Vibrant SoundBridge combined with auricle reconstruction for bilateral congenital aural atresia

https://doi.org/10.1016/j.ijporl.2016.05.006Get rights and content

Abstract

Objectives

To report an integrating surgical method of Vibrant SoundBridge (VSB) implant and auricle reconstruction.

Methods

4 cases of congenital bilateral external/middle ear malformation were enrolled. All of them were diagnosed as bilateral bony atresia and grade III microtia. Stapes vibroplasty was performed for all subjects in one operation with auricle reconstruction stage 3. The clinical information and hearing outcomes were analyzed.

Results

Satisfied aesthetic outcomes were confirmed by sculptured outline and symmetric shape on both sides. Mean improvement in hearing threshold with VSB activation was 25.9 dB HL, while mean scores of speech recognition test were 21.8–46.3%.

Conclusion

Combined surgical method of VSB implant and aesthetic reconstruction is safe and efficient for congenital external/middle ear malformation case.

Introduction

Congenital auricle deformity frequently occurs with external ear canal (EAC)/middle ear malformation and results in both hearing loss and aesthetic abnormality. Further, potential mental-psychological problems may also be induced especially in children. Incidence of congenital external/middle ear malformation is reported around 0.5–1/10,000. Although EAC reconstruction and tympanoplasty have been introduced successfully, it remains a challenge for experienced oto-microsurgeon to restore hearing for above cases which are often followed by complication including peripheral facial paralysis, EAC restenosis and lateralization of tympanic membrane [1]. In recent years, Bone Anchored Hearing Aids (BAHA) and Vibrant SoundBridge (VSB) have been applied for congenital hearing loss cases caused by external/middle ear malformation and reported efficient in hearing restoration. As BAHA or VSB operations are generally carried out by otological and plastic surgeons separately, it requires several times of operation under general anesthesia and may result in improper incision and flap design against each side, as well as possible overlap of hearing and plastic prosthesis. Thus, a therapy of combining VSB implantation and aesthetic reconstruction was designed and applied in 4 bilateral congenital external/middle ear malformation cases.

Section snippets

Patient information

Four bilateral congenital external/middle ear malformation cases were treated in our center from August 2013 to May 2015. The age ranged from 7 to 11 years old. All of them were diagnosed as bony atresia by High Resolution Computed Tomography (HRCT). According to Marx method, they were identified as bilateral grade III auricle deformity. Auditory assessment including Pure Tone Audiometry (PTA), Auditory Brainstem Response (ABR) and speech recognition test were performed pre-operation. Results

Result

A combined follow-up by otological and plastic sections was conducted for 4 subjects post operation. No complication including hearing loss, peripheral facial paralysis, tinnitus and vertigo was observed, either plastic complication such as scalp hematoma, ischemia of reconstructed auricle and necrosis.

Feasibility of VSB device for bony atresia case

Congenital external/middle ear malformation often combines with abnormality in ossicular chain, pneumatization of mastoid, facial nerve course and bifurcation [4], vestibular window and round window morphology, which are usually negative factors to auditory outcome of tympanoplasty. Thus, pre-operation assessment of temporal bone based on HRCT is necessary to decide for adequate operation plan. As a widely accepted grading method for aural atresia cases, Jahrsdoerfer score system refers to both

Conclusion

Concerning hearing restoration and auricle reconstruction, integrating surgical method is suggested to be safe and beneficial for bilateral congenital external/middle ear malformation cases.

Acknowledgments

This study was financially supported by Capital Medical Development Research Fund 2014-2-2052.

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Financial funding: Capital Medical Development Research Fund 2014-2-2052.

We confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome.

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