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Aktive Hörimplantate bei chronischer Otitis media

Active hearing implants in chronic otitis media

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Zusammenfassung

Bei Patienten mit unzureichender Hörverbesserung nach Tympanoplastik können aktive Hörimplantate eine Hörrehabilitation bei frustraner Hörgeräteversorgung ermöglichen, in dem sie im Sinne eines vibromechanischen Bypasses die Steifigkeit und Dämpfung eines schlecht schwingenden Trommelfells bzw. einer (rekonstruierten) Gehörknöchelchenkette umgehen. Die Auswahl des Hörsystems ist dabei abhängig vom maximalen Ausgangspegel des Hörsystems sowie den anatomischen Voraussetzungen im meist mehrfach voroperierten Ohr. In den letzten Jahren führte die Entwicklung variabler Koppelelemente für aktive Mittelohrimplantate zu einer Indikationserweiterung von der reinen Schallempfindungsschwerhörigkeit zur Schallleitungs- und kombinierten Schwerhörigkeit, da sie nun am (beweglichen) Steigbügel oder der Rundfenstermembran angekoppelt werden können. Der Artikel gibt eine Übersicht über aktuelle Studienergebnisse und Indikationsempfehlungen für aktive Hörimplantate bei Patienten mit chronischer Otitis media.

Abstract

In patients with inadequate hearing improvement after tympanoplasty and failure of conventional hearing aid fitting, active hearing implants provide an alternative treatment option. Active middle ear implants function as a vibromechanical bypass of the stiffness and damping effect of a poorly oscillating tympanic membrane and the (reconstructed) ossicular chain. The selection of the hearing system depends on the maximum output levels of the hearing system and the anatomical conditions in mostly multiply operated ears. The development of variable coupling elements for active middle ear implants led to an extension of the indications to include not only purely sensorineural hearing loss but also mixed and conductive hearing loss in patients, as the transducer can now be coupled to the (mobile) stapes or the round window membrane. The article provides an overview of current clinical study results and recommendations on the indications for active hearing implants in patients with chronic otitis media.

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Literatur

  1. de Abajo J, Sanhueza I, Giron L, Manrique M (2013) Experience with the active middle ear implant in patients with moderate-to-severe mixed hearing loss: indications and results. Otol Neurotol 34:1373–1379. https://doi.org/10.1097/MAO.0b013e3182a0044e

    Article  PubMed  Google Scholar 

  2. Atas A, Tutar H, Gunduz B, Bayazıt YA (2014) Vibrant SoundBridge application to middle ear windows versus conventional hearing aids: a comparative study based on international outcome inventory for hearing aids. Eur Arch Otorhinolaryngol 271:35–40. https://doi.org/10.1007/s00405-013-2387-2

    Article  PubMed  Google Scholar 

  3. Baumgartner W‑D, Böheim K, Hagen R et al (2010) The vibrant soundbridge for conductive and mixed hearing losses: European multicenter study results. Adv Otorhinolaryngol 69:38–50. https://doi.org/10.1159/000318521

    Article  PubMed  Google Scholar 

  4. Beleites T, Neudert M, Bornitz M, Zahnert T (2014) Sound transfer of active middle ear implants. Otolaryngol Clin North Am 47:859–891. https://doi.org/10.1016/j.otc.2014.08.001

    Article  PubMed  Google Scholar 

  5. Beutner D, Delb W, Frenzel H et al (2018) Guideline “Implantable hearing aids”-short version: German S2k guideline of the Working Group of German-speaking Audiologists, Neurootologists and Otologists (ADANO), of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery (DGHNO) in collaboration with the German Society of Audiology (DGA), the German Society of Phoniatrics and Pediatric Audiology (DGPP), and patient representatives. HNO 66:654–659. https://doi.org/10.1007/s00106-018-0531-4

