Wk9-25-ME implants Flashcards
Describe the Vibrant Soundbridge and typical candidates
Transcutaneous ME implantable device (MEI)
- internal and external components
- Classic approach clips on to incus; floating mass transducer (FMT) does not touch ossicles (can attach to long or short process of incus, head of stapes, or at the round window)
- mild to severe SNHL
- mixed or conductive losses
- paediatrics (10-17 yrs old)
- Loss should be stable, with normal ME function, and good speech scores (>50%)
Is the Soundbridge safe for MRI?
Only for 1.5 T
How does the Vibrant SoundBridge work?
- sounds picked up by mic of audio processor
- processor converts sound to electrical signal
- signals transmitted across skin to implanted portion
- implant relays signal to FMT (floating mass transducer)
- FMT converts signal into mechanical vibrations, which are transmitted through ossicles to cochlea
- Direct drive (no occlusion or FB)
What are the 3 parts of the SoundBridge?
- Speech processor
- VORP - Vibratory Ossicular Replacement Prosthesis (FMT)
- Couplers (to attach the FMT without it touching ossicles directly)
Which speech processor does SoundBridge use?
Samba (same as BoneBridge)
- advanced acoustic features
- 250-8k Hz
- 675 zn air battery
Does SoundBridge surgery affect residual hearing?
No
To what degree of hearing loss can SoundBridge fit?
Severe
Why might the SoundBridge be a better option than hearing aids?
Can provide improved mid to high frequency gain over HAs
What is notable about Esteem? How does it work?
It is implanted completely under the skin, allows 24/7 natural sounding hearing, is maintenance-free, and is waterproof.
- sensor is attached to the incus and serves as mic
- sends stimulus to speech processor
- processor sends signal to driver, which moves the stapes
- *Note: 4.5-9 year battery life (not rechargeable)
What are the indication criteria for Esteem?
- 18 yrs old or older
- stable bilat SNHL
- unaided speech discrimination of at least 40%
- normal functioning eustachian tube
- normal ME anatomy
- normal TM
- adequate space for implant
- min 30 days experience c/ HAs
- mod or severe loss?
Why does the ME need to be normally functioning for the Esteem implant?
- need TM to move freely for incus sensor to correctly pick up vibrations
- eustachian dysfunction may alter vibrations
What are some of the contraindications for Esteem implants?
- hx of post-adolescent chronic ME infections
- inner ear disorders
- recurring vertigo requiring tx
- disorders such as mastoiditis, Hydrops, or Meniere’s
- known hx of fluctuating AC or BC loss
- cholesteatoma or destructive ME disease
- retrocochlear or central auditory disorders
- disabling tinnitus
- hx of keloid formation (poor skin healing)
- hypersensitivity to implant materials
Who makes Carina?
Cochlear
Carina has many of the same benefits, indications and contraindications as Esteem. How does it differ?
- Includes mixed losses
- Has under the skin mic as opposed to sensor on the incus -> less dependent on good ME function, just needs to be intact
- Charges transcutaneously (40 mins gives 16 hrs) and should last ~10 yrs
- Remote allows user to turn it off at night
- Button audio processor allows for additional volume/power
What are the components of the Carina?
- totally implantable microphone
- internal processor
- fixed MicroDrive system (drives incus and puts ossicular chain in motion)
