Endoscopic versus microscopic ossiculoplasty: Does the functional outcome vary according to the type of osciculoplasty?

OBJECTIVE: To compare functional outcome of microscopic and endoscopic approach regarding type of ossiculoplasty. METHODS: In this retrospective study, cases who had undergone type-II and type-III tympanoplasty between February 2007 to September 2019 were divided into two groups according to the type of approach as microscopic and endoscopic. In cases with type-II reconstruction; Partial Ossicular chain Replacement Prosthesis (PORP), incus interposition and bone cement were used in order of frequency. Whereas in cases with type-III reconstruction, only Total Ossicular chain Replacement Prosthesis (TORP) was used. The average Air Bone Gap (ABG) was determined pre- and post-operatively for the calculation of Air Conductance Gain (ACG). The ACG, pre- and post-operative ABG values of each group were compared with regard to the type of ossiculoplasty. RESULTS: A total of 79 cases consisting of 32 females and 47 males who had undergone type-II and type-III tympanoplasty were enrolled. No statistically significant difference between microscopic and endoscopic approach was found in terms of ACG (p = 0.42), pre-(p = 0.23) and postoperative ABG (p = 0.99). We did not find any significant difference in terms of ACG, pre- and postoperative ABG between two approaches for type-II and type-III reconstructions (p > 0.05). CONCLUSIONS: According to the current study, endoscopic approach in type-II and type-III reconstruction is at least reliable as microscopic approach regarding functional outcome. Since both techniques have similar functional results, other factors (anatomic characteristics, habitude of the surgeon and duration of the surgery) should be considered when choosing the technique. LEVEL OF EVIDENCE: In the current paper we present a retrospective comparative study of two different approaches of a particular type of otologic surgery. Level of evidence corresponds to level III.

Active transcutaneous bone conduction implant: audiological results in paediatric patients with bilateral microtia associated with external auditory canal atresia.

OBJECTIVE: To describe, in terms of functional gain and word recognition, the audiological results of patients under 18 years of age implanted with the active bone conduction implant, Bonebridge™. DESIGN: Retrospective case studies conducted by reviewing the medical records of patients receiving implants between 2014 and 2016 in the public health sector in Chile. STUDY SAMPLE: All patients implanted with the Bonebridge were included (N = 15). Individuals who had bilateral conductive hearing loss, secondary to external ear malformations, were considered as candidates. RESULTS: The average hearing threshold one month after switch on was 25.2 dB (95%CI 23.5-26.9). Hearing thresholds between 0.5 and 4 kHz were better when compared with bone conduction hearing aids. Best performance was observed at 4 kHz, where improvements to hearing were observed throughout the adaptation process. There was evidence of a significant increase in the recognition of monosyllables. CONCLUSIONS: The Bonebridge implant showed improvements to hearing thresholds and word recognition in paediatric patients with congenital conductive hearing loss.

A testbed for optimizing electrodes embedded in the skull or in artificial skull replacement pieces used after injury.

BACKGROUND: Custom-fitted skull replacement pieces are often used after a head injury or surgery to replace damaged bone. Chronic brain recordings are beneficial after injury/surgery for monitoring brain health and seizure development. Embedding electrodes directly in these artificial skull replacement pieces would be a novel, low-risk way to perform chronic brain monitoring in these patients. Similarly, embedding electrodes directly in healthy skull would be a viable minimally-invasive option for many other neuroscience and neurotechnology applications requiring chronic brain recordings. NEW METHOD: We demonstrate a preclinical testbed that can be used for refining electrode designs embedded in artificial skull replacement pieces or for embedding directly into the skull itself. Options are explored to increase the surface area of the contacts without increasing recording contact diameter to maximize recording resolution. RESULTS: Embedding electrodes in real or artificial skull allows one to lower electrode impedance without increasing the recording contact diameter by making use of conductive channels that extend into the skull. The higher density of small contacts embedded in the artificial skull in this testbed enables one to optimize electrode spacing for use in real bone. COMPARISON WITH EXISTING METHODS: For brain monitoring applications, skull-embedded electrodes fill a gap between electroencephalograms recorded on the scalp surface and the more invasive epidural or subdural electrode sheets. CONCLUSIONS: Embedding electrodes into the skull or in skull replacement pieces may provide a safe, convenient, minimally-invasive alternative for chronic brain monitoring. The manufacturing methods described here will facilitate further testing of skull-embedded electrodes in animal models.

An Implantable Hearing System As Rehabilitation for Hearing Loss Due to Bilateral Aural Atresia: Surgical Technique and Audiological Results.

