Cochlear Implantation: Long-Term Effect of Early Activation on Electrode Impedance.

Objectives: The growing adoption of cochlear implants (CIs) necessitates understanding the factors influencing long-term performance and improved outcomes. This work investigated the long-term effect of early activation of CIs on electrode impedance in a large sample of CI users at different time points. Methods: A retrospective study on 915 ears from CI patients who were implanted between 2015 and 2020. According to their CI audio processor activation time, the patients were categorized into early activation (activated 1 day after surgery, n = 481) and classical activation (activated 4 weeks after surgery, n = 434) groups. Then, the impact of the activation times on the electrode impedance values, along the electrode array contacts, at different time points up to two years was studied and analyzed. Results: The early activation group demonstrated lower impedance values across all the electrode array sections compared to the classical activation at 1 month, 1 year, and 2 years post-implantation. At 1 month, early activation was associated with a reduction of 0.34 kΩ, 0.46 kΩ, and 0.37 kΩ in the apical, middle, and basal sections, respectively. These differences persisted at subsequent intervals. Conclusions: Early activation leads to sustained reductions in the electrode impedance compared to classical activation (CA), suggesting that earlier activation might positively affect long-term CI outcomes.

A novel coupling quality index to estimate the coupling efficiency in Vibrant Soundbridge.

BACKGROUND: The objective-based methods for intraoperative monitoring have been suggested to assess the coupling and the outcomes of Vibrant Soundbridge (VSB). Although several techniques were proposed, they have not been widely adopted due to their complexity and invasiveness. PURPOSE: This study aimed to investigate the accuracy of a new coupling quality index using an intraoperative ABR threshold via AcoustiAP and its correlation with the perioperative measures. METHODS: This is a prospective study conducted at a tertiary center. The medical records were retrieved for all patients who underwent VSB implantation and had an intraoperative objective assessment for the coupling efficiency. AcoustiAP was used to evaluate the intraoperative ABR thresholds, which were assessed directly after the floating mass transducer (FMT) placement using acoustic CE-Chirp signals. The Vibrogram was used for the postoperative audiological evaluation. A new coupling quality index was calculated based on the intraoperative ABR thresholds. RESULTS: Ten patients were eligible for the present study. The ABR thresholds for good coupling ranged from 35 to 60 dBnHL. The loose coupling thresholds ranged considerably from 40 to 100 dBnHL. Overall, the median intraoperative ABR threshold at good coupling was 42.5 (40-60) dBnHL and 60 (40-100) dBnHL at loose coupling. The analysis showed that there was a significant change in the coupling quality index at the good and loose coupling points (24.3 ± 14 vs 38.8 ± 18.2, respectively, p < 0.001). At a cut-off value of 22.6 dB, the coupling quality index had a sensitivity of 70%  and specificity of 90% for discriminating good and loose coupling. CONCLUSION: This study provides evidence for the utility of intraoperative ABR measurements in predicting the coupling efficiency in patients with VSB. Our results showed that the coupling quality index had an acceptable accuracy in discriminating between good and poor coupling, which can help clinicians optimize the fitting process for individuals and may ultimately lead to improved patient outcomes.

Risk factors and management strategies of inadvertent facial nerve stimulation in cochlear implant recipients: A systematic review.

Objectives: To systematically review the prevalence and risk factors of inadvertent facial nerve stimulation (FNS) after cochlear implant (CI) surgery. And to report the different management strategies used for reducing and resolving FNS. Data Source: Web of Science, Scopus, PubMed, Cochrane Library, and Virtual Health Library (VHL) of the World Health Organization (WHO). Review Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) on studies that reported FNS as a complication after CI. A comprehensive electronic search strategy was used to identify the relevant articles. We extracted the data on the prevalence of FNS after CI activation, the reported grades, and the management strategies. The number of associated electrodes; cause of deafness; co-anomalies; and duration of hearing loss and their relationships with FNS were also studied. Results: Twenty-one relevant articles were included in this review. The prevalence of FNS among the CI populations was 5.29% (175/3306 patients). Among those whose ages were reported, 58.3% (95/163) were adults, and 41.7% (68/163) were pediatrics. Modifying the different fitting parameters was the most used strategy, as it successfully resolved FNS in 85.5% of the patients (142/166). The second commonly used management strategy was surgical intervention (reimplantation or explantation), which was reported in seven studies for 23 patients. Conclusion: FNS after CI activation could be controlled and resolved with many advances that range from readjusting the fitting parameters to surgical intervention. However, further studies are required to validate the efficacy of each management strategy and its impact on patients' performance. Our findings demonstrate that CI recipients with FNS could still benefit from the CI devices and their FNS could be controlled.

