Intraoperative Estimation of the Coupling Efficiency and Clinical Outcomes of the Vibrant Soundbridge Active Middle Ear Implant Using Auditory Brainstem Response Measurements

2019 ◽  
Vol 28 (3) ◽  
pp. 553-559 ◽  
Author(s):  
Ute Geiger ◽  
Andreas Radeloff ◽  
Rudolf Hagen ◽  
Mario Cebulla
Keyword(s):  
Auditory Brainstem Response ◽  
Speech Intelligibility ◽  
Bone Conduction ◽  
Coupling Efficiency ◽  
Auditory Brainstem ◽  
Vibrant Soundbridge ◽  
Active Middle Ear Implant ◽  
Middle Ear Implant ◽  
Behavioral Thresholds ◽  
Brainstem Response

Purpose This study intraoperatively measured the coupling efficiency of the Vibrant Soundbridge (VSB), with the aim of avoiding revision surgery due to insufficient outcome. This method can also be used to test the integrity of the implant at the end of the implantation surgery and to evaluate aided thresholds. In addition, this method makes it possible to objectively test how well the VSB has been fitted, provide assistance in fitting handicapped patients or children, evaluate hearing degradation, or test for a drop in coupling efficiency before revision surgeries. In order to analyze the feasibility of these new VSB-aided auditory brainstem response (ABR) thresholds, they were compared to behavioral thresholds from the Vibrogram and the preoperative bone conduction thresholds. Method The study included 30 patients with mild-to-severe hearing loss implanted with a VSB (VORP503). Intraoperative ABR thresholds during the VSB implantation were recorded using a VSB-optimized chirp stimulus. The new method is compared to the bone conduction threshold of the study sample and the aided Vibrogram thresholds. Speech intelligibility results up to 24 months after surgery are also presented. Results A reliable correlation between the bone conduction thresholds and the intraoperative ABRs was found and was higher in comparison to the Vibrogram. Furthermore, speech intelligibility outcomes were stable over time. Conclusion ABR measurements can be used intraoperatively to estimate the coupling efficiency of the VSB and test the integrity of the implant at the end of surgery.

Normal Brief-Tone Bone-Conduction Behavioral Thresholds Using the B-71 Transducer: Three Occlusion Conditions

2003 ◽  
Vol 14 (10) ◽  
pp. 556-562 ◽  
Author(s):  
Susan A. Small ◽  
David R. Stapells
Keyword(s):  
Auditory Brainstem Response ◽  
Pure Tone ◽  
Bone Conduction ◽  
Auditory Brainstem ◽  
Behavioral Thresholds ◽  
Brainstem Response ◽  
Occlusion Effect ◽  
Response Testing ◽  
Brief Tones ◽  
Air Conduction

Behavioral thresholds were measured from 31 adults with normal hearing for 500, 1000, 2000, and 4000 Hz brief tones presented using a B-71 bone oscillator. Three occlusion conditions were assessed: ears unoccluded, one ear occluded, and both ears occluded. Mean threshold force levels were 67, 54, 49, and 41 dB re:1μN peak-to-peak equivalent in the unoccluded condition for 500, 1000, 2000, and 4000 Hz, respectively (corrected for air-conduction pure-tone thresholds). A significant occlusion effect was observed for 500 and 1000 Hz stimuli. These thresholds may be used as the 0 dB nHL (normalhearing level) for brief-tone bone-conduction stimuli for auditory brainstem response testing.

Unraveling the Mystery of Auditory Brainstem Response Corrections: The Need for Universal Standards

2017 ◽  
Vol 28 (10) ◽  
pp. 950-960 ◽  
Author(s):  
Linda W. Norrix ◽  
David Velenovsky
Keyword(s):  
Auditory Brainstem Response ◽  
Auditory Brainstem ◽  
Evidence Based ◽  
Test Results ◽  
Behavioral Thresholds ◽  
Hearing Thresholds ◽  
Brainstem Response ◽  
Two Measures ◽  
Impaired Children ◽  
Universal Standard

Background: The auditory brainstem response (ABR) is used to estimate behavioral hearing thresholds in infants and difficult-to-test populations. Differences between the toneburst ABR and behavioral thresholds exist making the correspondence between the two measures less than perfect. Some authors have suggested that corrections be applied to ABR thresholds to account for these differences. However, because there is no agreed upon universal standard, confusion regarding the use of corrections exists. Purpose: The primary purpose of this article is to review the reasoning behind and use of corrections when the toneburst ABR is employed to estimate behavioral hearing thresholds. We also discuss other considerations that all audiologists should be aware of when obtaining and reporting ABR test results. Results: A review of the purpose and use of corrections reveals no consensus as to whether they should be applied or which should be used. Additionally, when ABR results are adjusted, there is no agreement as to whether additional corrections for hearing loss or the age of the client are necessary. This lack of consensus can be confusing for all individuals working with hearing-impaired children and their families. Conclusions: Toneburst ABR thresholds do not perfectly align with behavioral hearing thresholds. Universal protocols for the use of corrections are needed. Additionally, evidence-based procedures must be employed to obtain valid ABRs that will accurately estimate hearing thresholds.

Comparison of Alternative Coupling Methods of the Vibrant Soundbridge Floating Mass Transducer

2016 ◽  
Vol 21 (6) ◽  
pp. 347-355 ◽  
Author(s):  
Susan Busch ◽  
Thomas Lenarz ◽  
Hannes Maier
Keyword(s):  
Hearing Loss ◽  
Round Window ◽  
Bone Conduction ◽  
Regression Function ◽  
Ossicular Chain ◽  
Oval Window ◽  
Vibrant Soundbridge ◽  
Active Middle Ear Implant ◽  
Middle Ear Implant ◽  
Relevant Effect

The active middle ear implant Vibrant Soundbridge© provides a variety of coupling modalities of the floating mass transducer (FMT) to various structures of the ossicular chain and the round window. A retrospective analysis was performed on 125 subjects (n = 137 ears) (1) to compare the efficacy of the different FMT coupling modalities with increasing degree of hearing loss, (2) to compare the performance in speech outcome and the effective gain between the coupling types, and (3) to evaluate the risk of additional hearing loss of each coupling procedure. The patients were grouped according to their type of FMT coupling into incus vibroplasty (incus group, n = 59), round window vibroplasty with coupler (RWC group, n = 23), round window vibroplasty without coupler (RW group, n = 22), and oval window vibroplasty with coupler (OWC group, n = 33). For each coupling group, pre- and postoperative thresholds, the results of the Freiburg monosyllable test at 65 dB SPL, and the effective gain across frequencies (0.5-6 kHz) were evaluated. A logistic regression function was used to describe the relationship between word recognition scores (WRS, in % correct) and the mean bone conduction (BC) hearing loss. The surgical procedure had no clinically relevant effect on BC thresholds of patients in each coupling group. The BC pure tone average (PTA4) for 50% WRS predicted by the model function was similar for the incus (48.2 dB nHL), RW (47.8 dB nHL), and OWC (49.0 dB nHL) groups, but higher for the RWC group (67.9 dB nHL). However, the median WRS was 80% or better with no significant differences in speech perception between coupling types (Kruskal-Wallis test, p = 0.229). The effective gain shows an advantage for the incus coupling between 0.5 and 2 kHz over the other coupling types. The performance of the FMT coupling modalities is equally good for patients with a mild-to-moderate hearing loss, but the efficacy of coupling types differs for patients with greater hearing loss (>48 dB BC HL).

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