OBJECTIVE: To demonstrate the surgical technique and audiological results of a middle ear implant for restoring hearing in patients with bilateral aural atresia and microtia with conductive or mixed hearing loss. MATERIALS AND METHODS: In this prospective study, 12 subjects aged 12 years and older presenting with hearing loss and bilateral congenital aural atresia underwent surgical insertion of a middle ear implant. The patients underwent tympanomastoidectomy with a wide opening of the attic and preservation of the roof of the atresic tympanic bone to expose the middle ear and position the floating mass transducer of the implant. RESULTS: There were no intraoperative or postoperative complications. The hearing threshold averages in a free field were 53.5 dB preoperatively and 25.6 dB postoperatively. Monosyllabic word recognition averaged 61% preoperatively and 91.3% postoperatively. The average speech perception in quiet conditions during the hearing in noise test improved from 67.11 dB to 45.99 dB, and the signal-to-noise ratio improved from 5.64 to 1.31. CONCLUSION: The tested system is an excellent option for auditory rehabilitation of conductive hearing loss due to bilateral ear atresia. The surgery is well structured and safe and provides several alternatives to the surgeon, which is valuable in difficult cases.

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

OBJECTIVE: 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.

Active middle ear implants in patients undergoing subtotal petrosectomy: long-term follow-up.

OBJECTIVE: In 2009, we had introduced the active middle ear implant (aMEI) round window coupling in patients undergoing a subtotal petrosectomy and reported our first results. In the current study, we evaluated the long-term firmness of the vibranting floating mass transducer (FMT) within the round window niche, the long-term audiologic results and the patient's perspective of wearing the speech processor over time. PATIENTS AND INTERVENTION: Of 10 patients, 6 female and 1 male patients (age range from 30 to 71 yr) had undergone subtotal petrosectomy with aMEI round window vibroplasty and were available for a long-term follow-up. Indications were recurrent or chronic ear infections with preserved inner ear function and inability for ossicular chain reconstruction. A thin piece of fascia was placed between the FMT and the round window membrane once the round window niche had been enlarged by drilling. The operative cavity was filled with fat and a muscle flap in all cases. MAIN OUTCOME MEASURES: Audiologic evaluations included pre- and postoperative pure-tone audiometry, Freiburger syllable and numeric tests. All patients underwent preoperative computed tomographic (CT) scans and magnetic resonance imaging (MRI) examination. Postoperative follow-up included CT scans at 1 and preferentially 3 to 5 years to confirm the correct positioning of the FMT and the complete removal of the underlaying pathology. Subjective benefit was rated by the Glasgow Hearing Aid Benefit Profile. RESULTS: There were no immediate postoperative complications. CT scans confirmed the correct and durable positioning of the FMT. Audiometric tests revealed a stable and adequate functional gain in all patients with limited adjustments over time. Subjective rating reached a high satisfaction score, and all patients remained long-term implant users. One patient developed a skin necrosis over the implant because of excessive pressure exerted by the retaining magnet of the headpiece. Revision was performed using local skin flaps with preservation of the functioning implant. CONCLUSION: Our radiologic, audiometric, and subjective data show stable long-term results of round window vibroplasty in patients undergoing subtotal petrosectomy, and we continue to recommend this treatment option instead of another mastoid revision procedure.

Vibrant Soundbridge in congenital osseous atresia: multicenter study of 12 patients with osseous atresia.

CONCLUSION: The study suggests that the Vibrant Soundbridge (VSB) middle ear implant could be a valid alternative for patients with congenital aural atresia to compensate for their hearing loss. OBJECTIVE: To determine the audiologic benefit the VSB provides in patients with congenital aural atresia. METHODS: Twelve patients with congenital aural atresia were implanted with VSB: eight patients were unilaterally atretic (67%) and 4 (33%) were bilaterally atretic. In five cases the implant was placed onto the round window, in another five cases the implant was placed on the stapes, in only one case a prosthesis (coupler) was used to fix the implant into the oval window, and in one case a fenestration on the cochlear endostium was performed. RESULTS: The mean functional gain obtained for all patients evaluated was 62 dB at 0.5 kHz, 60 dB at 1 kHz, 48.3 dB at 2 kHz, and 50.8 dB at 4 kHz. The mean functional gain for all frequencies evaluated was 55.1 dB.

Biosilicate ototoxicity and vestibulotoxicity evaluation in guinea-pigs.

UNLABELLED: Changes, destructions and interruptions in middle ear ossicular chain architecture may be caused by infection, trauma, tumors, congenital alterations or prior surgeries. Nonetheless, infectious and inflammatory processes, focal or generalized which affect the middle ear are the most prevalent, causing a great demand for ossiculoplasty. Biosilicato is a new material which can be used in the middle ear with the goal of reconstructing the ossicular chain. It is a bioactive type A vitroceramic, in other words, it binds to bone or soft tissue in a matter of a few hours, thanks to the formation of hydroxy-carbonateapatatie in its contact surface when in contact with body fluids. AIMS: The goal of the present paper is to assess biosilicate ototoxicity and vestibular toxicity in experimental animals, for later use in humans. MATERIALS AND METHODS: This a clinical and experimental study in which otoacoustic emissions were performed before and after the placement of Biosilicate in the middle ear of experimental animals and a scanning electron microscopy was carried out in the cochlea, saccule, utriculus and macula of the semicircular canals after 30 and 90 days to assess oto and vestibular toxicity. RESULTS: There were no signs of oto or vestibular toxicity in any of the groups associated with biosilicate. CONCLUSION: Biosilicate is a safe material to be used in ossiculoplasties.

