Standardized Active Middle-Ear Implant Coupling to the Short Incus Process
| Autor: | Andreas Radeloff, Daniela Wildenstein, Andreas Heyd, Kristen Rak, Rudolf Hagen, Sebastian P. Schraven, Anthony W. Gummer, Ernst Dalhoff, Robert Mlynski |
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| Rok vydání: | 2015 |
| Předmět: |
Male
Models Anatomic medicine.medical_specialty Tympanic Membrane Adolescent medicine.medical_treatment Hearing Loss Sensorineural Incus Mastoidectomy Audiology Vibration Prosthesis Implantation Cadaver Temporal bone otorhinolaryngologic diseases medicine Humans Stapes medicine.diagnostic_test business.industry Temporal Bone Auditory Threshold Laser Doppler velocimetry Middle Aged Sensory Systems Footplate Ossicular Prosthesis Otorhinolaryngology Audiometry Pure-Tone Female Neurology (clinical) Audiometry business Audiometry Speech Noise |
| Zdroj: | Otologyneurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology. 36(8) |
| ISSN: | 1537-4505 |
| Popis: | INTRODUCTION Active middle-ear implants with floating-mass transducer (FMT) technology are used to treat mild-to-severe sensorineural hearing losses. The standard surgical approach for incus vibroplasty is a mastoidectomy and a posterior tympanotomy, crimping the FMT to the long incus process. An alternative fixation side with less surgical trauma might be the short incus process and incus body.The aim of this study was to develop and test a short incus process coupling device for its functional properties in temporal bone preparations and clinical practice. MATERIALS AND METHODS An extended antrotomy and a posterior tympanotomy were performed in 10 fresh human temporal bones. As a control for normal middle-ear function, the tympanic membrane was stimulated acoustically, and the vibration of the stapes footplate was measured using laser Doppler vibrometry. FMT-induced vibration responses of the stapes were then measured for standard attachment at the long process and for 2 types of couplers designed for attachment at the short process of the incus (SP1 and SP2 coupler). Additionally, the functional outcome in 2 patients provided with an SP2 coupler was assessed postoperatively at 2 weeks, 3 months, and then 11 months, using pure-tone audiometry, auditory thresholds for frequency-modulated (warble) tones, vibroplasty thresholds, and speech audiometry in quiet and noise. RESULTS For the SP2 coupler, velocity-amplitude responses in temporal-bone preparations showed generally similar mean amplitudes as compared with the standard coupling of the FMT to the long process but with clearly increased mean amplitudes between 0.7 and 1.5 kHz and with reduced interindividual variation between 0.5 and 3 kHz. The clinical data of 2 patients with mild-to-severe sensory hearing loss showed good vibroplasty thresholds and convincing results for speech audiometry in quiet (Freiburger monosyllables at 65 dB SPL, 23 ± 31% unaided versus 83 ± 4% aided) and noise (Hochmair-Schulz-Moser-test at 65 dB SPL at 10 dB SNR, 32 ± 45% unaided and 42 ± 29% aided). CONCLUSION The attachment of the FMT to the short incus process with the SP2 coupler leads to good mechanical and functional coupling in an experimental setup and clinical practice. |
| Databáze: | OpenAIRE |
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