Prótese auditiva ancorada ao osso percutânea: benefícios auditivos / Percutaneous bone ancored hearing aid: hearing benefits

RESUMO Objetivo Descrever os benefícios nos limiares auditivos e no desempenho de reconhecimento de sentenças no silêncio e no ruído em indivíduos com a adaptação unilateral do Sistema Ponto®. Métodos Estudo observacional, retrospectivo, de seguimento longitudinal. A casuística foi composta por fontes de dados secundários de dez indivíduos com perda auditiva condutiva ou mista, que foram submetidos à cirurgia com o Sistema Ponto®. Os resultados foram analisados nas seguintes condições: a) pré-cirúrgicas: sem AASI; com AASI por condução aérea ou óssea e com o processador Ponto Pro® acoplado a uma banda elástica; b) pós-cirúrgicas: na ativação e após seis meses de uso. Resultados Os limiares da audiometria tonal por conduções aérea e óssea mantiveram-se estáveis após a cirurgia, enquanto os limiares auditivos em campo livre e o reconhecimento de fala no silêncio e no ruído foram estatisticamente melhores na ativação e após seis meses de uso do Sistema Ponto®. Não houve diferença nos resultados com os indivíduos utilizando o Sistema Ponto® com a banda elástica e após a cirurgia. Conclusão O Sistema Ponto® propiciou benefício nas habilidades auditivas de detecção em todas as frequências testadas, assim como no reconhecimento de sentenças no silêncio e no ruído.

ABSTRACT Purpose To describe the benefits in hearing thresholds and sentence recognition performance in silence and noise, in users of the unilateral Ponto® system. Methods An observational, retrospective, longitudinal study. The sample consisted of secondary data sources from 10 individuals with conductive or mixed hearing loss who underwent surgery with the Ponto® System. The results were analyzed in the following pre-surgical conditions (without hearing aids; with hearing aids by air or bone conduction; with the Ponto Pro® processor with a soft band) and post-surgical (on activation and after six months of use). Results The thresholds of pure tone audiometry by air and bone conductions remained stable after surgery, while the auditory thresholds in free field and speech recognition in silence and in noise were statistically better when using the Ponto® system. There was no difference between the results obtained with the individuals using Ponto® with soft band and post-surgically. Conclusion The Ponto® system provided benefits in hearing detection skills in all tested frequencies, as well as, in recognition of the sentence in silence and noise.

Ossicular chain reconstruction in chronic otitis media: hearing results and analysis of prognostic factors / Reconstrução da cadeia ossicular na otite média crônica: resultados auditivos e análise de fatores prognósticos

Abstract Introduction The goal of ossiculoplasty is to improve hearing and the success of this procedure depends on several factors. Objective Analyze the hearing results in patients with chronic otitis media undergoing ossicular chain reconstruction, as well as predictive factors for successful surgery. Methods Charts of patients undergoing ossiculoplasty between 2006 and 2016 were reviewed. Sixty-eight patients were included, totaling 72 ears. The following data was analyzed: gender, age, smoking status, laterality, pathology, audiometric exams, type of surgery, previous surgery, characteristics of the middle ear, otorrhea and ossicular chain status. Patients were also classified according to two indices: middle ear risk index and ossiculoplasty outcome parameter staging. The results were evaluated by comparing the air-bone gap before and after surgery. The success of reconstruction was defined as air-bone gap ≤20 dB and the improvement of speech reception Thresholds, calculated through the mean frequencies 0.5, 1, 2 and 3 kHz. Results Reconstruction success rate was 61%. The mean preoperative air bone gap was 34.63 dB and decreased to 17.26 dB after surgery. There was a correlation between low risk in middle ear risk index and ossiculoplasty outcome parameter staging indices with postoperative success. The most frequently eroded ossicle was the incus and the type of prosthesis most used was tragal cartilage. In the patients without incus, we achieved success in 74.2% of the surgeries. In the absence of the stapes, the success rate decreased to 63.3%. In the absence of the malleus, 85% of the patients had and air bone gap ≤20 dB. Conclusion We achieved good audiometric outcomes in ossiculoplasty and the results are comparable to other centers. Ossicle status influenced postoperative results, especially in the presence of stapes. We also concluded that the indexes analyzed may help to predict the success of the surgery.

