scholarly journals A New Stapes-Head Coupler for the Vibrant Soundbridge System

2021 ◽  
pp. 1-8
Author(s):  
Birthe Warnholtz ◽  
Merlin Schär ◽  
Pascale Cuny ◽  
Kathrin Sonntag ◽  
Dirk Beutner ◽  
...  
Keyword(s):  
Middle Ear ◽  
Medical Electronics ◽  
Vibrational Motion ◽  
Canal Wall ◽  
Vibrant Soundbridge ◽  
Active Middle Ear Implant ◽  
Middle Ear Implant ◽  
Canal Wall Down ◽  
Canal Wall Down Mastoidectomy ◽  
Temporal Bones

Introduction: The Vibrant Soundbridge (MED-EL Medical Electronics, Austria) is an active middle ear implant with a floating mass transducer (FMT) for patients with conductive, sensorineural, or mixed hearing loss. While the FMT is vertically aligned above the stapes head (SH) with the current Vibroplasty Clip coupler (MED-EL Medical Electronics), the new SH coupler was developed to mount the FMT on the inferior side of the stapes and to fit in the reduced middle ear space after canal-wall-down mastoidectomy. Methods: Using 11 human cadaveric temporal bones (TBs), placements of the new SH couplers on the stapes were examined, and effective stimuli to the cochlea were evaluated by measuring piston-like motion of the stapes footplate with a current of 1 mA on the FMT. The results were assessed in comparison with the Vibroplasty Clip coupler. Results: The new SH coupler showed perfect coupling on the stapes in 9 out of 11 TBs. A small gap between the SH and the plate of the connection link part was unavoidable in 2 TBs but had negligible effect on vibrational motion of the stapes. Vibrational motion of the stapes with the new SH coupler was reduced at frequencies above 3 kHz compared to the corresponding motion with the current Vibroplasty Clip coupler, but the relative attenuation over all 11 cadaveric temporal bones was <10 dB. Conclusions: The new SH coupler provides an alternative with more stable fixation when placement of the current Vibroplasty Clip coupler is limited due to insufficient space after canal-wall-down mastoidectomy, while still delivering effective stimuli to the cochlea.

Acoustic Mechanisms

1998 ◽  
Vol 118 (6) ◽  
pp. 751-761 ◽  
Author(s):  
KENNETH R. WHITTEMORE ◽  
SAUMIL N. MERCHANT ◽  
JOHN J. ROSOWSKI
Keyword(s):  
Middle Ear ◽  
Sound Transmission ◽  
Canal Wall ◽  
Air Space ◽  
Canal Wall Down ◽  
Canal Wall Down Mastoidectomy ◽  
Temporal Bones ◽  
Head Neck ◽  
Canal Wall Up ◽  
Space Volume

The contribution of the middle ear air spaces to sound transmission through the middle ear in canal wall-up and canal wall-down mastoidectomy was studied in human temporal bones by measurements of middle ear input impedance and sound pressure difference across the tympanic membrane for the frequency range 50 Hz to 5 kHz. These measurements indicate that, relative to canal wall-up procedures, canal wall-down mastoidectomy results in a 1 to 5 dB decrease in middle ear sound transmission below 1 kHz, a 0 to 10 dB increase between 1 and 3 kHz, and no change above 3 kHz. These results are consistent with those reported by Gyo et al. (Arch Otolaryngol Head Neck Surg 1986;112:1262-8), in which umbo displacement was used as a measure of sound transmission. A model analysis suggests that the reduction in sound transmission below 1 kHz can be explained by the smaller middle ear air space volume associated with the canal wall-down procedure. We conclude that as long as the middle ear air space is aerated and has a volume greater than 0.7 ml, canal wall-down mastoidectomy should generally cause less than 10 dB changes in middle ear sound transmission relative to the canal wall-up procedure. (Otolaryngol Head Neck Surg 1998;118:751-61.)

scholarly journals The depth of the facial nerve in the mastoid bone

2018 ◽  
Vol 4 (3) ◽  
pp. 666
Author(s):  
B. Y. Praveen Kumar ◽  
K. T. Chandrashekhar ◽  
M. K. Veena Pani ◽  
Sunil K. C. ◽  
Anand Kumar S. ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Temporal Bone ◽  
Significant Variation ◽  
Canal Wall ◽  
Stylomastoid Foramen ◽  
Cortical Mastoidectomy ◽  
Canal Wall Down ◽  
Canal Wall Down Mastoidectomy ◽  
The Mean ◽  
Temporal Bones

