The influence of intraoperative auditory brainstem responses on vibroplasty coupling-quality and analysis of the impact of different fixation steps on the coupling.

PURPOSE: The Vibrant Soundbridge (VSB) is an established active-middle-ear-implant for patients with moderate-to-profound hearing-loss. This surgery is referred to as "Vibroplasty". Sufficient transfer of the VSB's floating-mass-transducers (FMT) energy to the inner ear is a crucial factor influencing the coupling-quality (CQ). However, assessing CQ is hamper by two issues: the method of CQ-assessment itself and the method of FMT-fixation during Vibroplasty. METHODS: This prospective study explored the influence of intraoperative auditory-brainstem-response (+ ABR) measurements and various fixation methods on postoperative CQ after Vibroplasty as compared to matched-patients after Vibroplasty without intraoperative ABR (-ABR). Propensity-score-matching was performed based on preoperative bone-conduction-pure-tone-average-3 (BC-PTA3) at 1-, 2- and 4 kHz. Primary outcome parameters were postoperative CQ-PTA3, intraoperative ABR threshold for various fixation methods and postoperative BC-PTA3. RESULTS: A total of 28 patients were included, of which 14 were + ABR. Preoperative BC-PTA3, sex, age, and number of previous surgeries did not differ significantly between groups (all p > 0.301). Mean postoperative CQ-PTA3 was significantly better for + ABR (1.8 vs. 12.3 dB-HL; p = 0.006). Mean intraoperative ABR threshold was superior for cartilage-counter-bearing and cartilage-housing compared to additional fixation with injectable-platelet-rich- fibrin (53 vs. 56 & 57 dB-HL, respectively; p = 0.04; η2 = 0.33). Mean postoperative BC-PTA3 did not significantly differ between patients (41.4 vs. 41.8 dB-HL; p = 0.77). A total of 7% of the patients required intraoperative readjustment of the FMT based on unsatisfactory intraoperative ABR threshold. CONCLUSION: Intraoperative ABR measurement resulted in significantly better postoperative CQ. Cartilage-counter-bearing and cartilage-housing were observed to have superior CQ. A total of 7% of the patients could be spared revision-Vibroplasty due to intraoperative ABR measurement.

Evaluation of sleeping parameters with peripheral arterial tonometry in childhood sleep apnea and snoring: a clinical feasibility study.

PURPOSE: The influence of adenoidectomy ± tonsillotomy/tonsillectomy on objective sleep parameters in children with Obstructive Sleep Apnea (OSA) was determined with the help of ambulatory polygraphy (WatchPat300®, Neucomed Ltd., Vienna, Austria). These results were compared with the findings of the OSA-18 questionnaire. METHODS: 27 children treated with adenoidectomy ± tonsillotomy/tonsillectomy at the Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, were consecutively included in this prospective clinical trial. Pre- and postoperative objective sleeping parameters were assessed with outpatient polygraphy (WatchPat300®) and subjective symptoms with the OSA-18 questionnaire. RESULTS: Most of the children presented with severe OSA (41%, 11/27). The mean preoperative AHI was 10.2 (± 7.4). Postoperatively it declined to 3.7 (± 1.8; p < 0.0001). Following surgery 19/24 (79%) children had a mild OSA and 8/24 (21%) a moderate OSA. None of the children suffered from severe OSA anymore after surgery. The postoperative AHI did not correlate with the age (p = 0.3), BMIp (p = 0.6) or extent of surgery (p = 0.9). The mean postoperative OSA-18 survey score was significantly lower than the preoperative one (70.7 ± 26.7 vs. 34.5 ± 10.5; p < 0.0001). The postoperative OSA-18 questionnaire showed a normal survey score below 60 in 23/24 (96%) of the children. CONCLUSIONS: The WatchPat® device might be a feasible way for objective assessment of pediatric OSA in children older than 3 years. Adenoidectomy ± tonsillotomy/tonsillectomy caused a significant decrease of the AHI in children with OSA. This effect was especially pronounced in children with severe OSA and none of the children had persistent severe OSA after surgery.