Resumo Introdução A ossiculoplastia tem como objetivo a melhoria da audição e o sucesso desse procedimento depende de diversos fatores. Objetivo Analisar os resultados auditivos em pacientes com otite média crônica submetidos a reconstrução da cadeia ossicular, bem como os fatores preditivos de sucesso cirúrgico. Método Prontuários de pacientes submetidos a ossiculoplastia entre 2006 e 2016 foram revistos. Sessenta e oito pacientes foram incluídos, total de 72 orelhas. Os seguintes dados foram analisados: sexo, idade, tabagismo, lateralidade, doença, exames audiométricos, tipo de cirurgia, cirurgia prévia, características da orelha média, otorreia e estado da cadeia ossicular. Os pacientes também foram classificados de acordo com dois índices: índice de risco da orelha média e estadiamento do parâmetro de desfecho da ossiculoplastia. Os resultados foram avaliados comparando o gap aéreo-ósseo antes e após a cirurgia. O sucesso da reconstrução foi definido como gap aéreo-ósseo ≤ 20 dB e a melhoria dos limiares de recepção de fala, calculados pelas frequências médias de 0,5, 1, 2 e 3 kHz. Resultados A taxa de sucesso da reconstrução foi de 61%. O gap aéreo-ósseo pré-operatório médio foi de 34,63 dB e diminuiu para 17,26 dB após a cirurgia. Houve correlação entre baixo risco no índice de risco para orelha média e os índices de estadiamento do parâmetro de desfecho da ossiculoplastia com sucesso pós-operatório. O ossículo com erosão mais frequente foi a bigorna e o tipo de prótese mais utilizada foi a cartilagem tragal. Nos pacientes sem bigorna o sucesso foi alcançado em 74,2% das cirurgias. Na ausência do estribo, a taxa de sucesso diminuiu para 63,3%. Na ausência do martelo, 85% dos pacientes apresentaram gap aéreo-ósseo ≤ 20 dB. Conclusão Melhora significativa da audição foi observada em pacientes submetidos à ossiculoplastia, os resultados foram comparáveis aos de outros centros. O "status" dos ossículos influenciou os resultados pós-operatórios, principalmente a presença do estribo. Também concluímos que os índices analisados podem ajudar a prever o sucesso da cirurgia.

A Case of Middle Ear Implantation Using the Vibrant Soundbridge in a Patient with Bilateral Mixed Hearing Loss / 대한이비인후과학회지

It is challenging to achieve sufficient hearing gain in patients with mixed hearing loss. In chronic middle ear diseases, conventional passive reconstructive surgeries often result in suboptimal hearing gain and additional hearing aids may have limitations due to insufficient sound amplification, occlusion effect, acoustic feedback, and skin irritation. Middle ear implantation (MEI) using Vibrant Soundbridge (VSB) is another option for auditory rehabilitation in mixed hearing loss as well as sensorineural hearing loss. The floating mass transducer of VSB can be placed on various middle ear structures either directly or using different types of couplers in order to deliver vibratory mechanical energy to the cochlea. We report a patient who presented with bilateral mixed hearing loss due to chronic otitis media and had limitations using conventional hearing aids in the worse hearing ear. The patient was successfully treated with MEI using the Bell coupler together with middle ear surgery in a single step.

