Modified-Power-Piston: Short-Incudial-Process-Vibroplasty and Simultaneous Stapedotomy in Otosclerosis.

OBJECTIVE: If mixed-hearing-loss (MHL) occurs in otosclerosis, hearing-aids (HA) in addition to conventional-stapedotomy (SDT) may be necessary. If otosclerosis progresses or technical or medical problems prevent use of HA, combining active-middle-ear-implants (AMEI) with SDT ("power-piston") may be considered. Previously, AMEI-coupling to the long-incudial-process was suggested. Here, a "modified-power-piston" surgery (mPP) coupling to the short-incudial-process was proposed, so no coupling over the positioned stapes-piston is required. We questioned whether mPP is as safe and effective as SDT. METHODS: Otosclerotic patients with MHL and limited satisfaction with previously worn HA receiving mPP were retrospectively reviewed at two Austrian tertiary otologic referral centers. Patients, receiving stapedotomy, were case-matched for preoperative pure-tone averages (PTA), bone-conduction (BC-PTA), air-conduction (AC-PTA), and air-bone gap (ABG-PTA). Postoperative changes in BC-PTA and in AC-PTA and ABG-PTA were defined as safety- and as efficacy outcome parameter. RESULTS: Of 160 patients, 14 received mPP and 14 stapedotomy. Preoperative findings were comparable (all p = 1.000). BC-PTA improved from 38.0 to 36.7 and from 37.1 to 36.9 dB-HL for mPP and SDT, respectively (Δ -1.3 versus -0.2 dB-HL; p = 0.077). AC-PTA improved from 66.8 to 47.1 and from 66.3 to 46.5 dB-HL for mPP and SDT, respectively (Δ -19.6 versus -19.7 dB-HL; p = 0.991). ABG-PTA improved from 28.8 to 10.4 and from 29.1 to 9.6 dB-HL for mPP and SDT, respectively (Δ -18.3 versus -19.5 dB-HL; p = 0.771). CONCLUSION: In otosclerosis with MHL and limited satisfaction with HA, mPP appeared as safe and effective as SDT and may be considered a treatment alternative in these patients.

Single Sided Deaf Cochlear Implant Users in the Difficult Listening Situation: Speech Perception and Subjective Benefit.

OBJECTIVES: Patients with single-sided deafness (SSD) have great difficulties in listening situations which rely on binaural auditory processing. The purpose of this study was to examine to which extent a cochlear implant (CI) can improve speech perception outcomes in various noisy listening environments. Additionally, the ability to use interaural level differences for sound localization and subjective benefit with the CI were assessed. METHODS: Ten single-sided deaf patients with CI were tested in different loudspeaker configurations with and without the CI. A multi-source noise field (MSNF) with uncorrelated noise from four different directions was used in addition to a setup with the signal from the CI side and noise from the normal-hearing side (SCINNH, azimuth of ±45 degrees). Ten normal-hearing subjects were used as a control for the setup. Speech understanding was measured by an adaptive sentence test (Oldenburg Sentence Test, OLSA) in stationary speech shaped noise and temporally modulated noise to assess the benefit in each listening situation. Sensitivity to interaural level differences was measured in a lateralization experiment. Furthermore, patients completed the Bern Benefit in Single-Sided Deafness (BBSS) questionnaire to assess subjective benefit with the CI. RESULTS: An overall average benefit in speech reception threshold (SRT) of 1.6 dB (±0.6 dB standard error of the mean [SEM]) was observed in the binaural listening condition (with CI) in all conditions. In the MSNF setup thresholds improved by 0.4 dB (±0.5 dB SEM) and in the SCINNH configuration by 2.7 dB (±0.7 dB SEM). The choice of masking noise effect also had a significant effect on the SRT outcome. The lateralization performance of the SSD users was on a par with the normal hearing group. BBSS scores reflect the overall benefit with the CI apparent in the speech test results. CONCLUSION: Patients with single-sided deafness do benefit from a CI in difficult listening environments and are able to localize sound based on interaural level differences. Considering these outcomes, cochlear implantation represents a promising treatment option for patients with single-sided deafness.

Successful Cochlear Implantation of a Split Electrode Array in a Patient With Far-advanced Otosclerosis Assisted by Electromagnetic Navigation: A Case Report.

BACKGROUND: Incomplete electrode insertion is frequent when implanting ossified cochleae with conventional linear electrodes. If split electrode arrays (SEA) are used, this complication occurs less frequently resulting in improved audiological performance (AP). Additional implementation of electromagnetic navigation systems (EMNS) may add additional safety to this procedure and may further improve AP. However, previously performed SEA cochlea implantations rarely implemented EMNS. The few cases reported a laborious approach with customized, three-dimensional-printed microstereotactic headframes, which limited clinical feasibility. Moreover, no postoperative AP was reported. In this case report a more feasible approach, using a commercially available EMNS, is described and postoperative AP is reported. PATIENT: A 70-year-old man with far-advanced otosclerosis was referred because of unsatisfactory speech intelligibility (monosyllabic word score of 0% at 75 dB sound pressure level) after cochlear implantation of a conventional linear electrode. Preoperative computed tomography revealed subtotal cochlear ossification and incomplete electrode insertion. INTERVENTION: Four titanium screws were inserted into the petrous bone for computed tomography-based registration using an EMNS. The previous mastoidectomy was expanded, the misplaced conventional linear electrode extracted and a manual, free-handed superior cochleostomy at the level of the tendon of the tensor tympani muscle was performed. The location and course of the drill-out procedure for the SEA was planned and verified with EMNS. RESULTS: Full electrode insertion for both electrode arrays of the SEA was achieved without any nerve dysfunction. Monosyllabic word score, determined 207 days after surgery, improved to 50 and 60% at 65 and 75 dB sound pressure level respectively. CONCLUSION: The implementation of EMNS in SEA cochlear implantation added additional safety to the procedure, which resulted in full electrode insertion and superior AP. Yet, outcome in cochlear implantation may vary. Larger case series to confirm this observation are required. The approach proposed for EMNS-guided SEA in this case report, using commercially available EMNS, may lead to a more frequent implementation in clinical routine due to its good clinical feasibility. Thus, larger case series may be generated.