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a Unaided pre-versus postoperative air conduction (AC) and b bone conduction (BC) PTA thresholds for each subject (dotted lines represent x = y line and standard deviations) (n = 22)
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The aim of this study was to describe the outcome and possible complications of subtotal petrosectomy (SP) for Vibrant Soundbridge (VSB) device surgery in a tertiary referral center. A secondary objective was the evaluation of hearing results in a subgroup of subjects who received the VSB device. Between 2009 and early 2011, 22 adult subjects with...
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Objective:
This study explores the influence of stimulation position on bone conduction (BC) hearing sensitivity with a BC transducer attached using a headband.
Design:
(1) The cochlear promontory motion was measured in cadaver heads using laser Doppler vibrometry while seven different positions around the pinna were stimulated using a bone anch...
Citations
... At the other end, placing a MEI in patients with conductive/mixed hearing loss might be challenging, especially in patients with congenital anomalies (e.g., aural atresia) and in patients with chronic otitis media. In the latter case, subtotal petrosectomy is a required first surgical step (Verhaert et al., 2013). Regarding point 2: Longevity is an important issue, especially when treating elderly people. ...
Wat is the best solution for a hearing impaired subject; a conventional behind-the-ear device, a cochlear implant, a bone-conduction device or middle ear implant
... Coker et al. in 1986 first employed the term "subtotal petrosectomy" [2]. Subsequently over approximately six decades, it has now become a wellestablished surgical technique, and its indications have expanded to include diverse situations like CI and bone conduction implants (BCI) [7,8]. Ugo Fisch (1988) furnished distinction between STP and other lateral skull base surgeries (LSBS). ...
Background
Subtotal petrosectomy (STP) has attracted massive interest over last two decades. The aim is to present our experience of this uncommon surgery. The indications, outcomes, and our variation in surgical technique would be presented and literature reviewed.
Methods
A retrospective observational study of all patients who underwent STP at a tertiary care center in India was analyzed.
Results
A total of 9 ears (in 8 patients) underwent STP over last 5 years at our center. The pathological conditions for which STP was done included chronic otitis media squamous (four ears), middle ear tumors (three ears), petrous apicitis (one ear), and traumatic cerebrospinal fluid (CSF) otorhinorrhea (one ear). The indication of STP included disease clearance (eight ears), unserviceable hearing (seven ears), hearing rehabilitation with otological implants (six ears), and intraoperative CSF gusher (one ear). Intraoperative indications included CSF gusher, large tegmen defect with erosion of apical turn of cochlea, and erosion of anterior bony wall of external auditory canal. The mean follow-up period was 36 months (range of 6 months to 60 months). None of the patients had any dehiscence of blind sac closure or secondary acquired cholesteatoma on imaging.
Conclusions
STP facilitates disease clearance by providing unmatchable exposure in difficult otological scenarios and additionally isolates middle ear cleft from external environment, thereby eliminating problems of mastoid cavity. Furthermore, it also prepares ear for second stage otological implants. It is a safe surgery with minimal complications.
... Ha ugyanazon intézet több közleményt is közzétett, akkor mindig a frissebb, vagy a nagyobb beteganyagot bemutató közleményt vettük alapul. A 10 legnagyobb beteganyagot feltüntető közleményt alapul véve, utalni kívántunk a patológia, a komplikációk, valamint a sebészi technika nevezéktanának változatosságára [16][17][18][19][20][21][22][23][24][25]. ...
