ObjectiveTo investigate the benefit of intraoperative auditory brainstem response (ABR) measurements in revision active middle ear implant surgery.Study designRetrospective data analysis.SettingTertiary referral center with a large active middle ear implant program.Main outcome measuresIntraoperative ABR thresholds, audiogram, sound field thresholds, speech understanding in the Freiburger monosyllabic word test.PatientsFourteen patients with active middle ear implant revision surgery.ResultsThe application of the ABR measurement resulted in improved sound field thresholds and enhanced speech understanding. Analysis revealed a significant correlation of intraoperative gain in ABR threshold with the postoperative gain in sound field thresholds.ConclusionABR monitoring can be a useful tool to provide information intraoperatively about the coupling efficiency of the FMT. Especially in revision surgeries, this might help to improve postoperative hearing success.

Patienten mit leicht bis hochgradigen Schallleitungs-, Schallempfindungs- und kombinierten Schwerhorigkeiten werden routinemasig nach erfolglosem Horgeratetrageversuch mit aktiven Mittelohrimplantaten versorgt. Aktive Mittelohrimplantate konnen an verschiedene Strukturen des Mittelohrs angekoppelt werden. Der Ort der Ankopplung ist abhangig vom Horverlust und der individuellen Physiologie des Mittelohres. Die Horverbesserung ist dabei stark von der Kopplungseffizienz des Implantatwandlers an die Mittelohrstruktur abhangig. Aktuell gibt es keine zufriedenstellende Moglichkeit die Kopplungseffizienz intraoperativ zu bestimmen. Daher wird eine objektive Methode eingefuhrt, um intraoperativ auditorische Hirnstammantworten (BERAs) bei Stimulation uber das Implantat abzuleiten. Die Vibrant Soundbrigde® (VSB) wird dabei mit einem Drahtlosubertrager (miniTEK, Signia GmbH, Erlangen) und der Carina®-Aktuator uber ein Audiokabel mit der BERA-Anlage verbunden. Die BERA-Anlage ubertragt die Stimuli direkt an das Implantat, welches an die Mittelohrstruktur angekoppelt ist. Die BERA-Antworten werden bei der VSB durch einen optimierten VSB-CE-Chirp und beim Carina®-System durch den Standard CE-Chirp evoziert, beginnend bei Pegeln oberhalb der Knochenleitungshorschwelle bis unter die Registrierungsschwelle. Diese Methode kann die intraoperative Integritat des Implantats sowie die Kopplungseffizienz bestimmen, um eine Aussage uber den zu erwartenden Horerfolg treffen zu konnen. Daruber hinaus kann die versorgte Horschwelle verwendet werden, um die Anpassung bei Kindern oder schwierigen Fallen zu unterstutzen und um eine Horverschlechterung uber die Zeit zu erfassen. Zusammenfassend, konnte eine Methode zur Bestimmung der intraoperativen Kopplungseffizienz wahrend der Implantation von VSBs und Carinas® etabliert werden. Daruber hinaus werden intraoperative BERA-Daten von 30 VSB- und 10-Carina®-Patienten sowie deren Horergebnisse gezeigt.

Introduction Preoperative Direct-Drive-Simulation (DDS) simulates the sound of “Vibroplasty-Hearing” to vibroplasty-candidates. The direct-drive-pure-tone-audiometry (DD-PTA), direct-drive-speech-audiometry (DD-SA) and direct-drive-ABR (DD-ABR) as further developments of the DDS are new audiometric tools. This study shows the first results of vibroplasty-candidates and attempts to proof the reliability of the DDS even in case of mixed and conductive hearing loss.

The intraoperative real-time monitoring of the Vibrant Soundbridge®(VSB) transmission efficiency by auditory brain stem responses (ABR) is used as a standard instrument at the Univ. ENT Clinic Würzburg since 2014. Especially in complex anatomical conditions, such as revisions and malformation operations, the system can be of great use, since the optimal coupling of the FMT to the middle ear structures can be checked intraoperatively. In the study all VSB®revisions and implantations of the VSB®in malformation cases, in which the system was used, were reviewed A retrospective analysis was performed and operation specific as well as postoperative audiological data were extracted. The quality of the measurements was divided into 3 groups and the measured ABR threshold was determined.