    Article  CAS  PubMed  Google Scholar 

  6. Bruschini L, Berrettini S, Forli F et al (2016) The Carina© middle ear implant: surgical and functional outcomes. Eur Arch Otorhinolaryngol 273:3631–3640. https://doi.org/10.1007/s00405-016-3998-1

    Article  PubMed  Google Scholar 

  7. Busch S, Lenarz T, Maier H (2016) Comparison of alternative coupling methods of the vibrant soundbridge floating mass transducer. Audiol Neurootol 21:347–355. https://doi.org/10.1159/000453354

    Article  PubMed  Google Scholar 

  8. Coker NJ, Jenkins HA, Fisch U (1986) Obliteration of the middle ear and mastoid cleft in subtotal petrosectomy: indications, technique, and results. Ann Otol Rhinol Laryngol 95:5–11. https://doi.org/10.1177/000348948609500102

    Article  CAS  PubMed  Google Scholar 

  9. Colletti V, Soli SD, Carner M, Colletti L (2006) Treatment of mixed hearing losses via implantation of a vibratory transducer on the round window. Int J Audiol 45:600–608. https://doi.org/10.1080/14992020600840903

    Article  PubMed  Google Scholar 

  10. Dejaco D, Riedl D, Gottfried T et al (2019) Modified-power-piston: short-Incudial-process-vibroplasty and simultaneous stapedotomy in otosclerosis. Otol Neurotol 40:292–300. https://doi.org/10.1097/MAO.0000000000002146

    Article  PubMed  PubMed Central  Google Scholar 

  11. Edfeldt L, Rask-Andersen H (2013) Round window vibroplasty in chronic ear surgery: comparison with conventional hearing rehabilitation. Acta Otolaryngol 133:814–825. https://doi.org/10.3109/00016489.2013.780294

    Article  PubMed  Google Scholar 

  12. Ernst A, Todt I, Wagner J (2016) Safety and effectiveness of the Vibrant Soundbridge in treating conductive and mixed hearing loss: A systematic review. Laryngoscope 126:1451–1457. https://doi.org/10.1002/lary.25670

    Article  PubMed  Google Scholar 

  13. Fisch U, Mattox D (1988) Microsurgery of the skull base. Thieme, Stuttgart ; New York

    Google Scholar 

  14. Free RH, Falcioni M, Di Trapani G et al (2013) The role of subtotal petrosectomy in cochlear implant surgery—a report of 32 cases and review on indications. Otol Neurotol 34:1033–1040. https://doi.org/10.1097/MAO.0b013e318289841b

    Article  PubMed  Google Scholar 

  15. Grossöhmichen M, Salcher R, Kreipe H‑H et al (2015) The CodacsTM direct acoustic cochlear implant actuator: exploring alternative stimulation sites and their stimulation efficiency. PLoS ONE 10:e119601. https://doi.org/10.1371/journal.pone.0119601

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Grossöhmichen M, Salcher R, Lenarz T, Maier H (2016) The effect of simulated mastoid obliteration on the mechanical output of electromagnetic transducers. Otol Neurotol 37:919–925. https://doi.org/10.1097/MAO.0000000000001062

    Article  PubMed  Google Scholar 

  17. Gunduz B, Atas A, Bayazıt YA et al (2012) Functional outcomes of Vibrant Soundbridge applied on the middle ear windows in comparison with conventional hearing aids. Acta Otolaryngol 132:1306–1310. https://doi.org/10.3109/00016489.2012.702353

    Article  PubMed  Google Scholar 

  18. Håkansson B, Eeg-Olofsson M, Reinfeldt S et al (2008) Percutaneous versus transcutaneous bone conduction implant system: a feasibility study on a cadaver head. Otol Neurotol 29:1132–1139. https://doi.org/10.1097/MAO.0b013e31816fdc90

    Article  PubMed  Google Scholar 

  19. Häusler R, Stieger C, Bernhard H, Kompis M (2008) A novel implantable hearing system with direct acoustic cochlear stimulation. Audiol Neurootol 13:247–256. https://doi.org/10.1159/000115434

