Advanced Middle Ear Surgery: Surgical Options for the Application of the Vibrant Soundbridge System

Abstract

The Vibrant Soundbridge (VSB) is an active middle ear implant designed to “directly” drive the ossicular chain for the treatment of hearing loss. Although initially intended and applied for sensorineural hearing loss, the VSB has recently been applied to conductive and mixed hearing losses as well. The aim of this paper is to evaluate the aided benefit from different surgical options and to consider medical and surgical complications. The VSB was implanted in adults with conductive or mixed hearing losses using the round window approach (Round Window (RW) Vibroplasty), or in combination with a PORP, TORP or Stapes prosthesis. The new couplers further expand treatment options for attaching the FMT to remnants of the ossicular chain. In ears with chronic mastoid cavities, reconstruction of the canal wall with cartilage has been useful. Surgery for atresia cases with major malformations of the outer and middle ear involves aesthetic as well as functional aspects. Reconstruction of the auricle is well established and has shown favorable results, whereas restoration of the middle ear sound conduction mechanism was considered possible, but surgically challenging. Unfortunately, functional results have turned out to be limited: for approximately 50% of the patients, hearing results with conventional techniques are unsatisfactory and a hearing aid is necessary. The VSB offers new possibilities for atresia cases, allowing for individual solutions for fixing the FMT. Several options have been explored, such as modifying the original clip so that an upside–down fixation to a malformed stapes superstructure was possible, or using the couplers or RW application.