Early activation after cochlear implantation: a systematic review.

PURPOSE: To systematically review the outcomes of early activation following cochlear implantation (CI) based on the findings from different studies in the literature. METHODS: A comprehensive search strategy was conducted through different databases to identify relevant articles. Our outcomes included impedance levels, rates of complications, hearing and speech perception performance, and patients' satisfaction levels. RESULTS: The total number of included studies in this systematic review is 19, which recruited 1157 patients, including 857 who underwent early activation following CI. Seventeen studies investigated impedance levels or feasibility rates of early activation approaches. Most of these studies (n = 10) reported that mean impedance levels remarkably decreased within the first day-to-month (first measurement) post-activation. In addition, all 17 studies showed that impedance levels finally normalize and become comparable with intraoperative levels or the conventional activation group. Seventeen studies reported the occurrence of complications in their population. Ten of these studies indicated that none of their patients developed any post-operative complications after early activation. Seven studies reported the development of some minor complications, including pain 9.2% (28/304), infection 4.7% (13/275), swelling 8.2% (25/304), vertigo 15.1% (8/53), skin hyperemia 2.2% (5/228), and others 16.4% (9/55). Hearing and speech perception was assessed in six studies, which showed a remarkable improvement in their patients. Three studies investigated patients' satisfaction and showed high satisfaction levels. Only one report investigated the economic advantages of early activation. CONCLUSION: Early activation is safe and feasible and does not impact the hearing and speech outcomes of the patients undergoing CI procedures.

Potential barriers to the daily use of hearing aids in children.

OBJECTIVES: To identify factors affecting hearing aid usage in children. METHODS: This retrospective study examined 59 hearing-impaired children fitted with hearing aids for at least 6 months. Patients with moderate to profound sensorineural hearing loss with complete data-logging information stored in the hearing aid programming file from January 2020 until June 2021 were included. Children with concomitant disabilities were excluded. Data for audiological assessments included hearing assessment, aided hearing thresholds, and aided speech tests. RESULTS: The children's age ranged from 6 months to 6 years. Average daily hearing aid usage was 5.5 hour (h) after 3 months, 7 h after 6 months; and 8.7± 4.7 h as reported by parents. Patient age was positively correlated with data logging at 3 months (r=0.414, p=0.01) and 6 months (r=0.406, p=0.01). CONCLUSION: We found that children's age, gender, severity of hearing loss, residential location, and parents' educational level had a significant effect on daily hearing aid usage. Whereas, family size and a family history of hearing loss or use of amplification devices had no discernible influence.

The Influence of the COVID-19 Pandemic on the Hearing Impaired.

Background In this study, we aimed to investigate the effect of the coronavirus disease 2019 (COVID-19) pandemic-induced social restrictions, including face masks, on patients with hearing problems. Methodology This cross-sectional survey study was conducted in an ENT tertiary care center. After signing the consent form, we invited study subjects with hearing disabilities who were using unilateral or bilateral hearing aids to participate in filling out the study survey. The study questionnaire was completed by 80 subjects. The questionnaire included various questions about the respondent's demographics, hearing aids, and communication with a face mask during COVID-19 restrictions. All statistical analyses were performed using SPSS version 19 (IBM Corp., Armonk, NY, USA). Results Overall, 40% of the study sample agreed that understanding people wearing face masks is harder because their speech is muffled, whereas 10% disagreed, and 50% were neutral. While 41.3% agreed that understanding is harder because they cannot see their mouth moving, 23.8% disagreed, and 35% were neutral. More than half of the study sample (55%) agreed that they are worried about how they will communicate with others if wearing face masks becomes more common. However, 50% of the participants thought that they can still hear people when they speak to them from a safe distance. Of note, 71.3% of subjects disagreed about tinnitus being worse since the lockdown. Conclusions The widespread use of face masks had a significant impact on the daily communication and interactions of people with hearing impairments. More research is needed to find creative ways to help these patients improve their daily communication and social interactions.

Speech performance and subjective satisfaction of middle ear implant in congenital aural atresia.

