ABSTRACT
The Vibrant Soundbridge is a semi-implantable, active middle ear implant that is a safe and effective treatment for patients with sensorineural hearing loss. Since Food and Drug Administration approval for this indication, many international investigators have expanded its use for conductive and mixed hearing losses. This article reviews the author's experience and the international uses of this versatile device.
Subject(s)
Hearing Loss, Conductive/surgery , Hearing Loss, Mixed Conductive-Sensorineural/surgery , Ossicular Prosthesis , Audiometry, Pure-Tone , Auditory Threshold , Hearing Aids , Humans , Prosthesis Design , Treatment Outcome , United StatesABSTRACT
Intraoperative facial nerve monitoring (IOFNM) has evolved from requiring sophisticated electromyography equipment to a self-contained monitor with an auditory signal. Subspecialty ear surgeons currently use IOFNM in most otologic and temporal bone procedures as it improves facial nerve outcomes. Our competency and near-universal adoption of IOFNM notwithstanding, otolaryngologists are rarely reimbursed for this procedure. Subspecialists value this technology as medically necessary and should importune fair reimbursement for their expertise in this procedure that is so vital to patient safety.
Subject(s)
Electromyography/methods , Facial Nerve Injuries/prevention & control , Monitoring, Intraoperative/economics , Monitoring, Intraoperative/methods , Otologic Surgical Procedures/adverse effects , Cost Control , Female , Humans , Male , Needs Assessment , Otologic Surgical Procedures/methods , Prognosis , Reimbursement Mechanisms , Risk Assessment , Treatment Outcome , United StatesABSTRACT
OBJECTIVE: To examine the current trend in intraoperative facial nerve monitoring (IOFNM) training, performance, and reimbursement by subspecialists. STUDY DESIGN: Cross-sectional survey of the American Neurotology Society, American Otological Society, American Society of Pediatric Otolaryngology, and program directors of otolaryngology-head and neck surgery programs accredited by the Accreditation Council on Graduate Medical Education. SETTING: American Academy of Otolaryngology-Head and Neck Surgery Intraoperative Nerve Monitoring Task Force. SUBJECTS AND METHODS: The task force developed 2 surveys, which were implemented through Surveymonkey.com: (1) a 10-question survey sent to 1506 members of the societies listed to determine IOFNM practice and reimbursement patterns and (2) a 10-question survey sent to the 107 accredited US otolaryngology residency program directors to examine the state of resident training on facial nerve monitoring. RESULTS: Response rates were 18% for practicing physicians and 15% for residency program directors. The majority agreed that IOFNM was indicated for most otologic and neurotologic procedures. In addition to facial nerve monitoring, facial nerve stimulation was used in complex skull base and temporal bone procedures. When queried about reimbursement by Medicare, only 4.4% of surgeons responded that they received reimbursement. Program directors indicated universal exposure of residents to IOFNM, with 61% of programs giving residents formal training. CONCLUSIONS: IOFNM is widely used among otologists and neurotologists in the United States. The majority of residents receive formal training, and all residents are exposed to the setup, use, monitoring, and troubleshooting of the device. Reimbursement for IOFNM is reported by a paucity of those surveyed.
ABSTRACT
OBJECTIVE: To review published literature regarding the use of intratympanic steroids in the treatment of Meniere's disease and sudden sensorineural hearing loss and to make recommendations regarding their use based on the literature review. DATA SOURCES: Literature review from 1996 to 2003, PubMed, Medline Plus, and Web of Science. STUDY SELECTION: Retrospective case series and uncontrolled prospective cohort studies were the only types of studies available for review. CONCLUSION: On the basis of the available literature, a weak recommendation is made to use intratympanic steroid treatment of sudden hearing loss if oral steroid therapy fails or is contraindicated. The available studies regarding intratympanic steroid treatment of Meniere's disease and tinnitus are inadequate to answer the question of the efficacy of this treatment for these conditions. Higher quality studies are needed.
Subject(s)
Adrenal Cortex Hormones/therapeutic use , Anti-Inflammatory Agents/therapeutic use , Hearing Loss, Sudden/drug therapy , Meniere Disease/drug therapy , Adrenal Cortex Hormones/administration & dosage , Adrenal Cortex Hormones/adverse effects , Animals , Anti-Inflammatory Agents/administration & dosage , Anti-Inflammatory Agents/adverse effects , Cohort Studies , Ear, Middle , Humans , Instillation, Drug , Retrospective Studies , Treatment OutcomeABSTRACT
OBJECTIVES: The goal of the study was to evaluate the performance of a semi-implantable middle ear hearing device (Vibrant Soundbridge System [VSB]; Symphonix Devices, Inc). STUDY DESIGN: A prospective, single-subject, repeated-measures multicenter study was conducted to determine the safety and efficacy of the VSB using analog and digital external processors. Measures included residual hearing, functional gain, speech recognition, acoustic feedback, occlusion, and patient self-assessment to determine satisfaction, perceived performance, and device preference compared with an appropriately fit acoustic hearing aid. Fifty-three adult subjects with moderate to severe sensorineural hearing loss were evaluated at 4 or more intervals after implantation. RESULTS: Improvements in satisfaction, performance, and preference were statistically significant with the VSB, as was functional gain across all test frequencies (P < 0.001). Occlusion and feedback were virtually eliminated. Aided speech recognition was comparable between VSB and the hearing aid. Residual hearing was unchanged. CONCLUSION: The VSB is a safe and effective treatment option for adults with moderate to severe sensorineural hearing loss.
