Intraoperative quantification of floating mass transducer coupling quality in active middle ear implants: a multicenter
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OTOLOGY
Intraoperative quantification of floating mass transducer coupling quality in active middle ear implants: a multicenter study Laura Fröhlich1 · Torsten Rahne1 · Stefan K. Plontke1 · Tobias Oberhoffner2 · Rüdiger Dahl2 · Robert Mlynski2 · Oliver Dziemba3 · Aristotelis Aristeidou3 · Maria Gadyuchko4,5 · Sven Koscielny4 · Sebastian Hoth6 · Miriam H. Kropp7 · Parwis Mir‑Salim7 · Alexander Müller7 Received: 7 July 2020 / Accepted: 19 August 2020 © The Author(s) 2020
Abstract Purpose Evaluating the effectiveness of intraoperative auditory brainstem responses (ABRs) to stimulation by the Vibrant Soundbridge (VSB) active middle ear implant for quantifying the implant’s floating mass transducer (FMT) coupling quality. Methods In a diagnostic multicentric study, patients (> 18 years) who received a VSB with different coupling modalities were included. Pre- and postoperative bone conduction thresholds, intraoperative VSB-evoked ABR thresholds (VSB-ABR) using a modified audio processor programmed to preoperative bone conduction thresholds, postoperative vibrogram thresholds, and postoperative VSB-ABR thresholds were measured. Coupling quality was calculated from the difference between the pure tone average at 1000, 2000, and 4000 Hz (3PTA) vibrogram and postoperative 3PTA bone conduction thresholds. Results Twenty-three patients (13 males, 10 females, mean age 56.6 (± 12.5) years) were included in the study. Intraoperative VSB-ABR response thresholds could be obtained in all except one patient where the threshold was > 30 dB nHL. Postoperatively, an insufficient coupling of 36.7 dB was confirmed in this patient. In a Bland–Altman analysis of the intraoperative VSB-ABRs and coupling quality, the limits of agreement exceeded ± 10 dB, i.e., the maximum allowed difference considered as not clinically important but the variation was within the general precision of auditory brainstem responses to predict behavioral thresholds. Five outliers were identified. In two patients, the postoperative VSB-ABR thresholds were in agreement with the coupling quality, indicating a change of coupling before the postoperative testing. Conclusion The response thresholds recorded in this set-up have the potential to predict the VSB coupling quality and optimize postoperative audiological results. Keywords Coupling quality · Active middle ear implant · Floating mass transducer · Objective measures · Intraoperative
* Laura Fröhlich laura.froehlich@uk‑halle.de 1
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Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle (Saale), Ernst‑Grube‑Str. 40, 06120 Halle (Saale), Germany Department of Otorhinolaryngology, Head and Neck Surgery “Otto Körner”, Rostock University Medical Center, Rostock, Germany
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Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
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Present Address: Department of Otorhinolaryngology, Helios Clinic, Erfurt, Germany
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Depart
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