Objectives: To evaluate the safety, speech performance in noise and subjective satisfaction of patients with congenital aural atresia (CAA) implanted with the active middle ear implant. Methods: This retrospective study included 13 patients (15 ears) implanted with middle ear implants with different methods of floating mass transducer attachment. In 6 ears, the floating mass transducer (FMT) was coupled with the short process of incus; in 8 ears, a clip coupler was used; and in one ear, a round window coupler was used. Patients were assessed preoperatively, and at one, three, and six months postoperatively. The assessment included Pure Tone Average (PTA4), Speech Reception Threshold (SRT) and Speech Discrimination Score (SDS). The Speech Spatial and Qualities of Hearing scale (SSQ12) was also used to evaluate levels of satisfaction. Results: The mean aided PTA4 using Vibrant Sound Bridge (VSB) was 26.44 4.03 dB HL compared to 61.88 ±1.53 dB HL unaided. The SDS improved significantly (p = 0.002) from 51% (± 9.17%) to 94.60% (± 4.43%). Furthermore, there was a significant improvement in SDS in noise (p = 0.008) and SSQ12 responses (p < 0.0001). Conclusions: Patients with hearing loss due to CAA can substantially benefit from VSB, with highly satisfactory subjective results and a negligible rate of complications.

Osseointegrated device placement with minimally invasive surgery: Experience and audiological outcome.

OBJECTIVES: To evaluate the clinical and audiological outcomes of percutaneous bone conduction device placement by minimally invasive Ponto surgery (MIPS). METHODS: This was a retrospective descriptive study of patients who underwent MIPS from March-November 2019 at King Abdullah Ear Specialist Center, Collage of Medicine, King Saud University, Riyadh, Saudi Arabia. We reviewed all the clinical data of patients, including preoperative data, postoperative surgical results, and audiological performance (aided and unaided pure tone audiometry and aided and unaided speech tests). RESULTS: A total of 9 patients with 10 implants were enrolled in this study. One patient underwent revision surgery because of infection and loss of the abutment. We followed the patients from 1-2 years, with a mean of 16.8 months. A significant difference was found between the unaided air conduction pure tone average, with a mean of 72.6±28.4 decibel (dB), and the postoperative aided threshold, with a mean of 20.8±12.2 dB/hectoliter (p=0.008), indicating a functional gain of 51.8 dB. The mean unaided speech discrimination at 65 dB sound pressure level was 34.7±24.8, which was significantly improved to 88.4±11.7 after implantation (p=0.007). CONCLUSION: minimally invasive Ponto surgery is a suitable minimally invasive surgical method for bone-anchored implant placement. This technique has an advantage in terms of skin sensitivity, cosmetic outcomes, and operative duration.

Performance of Children With Donnai-Barrow Syndrome After Cochlear Implantation: A Case Report.

Donnai-Barrow syndrome (DBS) is a rare autosomal recessive hereditary disorder that affects a variety of body systems. One of the most common symptoms in DBS patients is severe bilateral sensorineural hearing loss. The objective of this report is to highlight the performance of such patients after receiving cochlear implants as a management of their hearing loss. We reviewed the medical records of two cousins diagnosed with DBS before and after cochlear implantation, with a particular focus on their auditory and language performance. After receiving the cochlear implant, both patients showed substantial progress in auditory and speech perception, as well as their intelligence quotients, allowing them to join mainstream schools. In conclusion, our findings showed that cochlear implantation can be considered an ideal approach for the management of DBS patients who suffer from bilateral sensorineural hearing loss.

Cochlear implantation versus auditory brainstem implantation in children with auditory nerve deficiencies.

BACKGROUND: Cochlear nerve deficiency is one of the known causes of congenital sensorineural hearing loss. Management of hearing loss in children with cochlear nerve deficiency poses a multidimensional challenge. The absent or hypoplastic cochlear nerve may prevent electrical stimulation from reaching the brainstem and the auditory cortex. A deficient cochlear nerve can be associated with other inner ear malformations, which may diminish the success of cochlear implantation in those children. Promising results in adults after auditory brainstem implantation led to the expansion of candidacy to include the pediatric populations who were contraindicated for CIs. OBJECTIVE: To review the outcomes of cochlear implantation versus that of auditory brainstem implantation in children with various conditions of the auditory nerve. METHODS: This retrospective chart review study comprised two pediatric groups. The first group consisted of seven ABI recipients with cochlear nerve aplasia and the second group consisted of another seven children with cochlear nerve deficiencies who underwent CI surgery. The participants' auditory skills and speech outcomes were assessed using different tests selected from the Evaluation of Auditory Responses to Speech (EARS) test battery. RESULTS: There were some individual variations in outcomes depending on the status of the auditory nerve. The mean CAP score of the ABI group was 2.87, while the mean SIR score was 0.62. On the other hand, the mean CAP score of the CI group was 1.29, while the mean SIR score was 0.42. CONCLUSION: Our results are in good agreement with the reported auditory perception and speech and language development outcomes of pediatric auditory brainstem implantation. We added to the growing body of literature on the importance of verifying and identifying the status of the cochlear nerve in the decision-making process of the surgical management of those pediatric groups.