    Article  PubMed  Google Scholar 

  20. Huber AM, Ball GR, Veraguth D et al (2006) A new implantable middle ear hearing device for mixed hearing loss: a feasibility study in human temporal bones. Otol Neurotol 27:1104–1109. https://doi.org/10.1097/01.mao.0000244352.49824.e6

    Article  PubMed  Google Scholar 

  21. Hüttenbrink K‑B, Beutner D, Bornitz M et al (2011) Clip vibroplasty: experimental evaluation and first clinical results. Otol Neurotol 32:650–653. https://doi.org/10.1097/MAO.0b013e318218d180

    Article  PubMed  Google Scholar 

  22. Hüttenbrink K‑B, Zahnert T, Bornitz M, Beutner D (2008) TORP-vibroplasty: a new alternative for the chronically disabled middle ear. Otol Neurotol 29:965–971. https://doi.org/10.1097/MAO.0b013e318185fad8

    Article  PubMed  Google Scholar 

  23. Ihler F, Köhler S, Meyer AC et al (2014) Mastoid cavity obliteration and Vibrant Soundbridge implantation for patients with mixed hearing loss. Laryngoscope 124:531–537. https://doi.org/10.1002/lary.24180

    Article  PubMed  Google Scholar 

  24. Ihler F, Volbers L, Blum J et al (2014) Preliminary functional results and quality of life after implantation of a new bone conduction hearing device in patients with conductive and mixed hearing loss. Otol Neurotol 35:211–215. https://doi.org/10.1097/MAO.0000000000000208

    Article  PubMed  Google Scholar 

  25. Iwasaki S, Usami S‑I, Takahashi H et al (2017) Round window application of an active middle ear implant: a comparison with hearing aid usage in Japan. Otol Neurotol 38:e145–e151. https://doi.org/10.1097/MAO.0000000000001438

    Article  PubMed  PubMed Central  Google Scholar 

  26. Kam ACS, Sung JKK, Yu JKY, Tong MCF (2012) Clinical evaluation of a fully implantable hearing device in six patients with mixed and sensorineural hearing loss: our experience. Clin Otolaryngol 37:240–244. https://doi.org/10.1111/j.1749-4486.2012.02492.x

    Article  CAS  PubMed  Google Scholar 

  27. Kludt E, Büchner A, Schwab B et al (2016) Indication of direct acoustical cochlea stimulation in comparison to cochlear implants. Hear Res 340:185–190. https://doi.org/10.1016/j.heares.2016.01.016

    Article  PubMed  Google Scholar 

  28. Labassi S, Beliaeff M, Péan V, Van de Heyning P (2017) The Vibrant Soundbridge® middle ear implant: a historical overview. Cochlear Implants Int 18:314–323. https://doi.org/10.1080/14670100.2017.1358913

    Article  CAS  PubMed  Google Scholar 

  29. Lailach S (2019) Vollimplantierbare aktive Mittelohrimplantate. 22. Jahrestagung der Deutschen Gesellschaft für Audiologie, Heidelberg

    Google Scholar 

  30. Lassaletta L, Calvino M, Sánchez-Cuadrado I et al (2015) Pros and cons of round window vibroplasty in open cavities: audiological, surgical, and quality of life outcomes. Otol Neurotol 36:944–952. https://doi.org/10.1097/MAO.0000000000000763

    Article  PubMed  Google Scholar 

  31. Lassaletta L, Calvino M, Zernotti M, Gavilán J (2016) Postoperative pain in patients undergoing a transcutaneous active bone conduction implant (Bonebridge). Eur Arch Otorhinolaryngol 273:4103–4110. https://doi.org/10.1007/s00405-016-3972-y

