Comparison of Alternative Coupling Methods of the Vibrant Soundbridge Floating Mass Transducer

S. Busch, T. Lenarz, H. Maier
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引用次数: 29

Abstract

The active middle ear implant Vibrant Soundbridge© provides a variety of coupling modalities of the floating mass transducer (FMT) to various structures of the ossicular chain and the round window. A retrospective analysis was performed on 125 subjects (n = 137 ears) (1) to compare the efficacy of the different FMT coupling modalities with increasing degree of hearing loss, (2) to compare the performance in speech outcome and the effective gain between the coupling types, and (3) to evaluate the risk of additional hearing loss of each coupling procedure. The patients were grouped according to their type of FMT coupling into incus vibroplasty (incus group, n = 59), round window vibroplasty with coupler (RWC group, n = 23), round window vibroplasty without coupler (RW group, n = 22), and oval window vibroplasty with coupler (OWC group, n = 33). For each coupling group, pre- and postoperative thresholds, the results of the Freiburg monosyllable test at 65 dB SPL, and the effective gain across frequencies (0.5-6 kHz) were evaluated. A logistic regression function was used to describe the relationship between word recognition scores (WRS, in % correct) and the mean bone conduction (BC) hearing loss. The surgical procedure had no clinically relevant effect on BC thresholds of patients in each coupling group. The BC pure tone average (PTA4) for 50% WRS predicted by the model function was similar for the incus (48.2 dB nHL), RW (47.8 dB nHL), and OWC (49.0 dB nHL) groups, but higher for the RWC group (67.9 dB nHL). However, the median WRS was 80% or better with no significant differences in speech perception between coupling types (Kruskal-Wallis test, p = 0.229). The effective gain shows an advantage for the incus coupling between 0.5 and 2 kHz over the other coupling types. The performance of the FMT coupling modalities is equally good for patients with a mild-to-moderate hearing loss, but the efficacy of coupling types differs for patients with greater hearing loss (>48 dB BC HL).
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振动声桥浮式质量传感器几种耦合方式的比较
主动式中耳植入物Vibrant Soundbridge©提供了浮动质量换能器(FMT)与听骨链和圆窗的各种结构的多种耦合模式。对125名受试者(n = 137耳)进行回顾性分析(1),比较不同的FMT耦合方式对听力损失程度增加的影响;(2)比较不同耦合方式在言语效果和有效增益方面的表现;(3)评估每种耦合方式对额外听力损失的风险。根据FMT偶联方式将患者分为凹形振动成形术(凹形组,n = 59)、带偶联器的圆窗振动成形术(RWC组,n = 23)、不带偶联器的圆窗振动成形术(RW组,n = 22)、带偶联器的椭圆窗振动成形术(OWC组,n = 33)。对于每个耦合组,评估了术前和术后阈值、65 dB SPL下的Freiburg单音节测试结果以及跨频率(0.5-6 kHz)的有效增益。使用逻辑回归函数来描述单词识别分数(WRS,以正确率为单位)与平均骨传导(BC)听力损失之间的关系。手术方式对两组患者BC阈值无临床相关性影响。模型函数预测的50% WRS的BC纯音平均值(PTA4)在incus (48.2 dB nHL), RW (47.8 dB nHL)和OWC (49.0 dB nHL)组中相似,但RWC组更高(67.9 dB nHL)。然而,中位WRS为80%或更高,耦合类型之间的语音感知没有显著差异(Kruskal-Wallis检验,p = 0.229)。在0.5和2khz之间的电感耦合中,有效增益优于其他耦合类型。对于轻度至中度听力损失的患者,FMT耦合方式的性能同样良好,但对于听力损失较大(>48 dB BC HL)的患者,耦合类型的效果不同。
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