Feasibility of ossicular chain reconstruction with resin cement / Viabilidade da reconstrução da cadeia ossicular com cimento resinoso

Abstract Introduction: Disjunction of ossicular chain is a common finding in middle ear chronic disease. In addition to ossicular interposition, various materials have been used for reconstruction, such as ceramic prostheses, polyethylene, and titanium. Objective: Because of the high cost of the available options, the authors propose to reconstruct the ossicular chain with resin cement, a material typically used in dental reconstruction and fixation. Methods: Two anatomical parts of the temporal bones were used, creating a disjunction of the ossicular chain between the incus and staples and then reconstructing with resin cement. These reconstructions were repeated four times by three different surgeons to ensure the feasibility of the method. Results: A total of 12 reconstructions were carried out, four per surgeon. After applying the cement, it could be verified by touch that the space was filled properly by the used material. Proper articulation with motion transfer to the entire ossicular chain was also observed. Conclusion: Resin cement is a suitable material in the reconstruction of ossicular chain injury, and it is inexpensive and technically simple.

Resumo Introdução: É frequente a disjunção da cadeia ossicular nas doenças crônicas da orelha média. Além de interposições ossiculares, vários materiais já foram usados com a finalidade de reconstruí-la, como próteses de cerâmica, polietileno e titânio. Objetivo: Devido ao alto custo das opções existentes, propomos reconstruir a cadeia com cimento resinoso, material usado normalmente na reconstrução e fixação dentária. Método: Serão usadas duas peças anatômicas de ossos temporais, nas quais será criada uma disjunção da cadeia entre a bigorna e o estribo que, a seguir, será reconstruída com o cimento resinoso. Essas reconstruções serão repetidas quatro vezes por três cirurgiões diferentes, para certificação da viabilidade do método. Resultados: Foram feitas 12 reconstruções, quatro por cada cirurgião. Após aplicação do cimento, conseguimos, ao toque, perceber que o espaço foi preenchido adequadamente pelo material empregado. Notamos ainda adequada articulação com transferência de movimento para toda a cadeia ossicular. Conclusão: O cimento resinoso é um material viável na reconstrução de lesões da cadeia ossicular e proporciona um método tecnicamente simples e de baixo custo.

A Case of the Vibrant Soundbridge Implantation to Unilateral Congenital Aural Atresia / 대한이비인후과학회지

Middle ear implantation is indicted for patients who have sensorineural, conductive or mixed hearing loss when conventional surgery or hearing aids do not producde sufficient improvement. This study reports the long-term results of an active middle ear implant, the Vibrant Soundbridge® (VSB) implantation, in a patient with unilateral congenital aural atresia (CAA). VSB was implanted for hearing rehabilitation after failed canaloplasty in a 15-year-old girl. After exposure of deformed ossicle, the floating mass tranceducer was coupled to the stapes head and subsequent subtotal petrosectomy was completed. Preoperative pure-tone air conduction threshold was 68.8 dB, which improved to 15 dB at one year of surgery. The mean aided free field speech discrimination in quiet was 98%. The speech understanding in noise evaluated by the composite score of Hearing-In-Noise test improved from SNR −2.5 dB to −5.2 dB. We present a first report of VSB implantation in a patient with unilateral CAA in Korea. The patient showed a significant hearing gain after the implantation of VSB; moreover, her hearing in noisy environment also showed improvement.

Comparison of the Effects of Middle Ear Implants and Conventional Hearing Aids on Cognitive Function / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The association between hearing impairment and cognitive function has been established in previous studies. The aim of this study was to compare the effects of conventional hearing aids and middle ear implants on cognitive function. SUBJECTS AND METHOD: This study included 22 participants who underwent middle ear implantation between October 2013 and September 2016. Their mean age at surgery was 70 years. Using Pure tone audiometry (PTA), the Speech discrimination test (SDT), and the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire, we compared audiologic benefits of three conditions [without hearing aids, with conventional hearing aids, or with Vibrant Sound bridge (VSB)]. Cognitive ability was evaluated using neuropsychological testings (Seoul Neuropsychological Screening Battery) at intervals of approximately eight weeks. RESULTS: The results of PTA showed a 7.96 dB HL gain with conventional hearing aids and a 10.00 dB HL gain with the use of VSB. SDT results showed a 4.10% gain with conventional hearing aids and a 10% gain with the use of VSB. Results of the APHAB questionnaire showed a significant increase with the use of VSB compared to conventional hearing aids. In the Korean Mini-Mental State Examination, a slight improvement was observed after middle ear implantation. In the Digit Span Test and Korean-Boston Naming Test, a significant improvement was seen with the use of VSB compared to conventional hearing aids. CONCLUSION: The use of middle ear implants in rehabilitation of hearing communication in patients showed improvements in cognitive abilities, compared to the use of conventional hearing aids.