    Article  PubMed  Google Scholar 

  32. Lefebvre PP, Gisbert J, Cuda D et al (2016) A retrospective multicentre cohort review of patient characteristics and surgical aspects versus the long-term outcomes for recipients of a fully Implantable active middle ear implant. Audiol Neurootol 21:333–345. https://doi.org/10.1159/000454666

    Article  PubMed  Google Scholar 

  33. Lenarz T, Zimmermann D, Maier H, Busch S (2018) Case report of a new coupler for round window application of an active middle ear implant. Otol Neurotol 39:e1060–e1063. https://doi.org/10.1097/MAO.0000000000001996

    Article  PubMed  Google Scholar 

  34. Linder T, Schlegel C, DeMin N, van der Westhuizen S (2009) Active middle ear implants in patients undergoing subtotal petrosectomy: new application for the Vibrant Soundbridge device and its implication for lateral cranium base surgery. Otol Neurotol 30:41–47. https://doi.org/10.1097/MAO.0b013e31818be812

    Article  PubMed  Google Scholar 

  35. Loader B, Sterrer E, Reichmayr C et al (2018) Direct comparison of mastoidal and retrosigmoidal placement of a transcutaneous bone conduction device after canal wall down tympanoplasty. Clin Otolaryngol 43:1603–1606. https://doi.org/10.1111/coa.13187

    Article  PubMed  Google Scholar 

  36. Luers JC, Hüttenbrink K‑B, Zahnert T et al (2013) Vibroplasty for mixed and conductive hearing loss. Otol Neurotol 34:1005–1012. https://doi.org/10.1097/MAO.0b013e3182990d2b

    Article  PubMed  Google Scholar 

  37. Maier H, Baumann U, Baumgartner W‑D et al (2018) Minimal reporting standards for active middle ear hearing implants. Audiol Neurootol 23:105–115. https://doi.org/10.1159/000490878

    Article  PubMed  PubMed Central  Google Scholar 

  38. Maier H, Salcher R, Schwab B, Lenarz T (2013) The effect of static force on round window stimulation with the direct acoustic cochlea stimulator. Hear Res 301:115–124. https://doi.org/10.1016/j.heares.2012.12.010

    Article  PubMed  Google Scholar 

  39. Manrique M, Sanhueza I, Manrique R, de Abajo J (2014) A new bone conduction implant: surgical technique and results. Otol Neurotol 35:216–220. https://doi.org/10.1097/MAO.0000000000000253

    Article  PubMed  Google Scholar 

  40. Marino R, Linton N, Eikelboom RH et al (2013) A comparative study of hearing aids and round window application of the vibrant sound bridge (VSB) for patients with mixed or conductive hearing loss. Int J Audiol 52:209–218. https://doi.org/10.3109/14992027.2012.750431

    Article  PubMed  Google Scholar 

  41. Martin C, Deveze A, Richard C et al (2009) European results with totally implantable carina placed on the round window: 2‑year follow-up. Otol Neurotol 30:1196–1203. https://doi.org/10.1097/MAO.0b013e3181c34898

    Article  PubMed  Google Scholar 

  42. Mueller H, Killion M (1990) An easy method for calculating the articulation index. Hear J 43(9):14–17, 199

    Google Scholar 

  43. Müller C, Zahnert T, Ossmann S et al (2019) Vibroplasty combined with tympanic membrane reconstruction in middle ear ventilation disorders. Hear Res. https://doi.org/10.1016/j.heares.2019.02.012

    Article  PubMed  Google Scholar 

  44. Müller M, Salcher R, Lenarz T, Maier H (2017) The Hannover coupler: controlled static prestress in round window stimulation with the floating mass transducer. Otol Neurotol 38:1186–1192. https://doi.org/10.1097/MAO.0000000000001484

    Article  PubMed  Google Scholar 

  45. Neudert M, Zahnert T (2017) Tympanoplasty—news and new perspectives. Laryngorhinootologie 96:S66–S83. https://doi.org/10.1055/s-0042-120048