Objective:The Carina(R)implant system is a fully implantable active middle ear implant, which can be coupled to various structures in the middle ear, depending on the nature of the hearing loss and the middle ear anatomy. Currently, there is only one method for determining the coupling efficiency of the actuator of this implant system, and this is limited to incus coupling. Design:The proposed method is based on the intraoperative recording and evaluation of auditory brainstem responses (ABRs) while directly stimulating the hearing system via the actuator. The acoustic stimulation was achieved using an optimised broadband chirp stimulus (CE-Chirp(R)). Study samples:This study included 10 subjects having moderate to severe sensorineural or mixed hearing loss. Results:The intraoperative ABR measurements show, that it is possible to derive reliable AEP thresholds via the actuator of the implant. The ABR thresholds correlate well with preoperative BC PTA4 thresholds (r = 0.87) while the postoperative OC-direct thresholds (in situ audiogram via the implant) correlate with r = 0.77. Conclusion:The results demonstrated that the direct actuator stimulation allow for reliable intraoperative ABR measurements and that the proposed method can be used to estimate the coupling efficiency of the actuator and facilitate its positioning.

Introduction When coupling the Vibrant Soundbridge (VSB) to the middle ear structures, there may be uncertainty intraoperatively as to whether sufficient sound transmission can be achieved. In particular, a no longer intact ossicular chain, middle ear malformations but also poor overview can represent major challenges here. A system for intraoperative real-time monitoring of VSB transmission efficiency has been developed and implemented in the clinical routine. In our video contribution, the basics, the structure, the implementation and the evaluation of the measurements are presented.

Purpose This study intraoperatively measured the coupling efficiency of the Vibrant Soundbridge (VSB), with the aim of avoiding revision surgery due to insufficient outcome. This method can also be used to test the integrity of the implant at the end of the implantation surgery and to evaluate aided thresholds. In addition, this method makes it possible to objectively test how well the VSB has been fitted, provide assistance in fitting handicapped patients or children, evaluate hearing degradation, or test for a drop in coupling efficiency before revision surgeries. In order to analyze the feasibility of these new VSB-aided auditory brainstem response (ABR) thresholds, they were compared to behavioral thresholds from the Vibrogram and the preoperative bone conduction thresholds. Method The study included 30 patients with mild-to-severe hearing loss implanted with a VSB (VORP503). Intraoperative ABR thresholds during the VSB implantation were recorded using a VSB-optimized chirp stimulus. The new method is compared to the bone conduction threshold of the study sample and the aided Vibrogram thresholds. Speech intelligibility results up to 24 months after surgery are also presented. Results A reliable correlation between the bone conduction thresholds and the intraoperative ABRs was found and was higher in comparison to the Vibrogram. Furthermore, speech intelligibility outcomes were stable over time. Conclusion ABR measurements can be used intraoperatively to estimate the coupling efficiency of the VSB and test the integrity of the implant at the end of surgery.

Objective: Active middle ear implants are widely used to treat adults and children with sensorineural, conductive, or mixed hearing loss. Currently, there is no adequate method to determine the performance of active middle ear implant systems.Design: The proposed method is based on measuring the auditory brainstem response while stimulating the hearing system via the active middle ear implant (Vibrant Soundbridge((TM)), VSB; MEDEL, Austria). The acoustic stimulation was achieved via an optimised chirp stimulus (CE-Chirp), implemented in the Eclipse system (Interacoustics, Denmark). To compensate for the frequency-specific delays in the VSB system, the underlying model function of the CE-Chirp was adjusted accordingly (VSB-CE-Chirp).Study samples: The study includes 12 subjects having mild to profound sensorineural, conductive or mixed hearing loss.Results: The use of an optimised VSB-CE-Chirp instead of the CE-Chirp increases significantly the ABR wave V amplitudes (1.63 times) and so also increases their identifiability (by 15.2%). On average, wave V could be identified at a 7.5dB lower stimulation level.Conclusion: The constructed VSB-CE-Chirp stimulus, after it had been transmitted through the VSB system, follows well the shape of the original CE-Chirp. Preliminary measurements in VSB patients demonstrated a significantly improved ABR amplitude with the VSB-CE-Chirp.