Utility of Vibrant Soundbridge in Patients with Congenital Middle and Outer Ear Deformities

Abstract

ObjectiveTo report use of the Vibrant Soundbridge (VSB) in patients with congenital deformation of the middle and outer ears and investigate its utility in this patient population. MethodFour patients with congenital deformation of middle and outer ears underwent VSB implantation. All were male (aged 3-18 years, average 13.5 years) and operated on the left side. Malformation was bilateral in 3 patients and unilateral in 1 patient. Surgical techniques were modified to accommodate each patient's unique conditions and needs. The implant site was approached via the facial recess in 3 patients and through a retro-facial nerve route in 1 patient. The VSB implant was connected to either the stapes (2 cases) or the round window (2 cases). Pure tone and speech audiometry results and daily communication capabilities before and after VSB activation were compared. ResultsThe operations were successful in all patients, with no complications. The patient communication level improved significantly after VSB activation. Average air conduction pure tone threshold or conditioned reflex audiometry threshold improved by 35 dB in the 0.25-4 kHz range, from 69 dB HL before VSB activation to 34 dB HL after. The sentence recognition rate in quiet at 65 dB SPL went up to 86% from 0% without VSB for patients with bilateral deformation and remained at 100% for the patient with unilateral deformity. However, for the latter patient, the rate improved to 20% from 0% without VSB in noise (-8 dB SNR). ConclusionVSB is an excellent solution for improving hearing in patients with congenital deformation of middle and outer ears. Operation can be completed and good results can be achieved even in patients with unique conditions and needs.