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Oval Window Membrane Vibroplasty for Direct Acoustic Cochlear Stimulation: Treating Severe Mixed Hearing Loss in Challenging Middle Ears

Objective To date, all the Vibrant Soundbridge (VSB) applications have managed to stimulate the inner ear indirectly. Our objective was to present a new VSB application for direct inner ear stimulation. Study Design Prospective cohort study. Settings Tertiary, referral center Patients Three patients with previous middle ear surgery and moderate-to-severe ipsilateral, mixed hearing loss. Interventions Oval window membrane vibroplasty (OWMV) for direct acoustic cochlear stimulation. A total ossicular replacement prosthesis (TORP) was attached to the floating mass transducer (FMT). Then, the stapes footplate was perforated, and the tip of the FMT-TORP assembly was advanced approximately 1 mm into the inner ear. A silicon ring was placed around the TORP’s tip to prevent it from slipping deeper into the inner ear. Main Outcome Measure Audiologic assessment involving pure-tone audiometry, aided and unaided free-field audiometry, Freiburg monosyllabic word test, and registration of any complications. Results OWMV resulted in an average functional hearing gain of 36.1 dB (range, 24.2–47.5 dB). Although the greatest amplification was observed in the higher frequencies, there also was a significant improvement in the lower frequencies. The surgery was not related to any difficulties; vertigo, inner ear trauma, or further complications did not occur. Conclusion We present a new method for direct acoustic cochlear stimulation using an active middle ear implant. The preliminary results show that OWMV is a promising and safe option for treating moderate and severe hearing loss, even in challenging cases with previous middle ear operations or fixed stapes footplate.