Otologic Active Middle Ear Implants / 대한이비인후과학회지

Implantable devices for aural rehabilitation are widely developed worldwide. In the manuscript, we review the implantable middle ear hearing devices currently in use, such as the Vibrant Soundbridge system (Med-El Corporation), the MAXUM system (Ototronix LLC), the fourth-generation of Carina prosthesis (Otologics LLC), and the Esteem device. Implantable hearing aids will unquestionably be the major drivers of advancement in otologic practice in early future, improving the quality of life of an increasingly aged population, which will consequently require increased levels of hearing support.

Methodology for Intraoperative Laser Doppler Vibrometry Measurements of Ossicular Chain Reconstruction

OBJECTIVES: Despite the increasing number of research concerning the applications of the Laser Doppler Vibrometry (LDV) in medicine, its usefulness is still under discussion. The aim of this study is to present a methodology developed in our Department for the LDV intraoperative assessment of ossicular chain reconstruction. METHODS: Ten patients who underwent "second look" tympanoplasty were involved in the study. The measurements of the acoustic conductivity of the middle ear were performed using the LDV system. Tone bursts with carrier frequencies of 500, 1,000, 2,000, and 4,000 Hz set in motion the ossicular chain. The study was divided into four experiments that examined the intra- and interindividual reproducibility, the utility of the posterior tympanotomy, the impact of changes in the laser beam angle, and the influence of reflective tape presence on measurements. RESULTS: There were no statistically significant differences between the two measurements performed in the same patient. However, interindividual differences were significant. In all cases, posterior tympanotomy proved to be useful for LDV measurements of the ossicular prosthesis vibrations. In most cases, changing the laser beam angle decreased signal amplitude about 1.5% (not significant change). The reflective tape was necessary to achieve adequate reflection of the laser beam. CONCLUSION: LDV showed to be a valuable noncontact intraoperative tool for measurements of the middle ear conductive system mobility with a very good intraindividual repeatability. Neither a small change in the angle of the laser beam nor performing the measurements through posterior tympanotomy showed a significant influence on the results. Reflective tape was necessary to obtain good quality responses in LDV measurements.

The application of autologous conchal cartilage in ossicular chain reconstruction / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the efficiency of autologous conchal cartlage in ossicular chain reconstruction in patients with chronic suppurative otitis media.@*METHOD@#Seventy-three cases of chronic suppurative otitis media (COM) with or without cholesteatoma who had undergone mastoidectomy with tympanoplasty and ossicular chain reconstruction(OCR) using autologous conchal cartilage as prosthesis were studied retrospectively. Sixty-six cases of COM who had undergone mastoidectomy with tympanoplasty and without OCR were studied as control. The examination of pure tone hearing level of air conduction(AC) and bone conduction(BC) was done before operation, 2 months and 6 months after operation respectively. The pure tone average (PTA) of 0.5, 1.0, 2.0 kHz was observed.@*RESULT@#The average air conduction gain was more than 15dB or the PTA (AC) was less than 25 dB 2 months after operation in 35 out of 73 cases who had undergone OCR. Nevertheless, the data became 56 out of 73 cases 6 months after operation. In the control group, The average air conduction gain was more than 15dB or the PTA(AC) was less than 25 dB 2 months after operation in 10 out of 66 cases who had not undergone OCR. The data became 14 out of 66 cases 6 months after operation. In OCR group, air bone gap(ABG) was less than 20 dB in 39 cases 2 months after operation and in 57 cases 6 months after operation. In the control group without OCR, ABG was less than 20 dB only in 11 cases 2 months after operation and in 16 cases 6 months after operation. By statistically analysis, there was significant difference of postoperative hearing improvement between the two groups.@*CONCLUSION@#The autologous conchal cartilage can be used as the material of prosthesis for ossicular chain reconstruction in the operation of chronic otitis media. It has many advantages, such as easily--obtained, good histocompatibility, easy to shape and so on.