Bilateral Cochlear Implantations in Temporal Bone Fracture: A Viable Treatment Option.

OBJECTIVES/HYPOTHESIS: Although it is surgically more challenging, patients with bilateral temporal bone fractures (TBFs) are potential candidates for successful bilateral cochlear implantation (CI). This study aimed to investigate the feasibility of bilateral implantation in patients with sustained bilateral TBFs. STUDY DESIGN: Retrospective database study. METHODS: Seven patients with bilateral cochlear implants who were diagnosed with TBFs were included in this study. Preoperative radiological and audiological evaluations were performed. The outcomes of the CI were also investigated. RESULTS: Hearing levels were restored to the mild-moderate range (<40 dB) for nearly all patients and they reported an improved quality of life. CONCLUSIONS: CI in patients with TBF is safe and offers a solution for the restoration of hearing in a population who may experience sudden bilateral deafness. However, preoperative confirmation of intact auditory nerves and patent cochlea is essential to maximize the success of CI in this population. LEVEL OF EVIDENCE: 4 Laryngoscope, 132:2050-2055, 2022.

Performance of Children With Johanson-Blizzard Syndrome After Cochlear Implantation.

Johanson-Blizzard syndrome (JBS) is a rare autosomal recessive hereditary disorder characterized by multi-system involvement and facial dysmorphic features. One of the most common symptoms in JBS patients is bilateral severe to profound sensorineural hearing loss. The objective of this report is to highlight the performance of those patients after receiving cochlear implants (CI) as a management for their hearing loss. In this study, we reviewed the medical records of one female child diagnosed with JBS before and after cochlear implantation, with a particular focus on their auditory and language performance. After receiving the cochlear implant, our patient showed substantial improvement in her hearing threshold and communication abilities when compared to the preoperative condition. In conclusion, although cochlear implantation is considered a good approach for the management of JBS patients, the development of spoken language is not always achieved.

Arabic Version of short form of the Speech, Spatial, and Qualities of Hearing Scale (SSQ12).

OBJECTIVES: To translate and validate the short form of the speech, spatial, and qualities of hearing scale (SSQ12). This will help in the assessment of hearing disability in the daily life of hearing-impaired populations, as well as the improvement of their quality of life. METHODS: This cross-sectional study was conducted at the King Abdullah Ear Specialist Center, Riyadh, Saudi Arabia, between April and June 2021. The study included 102 hearing-impaired participants as the patient group and 84 normal-hearing participants as the control group. The English SSQ12 was translated according to the International Quality of Life Assessment method. Internal consistency and reliability of the Arabic SSQ12 were then assessed using Cronbach's alpha (α) and test-retest reliability. Discriminant validity was also assessed by comparing the patients' scores with the control participants. RESULTS: The overall internal consistency of the Arabic SSQ12 was excellent (α=0.9), with good test-retest reliability (intraclass correlation coefficient [ICC]=0.8). There was a significant difference between the Arabic SSQ12 scores of the patient and control groups (p<0.0001). CONCLUSION: The Arabic version of the SSQ12 appears to be a valid and reliable tool that can be used to assess the communication ability of hearing-impaired patients in audiology clinics.

Validation of LittlEARS® Early Speech Production Questionnaire in Arabic-speaking children with normal hearing.

OBJECTIVES: To validate an Arabic version of the LittlEARS® Early Speech Production Questionnaire (LEESPQ), which assesses the early development of speech and language in infants between 0 and 18 months, in Arabic-speaking children with normal hearing in Saudi Arabia. METHODS: This is a cross-sectional study conducted in the city of Riyadh, Saudi Arabia between September and December 2020. Parents completed the LEESPQ regarding their child's speech production development. To assess the ability of normal hearing children aged 0-18 months in developing speech and language production, a norm curve has been generated based on the standardized values that were calculated from the Arabic normal-hearing data set. RESULTS: A total of 198 questionnaires were analyzed. The total score on the LEESPQ correlated with age, gender, and bilingualism. A norm curve for early speech production in children with normal hearing was created. CONCLUSION: The Arabic version of LEESPQ appears to be a valid questionnaire that can be used in the assessment of early language and speech development of Arabic-speaking children with normal hearing in the age range of 0-18 months. The Arabic version of the LEESPQ might also be a useful tool to detect developmental delays and hearing disorders in young children.