Introduction: Subtotal petrosectomy (STP) has been known for decades and it is considered being on the borderline between ear and skull-base surgery. Due to its excessive radicalism and adverse effects on hearing, it has been a forgotten surgical technique until recently. Over the last decade, due to its many benefits and the ability to combine it with modern hearing rehabilitation methods, STP has reappeared, providing a definitive solution to a number of problematic middl-ear disorders. Aim: In our retrospective clinical study, we wanted to highlight the effectiveness of STP, analyzing the efficiency of this surgery for the first time in domestic patient records, and to report our own experiences to date. Method: We processed data from 45 surgeries on our 44 patients. In addition to presenting the various surgical indications, we review the steps of the operation, analyze the audiological results, including the various methods of hearing rehabilitation, and also analyze the complications that have occurred. Our results are also summarized in the light of international professional literature. Results: Of our 44 patients, 23 were female and 21 were male. Patients had a mean age of 44.6 ± 20.5 years and a mean follow-up of 23 ± 16 months. Of our patients, 25 (57%) had undergone at least two previous unsuccessful ear operations, and 6 (14%) had deafness before surgery. The most common indication was chronic otitis media with cholesteatoma. 13 patients underwent 14 cochlear implantations (23%), in addition 6 patients received bone anchored hearing aids (BAHA) (14%), and 2 patients (5%) underwent VSB (Vibrant Soundbridge) placement against the round window membrane. Complications occurred in 11 of our patients, the most common of which was cerebrospinal fluid leak (5 cases, 11%) and wound dehiscence (3 cases, 7%). Data from 3 patients were available for processing the audiological results. Conclusion: STP is an extremely favorable surgical solution for a number of middle-ear pathologies that have previously caused major problems. The main reason for its growing popularity is that it can be combined with a number of modern, effective methods of hearing rehabilitation. Orv Hetil. 2020; 161(14): 544-553.
... Comparing functional gain between the different coupling sites, in the present study the round window group benefited the most from the implantation, which are those patients who present with the worst hearing levels in the first place. This is in line with results of other studies (14,16,(34)(35)(36). In stapes patients, a functional gain of approximately 30 to 35 dB HL is reported which is in line with our findings (34)(35)(36). ...
... This is in line with results of other studies (14,16,(34)(35)(36). In stapes patients, a functional gain of approximately 30 to 35 dB HL is reported which is in line with our findings (34)(35)(36). Whereas, in round window application, both in experimental and clinical studies a higher functional gain of around 50 dB HL has been observed (14,36). ...
... In stapes patients, a functional gain of approximately 30 to 35 dB HL is reported which is in line with our findings (34)(35)(36). Whereas, in round window application, both in experimental and clinical studies a higher functional gain of around 50 dB HL has been observed (14,36). ...
Objectives:
Indication and implantation of active middle ear implants (AMEI) are well established. Choice of the coupling site depends from the individual anatomical situation. Long-term stability of different coupling sites in terms of functional outcome and complications are rare and were investigated in this study.
Design:
Retrospective analysis of 41 consecutive patients (45 ears) with coupling of the AMEI at the incus, stapes, and round window. Analysis of preoperative, postoperative, and long-term results of pure-tone average, speech discrimination in quiet at 65 dB (German language Freiburg Monosyllabic Test) and noise (German language Oldenburger Sentence Test), rate of revision surgeries as well as explantations and the novel parameter patient years (py).
Results:
Mean of follow-up was 3.0 ± 1.7 years resulting in a total of 135.6 py. Bone conduction was stable in all patients pre- to postoperatively as well as preoperatively to the long-term. Round window patients had the broadest air-bone gap (31.4 ± 19.4 dB HL) benefitting the most from the AMEI (functional gain = 39.0 ± 12.8 dB HL). Regarding speech discrimination, incus patients performed the best both in quiet (77.7 ± 22.8%) and noise (3.4 ± 2.9 dB SNR). In terms of revision surgery and explantations, round window patients exhibited the highest rates (20%).
Conclusions:
Regarding all coupling sites, satisfying long-term stability results and comparable complication rates were reported with best performance of coupling to the incus. Implementation of patient years might be a novel parameter for the comparison of revisions and explantations.
