Profound mixed hearing loss: bone-anchored hearing aid system or cochlear implant?

OBJECTIVES: We evaluated 5 patients who were changed over from a Baha Cordelle to a cochlear implant (CI). Moreover, the level of phoneme score was determined at which a Baha Cordelle user was better helped with a CI. METHODS: We offer descriptive case reports and a retrospective evaluation of speech recognition in Baha Cordelle users and CI users. RESULTS: In the CI users with noncompromised cochleas, the 10th percentile of the aided phoneme score in quiet at 65 dB sound pressure level (PS65) was 42%. We consider this PS65 as the cutoff level for switching from a Baha Cordelle to a CI. When patients with mixed hearing loss were using the Baha Cordelle, the PS65 of 42% was obtained at a mean sensorineural hearing loss component of about 70 dB hearing level (HL). This 70-dB HL component was used to consider Baha Cordelle users for cochlear implantation. The results of the 5 patients support these transition criteria. CONCLUSIONS: A CI is a valuable option in patients with mixed hearing loss when the sensorineural hearing loss component exceeds 70 dB HL or when the PS65 with a Baha Cordelle is less than about 40%. In such patients, the implantation procedure should be individualized on the basis of the clinical findings in the middle ear and mastoid cavity.

Application of active middle ear implants in patients with severe mixed hearing loss.

OBJECTIVE: To determine the long-term benefit of the Vibrant Soundbridge (VSB) middle ear implant in patients with severe mixed hearing loss and to compare it with other hearing devices. DESIGN: A retrospective analysis. SETTING: University-affiliated medical center. PATIENTS: Six patients with severe mixed hearing loss and a mean sensorineural hearing loss component between 40 and 70 dB. INTERVENTIONS: Patients received a VSB with the floating mass transducer (FMT) coupled to the round window or to the oval window via a residual stapes structure. MAIN OUTCOME MEASURES: Functional gain and speech recognition results. Results are compared with 2 control groups matched for mean sensorineural hearing loss: 1) patients with mixed hearing loss and a bone-anchored hearing device, and 2) patients with sensorineural hearing loss and traditional implantation of the VSB. RESULTS: There is large variance in functional gain between the patients suggesting high variability in the effectivity of the FMT coupling. The speech recognition results for the experimental group were not systematically better than in either control group. CONCLUSION: There is large variability in results that might be ascribed to coupling effectivity. On the average, speech recognition results were not better or worse than those found in patients with similar hearing loss fitted with bone-anchored hearing devices.

Endoscopic carbon dioxide laser diverticulostomy versus endoscopic staple-assisted diverticulostomy to treat Zenker's diverticulum.

BACKGROUND: The 2 most frequently used endoscopic methods to treat Zenker's diverticulum are staple-assisted and CO(2) laser esophagodiverticulostomy. METHODS: The study centered around a retrospective evaluation of 107 patients with Zenker's diverticulum who were treated endoscopically by CO(2) laser (n = 72) or staple-assisted diverticulostomy (n = 35). RESULTS: Patients in the staple-assisted group had a shorter duration of postoperative hospitalization, attributed to earlier oral intake, than patients in the CO(2) laser group. There were no serious postoperative complications in either group. Postoperative fever and emphysema in the neck or mediastinum occurred more frequently in the CO(2) laser group, but this did not lead to any complications. Most patients reported partial or complete relief of their symptoms and there was no significant difference in the number of reoperations between the 2 treatment groups. CONCLUSIONS: Zenker's diverticulum was treated safely and effectively by the 2 endoscopic techniques, but the staple-assisted method seemed to be the most favorable.

Intraoperative auditory steady state response measurements during Vibrant Soundbridge middle ear implantation in patients with mixed hearing loss: preliminary results.

