Revision of active middle ear implants (AMEI): causes, surgical issues and rehabilitative transition at a single implanting center

Abstract

Purpose To report on failures related to active middle ear implants (AMEI) surgery, within a series of subjects treated at a single Implanting Center. Methods A retrospective review of 79 cases of implanted AMEI has been performed to report the failure ratio, the causes for the failure and the selected rehabilitative solution. The AMEI included 25 Vibrant Soundbridge ® (Medel, Innsbruck, Austria), 20 as round window vibroplasty (RW-VSB) for mixed hearing loss, 5 as incus-vibroplasty for sensorineural hearing loss; 7 MET/Carina ® (Cochlear, Melbourne, Australia), 2 MET for mixed and sensorineural hearing loss, 5 Carina for sensorineural hearing loss; 43 Esteem ® (EnvoyMedical, St Paul, USA) for sensorineural hearing loss; 3 Maxum ® (Ototronics, Texas, USA) for sensorineural hearing loss; 1 Codacs ® (Cochlear, Melbourne, Australia) for severe mixed hearing loss. Results The overall complication rate affected 20% of the implanted devices, individually ranging from 6.9 to 100%. Hardware system failures were recorded in all the AMEI, ranging from 10 to 50%. The alternative auditory rehabilitation included replacement of the same system in 2 cases, use of a conventional hearing aid in 3 cases, Cochlear implantation in 4 cases and implantation in the contralateral ear in 2 cases. Conclusion The present clinical experience showed that, in spite of the successful functional rate displayed by the majority of the AMEI implantees, complications may occur to a certain percentage of cases and should prompt the professionals to select alternative solutions, starting from the (re)adoption of a conventional hearing aid and ending up to Cochlear implantation.