Biosilicate® Ototoxicity and Vestibulotoxicity evaluation in guinea-pigs / Avaliação da ototoxicidade e vestibulotoxicidade do biosilicato® em orelhas de cobaias

Changes, destructions and interruptions in middle ear ossicular chain architecture may be caused by infection, trauma, tumors, congenital alterations or prior surgeries. Nonetheless, infectious and inflammatory processes, focal or generalized which affect the middle ear are the most prevalent, causing a great demand for ossiculoplasty. Biosilicato® is a new material which can be used in the middle ear with the goal of reconstructing the ossicular chain. It is a bioactive type A vitroceramic, in other words, it binds to bone or soft tissue in a matter of a few hours, thanks to the formation of hydroxy-carbonateapatatie in its contact surface when in contact with body fluids. AIMS: The goal of the present paper is to assess biosilicate ototoxicity and vestibular toxicity in experimental animals, for later use in humans. MATERIALS AND METHODS: This a clinical and experimental study in which otoacoustic emissions were performed before and after the placement of Biosilicate in the middle ear of experimental animals and a scanning electron microscopy was carried out in the cochlea, saccule, utriculus and macula of the semicircular canals after 30 and 90 days to assess oto and vestibular toxicity. RESULTS: There were no signs of oto or vestibular toxicity in any of the groups associated with biosilicate. CONCLUSION: Biosilicate is a safe material to be used in ossiculoplasties

As alterações, destruições e interrupções da arquitetura da cadeia ossicular da orelha média podem ser causadas por infecções, trauma, tumores, alterações congênitas ou cirurgias prévias. Entretanto os processos inflamatórios e infecciosos, focais ou generalizados que acometem a orelha média são os mais prevalentes, gerando uma enorme demanda de ossiculoplastias. O Biosilicato® é um novo material que pode ser usado em orelhas médias com o objetivo de reconstruir a cadeia ossicular. Constitui-se de uma vitrocerâmica bioativa do tipo A, ou seja, que se liga a tecido ósseo ou a tecido mole em algumas horas, devido à formação de hidroxicarbonatoapatita em sua superfície de contato quando em contato com fluidos corpóreos. OBJETIVO: O objetivo deste trabalho é avaliar a ototoxicidade e vestibulotoxicidade do Biosilicato em cobaias, para posterior utilização em humanos. MATERIAL E MÉTODO: Trata-se de um estudo clínico e experimental, onde foram realizadas emissões otoacústicas antes e após a colocação de Biosilicato na orelha média de cobaias e realizada microscopia eletrônica de varredura da cóclea, sáculo, utrículo e máculas dos canais semicirculares após 30 e 90 dias para avaliar a oto e vestibulotoxicidade. RESULTADOS: Não houve sinais de oto ou vestibulotoxicidade em nenhum dos grupos relacionados ao Biosilicato. CONCLUSÃO: O Biosilicato é um material seguro para ser usado em ossiculoplastias.

Cirurgia de reconstrução de orelha média / Middle ear reconstruction

A orelha média funciona como um amplificador sonoro. Utiliza para isso três mecanismos: o hidráulico, a alavanca dos ossículos e o jogo das janelas, sendo o mais importante o fato da energia mecânica captada pela membrana timpânica ser concentrada na área da janela oval, que é muitas vezes menor (mecanismo hidráulico). Podemos dividir o não funcionamento da cadeia ossicular em duas categorias: com diminuição da vibração da cadeia e com interrupção da cadeia. Neste artigo, o autor discorre sobre os problemas da cirurgia de reconstrução.

Resultados de timpanoplastia tipo II de Wullstein: análise comparada com a literatura / Results of Wullstein type II timpanoplasty: comparative analysis with the literature

Os autores revêem a literatura sobre reconstrução de cadeia ossicular e fazem uma análise comparando os diferentes materiais e técnicas com a utilização de bigorna moldada interposta entre a membrana timpânica e estribo íntegro.

Transplantes e implantes en la cirugía del oído medio / Transplant and you implants in the middle ear

El autor muestra en el presente trabajo las diferentes opciones que hay de manejo de la cadena osicular del oído medio por alteraciones de esta en diferentes circunstancias. Se hace mensión de las posibilidades de utilización de diferentes elementos para la reconstrucción de la cadena osicular como pueden ser (hueso, diente, cartilago, metales, cerámicas, polietileno, cemento dental, etc.) muestra en el presente artículo la s estadísticas en este tipo de reconstrucción.

The author shows different options in the ossicular chain management because in different circumstances. He describes some possibilities about using a variety of elements for the ossicular chain reconstruction such as bone, teeth, polythelene, metals, ceramic, cartilage, dental clay, etc. Finally statistics abut tis kind of reconstruction is also detailed.