OBJECTIVE: To optimize intraoperatively the coupling of the floating mass transducer (FMT) of the Vibrant Soundbridge middle ear implant to the round or oval cochlear window in patients with mixed hearing loss. STUDY DESIGN: Intraoperative measurement of objective hearing thresholds using auditory steady state responses (ASSRs). SETTING: Radboud University Nijmegen Medical Centre, tertiary referral hospital. PATIENTS: Four individuals with mixed hearing loss and, at least no incus, in need for a middle ear implant. INTERVENTION: Surgical placement of the Vibrant Soundbridge. ASSR thresholds were measured intraoperatively, whereas FMT coupling to the cochlea was manipulated to find the most effective coupling of the FMT. MAIN OUTCOME MEASURE: Differences in ASSR thresholds between different FMT coupling options within patients. RESULTS: With ASSR, we assessed placement of the FMT in the round window niche, loosely or tightly packed in the niche; creation of a mobile window in case of a fixed stapes footplate; and FMT position coupled to the stapes that afforded vibration in the natural vibration direction or perpendicular to it. Furthermore, test-retest variations in ASSR thresholds were studied. It was shown that differences in ASSR thresholds could be detected, while manipulating the FMT couplings, which were statistically significant. CONCLUSION: Intraoperative ASSR measurement is a good method to study different positions of the FMT and to determine the best position of the FMT for a patient.

The floating mass transducer of the Vibrant Soundbridge interposed between the stapes and tympanic membrane after incus necrosis.

HYPOTHESIS: The floating mass transducer (FMT) of the Vibrant Soundbridge (VSB) can be interposed in the middle ear in case of an absent incus. BACKGROUND: The VSB is a middle ear implant in which the FMT is attached to the long process of the incus to directly drive the ossicular chain. In this case report, there was gradual deterioration in speech perception after VSB fitting and deterioration in hearing thresholds. During exploratory resurgery, it became clear that the ossicular chain was interrupted due to necrosis of the long process of the incus. The VSB could no longer function because there was no connection between the incus and stapes. METHODS: Reconnection of the FMT to the anterior crus of the stapes on 1 side and the tympanic membrane on the other side. RESULTS: Reconnection of the FMT to the stapes head led to obvious improvement in audiometric results. The air-bone gap was reduced from approximately 35 to approximately 25 dB, which indicated that the construction with the FMT was working like a partial ossicular replacement prosthesis. At 1.5 years' follow-up, the aided hearing thresholds of approximately 45 dB hearing level were slightly poorer than those measured after the first procedure with classical positioning of the FMT. However, the speech recognition score in quiet at 65 dB sound pressure level was 70% with the classical FMT application and with the FMT connected between the stapes and tympanic membrane. CONCLUSION: It could be concluded that when the incus is absent, placement of the FMT directly on to the stapes is an acceptable solution.

Audiological application criteria for implantable hearing aid devices: a clinical experience at the Nijmegen ORL clinic.

OBJECTIVES/HYPOTHESIS: To define audiological application criteria for different implantable hearing aid devices. STUDY DESIGN: Retrospective study. METHODS: Comparisons were made between aided speech recognition scores obtained at conversational level (65 dB) in patients with the Vibrant Soundbridge (VSB) (n = 22), the Otologics middle ear transducer (MET) (n = 10), conventional hearing aids (behind-the-ears) (n = 47), and cochlear implants (CIs) (n = 123). RESULTS: In relation to hearing loss, only for mild hearing loss, speech recognition scores with VSB were comparable to that with conventional hearing aids. In the Otologics MET users, speech recognition scores were comparable with those of the conventional hearing aid users until a mean hearing loss of about 75 dB HL. At a sensorineural hearing loss of about 65 dB HL or more, the Otologics MET users have better speech recognition scores than the VSB users. For comparison with CI users, we followed a more conservative approach. In 90% of the users of a CI, speech recognition scores were better than those in: 1) patients with a conventional hearing aid and a mean hearing loss of about 95 dB HL or worse; 2) patients with an Otologics MET and a mean hearing loss of 85 dB HL or worse. CONCLUSIONS: Patients fitted with a VSB or an Otologics MET middle ear implant do not demonstrate better speech recognition scores than patients fitted with today's conventional hearing aids. Results might even been worse. However, the VSB and Otologics MET are a good option in patients with moderate (VSB) to severe (Otologics MET) sensorineural hearing loss and external otitis.