... At shortterm observation, this surgical refinement was effective in avoiding relapse of cable extrusion. In this regard, an alternative procedure that can also be directly applied during the primary implanting procedure could be represented by the blind-sac closure of the external auditory meatus (EAM), followed by abdominal fat obliteration of the middle ear, usually carried out during a subtotal petrosectomy (STP) for aggressive or recurrent cholesteatoma [3,7,10,11]. It 1 3 would, therefore, be logical to assume that the adoption of this surgical variant would have avoided the most frequent complication observed in this study sample, i.e., the device cable's exposure. ...
Purpose
To evaluate the complication rate in adult subjects with open cavities that were implanted with the Vibrant Soundbridge implant, using the round window (RW) vibroplasty procedure.
Methods
From 2009 to 2014, 21 adult subjects with mixed hearing loss, all with sequel from open tympanoplasty surgery, underwent RW vibroplasty (RW-VPL). Surgical complications were recorded and a standard minimal approach was used as a basis for all the cases that needed revision.
Results
The mean follow-up was 42 months (range 12–76). Complications occurred in nearly half of the cases and included: cable extrusion (23.8%), hardware failure (14.3%), profound hearing loss (9.5%), and inadequate RW coupling (9.5%). A minimal endaural approach (MEA) was used in the majority of the cases (86.7%), while the extended endaural approach was adopted for those patients requiring explantation with or without replacement (14.3%).
Conclusions
RW-VPL can be considered a possible option for the rehabilitation of auditory impairment derived from an open tympanoplasty procedure due to cholesteatoma. The procedure may lead to minor/major complications that may require a surgical revision. By adopting an MEA, it has been possible to manage all the situations in which functionality of the device is worth being preserved.
... In the worst cases of FN anomalies, the FN sometimes runs on the site where surgeons usually plan to perform the cochleostomy, and then another approach to the cochlea may be required. Because subtotal petrosectomy and blind sac closure of the external ear canal give surgeons excellent visibility and easy access for cochleostomy in cases with such difficult temporal bone anatomy, this procedure for CI surgery in cases with inner ear and FN malformations has recently become widely accepted [1][2][3]. A case of CI surgery in the presence of FN bifurcation and the FN running on the cochleostomy site is presented. ...
... This technique aims for eradication of the disease, avoidance of recurrence, prevention of meningitis, and secure placement of the CI electrode. Additionally, because it gives excellent visibility and access during the operation, subtotal petrosectomy is also advantageous when the implantation of a CI is performed in the presence of poorly pneumatized temporal bones and temporal bone malformations, including cochleovestibular and FN anomalies [1][2][3]. ...
Facial nerve anomalies are a potential problem in patients with cochleovestibular malformations. A case of cochlear implant (CI) surgery in the presence of intra-temporalbone facial nerve bifurcation is presented. During the first surgery, the facial nerve bifurcation obscured the promontory and round window. It was difficult to perform cochleostomy because of the lack of landmarks of the basal turn of the cochlea, and the first surgical attempt at cochleostomy was abandoned. A repeat CT scan was performed after the first surgery with reconstructed 3D images of the temporal bone and the cochlea, and then the cochlea was successfully opened at revision surgery. Reconstructed 3D CT images were very useful to identify the site of cochleostomy in this case with such difficult temporal bone anatomy.
... While there has been a growing consensus on the use of STP/middle ear obliteration in implantation in SCOM (6,8,(9)(10)(11)(12), few authors have used alternative methods such as canal wall reconstruction (14) and use of pericranial flaps with retention of open cavity (13), though limited to few patients with variable follow-up and outcomes. The use of STP has been seen with favorable outcomes not just with CI but also with other auditory implantable devices such as active middle ear implants (18,19), and as a final management of recalcitrant chronic otitis with multiple previous surgeries as standalone procedure (4,20), or in the preparation of future implantable auditory devices (21). A recent systematic review and meta-analysis on surgical complications of CI in canal wall down mastoid cavities analyzed 42 articles encompassing 424 patients and proved a significantly fewer global complications rate in patients with EAC closure than maintaining a canal wall down cavity (22). ...
