Speech perception and hearing effort using a new active middle ear implant audio processor

Purpose The Vibrant Soundbridge (VSB) was introduced in 1996, and the fourth generation of the audio processor recently released. This clinical study evaluates the audiological performance and subjective satisfaction of the new SAMBA 2 audio processor compared to its predecessor, SAMBA. Method Fifteen VSB users tested both audio processors for approximately 3 weeks. Air conduction and bone conduction thresholds and unaided and aided sound field thresholds were measured with both devices. Speech performance in quiet (Freiburg monosyllables) and noise (OLSA) was evaluated as well as subjective listening effort (ACALES) and questionnaire outcomes (SSQ12 and APSQ). In addition, data from 16 subjects with normal hearing were gathered on sound field tests and ACALES. Results Both audio processors showed substantial improvement compared to the unaided condition. The SAMBA and SAMBA 2 had comparable performance in sound filed thresholds, while the SAMBA 2 was significantly better in speech in quiet, speech in noise, reduced listening effort, and improved subjective satisfaction compared with the SAMBA. Conclusion The SAMBA 2 audio processor, compared to its predecessor SAMBA, offers improved performance throughout the parameters investigated in this study. Patients with a VSB implant would benefit from an upgrade to SAMBA 2.

New Considerations for a Totally Implantable Active Middle Ear Implant

Totally implantable active middle ear implants (AMEI) provide full-time hearing amplification to those with moderate to severe sensorineural hearing loss. While technology in conventional hearing aids (CHA) has advanced greatly, limitations remain for people with active lifestyles, limited vision or dexterity, and hearing aid fit issues. Furthermore, direct-drive properties of AMEI are thought to provide those with inefficient middle ear transfer functions a distinct advantage in delivering prescribed sound to the cochlea, ultimately improving speech understanding with less distortion. AMEI safety, stability, and efficacy outcomes are well documented and fitting strategies continue to improve. Recent studies show how simple aided speech testing can help predict whether a patient struggling with CHA may instead benefit from an AMEI. Totally implantable AMEI continue to be a viable option for patients who cannot or will not utilize traditional hearing aids.

A New Stapes-Head Coupler for the Vibrant Soundbridge System

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.

Simultane Implantation von Epithesenankern und Bonebridge zur Versorgung großer Ohrmissbildungen

Zusammenfassung Hintergrund Die chirurgische Versorgung mit einem Hörimplantat und Epithesen bei Ohrmissbildungen bietet eine gute Kombination aus Hörrehabilitation und kosmetischer Rekonstruktion. Oft wird die Versorgung in 2-zeitigen Operationsschritten durchgeführt. Ziel der Arbeit war es, Erfahrungswerte mit einem Vorgehen zu gewinnen, bei dem das Hörimplantat und die Epithesenanker simultan eingesetzt werden. Material und Methoden Vier Ohren von 3 Patienten (nw = 1, nm = 2) mit großen Ohrmissbildungen (Typ III nach Weerda) erhielten jeweils in einer Operation eine MedEL Bonebridge und einen Epithesenanker mit 3 Basispfosten. Zuvor war die Indikation mithilfe des Active Middle Ear Implant (aMEI) -Scores nach Frenzel (2013) gestellt worden. Ergebnisse Alle Patienten erzielten jeweils 4 Punkte im aMEI-Score, was auf eine ungünstige Prognose für eine erfolgreiche Implantation eines aktiven Mittelohrimplantats hinwies. Die Versorgung mit der Bonebridge und einem Epithesenanker konnte daraufhin komplikationslos durchgeführt werden. Postoperativ erfolgten nach 4 Wochen die audiologische Erstanpassung und die Bestückung mit Magneten. In der Audiometrie bestand ein funktioneller Gewinn von bis zu 30 dB sowie ein verbessertes Sprachverständnis. Die Epithese wurde dem gesunden Ohr nachgebildet. Nach der Versorgung waren die Patienten mit dem audiologischen und kosmetischen Ergebnis zufrieden. Schlussfolgerungen Das simultane chirurgische Vorgehen mit einem Hörimplantat und Epithesenankern stellt eine gute Option in der Versorgung von Ohrmissbildungen dar. Der aMEI-Score war ein hilfreiches Instrument zur Indikationsstellung. Durch das Vorgehen konnten das Operationsrisiko und der Aufwand der Versorgung reduziert werden.

Unexplained Variation in Benefit of Treatment of Congenital Unilateral Aural Atresia: A Review of the Literature

<b><i>Objective:</i></b> A review of published data regarding binaural hearing after treatment of congenital unilateral conductive hearing loss (UCHL) due to aural atresia. Treatment options concern atresia surgery (reconstructive surgery), application of a bone conduction device (BCD), or application of a middle ear implant (MEI). <b><i>Data Sources:</i></b> Database PubMed was searched for articles published in English and German between January 1, 1994, and January 1, 2019. <b><i>Study Selection:</i></b> The initial search identified 52 studies, of which 9 met the inclusion criteria. <b><i>Data Synthesis:</i></b> Comparison of studies was based on a structured review. Meta-analysis was not feasible because of the heterogeneity of outcome measures, the limited number of relevant papers (9), and diverse types of treatment (5). <b><i>Conclusions:</i></b> Treatment of UCHL results in bilateral hearing instead of binaural hearing. The large intersubject variability in benefit of treatment is unexplained with a clear improvement in the minority of listeners and a limited improvement or binaural interference in most listeners after atresia repair or amplification with a BCD or MEI.

Research on coupling effects of actuator and round window membrane on reverse stimulation of human cochlea

An active actuator of a middle-ear implant coupled to the round window membrane (RWM), which transmits vibration to the cochlea, has been used to compensate for hearing loss in patients. However, various factors affect the coupling condition between the actuator and the RWM, resulting in coupling leakage. In this study, a coupling impedance model of the human ear and the actuator was used to investigate the effect of inefficient coupling during reverse stimulation. First, the three-port circuit network model of the actuator was coupled with the acoustic impedance model of human ear reverse sound transmission. Meanwhile, the inefficient coupling impedance was estimated. Then, the effect of the actuator’s coupling on reverse stimulation was studied by comparing the reverse pressure transfer function. Furthermore, the inefficient coupling’s influence in the ear with middle-ear disorder was also investigated by simulating two typical forms of middle-ear disorder: otosclerosis and ossicular chain disarticulation. The results show that the change of the inefficient coupling impedance plays a significant role during reverse stimulation. Inefficient coupling of the actuator and the RWM deteriorates the cochlear response of reverse stimulation over the entire frequency range. Additionally, the coupling effect of the actuator does not change the influence tendency of middle-ear disorder on reverse stimulation’s performance, but changes the response amplitude of the reverse stimulation.