Why bother with surgery for middle ear implants when current hearing aids have the ability to amplify sounds even for those with severe hearing loss? That was an important question for me before I started with middle ear implants in 2006, at a time when it was in its infancy still worldwide and the first of its kind in Asia.
Research then was showing however, an important point – patient feedback was that it had the ability to offer higher quality, naturalness and fidelity of sound compared to hearing aids, as it sort to transmit sound through ossicular chain and cochlear fluid vibrations. Hearing aids amplify sounds like a loudspeaker, and sounds are thus less natural, even with directional processing and open fittings. Higher gain may also be delivered to the ear without feedback or occlusion of the ear canal.
There are many types of middle ear implants available, eg VSB, Carina, Maxum, Esteem amongst others. In some cases where the ear canal is absent (atresia) or cannot be fitted with current hearing aids due to stenosis, skin or discharge problems; or when the middle ear bones are extensively damaged failing ossicle prosthesis reconstruction – the middle ear implants like the Vibrant Soundbridge (VSB) are good alternative options. For example, the VSB can be placed onto the incus, the stapes or round window directly. It can thus overcome conductive, mixed and sensorineural hearing loss. However, realistic patient expectations is key to satisfactory patient perception, as cochlear hearing loss continues to have cochlear distortion, reduced dynamic range and impaired temporal processing.