Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
Department of Medical Psychology, Medical University of Innsbruck, Schöpfstr. 23a, 6020, Innsbruck, Austria.
Eur Arch Otorhinolaryngol. 2024 Jan;281(1):141-151. doi: 10.1007/s00405-023-08103-9. Epub 2023 Jul 13.
The Vibrant Soundbridge (VSB) is an established active-middle-ear-implant for patients with moderate-to-profound hearing-loss. This surgery is referred to as "Vibroplasty". Sufficient transfer of the VSB's floating-mass-transducers (FMT) energy to the inner ear is a crucial factor influencing the coupling-quality (CQ). However, assessing CQ is hamper by two issues: the method of CQ-assessment itself and the method of FMT-fixation during Vibroplasty.
This prospective study explored the influence of intraoperative auditory-brainstem-response (+ ABR) measurements and various fixation methods on postoperative CQ after Vibroplasty as compared to matched-patients after Vibroplasty without intraoperative ABR (-ABR). Propensity-score-matching was performed based on preoperative bone-conduction-pure-tone-average-3 (BC-PTA3) at 1-, 2- and 4 kHz. Primary outcome parameters were postoperative CQ-PTA3, intraoperative ABR threshold for various fixation methods and postoperative BC-PTA3.
A total of 28 patients were included, of which 14 were + ABR. Preoperative BC-PTA3, sex, age, and number of previous surgeries did not differ significantly between groups (all p > 0.301). Mean postoperative CQ-PTA3 was significantly better for + ABR (1.8 vs. 12.3 dB-HL; p = 0.006). Mean intraoperative ABR threshold was superior for cartilage-counter-bearing and cartilage-housing compared to additional fixation with injectable-platelet-rich- fibrin (53 vs. 56 & 57 dB-HL, respectively; p = 0.04; η = 0.33). Mean postoperative BC-PTA3 did not significantly differ between patients (41.4 vs. 41.8 dB-HL; p = 0.77). A total of 7% of the patients required intraoperative readjustment of the FMT based on unsatisfactory intraoperative ABR threshold.
Intraoperative ABR measurement resulted in significantly better postoperative CQ. Cartilage-counter-bearing and cartilage-housing were observed to have superior CQ. A total of 7% of the patients could be spared revision-Vibroplasty due to intraoperative ABR measurement.
Vibrant Soundbridge（VSB）是一种已确立的用于中度至重度听力损失患者的主动中耳植入物。该手术被称为“Vibroplasty”。VSB 的浮动质量换能器（FMT）能量向内耳的充分传递是影响耦合质量（CQ）的关键因素。然而，CQ 的评估受到两个问题的阻碍：CQ 评估方法本身和 Vibroplasty 期间 FMT 固定方法。
这项前瞻性研究探讨了术中听觉脑干反应（+ ABR）测量以及各种固定方法对 Vibroplasty 后 CQ 的影响，与没有术中 ABR（-ABR）的 Vibroplasty 后匹配患者进行比较。基于术前骨导纯音平均 3（BC-PTA3）在 1、2 和 4 kHz 处进行倾向评分匹配。主要结局参数是术后 CQ-PTA3、各种固定方法的术中 ABR 阈值和术后 BC-PTA3。
共纳入 28 例患者，其中 14 例为+ ABR。两组间术前骨导纯音平均 3（BC-PTA3）、性别、年龄和手术次数无显著差异（均 p>0.301）。+ ABR 组术后 CQ-PTA3 明显更好（1.8 与 12.3 dB-HL；p=0.006）。软骨对载物和软骨外壳的平均术中 ABR 阈值优于附加的血小板丰富纤维蛋白注射固定（分别为 53、56 和 57 dB-HL；p=0.04；η=0.33）。两组间术后 BC-PTA3 无显著差异（41.4 与 41.8 dB-HL；p=0.77）。共有 7%的患者需要根据不满意的术中 ABR 阈值在术中进行 FMT 调整。
术中 ABR 测量导致术后 CQ 明显改善。软骨对载物和软骨外壳观察到具有更高的 CQ。由于术中 ABR 测量，共有 7%的患者可以避免 revision-Vibroplasty。