<p class="abstract"><strong>Background:</strong> The hallmark of the temporal bone is variation. Various important structures like the facial nerve run in the temporal bone at various depths which can be injured during mastoidectomy.</p><p class="abstract"><strong>Methods:</strong> Twenty wet cadaveric temporal bones were dissected. A cortical mastoidectomy was performed followed by a canal wall down mastoidectomy and the depth of the vertical segment of the facial nerve in the mastoid was determined.  </p><p class="abstract"><strong>Results:</strong> The mean depth of the second genu was 13.82 mm. The mean depth of the stylomastoid foramen was 12.75 mm and the mean distance from the annulus at 6’0 clock to the stylomastoid foramen was 10.22 mm.</p><p><strong>Conclusions:</strong> There is significant variation in the average depth of the facial nerve in the mastoid. </p>

scholarly journals Management of Benign Middle Ear Tumors: A Series of 7 Cases

2017 ◽  
Vol 96 (10-11) ◽  
pp. 426-432
Author(s):  
Z. Jason Qian ◽  
Amy M. Coffey ◽  
Kathleen M. O'Toole ◽  
Anil K. Lalwani
Keyword(s):  
Surgical Management ◽  
Middle Ear ◽  
Ossicular Chain ◽  
Clinical Findings ◽  
Mastoid Cavity ◽  
Canal Wall ◽  
Tumor Excision ◽  
Canal Wall Down ◽  
Canal Wall Down Mastoidectomy ◽  
Rare Group

Benign middle ear tumors represent a rare group of neoplasms that vary widely in their pathology, anatomy, and clinical findings. These factors have made it difficult to establish guidelines for the resection of such tumors. Here we present 7 unique cases of these rare and diverse tumors and draw from our experience to recommend optimal surgical management. Based on our experience, a postauricular incision is necessary in nearly all cases. Mastoidectomy is required for tumors that extend into the mastoid cavity. Whenever exposure or hemostasis is believed to be inadequate with simple mastoidectomy, canal-wall-down mastoidectomy should be performed. Finally, disarticulation of the ossicular chain greatly facilitates tumor excision and should be performed early in the procedure.

Active middle ear implant (vibrant soundbridge) in children with unilateral congenital aural atresia

2020 ◽  
Vol 141 (1) ◽  
pp. 34-38
Author(s):  
Masahiro Takahashi ◽  
Satoshi Iwasaki ◽  
Sakiko Furutate ◽  
Shinichiro Oka ◽  
Shogo Oyamada ◽  
...  
Keyword(s):  
Middle Ear ◽  
Vibrant Soundbridge ◽  
Aural Atresia ◽  
Active Middle Ear Implant ◽  
Middle Ear Implant ◽  
Congenital Aural Atresia

Canal wall down mastoidectomy: causes of failure, pitfalls and their management

1995 ◽  
Vol 109 (7) ◽  
pp. 583-589 ◽  
Author(s):  
Sanjaya Bhatia ◽  
Sandeep Karmarkar ◽  
Giuseppe DeDonato ◽  
Cemil Mutlu ◽  
Abdelkader Taibah ◽  
...  
Keyword(s):  
Middle Ear ◽  
Revision Surgery ◽  
Tympanic Membrane Perforation ◽  
Canal Wall ◽  
Revision Procedure ◽  
Primary Procedure ◽  
Membrane Perforation ◽  
Canal Wall Down ◽  
Canal Wall Down Mastoidectomy ◽  
Causes Of Failure

AbstractManaging patients with failed canal wall down mastoidectomy, requires a meticulous approach to control the disease and restore hearing. The present article reviews the causes of failure of the primary procedure and pitfalls encountered in 105 patients referred to our centre for revision canal wall down mastoidectomy. At post-revision surgery there were no cases with residual or recurrent cholesteatoma. The failures in our revision procedure were due to tympanic membrane perforation which occurred in five percent (n = 4) and intermittent otorrhoea in two percent (n = 2). A dry cavity with adequate middle ear space allowed for optimum audiological function even in revision canal wall down procedures.

scholarly journals Hearing Benefit in Allograft Tympanoplasty Using Tutoplast Processed Malleus

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Anja Lieder ◽  
Wolfgang Issing
Keyword(s):  
Hearing Loss ◽  
Middle Ear ◽  
Conductive Hearing Loss ◽  
Canal Wall ◽  
Hearing Improvement ◽  
Safe Alternative ◽  
Hearing Thresholds ◽  
Canal Wall Down ◽  
Canal Wall Down Mastoidectomy ◽  
Conductive Hearing

