Historical overview and surgical applications of the Vibrant Soundbridge active middle ear implant

Osszefoglalo. A Vibrant Soundbridge aktiv kozepful-implantatum vezeteses, sensorineuralis es kevert tipusu hallascsokkenes eseten is megoldast jelenthet a beteg hallasrehabilitacioja soran. Sensorineuralis hallascsokkenes eseten akkor indikalhato, ha a legvezeteses hallaskuszob nem haladja meg a 80-85 dBHL-t a 3-4 kHz frekvenciakon, vezeteses, illetve kevert tipusu hallascsokkenes eseten pedig akkor, ha a csontvezeteses hallaskuszob nem haladja meg a 45-65 dBHL-t a 0,5-4 kHz kozti frekvenciatartomanyban. Az implantatum beulteteset eleinte tisztan sensorineuralis hallascsokkenes eseten vegeztek, es csupan egyfelekeppen tortenhetett: a rezgeskeltő rendszer oldalan levő rogzitőcsipeszt ra kellett applikalni az incus hosszu nyujtvanyara. Azokra az esetekre, amikor a rezgeskeltő rogzitese nem kivitelezhető, kulonboző rogzitőelemeket (coupler) fejlesztettek ki. Az incusra valo rogzites hosszunyujtvany-couplerrel, illetve rovidnyujtvany-couplerrel lehetseges. Vezeteses es kevert tipusu hallascsokkenes eseten a kerek ablak membranjahoz is illeszthető a rendszer, előrehaladott otosclerosis eseten pedig a Soundbridge-implantacio stapedotomiaval kiegeszitett valtozata ("power stapes") hozhat kielegitő hallaseredmenyt. Ezek a technikak meglehetősen megnoveltek a sebesz szabadsagat, igy szeles korben alkalmazott, megbizhato megoldassa valtak. A Pecsi Tudomanyegyetem Ful-Orr-Gegeszeti es Fej-Nyaksebeszeti Klinikajan az elmult evtizedben szamos incusvibroplastica tortent, de kerekablak-vibroplasticara is tobb alkalommal sor kerult. A jelen osszefoglalo tanulmanyban a Vibrant Soundbridge implantatum technikai fejlődesenek torteneti attekintesen felul az alkalmazhato műteti megoldasokat mutatjuk be. Orv Hetil. 2021; 162(40): 1619-1626. Summary. The Vibrant Soundbridge active middle ear implant can provide a reliable solution for hearing rehabilitation of patients with conductive, sensorineural or mixed hearing loss. For sensorineural hearing loss, the air conduction threshold of the patient should not be more increased than 80-85 dBHL at the range of 3-4 kHz, and for conductive and mixed hearing loss, the bone conduction threshold should not be more increased than 45-65 dBHL between 0.5 and 4 kHz. The standard surgical procedure was originally designed for purely sensorineural hearing loss, and the fixation clip of the vibrating transducer needed to be crimped onto the long process of the incus. In many cases, it is impossible to crimp the vibrator onto the incus. In order to solve such circumstances, fixation clips (couplers) have been developed. There are two options to crimp the device on the incus: applying a long process coupler or a short process coupler. For conductive or mixed hearing loss, a round window soft coupler has been introduced. In advanced otosclerotic cases, a special combined technique of Soundbridge implantation with simultaneous stapedotomy can result in sufficient hearing rehabilitation. These techniques significantly broadened the scale of possibilities for the implantation, therefore, it became a widely utilized, reliable procedure. At the Department of Otorhino-laryngology, Clinical Center, University of Pecs, in addition to a noteworthy amount of incus vibroplasty, several cases of round window vibroplasty have also been performed. The aim of the present study is to summarize the history of development of the Vibrant Soundbridge and to present an overview of the applicable surgical techniques. Orv Hetil. 2021; 162(40): 1619-1626.