Translabyrinthine vestibular neurectomy and simultaneous cochlear implant for Ménière's disease.

BACKGROUND: Surgical management of Ménière's disease (MD) is recommended in case of medical and intratympanic treatment failures. Translabyrinthine vestibular nerve section has been considered the gold standard for denervation procedures in order to control vertigo attacks, although at the cost of sacrificing residual hearing. To the best of our knowledge, no work has been published with regard to a group of patients submitted to translabyrinthine vestibular neurectomy and simultaneous cochlear implant for MD. The aim of the present study was to assess the effectiveness of translabyrinthine vestibular nerve section and simultaneous cochlear implant in a prospective study. METHODS: All adult patients (over 18 years of age) with a diagnosis of intractable unilateral definite MD and useless residual hearing function were enrolled after medical and intratympanic treatment failures. Pre- and postoperative otoneurological evaluation concerned: frequency of vertigo attacks, head impulse test and caloric testing, pure tone average and speech perception audiometry in quiet conditions, tinnitus handicap inventory test, functional level scale and rate of vertigo control, dizziness handicap inventory test, and MD patient-oriented severity index. At least 6 months of follow-up were needed to be enrolled in the study. RESULTS: Four patients were included in the study. Translabyrinthine vestibular nerve section and simultaneous cochlear implant seemed to considerably improve the disabling effects of MD, achieving a good control of vestibular symptoms (mean pre/postoperative vertigo attacks per month: 16.5/0), resolving hearing loss (mean pre/postoperative pure tone average in the affected ear: 86.2/32.5 dB), improving the tinnitus (mean pre/postoperative tinnitus handicap inventory test: 77.2/6), and finally increasing the overall quality-of-life parameters. CONCLUSIONS: In our preliminary report, translabyrinthine vestibular nerve section and simultaneous cochlear implant showed encouraging results in order to definitively control both vestibular and cochlear symptoms during the same therapeutic procedure.

Retrosigmoidal placement of an active transcutaneous bone conduction implant: surgical and audiological perspectives in a multicentre study.

INTRODUCTION: The retrosigmoidal (RS) placement of the Bonebridge system (BB) has been advocated for cases of unfavourable anatomical or clinical conditions which contraindicate transmastoid-presigmoidal positioning. However, these disadvantageous conditions, combined with the considerable dimensions of the implant, may represent a challenge, especially for surgeons with no skull base experience. Moreover, the literature reports only limited experience concerning RS implantation of the BB system. METHODS: A multicentre, retrospective study was conducted to analyse the surgical and functional outcomes of a wide population of patients undergoing RS placement of the BB system by means of a surgical technique specifically developed to overcome the intraoperative issues related to this surgery. Twenty patients with conductive or mixed hearing loss and single sided deafness were submitted to RS implantation of the BB system. RESULTS: Audiological assessment concerning the measurement of the functional and effective gain by pure-tone audiometry (28 dB HL and -12.25 dB HL, respectively) and speech audiometry (24.7 dB HL and -21 dB HL, respectively) was conducted. A high overall subjective improvement of quality of life was recorded with the Glasgow Benefit Inventory questionnaire. No major complications, such as device extrusions or other conditions requiring revision surgery, were reported during the follow-up period (median: 42 months). CONCLUSIONS: In our study, which has one of the largest cohort of patients reported in the literature, RS placement of the BB system was safe and effective. Our functional results showed comparable hearing outcomes with presigmoidal placement. The effective gain, rarely investigated in this field, may be the object of further research to improve our understanding of bone conduction mechanisms exploited by bone conduction hearing implants.

Monitored anesthesia care with target-controlled infusion in vibroplasty.

OBJECTIVES: Correct positioning of a floating mass transducer during middle ear implant surgery is often problematic. With the use of monitored anesthesia care (MAC), however, deep sedation is maintained during surgery, followed by conscious sedation in which the patient can respond to test questions that investigate correct device position and function. The main aim of this study was to determine whether intraoperative audiometric assessment was feasible with MAC with target-controlled infusion in vibroplasty. An additional aim was to determine whether MAC was sufficiently comfortable for patients during the procedure. METHODS: The study group comprised 8 patients who underwent vibroplasty under sedation. Before suturing, audiometric assessment was done by stimulating the external auditory processor with pure tones at 0.5, 1,2, and 4 kHz. Blood pressure, arterial oxygen saturation level, heart rate, and end tidal carbon dioxide level were monitored during the procedure and at awakening. RESULTS: Audiometric assessment was successfully completed in all 8 patients. The selected parameters indicated that no patient experienced pain or discomfort during surgery; the absence of discomfort was confirmed 1 to 2 hours after the operation by simple questioning. CONCLUSIONS: We found MAC to be an efficient and relatively safe technique for verifying the correct coupling of the floating mass transducer with the middle ear during vibroplasty. The patients were able to respond appropriately to questions and commands; moreover, none reported having experienced pain or discomfort during the operation.

Transcutaneous bone-conduction hearing device: audiological and surgical aspects in a first series of patients with mixed hearing loss.

CONCLUSIONS: The Bonebridge(®) (BB) transcutaneous bone conductive implant (BCI) may overcome some of the issues related to a percutaneous BCI, such as management of the external screw, delayed activation or possible skin complications. Moreover, it has been shown to enable a functional outcome similar to percutaneous BCI in both conductive and mixed types of hearing loss. OBJECTIVES: To obtain clinical data from a preliminary series of patients implanted with a new transcutaneous BCI. METHODS: Four subjects affected by conductive/mixed hearing loss underwent implantation of the BB by two approaches: the transmastoid, presigmoid approach and the retrosigmoid approach. Soundfield thresholds were assessed with warble tones in a soundproof audiometric booth, and word recognition scores (WRSs) as speech reception thresholds (SRTs) were used to compare the unaided versus the post-implantation condition. RESULTS: The surgical procedure was completed in all cases, with only minor intraoperative divergence from the CT-based planning and no postoperative complications. The average improvement of the SRT in quiet with the BB in comparison to the unaided condition was 36.25 dB. All the implanted subjects reached SRT values below 65 dB, indicating a better understanding in quiet, with 100% word recognition.