAA的效果。该研究是一项多中心回顾性研究。对四个合作中心进行CAA患者VSB植入的数据（患者的人口统计学、临床、植入和听力学信息）进行了回顾性分析。还使用雅尔斯多费尔和耶伦-布兰斯泰特评分系统评估了基于闭锁严重程度的结果。来自四个中心的28例患者的数据显示，没有医源性面神经损伤或骨阈值变化。术后言语阈值和言语识别率分别为39 dB和94%。雅尔斯多费尔评分和耶伦评分分别为4至9分和4至12分。这些评分与结果无关，也不能预测结果。评分中的三个单独要素与初始结果相关，但与长期结果无关。耳道成形术和BAHA在CAA治疗中并非完整的解决方案。VSB可能为这些手术复杂的患者提供实现听力放大的替代方案，不过需要制定更好的患者选择指标。证据级别：IV级。
