Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany.
Otol Neurotol. 2021 Dec 1;42(10):1507-1514. doi: 10.1097/MAO.0000000000003278.
Hearing rehabilitation with an active middle ear implant (AMEI) in patients with mixed hearing loss (MHL) after multiple ear surgeries is surgically challenging and requires individual solutions in some cases. Our objective was to introduce a feasible novel technique for direct oval window vibroplasty (OW vibroplasty) using a partial ossicular replacement prosthesis (PORP) to ensure stability and enable active and passive sound transmission.
Four patients with MHL following multiple middle ear surgeries and indication for an AMEI received direct OW vibroplasty in combination with a customized PORP between the enwrapped actuator and reconstructed tympanic membrane (TM).
Postoperative bone conduction was stable in all patients. All patients benefitted from the AMEI in combination with PORP with a mean functional gain of 31.5 ± 17.0 dB. Mean aided postoperative pure tone average was 27.3 ± 2.6 dB. Speech discrimination in quiet at 65 dB with the German Language Freiburg Monosyllabic Test improved for all patients to 68.8 ± 6.3% and in noise with the German Language Oldenburger Sentence Test to -10.4 ± 3.3 dB SNR. No complications were observed.
This novel technique of direct OW vibroplasty extends the portfolio of reconstructive middle ear procedures by combining an intraoperatively customized "off-the-shelf" PORP as a coupler between floating mass transducer (FMT) and a cartilage TM. We found satisfying functional hearing results. Benefits of the reported technique comprise 1) stabilization and optimized coupling of the reconstruction, 2) possibility of passive sound transmission, 3) general feasibility due to great availability of a regular PORP, and 4) flexibility in bridging of large gaps between TM and actuator.
对于多次耳部手术后患有混合性听力损失（MHL）的患者，使用主动中耳植入物（AMEI）进行听力康复具有挑战性，在某些情况下需要个体化解决方案。我们的目的是引入一种可行的新型技术，即使用部分听骨置换假体（PORP）直接进行卵圆窗振动（OW 振动），以确保稳定性并实现主动和被动声音传输。
4 名多次中耳手术后患有 MHL 且需要 AMEI 的患者接受了直接 OW 振动与包裹式致动器和重建鼓膜（TM）之间定制 PORP 的联合治疗。
所有患者的骨导术后均稳定。所有患者均受益于 AMEI 与 PORP 的联合治疗，平均功能增益为 31.5±17.0dB。平均辅助术后纯音平均为 27.3±2.6dB。所有患者的德国弗里堡单音节测试在 65dB 安静环境下的言语识别率提高至 68.8±6.3%，德国奥尔登堡句子测试在-10.4±3.3dB SNR 噪声环境下提高至 68.8±6.3%。未观察到并发症。
该直接 OW 振动新技术通过将术中定制的“现成”PORP 作为浮动质量换能器（FMT）和软骨 TM 之间的耦合器，扩展了重建中耳手术的范围。我们发现功能听力结果令人满意。该技术的优点包括 1）重建的稳定性和优化耦合，2）被动声音传输的可能性，3）由于常规 PORP 的可用性高，具有普遍的可行性，以及 4）在 TM 和致动器之间的大间隙桥接方面的灵活性。