Objectives:
To evaluate the long-term surgical outcomes of cochlear implantation (CI) in chronic otitis media (COM) with cholesteatoma and open cavities using subtotal petrosectomy (STP). To review device explantation (DE) patients and reimplantation considerations.
Study design:
Retrospective review.
Setting:
Otology and skull base center.
Patients and methods:
Charts of 35 patients (36 ears) with COM with cholesteatoma, including open cavities, who underwent CI were reviewed for surgical outcomes and DE. Patient demographics, pathologies, previous surgeries, staging of implantation, salient intraoperative findings at the time of implantation and follow-up were evaluated. Details of patients with DE were evaluated for cause, operative findings, and reimplantation considerations.
Results:
Mean age of patients was 65.94 years. Nineteen open cavities, 11 primary cholesteatomas, 3 petrous bone cholesteatomas, and 3 atelectatic middle ears represented the pathologies with 31 patients of CI with concurrent STP and 5 patients where implantation was staged. The mean follow-up was 7.16 years ranging from 2 to 13 years. Four patients (11%) had DE due to extrusion and cavity infection with three reimplanted in same or contralateral ear. All explantations occurred within 24 months of primary implantation. No residual or recurrent cholesteatoma was observed in any of the patients during follow-up.
Conclusion:
CI is feasible in COM with cholesteatoma and open cavities with the use of STP and single-stage implantation can be performed in the absence of purulence. Despite low risk of residual cholesteatoma post meticulous disease removal, risk of DE remains, particularly in open cavity patients, and is higher than standard implantation. Reimplantation is often possible with careful considerations.
... In the same patients, no other failure was noted 5-8 years after reimplantation. In a population of 178 subjects with mixed or conductive hearing loss from 8 short-, mid-, or longterm studies (Baumgartner et al., 2010;Bernardeschi et al., 2011;Claros and Del Carmen Pujol, 2013;Colletti et al., 2011;McKinnon et al., 2014;Streitberger et al., 2009;Verhaert et al., 2013;Zernotti et al., 2013), among them three multicentric, no device failures were reported. Colletti et al. (2009Colletti et al. ( , 2013 and Marino et al. (2013) note four implant failures in a population of 106 individuals, one of them caused by a breakage of the conductor link. ...
... In noise, similar results were found in 62 patients. In a mixed and conductive hearing loss population of 305 subjects (children and adults) from 13 studies (six multicentric), Bernardeschi et al. (2013), Zernotti et al. (2013) and Verhaert et al. (2013) found that speech intelligibility in quiet was, on average, significantly better than the unaided condition. Speech in noise results was significantly better in 18 patients involved in a multicentric study (Marino et al., 2013) compared to the HA in three conditions: speech and noise in front, noise on the aided ear, and noise on the contralateral ear. ...
Objective: To present a historical overview of the Vibrant Soundbridge® (VSB) middle ear implant (MEI), since its beginning in the 1990s to date and to describe its course and contemplate what it might become in the future.
History: MEIs started to take form in researchers’ mind in the 1930s with the first experiment of Wilska. In the 1970s, several devices, such as the Goode and Perkins’, the Maniglia’s, or the Hough and Dormer’s were created but remained prototypes. It is only in the 1990s the devices that emerged remained on the market. In 1994, Symphonix, Inc. was created and aimed to manufacture and commercialize its semi-implantable MEI, the VSB. The principle of the VSB lies on a direct drive of the sound to a vibratory structure of the middle ear through an electromagnetic transducer, the floating mass transducer (FMT). The particularity of the system VSB is the simplicity of the transducer which is made of both the magnet and the coil; thus, the FMT, fixed on a vibrating middle ear structure, mimics the natural movement of the ossicular chain by moving in the same direction. The goal of the VSB was to give an alternative to patients with mild-to-severe sensorineural hearing loss who could not wear hearing aids (HAs) or who were unsatisfied conventional HA users. Subsequent to Tjellström’s experiment in 1997, implantations started to include etiologies such as otosclerosis, radical mastoidectomy, failed ossiculoplasty/tympanoplasty, and atresia.
