This VIBRANT SOUNDBRIDGE implantation surgery was filmed live with a high-resolution camera, making it possible to see all the steps in great detail. Audio commentary has also been added to the video by head surgeon Prof. Farid Alzhrani.

The implantation:

• Patient: 11 years old at time of operation
• Diagnosis: unilateral conductive hearing loss
• Received a VIBRANT SOUNDBRIDGE middle ear implant
• Transducer attached to the head of the stapes with a Stapes-SH-Coupler

Patient History and Preparation

As Prof. Alzhrani explains, the 11-year-old came to the King Abdullah Ear Specialist Center at the King Saud University Medical City in Riyadh after having significant trouble following what his teacher was saying in the classroom. About five years before, he had received a bone conduction hearing aid to treat the conductive hearing loss he had in his left ear due to congenital microtia and atresia. This treatment, however, turned out to be insufficient in school, especially when trying to understand speech in noise.

In addition to a comprehensive audiological exam, a CT scan including the ear canal, middle ear, and inner ear was performed at the clinic. Alzhrani discovered a malformation of the ossicular chain, and the ear canal was completely closed off due to ossification. He also established that the stapes was present but immobile.

Treatment Options for Conductive Hearing Loss Due to Microtia & Atresia

There are essentially three surgical treatment options, Prof. Alzhrani explained: canalplasty, a bone conduction implant, or an active middle ear implant (VIBRANT SOUNDBRIDGE).

In this case, canalplasty was not an option since there would have been a low chance of success for this particular patient. The importance of unilateral, ear-specific stimulation was key in Alzhrani’s decision to go with VIBRANT SOUNDBRIDGE rather than a bone conduction implant.

Choosing a solution that is effective on the affected side and leaves the other, completely normally functioning ear alone was a key concern for him as well as the patient and his parents.

Interoperative Decision: Stapes-SH-Coupler

The preoperative CT scan did not make it clear whether the stapes would be suitable for attaching the transducer. For this reason, the decision about whether to choose the Stapes-SH-Coupler or the CliP-Coupler had to be made intraoperatively. After removing the malleus and the incus, the stapes was mobile enough to be suitable for the Stapes-SH-Coupler.

This coupler could be easily placed on to the stapes since intraoperative ABR measurements showed optimal processing of the vibrations.

What You’ll See in the Video

The surgical video is split into the following chapters and surgical steps:

• Preparation:
  • Planning with consideration of possible future ear reconstruction
• Incision:
  • Opening of skin and periosteum; fixation of skin for clear view of the bone
• Access to the Middle Ear:
  • Opening the facial recess; malleus and incus completely removed; ensuring there is enough space for the transducer (Floating Mass Transducer, FMT)
• Periosteal Pocket and Bone Bed:
  • Drilling the implant bed (only the surface); skin flap thickness check
• Fixation of Implant:
  • Implant placed and attached with self-drilling screws
• Attachment of Coupler to FMT:
  • Stapes-SH-Coupler selected; FMT attached to the coupler
• FMT Placement:
  • Positioning of the conductor link: coupler pressed gently onto the stapes
• ABR Measurements:
  • Intraoperative objective brainstem audiometry with clear response at 100, 80, and 60 dB
• Closure:
  • Covering of the mastoid; closure in three layers

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