A Case of Incus Vibroplasty: Postoperative Changes in Residual Hearing

In patients with mild to severe hearing loss, conventional hearing aids offer limited benefits and several problems with feedback and cosmesis. Middle ear implants are a feasible option for patients with moderate to severe hearing loss who are unable to achieve adequate benefit from or cannot tolerate hearing aids for various reasons. Here we present a case of middle ear implant surgery using Vibrant Soundbridge with incus vibroplasty technique, and describe the hearing changes during postoperative follow-up.

Middle Ear Implant / 한양의대학술지

Patients with hearing loss have been increasing according to the extension of lifespan. Recently, new technology which solves the limitation of conventional hearing aids has been developed. For example, the active middle ear implantation which can directly transfer the vibration energy to the ossicles and inner ear fluid can avoid the feedback and occlusion effect, because this device uses the electromagnetic transducer, not a microphone. Active middle ear implants give more clear sounds and more gain in high frequency area. This device can apply to the patients with ski-sloping hearing loss and severe mixed hearing loss. In the paper, we reviewed the benefits and ideal candidates of the middle ear implant.

Regenerative Cell Therapy for the Sensorineural Hearing Loss / 한양의대학술지

Sensorineural hearing loss is the most common disability in the world and nearly one third of all individuals over the age of 65 are affected. For hearing handicapped people, many devices (hearing aid, cochlear implant, middle ear implant etc.) have been developed to reduce or overcome the disability. But these devices do not give perfect benefit to the patients functionally and there are aesthetic problems. That is why researchers have interest in regenerative measures to restore or prevent hearing loss. Recently there were fruitful results from gene and stem cell therapy research for hearing loss. Gene therapy with Atoh 1 gene and transplantation of stem cells into the cochlea regenerate damaged hair cells and morphologically restore spiral ganglion neurons allowing functional hearing in the deaf animal model. Based on these results, many countries including Korea have done clinical trials in deaf patients. The past ten years have shown an incredible advancement in medical biotechnology in the otologic field and this progress may someday substitute the medical devices for the hard of hearing patients.

Effect of ossicular chain reconstruction with titanium ossicular replacement prosthesis in mastoidectomy with synchronous ossiculoplasty / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To assess hearing effect of ossicular chain reconstruction with titanium ossicular replacement prosthesis during mastoidectomy with synchronous ossiculoplasty in chronic middle ear disease.@*METHOD@#Retrospective reviews were performed for 139 patients who had underwent mastoidectomy and tympanoplasty with titanium ossicular replacement prostheses at the same time between 2008 and 2011. The partial ossicular replacement prostheses (PORP) were used in 91 patients and the total ossicular replacement prostheses (TORP) were used in 48 patients respectively. All patients had follow-up for 2 to 5 years. The preoperative and postoperative mean air conduction and air-bone gaps(ABG) for the four frequencies (0.5, 1.0, 2.0 and 4.0 kHz) were evaluated. The improvement of mean air conduction and ABG over the same frequencies were measured. A postoperative ABG less than or equal to 20 dB was considered a successful operation. The hearing results of titanium PORP and TORP were compared.@*RESULT@#The mean air conductions were (53.97 +/- 11.32)dB and (36.80 +/- 11.68) dB preoperatively and postoperatively in PORP group. The mean improvement in air conduction was (17.17 +/- 5.79)dB. The mean ABG was (31.84 +/- 6.17)dB and (15.13 +/- 7.22)dB preoperatively and postoperatively in PORP group. The mean improvement in ABG was (17.71 +/- 5.5)dB. The difference of hearing threshold between preoperative and postoperative had statistical significance (P < 0.01). The mean air conduction were (58.05 +/- 11.35)dB and (44.53 +/- 13.15)dB preoperatively and postoperatively in TORP group. The mean improvement in air conduction was (13.52 +/- 7.81)dB. The mean ABG; were (35.67 +/- 5.73)dB and (21.48 +/- 7.01)dB preoperatively and postoperatively for TORP group. The mean improvement of hearing threshold in ABG was (14.18 +/- 7.53)dB. The difference of hearing threshold between preoperative and postoperative had statistical significance (P < 0.01). ABG less than 20 dB after operationwas happened in 68.63% of the patients (74.73% for PORP and 54.17% for TORP). There was statistically significant difference between PORP and TORP (P < 0.05).@*CONCLUSION@#We conclude that titanium ossicular reconstruction during mastoidectomy with synchronous ossiculoplasty give stable and excellent hearing results. We obtained better results with PORP than with TORP.