Nowadays, the VSB, with more than 20 years of experience, is the oldest and most used middle ear implant worldwide. It is well acknowledged that the straightforward design and reliability of the transducer have certainly contributed to the success of the device.
... Subtotal petrosectomy proved to be a safe method of eradicating chronic inflammation in the middle ear and the mastoid prior to cochlear implantation [6][7][8] or implantation of an active middle ear device [9][10][11]. It provides good protection of the implant and especially of the electrode array which could be extruded by frequent wax cleaning in radical cavity cases [7,12]. ...
... Our greater revision rate in comparison to the case series from [10]. ...
The objective of the study was to examine the impact of the surgical wound closure technique as protection of the obliterated tympanomastoid cavity on the revision surgery rate after subtotal petrosectomy (SP). This is a retrospective case series conducted in a tertiary care referral center. 199 patients (212 ears) with recurrent chronic otitis media underwent SP followed by tympanomastoid obliteration with abdominal fat at a single tertiary referral center between 2005 and 2015. 124 SP were carried out without (group A), 74 with temporalis muscle flap (group B) and 14 with reinforcing material like polydioxanone foil or bovine pericardium or allogenic fascia lata (group C) for wound closure. The evaluated follow-up was either until the scheduled device implantation or 6 months postoperatively. We assessed the rate of postoperative wound healing disorder with revision surgery according to the surgical technique for closure of the obliterated cleft. Revision surgery due to impaired wound healing was necessary in 16 % of the total cases (group A: 18.5 %, group B: 10.8 %, group C: 21.4 %). Further analysis concerning the dehiscent area in both sites (retroauricular and blind sac of the external auditory canal) was conducted and discussed. There was no significant difference observed in the rate of revision surgery between the three groups. The wound healing process after SP is determined by many factors and cannot be significantly influenced solely by reinforcing tissue like the temporalis muscle flap or supporting materials.
... The indication for an AMEI varies from (pure) sensorineural hearing loss (1)(2)(3)(4) to mixed hearing loss (5)(6)(7)(8)(9)(10) and even pure conductive hearing loss (i.e., in case of a bony atresia of the external ear canal) (11,12). In the Netherlands, AMEIs are reimbursed for patients with sensorineural hearing loss, if they suffer from therapy resistant chronic external otitis that inhibits the use of a conventional hearing aid with any ear mould in the external ear canal. ...
Objective: To evaluate the long-term medical and technical results, implant survival, and complications of the semi-implantable vibrant soundbridge (VSB), otologics middle ear transducer (MET), and the otologics fully implantable ossicular stimulator (FIMOS). Study Design: Retrospective cohort study. Patients: Patients with chronic external otitis and either moderate to severe sensorineural or conductive/mixed hearing loss. Setting: Tertiary referral center. Intervention: Implantation with the VSB, MET, or FIMOS. Main Outcome Measures: Medical complications, number of reimplantations, and explantations. Results: Ninety-four patients were implanted, 12 patients with a round window or stapes application. 28 patients were lost to follow-up. The average follow-up duration was 4.4 years (range, 1 month-15 years). 128 devices were evaluated: (92 VSB, 32 MET, 4 FIMOS). 36 devices (28%) have been explanted or replaced (18 VSB, 14 MET, 4 FIMOS). Device failure was 7% for VSB, 28% for MET, and 100% for FIMOS. In 16 patients (17%) revision surgery (n = 20) was performed. Twenty patients (21%) suffered any medical complication. Conclusion: Medical and technical complications and device failures have mostly occurred in the initial period of active middle ear implants (AMEI) implementation and during clinical trials or experimental procedures. All four FIMOS had technical difficulties. An important decrease in the occurrence of both medical and technical complications was observed. Application in more recent years did not show any complications and the recent device failure rates are acceptable. Magnetic resonance imaging (MRI) incompatibility should be taken into account when indicating AMEI. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company