Auditory Performance and Subjective Satisfaction with the ADHEAR System.

BACKGROUND: The ADHEAR device, a new nonsurgical bone conduction hearing device, has been developed for patients with conductive hearing loss. OBJECTIVES: This study aims to assess the impact of the ADHEAR device on the audiological performance and satisfaction level in subjects with conductive hearing loss. METHODS: Twelve patients with conductive hearing loss were included. All patients received the device for 3 months. The audiological outcomes were determined using basic audiological assessments, including pure tone audiometry and sound field measurements of pure tone and speech audiometry with the contralateral ear occluded with a specific earplug. Additionally, the patients were subjectively evaluated using (1) the Speech, Spatial, and Qualities Questionnaire (SSQ), and (2) the custom-made ADHEAR questionnaire. RESULTS: Analysis of the measured audiological outcomes revealed an average improvement in pure tone thresholds (functional gain) of 23 (± 4.4) dB HL when the ADHEAR system was used compared to the unaided condition in the sound field. Moreover, speech reception thresholds improved by an average of 23 (± 15.3) dB SPL in the aided condition with plugged contralateral ear. Additionally, when using ADHEAR in the sound field, subjects' speech recognition scores improved by 32% (± 17.7) in quiet and 21% (± 15.1) in the presence of interfering noise. The average SSQ questionnaire scores improved from 3.9 at the study initiation to 6.6 after 3 months of device usage. ADHEAR custom questionnaire assessments revealed high satisfaction and acceptance of the device with no pain or skin irritation. CONCLUSION: During the study period, this new adhesive system yielded improved audiological outcomes with high patient satisfaction and acceptance and no reported skin irritation or pain.

Effect of early activation of cochlear implant on electrode impedance in pediatric population.

OBJECTIVES: To assess the evolution of electrode impedance after the early fitting of audio processors (activation after one-day) and classical fitting (activation after one-month) over an up-to-one year after cochlear implant (CI) surgery. METHODS: A retrospective cohort study on Fifty-two CI recipients divided into two groups. The study group included 24 recipients (40 ears) who underwent early fitting, whereas the control group contained 28 recipients (40 ears) who underwent classical fitting. The electrode impedance was recorded during the surgery, switch-on session and at one, three, six, and twelve-months after the surgery. RESULTS: In the study group, electrode impedance values obtained intraoperatively and at switch-on and one, three, six, and twelve-months were 4.89, 3.69, 6.52, 6.24, 6.05, and 5.81 KΩ, respectively, and only the switch-on and one-month values were significantly different (p < 0.0001). In the control group, electrode impedance values obtained intraoperatively and at switch-on and one, three, six, and twelve-months were 4.71, 7.19, 6.40, 6.05, and 5.73 KΩ, respectively. Thus, the electrode impedance value at switch-on was 52.65% (p < 0.001) greater than it intraoperatively. For both groups, the electrode impedance value at twelve-months was significantly higher than the respective intraoperative values (study group: 18.6% higher, P = 0.04; control group: 21.65% higher, P = 0.0001). CONCLUSION: Electrode impedance was significantly lower in the study group compared to the control group until one month after the surgery. However, the electrode impedance at twelve-months after the CI was similar in both groups.

Performance of cochlear implant recipients fitted with triphasic pulse patterns.