A Case of Middle Ear Implantation with Vibroplasty Coupler at the Stapes / 대한이비인후과학회지

Middle ear implantation is an effective treatment for sensorineural, conductive and mixed hearing loss. The active middle ear implant's floating mass transducer (FMT) is placed on the middle ear structure or coupled to the inner ear fluid. Since the device is not directly placed on the external auditory canal, patients are free from feedback phenomenon and occlusion effect resulting from hearing aids. A 66-year-old patient suffered from bilateral hearing loss. The patient had difficulties in adapting to a conventional hearing aid because of feedback phenomenon in the right ear. The patient underwent a middle ear implantation using a CliP-Coupler to connect stapes head and FMT in the left ear. To our knowledge, this is the first case reported in Korea on middle ear implantation with CliP-Coupler at the stapes, for which hearing results were successful at postoperative 7 months.

Avaliação audiométrica após estapedotomia com prótese de titânio do tipo Fisch / Audiometric evaluation after stapedotomy with Fisch titanium prosthesis

Otosclerose é uma doença que provoca fixação do estribo, levando à perda auditiva tipicamente condutiva, corrigida com aparelhos auditivos ou cirurgia de estapedotomia, substituindo o estribo doente por uma prótese. O material mais recentemente utilizado é o titânio e no Brasil há apenas duas próteses comercialmente disponíveis. A prótese de pistão tipo Fisch, da Storz, não possui resultados relatados na literatura. OBJETIVO: Estudo retrospectivo avaliando resultado auditivo após estapedotomia com uso desta prótese. MÉTODO: Usando critérios da Academia Americana de Otorrinolaringologia, comparou-se o gap nas audiometrias pré e pós-operatórias, avaliando-se melhora auditiva. RESULTADOS: O gap pós-operatório em baixas frequências teve média de 12,9 dB, em altas frequências de 5,2 dB (média 9,1 dB), mediana 8,8 dB, mínimo 1,3 dB e máximo 21,6 dB, desvio padrão 5,7 e p < 0,001. Dividindo o resultado conforme o gap pós-operatório a cada 10 dB, em 25 pacientes (75,8%) foi < ou igual a 10 dB, em 32 pacientes (96,9%) foi < ou igual a 20 dB, em 100% dos casos foi < ou igual a 30 dB. CONCLUSÃO: Prótese de pistão tipo Fisch apresenta resultados compatíveis com a literatura, podendo ser usada com segurança como mais uma boa opção para estapedotomia.

Otosclerosis causes the fixation of the stapes and conductive hearing loss, usually corrected with the use of hearing aids or through stapedotomy and the replacement of the involved stapes with a prosthesis. Titanium has been the most recently used material of choice in stapedotomy prostheses. Only two prostheses are commercially available in Brazil. There are no reports in the literature on the Fisch-type Storz titanium stapes piston prosthesis. OBJECTIVE: This retrospective study aims to look into the auditory outcomes of patients submitted to stapedotomy and titanium stapes piston prosthesis implantation. METHOD: The criteria described by the American Academy of Otolaryngology were used to compare pre and postoperative air-bone gaps seen in audiometry tests. RESULTS: The mean low-frequency postoperative air-bone gap was 12.9 dB; the mean high-frequency air-bone gap was 5.2 dB (mean 9.1 dB); median gap was 8.8 dB, with a minimum of 1.3 dB and a maximum of 21.6 dB; standard deviation was 5.7 dB, and p < 0.001. Twenty-five (75.8%) patients had air-bone gaps of 10 dB and under; 32 (96.9%) patients had gaps of 20 dB and under; and all patients had gaps of 30 dB and under. CONCLUSION: The Fisch-type titanium stapes piston prosthesis presented outcomes consistent with the literature and can be used safely in stapedotomy procedures.