    Article  PubMed  Google Scholar 

  46. Plontke SK, Radetzki F, Seiwerth I et al (2014) Individual computer-assisted 3D planning for surgical placement of a new bone conduction hearing device. Otol Neurotol 35:1251–1257. https://doi.org/10.1097/MAO.0000000000000405

    Article  PubMed  Google Scholar 

  47. Rader T, Stöver T, Lenarz T et al (2018) Retrospective analysis of hearing-impaired adult patients treated with an active transcutaneous bone conduction implant. Otol Neurotol 39:874–881. https://doi.org/10.1097/MAO.0000000000001834

    Article  PubMed  Google Scholar 

  48. Rahne T, Plontke SK (2016) Device-based treatment of mixed hearing loss: an audiological comparison of current hearing systems. HNO 64:91–100. https://doi.org/10.1007/s00106-015-0087-5

    Article  CAS  PubMed  Google Scholar 

  49. Rahne T, Seiwerth I, Götze G et al (2015) Functional results after Bonebridge implantation in adults and children with conductive and mixed hearing loss. Eur Arch Otorhinolaryngol 272:3263–3269. https://doi.org/10.1007/s00405-014-3403-x

    Article  PubMed  Google Scholar 

  50. Ricci G, Volpe DA, Faralli M et al (2010) Results and complications of the Baha system (bone-anchored hearing aid). Eur Arch Otorhinolaryngol 267:1539–1545. https://doi.org/10.1007/s00405-010-1293-0

    Article  CAS  PubMed  Google Scholar 

  51. Savaş VA, Gündüz B, Karamert R et al (2016) Comparison of Carina active middle-ear implant with conventional hearing aids for mixed hearing loss. J Laryngol Otol 130:340–343. https://doi.org/10.1017/S0022215116000748

    Article  PubMed  Google Scholar 

  52. Schmerber S, Deguine O, Marx M et al (2017) Safety and effectiveness of the Bonebridge transcutaneous active direct-drive bone-conduction hearing implant at 1‑year device use. Eur Arch Otorhinolaryngol 274:1835–1851. https://doi.org/10.1007/s00405-016-4228-6

    Article  PubMed  Google Scholar 

  53. Schraven SP, Gromann W, Rak K et al (2016) Long-term stability of the active middle-ear implant with floating-mass transducer technology: a single-center study. Otol Neurotol 37:252–266. https://doi.org/10.1097/MAO.0000000000000943

    Article  PubMed  Google Scholar 

  54. Schraven SP, Mlynski R, Dalhoff E et al (2015) Vibro-EAS: a proposal for electroacoustic stimulation. Otol Neurotol 36:22–27. https://doi.org/10.1097/MAO.0000000000000593

    Article  PubMed  Google Scholar 

  55. Schwab B, Kludt E, Maier H et al (2016) Subtotal petrosectomy and CodacsTM: new possibilities in ears with chronic infection. Eur Arch Otorhinolaryngol 273:1387–1391. https://doi.org/10.1007/s00405-015-3688-4

    Article  PubMed  Google Scholar 

  56. Schwab B, Salcher RB, Maier H, Kontorinis G (2012) Oval window membrane vibroplasty for direct acoustic cochlear stimulation: treating severe mixed hearing loss in challenging middle ears. Otol Neurotol 33:804–809. https://doi.org/10.1097/MAO.0b013e3182595471

    Article  PubMed  Google Scholar 

  57. Skarzynski H, Olszewski L, Skarzynski PH et al (2014) Direct round window stimulation with the med-el vibrant soundbridge: 5 years of experience using a technique without interposed fascia. Eur Arch Otorhinolaryngol 271:477–482. https://doi.org/10.1007/s00405-013-2432-1

    Article  PubMed  Google Scholar 

  58. Smyth GD, Gormley PK (1987) Preservation of cochlear function in the surgery of cholesteatomatous labyrinthine fistulas and oval window tympanosclerosis. Otolaryngol Head Neck Surg 96:111–118. https://doi.org/10.1177/019459988709600201