Objectives.Tutoplast processed human cadaveric ossicular allografts are a safe alternative for ossicular reconstruction where there is insufficient material suitable for autograft ossiculoplasty. We present a series of 7 consecutive cases showing excellent air-bone gap closure following canal-wall-down mastoidectomy for cholesteatoma and reconstruction of the middle ear using Tutoplast processed malleus.Patients and Methods.Tympanoplasty with Tutoplast processed malleus was performed in seven patients to reconstruct the middle ear following canal-wall-down mastoidectomy in a tertiary ENT centre.Main Outcome Measures.Hearing improvement and recurrence-free period were assessed. Pre-and postoperative audiograms were performed.Results.The average pre operative hearing loss was 50 ± 13 dB, with an air-bone gap of 33 ± 7 dB. Post operative audiograms at 25 months demonstrated hearing thresholds of 29 ± 10 dB, with an air-bone gap of 14 ± 6 dB. No prosthesis extrusion was observed, which compares favourably to other commercially available prostheses.Conclusions.Tutoplast processed allografts restore conductive hearing loss in patients undergoing mastoidectomy and provide an excellent alternative when there is insufficient material suitable for autograft ossiculoplasty.

Active middle-ear implant fixation in an unusual place: clinical and audiological outcomes

2016 ◽  
Vol 130 (4) ◽  
pp. 404-407 ◽  
Author(s):  
J F Polanski ◽  
A D Soares ◽  
Z M Dos Santos ◽  
O L Mendonça Cruz
Keyword(s):  
Middle Ear ◽  
Hearing Aid ◽  
Round Window ◽  
Vibrant Soundbridge ◽  
Implant Fixation ◽  
Active Middle Ear Implant ◽  
Middle Ear Implant ◽  
Hearing Aid Use ◽  
Feasible Option ◽  
Disyllabic Words

AbstractObjective:The Vibrant Soundbridge is an active middle-ear implant for hearing rehabilitation that is usually placed in the long process of the incus or round window. This study reports on the unusual implant attachment to the short process of the incus in a patient with ear malformation, and describes their audiological and clinical outcomes.Methods:Case report and literature review.Results:Audiological evaluation with the Vibrant Soundbridge implant showed a pure tone average of 31 dB. The speech test, at 65 dB HL, revealed correct recognition of 92 per cent of disyllabic words. The Glasgow Hearing Aid Benefit Profile showed high levels of satisfaction, hearing aid use and benefit.Conclusion:Fixation of the Vibrant Soundbridge implant on the short process of the incus is a feasible option, with good clinical and audiological outcomes. Coupling the floating mass transducer to the short process of the incus is a good surgical option, especially when the long process and the oval or round window are inaccessible.

Long-term status of middle-ear aeration post canal wall down mastoidectomy

2019 ◽  
Vol 133 (8) ◽  
pp. 662-667 ◽  
Author(s):  
T Ezulia ◽  
B S Goh ◽  
L Saim
Keyword(s):  
Tympanic Membrane ◽  
Middle Ear ◽  
Mastoid Cavity ◽  
Canal Wall ◽  
Retraction Pocket ◽  
The Status ◽  
Tube Dysfunction ◽  
Canal Wall Down ◽  
Canal Wall Down Mastoidectomy

AbstractBackgroundRetraction pocket theory is the most acceptable theory for cholesteatoma formation. Canal wall down mastoidectomy is widely performed for cholesteatoma removal. Post-operatively, each patient with canal wall down mastoidectomy has an exteriorised mastoid cavity, exteriorised attic, neo-tympanic membrane and shallow neo-middle ear.ObjectiveThis study aimed to clinically assess the status of the neo-tympanic membrane and the exteriorised attic following canal wall down mastoidectomy.MethodsAll post canal wall down mastoidectomy patients were recruited and otoendoscopy was performed to assess the neo-tympanic membrane. A clinical classification of the overall status of middle-ear aeration following canal wall down mastoidectomy was formulated.ResultsTwenty-five ears were included in the study. Ninety-two per cent of cases showed some degree of neo-tympanic membrane retraction, ranging from mild to very severe.ConclusionAfter more than six months following canal wall down mastoidectomy, the degree of retracted neo-tympanic membranes and exteriorised attics was significant. Eustachian tube dysfunction leading to negative middle-ear aeration was present even after the canal wall down procedure. However, there was no development of cholesteatoma, despite persistent retraction.

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