Efficacy observation of auditory reconstruction using three different materials in ossiculoplasty and mastoidectomy to treat chronic otitis media / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the effects of different types of prosthesis used in ossiculoplasty on mastoidectomy of treating chronic otitis media.@*METHOD@#One hundred and forty three patients with chronic otitis media were treated by canal wall-down tympanoplasty with ossiculoplasty in a single stage. According to material of prosthesis, they were classified as titanium group (group A, 52 cases), hydroxypatite group (group B, 47 cases) and autogenous bone group(group C, 44 cases). The postoperative complication and hearing thresholds were analyzed in the 24 months follow-up. Average postoperative air-conduction gain and air-bone gap were measured at four frequencies: 0.5, 1.0.2, and 4.0 kHz.@*RESULT@#12-month after operation, the average air threshold and air-bone gaps of the three groups were reduced (P < 0.05). The reconstruction successful rate (78.7%) of group A was slightly better than that of B, C (68.1%, 70.4%), there was no statistically significant difference. The difference of the average air threshold and air-bone gaps of group B, C after 24-month of operation and 12-month after operation was statistically significant (P < 0.05). The reconstruction successful rate (48.9%, 45.5%) of group B, C was lower than that of A (76.9%), the difference was also statistically significant (P < 0.05).@*CONCLUSION@#Prostheses using titanium type could give good functional results and strong stability with low complication.

Two Cases of Middle Ear Implantation: Incus Vibroplasty / 대한이비인후과학회지

The Vibrant Soundbridge (VSB) middle ear implant is an alternative rehabilitation option for sensorineural, conductive, and mixed hearing loss. The mechanism of VSB implantation is direct-drive stimulation of the inner ear through a floating mass transducer placed on the ossicular chain. We report our experience of VSB incus vibroplasty, which were successfully performed in two cases without complications and resulted in good functional gain and improve-ment of speech discrimination.

Ossiculoplasty for Monocrural Stapes Anomaly / 대한이비인후과학회지

Congenital anomalies of ossicle in the middle ear are rare and could appear in various forms. The most common congenital isolated ossicular anomalies are stapes fixation and incudostapedial discontinuity, with isolated congenital stapes fixation representing about one third of ossicular malformations. We present a rare case of monocrural anomaly of unilateral stapes in a 36-year-old woman with nonprogressive conductive hearing loss. During explotympanotomy, the lateral half of the suprastructure of anomalous stapes was removed and sculptured total ossicular replacement prosthesis was fitted between the long process of incus and remained stapes. Postoperative pure tone audiogram showed a significant decrease in air-bone gap. We report this case with a review of literature.

A Case of Totally Lateralized Tympanic Membrane / 대한이비인후과학회지

Lateralized tympanic membrane is a complication of tympanoplasty resulting in conductive hearing loss. We describe a case of a 23-year-old patient who developed totally lateralized left tympanic membrane with hearing disturbance. The blind-pouch appearance of the left ear canal and conductive hearing loss were checked. The revision of underling tympanoplasty was performed using temporalis fascia and conchal cartilage. The ossicular chain was reconstructed with partial ossicular replacement prosthesis. Canaloplasty and split thickness skin graft were applied for the skin defect of the left external auditory meatus. Totally lateralized tympanic membrane was successfully reconstructed with cartilage tympanoplasty and canaloplasty, achieving improved hearing.