PURPOSE: To assess the effect of triphasic pulse pattern stimulation strategy on the audiological performance of cochlear implant recipients with unintended facial nerve stimulation (FNS), and to compare the audiological and speech outcomes before and after switching to triphasic stimulation. METHODS: A retrospective study of patients who have changed their fitting maps from biphasic to triphasic pulse pattern stimulation because of FNS after cochlear implantation (CI). All identified patients with FNS after CI from 2017 to 2019 were included in this study. The medical records of 11 patients (16 ears) were queried for demographic and radiological data, pure tone audiometry, speech reception thresholds, speech discrimination score at 65 dB, maximum comfortable levels, thresholds, and dynamic range. Then, these parameters were compared in the two conditions, biphasic and triphasic. RESULTS: Using triphasic pulse stimulation only or combined with switch-off of few channels, complete resolution of FNS was achieved. Triphasic pulse pattern stimulation was associated with better speech discrimination scores (75.25 ± 26.13%) compared to the biphasic pulse (58.25 ± 26.13%). This triphasic strategy also showed higher maximum comfortable levels (36.62 ± 1.63 qu) than biphasic strategy (31.58 ± 2.5 qu). Moreover, the dynamic range was wider using triphasic pulse strategy. In general, the triphasic pulse pattern resulted in successful suppression of facial nerve stimulation with suitable maximum comfortable levels and better speech discrimination. CONCLUSION: Triphasic pulse pattern stimulation is an appropriate tool in controlling FNS following cochlear implantation with wider dynamic range. We recommend that all patients with facial nerve stimulation after CI surgery be switched to a triphasic pulse program prior to considering further surgery.

Audiologic Outcome of Cochlear Implantation in Children With Cochlear Nerve Deficiency.

OBJECTIVE/HYPOTHESIS: The aim of this study was to investigate cochlear implantation (CI) outcome in children with nerve deficiency. STUDY DESIGN: Retrospective chart review. METHODS: A total of seven children with prelingual profound deficiency (hypoplasia or aplasia) were included. A control group of 10 CI children with no cochlear nerve anomalies was also included. In addition to implant stimulation levels, children's performance on pure-tone audiometry, speech reception measure, and auditory and speech skills ratings were compared across groups. Additionally, pre- and postoperative audiologic results were evaluated for the group with nerve deficiency. RESULTS: In general, children with nerve deficiency performed poorer than those without nerve deficiency on all tested measures. Stimulation levels were considerably higher and more variable than the control group. Results further showed that performance was dependent on the diameter of the internal auditory canal. CONCLUSION: Overall, cochlear implantation outcome in children with auditory nerve deficiency is poorer and extremely more variable than those without nerve deficiency. However, three of the patients had a noticeable improvement in auditory performance postimplantation suggesting that CI is a viable option in this population but expected benefit can be dependent on the status of the cochlear nerve.

Cochlear electrode array tip fold-over in incomplete partition-I - A case report.

Electrode tip fold-over is a rare complication of cochlear implantation (CI), especially in lateral wall (LW) electrodes. We describe a case of LW electrode tip fold-over in a patient with incomplete partition type-1 (IP-I). Preoperative measurement of cochlear length is important for optimal CI electrode selection. In cochlear malformation, Stenvers x-ray is superior to spread of excitation in detecting tip fold-over. Despite tip fold-over, hearing threshold, speech reception threshold, and word recognition score were almost symmetrical bilaterally. Therefore, revision surgery should be reserved for patients with persistent symptoms or markedly affected speech performance, in whom deactivation did not suffice.

Feasibility and Efficacy of Vibrant Soundbridge Short Process Coupler in Patients With Aural Atresia.

OBJECTIVES: Different options are available for hearing restoration in patients with aural atresia. Middle ear implantation with the Vibrant Soundbridge (VSB) has been used successfully in many patients with aural atresia with conductive or mixed hearing loss. The aim of the current study was to assess the safety and the efficiency of VSBs coupled to the short process of the incus in patients with aural atresia with conductive or mixed hearing loss. METHODS: The study was a retrospective chart review conducted at a tertiary university hospital. Audiological and surgical data from six ears with aural atresia implanted with VSBs coupled to the short process of the incus were analyzed. The audiological results were compared with previously reported results obtained after the utilization of different coupling techniques. RESULTS: All six atretic ears were successfully implanted using the short process coupler, and there were no major complications. Postoperative bone conduction thresholds did not differ substantially from preoperative thresholds. The respective mean preoperative pure-tone average 4, speech reception threshold, and word recognition score values were 56.7 dB, 61.7 dB, and 44%. Postoperative pure-tone average 4 thresholds (25 ±â€Š3.5 dB) and speech reception thresholds (20.8 ±â€Š8 dB) were significantly improved. The maximum postoperative word recognition score achieved was 100%. The audiological outcomes obtained were similar to previously reported outcomes after classic stapes placement. CONCLUSION: Coupling of the floating mass transducer to the short process of the incus in patients with aural atresia resulted in significant audiological improvements that were comparable to previously reported improvements after placement via other methods.