    Article  CAS  PubMed  Google Scholar 

  59. Sprinzl G, Lenarz T, Ernst A et al (2013) First European multicenter results with a new transcutaneous bone conduction hearing implant system: short-term safety and efficacy. Otol Neurotol 34:1076–1083. https://doi.org/10.1097/MAO.0b013e31828bb541

    Article  PubMed  Google Scholar 

  60. Stump R, Dobrev I, Krayenbühl N et al (2018) In-vivo assessment of osseous versus non-osseous transmission pathways of vibratory stimuli applied to the bone and the dura in humans. Hear Res 370:40–52. https://doi.org/10.1016/j.heares.2018.09.007

    Article  PubMed  Google Scholar 

  61. Tringali S, Pergola N, Berger P, Dubreuil C (2009) Fully implantable hearing device with transducer on the round window as a treatment of mixed hearing loss. Auris Nasus Larynx 36:353–358. https://doi.org/10.1016/j.anl.2008.09.003

    Article  PubMed  Google Scholar 

  62. Verhaert N, Mojallal H, Schwab B (2013) Indications and outcome of subtotal petrosectomy for active middle ear implants. Eur Arch Otorhinolaryngol 270:1243–1248. https://doi.org/10.1007/s00405-012-2113-5

    Article  PubMed  Google Scholar 

  63. Vyskocil E, Riss D, Arnoldner C et al (2017) Dura and sinus compression with a transcutaneous bone conduction device—hearing outcomes and safety in 38 patients. Clin Otolaryngol 42:1033–1038. https://doi.org/10.1111/coa.12793

    Article  CAS  PubMed  Google Scholar 

  64. Weiss R, Leinung M, Baumann U et al (2017) Improvement of speech perception in quiet and in noise without decreasing localization abilities with the bone conduction device Bonebridge. Eur Arch Otorhinolaryngol 274:2107–2115. https://doi.org/10.1007/s00405-016-4434-2

    Article  PubMed  Google Scholar 

  65. Wullstein H (1956) Theory and practice of tympanoplasty. Laryngoscope 66:1076–1093

    Article  CAS  Google Scholar 

  66. Zahnert T, Bornitz M, Hüttenbrink KB (2010) Experiments on the coupling of an active middle ear implant to the stapes footplate. Adv Otorhinolaryngol 69:32–37. https://doi.org/10.1159/000318520

    Article  CAS  PubMed  Google Scholar 

  67. Zahnert T, Mlynski R, Löwenheim H et al (2018) Long-term outcomes of vibroplasty coupler Implantations to treat mixed/conductive hearing loss. Audiol Neurootol 23:316–325. https://doi.org/10.1159/000495560

    Article  PubMed  Google Scholar 

  68. Zwartenkot JW, Snik AFM, Mylanus EAM, Mulder JJS (2014) Amplification options for patients with mixed hearing loss. Otol Neurotol 35:221–226. https://doi.org/10.1097/MAO.0000000000000258

    Article  PubMed  Google Scholar 

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  1. Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf-Hals-Chirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland

    S. Lailach, C. Müller, N. Lasurashvili, H. Seidler & T. Zahnert

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Correspondence to S. Lailach.

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Interessenkonflikt

S. Lailach, N. Lasurashvili, H. Seidler und T. Zahnert geben an, dass sie Forschungsarbeiten im Zusammenhang mit der Kopplerentwicklung mit MED-EL sowie klinische Anwendungsstudien mit den in der Übersichtsarbeit erwähnten Medizinprodukten von MED-EL und Cochlear durchführten. C. Müller gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Lailach, S., Müller, C., Lasurashvili, N. et al. Aktive Hörimplantate bei chronischer Otitis media. HNO 69, 447–463 (2021). https://doi.org/10.1007/s00106-019-00775-2

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