Learning Objectives: video instruction session

Introduction: Middle ear implants (MEIs) such as VSB^® (Vibrant soundbridge) are attractive and alternative treatments for patients with conductive, sensorineural, and mixed hearing loss who do not benefit from, or who choose not to wear, conventional hearing aids (HA). Recent studies suggest that MEIs can provide better improvements in functional gain, speech perception, and quality of life than HA, while there certain risks associated with the surgery should be taken into consideration, including facial nerve or chorda tympanic nerve damage, dysfunctions of the middle and inner ears, and future device failure/explantation.

Materials and Methods: In our institute, twelve patients received VSB implantation. The cause of conductive or mixed hearing loss was middle ear diseases in all cases. Round window vibroplasty via transmastoid approach was conducted. The bony lip overhanging round window membrane (RWM) was extensively but very carefully drilled to introduce the Floating Mass Transducer (FMT). Perichondrium sheets were used to stabilize the FMT onto RWM.

Results: Significant improvements of free-field Pure Tone Audiogram (PTA) from 250 Hz to 8000 Hz were confirmed (P < 0.001). Hearing gain up to 40 dB was achieved from 1000 Hz to 4000 Hz range. No deterioration in both air conduction and bone conduction at PTA was noted at 20 weeks after the surgery. Monosyllable speech perception in both quiet and noise conditions improved significantly (P < 0.001). Speech discrimination score in both quiet and noise conditions improved significantly too (P < 0.001).

Discussion: In the future, it is likely that there will be an increasing population even in Japan that will meet the criteria for MEIs such as VSB. However, the long-term efficacy and safety of these devices should be established.