Background: Based on a study evaluating the lifetime costs of hearing improvement surgeries and an alternative implantation of the Vibrant Soundbridge (VSB), this study examines variances in the costs per successfully treated life years, when the number of successfully treated life years is maximized. Three alternatives treatment strategies were considered: G1: Direct VSB implantation; G2: >=1 hearing improvement surgeries, then VSB; and G3: >1 hearing improvement surgeries. Data from 10,000 simulation runs are available.
Methods: For each implantation age, the risk of not receiving successful treatments by the end of life was determined, based on variances in the implantation age. The treatment option with the highest probability of successful treatment within the age group is considered the preferred alternative. The most cost-effective option is selected.
Results: The combination with the lowest overall costs and a 99.93% chance of being successfully treated is achieved when G1 is used for remaining life expectancies of more than 13 years (€1.060).
Discussion: In practice, direct VSB implantation will not always be possible for life expectancies of more than 13 years. However, it should be noted that the earlier this option is included, the lower the costs and the higher the success rate. If only one hearing improvement surgery is performed prior to VSB implantation for a life expectancy of 14 to 35 years, the total treatment costs per year are €1,089 (with <14=G3 and >35=G1). In contrast, the cost per year is €1,213 for hearing improvement surgery only (G3) with a success rate of 87.56%.

Purpose
Vibrant Soundbridge (VSB) is an active middle ear implant that serves as a solution for people unable to use
conventional hearing aids properly. Surgical techniques for VSB implantation have progressively advanced, improving its
outcomes. Traditionally, VSB processor activation transpires around four weeks after the surgery to provide enough healing; however, contemporary practices in cochlear implant and bone-anchored hearing device activations indicate reduced waiting times. The purpose of this research is to explore the feasibility, safety, and advantages of early VSB activation.
Methods This prospective study was conducted in two phases. In phase one, the patients only attempt using the device on
the first business day after surgery and then return in 4 weeks for a complete and standard fitting and device use. In the second phase, participants had a thorough fitting and began using the device on a regular basis the first working day after surgery.
Feasibility, safety, and audiological results were assessed throughout both phases.
Results Early activation was successfully achieved in all patients in the early group without significant complications. When comparing the audiological examination and fitting parameters between the initial session the day after surgery and the one month follow-up, there was no statistically significant change.
Conclusion The study emphasizes the possibility for early VSB activation, which might minimize wait times and enhance
patient satisfaction without compromising device function. Further study is required to validate these results in broader
groups and investigate long-term consequences

Background:
Bone-conducted (BC) sound transmission involves multiple anatomical pathways, including inertial, compressional, and osteotympanic components. While previous studies have provided insights into individual mechanisms, the relative contributions of these pathways – particularly the role of the ossicular chain (OC) – remain incompletely understood. This knowledge gap limits the design of fully implantable hearing systems. The present study uses a multimodal approach on whole human head specimens to map BC transmission with respect to implantable sensors.

Methods:
Three ears in two cadaveric heads were investigated to date, with further specimens pending. Airborne (AC) stimulation was delivered via free-field and in-ear transducers; BC stimulation was applied using a calibrated audiometric bone conduction transducer and an implantable actuator. Ipsilateral and contralateral excitations were tested. Sensors included a piezoelectric force sensor in the incudostapedial joint, a subcutaneous microphone-accelerometer unit, various reference microphones and accelerometers, and differential laser Doppler vibrometry on stapes footplate and promontory to isolate OC motion and correct for inertial artifacts.

Results:
Preliminary findings show that the OC is more responsive to BC than to AC, but still seems decoupled by about 20 dB, depending on frequency, compared to subcutaneous sensor signals. These results complement earlier findings and emphasize the relevance of osteotympanic transmission for implantable systems.

Conclusion:
Whole-head measurements provide quantitative evidence for ossicular involvement in BC and demonstrate the value of middle ear sensor strategies in fully implantable hearing systems. By combining ossicular and subcutaneous measurements, this study extends previous work and offers new insights on sound transmission in the human head.

Background: This study includes a comparison between state-of-the-art hearing aids (HA) and the Vibrant Soundbridge (VSB) in patients with conductive and mixed hearing loss, focusing on speech understanding and patient-reported satisfaction.
Methods: In this study, 11 patients were implanted with VSB following a test period of the “state-of-the-art” hearing aids. ABR measurements were used intra-operatively. Outcome measures were assessed according to pure-tone audiometry, vibrograms, word recognition in quiet (WRS; Freiburger monosyllabic test), in noise using the OLKISA test. Satisfaction and quality of life were measured using the Abbreviated Profile of Hearing Aid Benefit, the Spatial and Qualities of Hearing Scale 12, and the Assessment of Quality of Life – 8 dimensions.
Results:
All implanted patients showed no significant change in bone conduction pre- and post-operatively. PTA4 in sound field demonstrated a significant difference to the unaided situation when using the S-HA or the SAMBA2 audio processor after six months of implantation. The WRS indicated a positive trend for the VSB thus far as the median functional gain was 50% for the S-HA group and 60% for the VSB group.
The aided conditions for speech in noise showed comparable improvements in three conditions (S0N0, S0N180, S0N135ISTS180N225). A positive trend for the VSB was observed. The SSQ12, the APHAB and the AQoL-8D showed higher satisfaction for both S-HA and VSB at six months, with better results in the VSB group.
Conclusion
The VSB provides comparable results to "high-end" hearing aids from an audiological perspective with a better trend observed in "speech in noise" and subjective data.

Background:
Otosclerosis is a common cause of progressive conductive hearing loss in adults, characterized by abnormal bone remodeling, most notably affecting the stapes footplate. This pathological fixation of the stapes impairs its mobility, disrupting the normal transmission of sound to the inner ear. Traditional management of otosclerosis typically involves hearing aids or surgical intervention, such as stapedotomy or stapedectomy, to restore mechanical transmission through the ossicular chain. A possible alternative is power stapes vibroplasty, a form of active middle ear implantation that combines stapes surgery with the application of an active transducer, such as the Vibrant Soundbridge (VSB) system. This approach involves coupling the floating mass transducer (FMT) to the incus, together with a stapedotomy. Thereby, the impaired ossicular mechanics are augmented or bypassed to deliver enhanced vibratory input to the inner ear.
Methods:
A retrospective chart review was conducted to identify all power stapes vibroplasty cases and assess the post operative outcome.
Results:
The average preoperative air bone gap (for 0.5; 1; 2; 3kHz) was 28.9 dB and reduced to 11.6 dB after surgery, yielding an average improvement of 17.3 dB (SD +/- 11 dB). After activation of the VSB, speech perception in quiet improved on average by 33% at 65 dB SPL and by 56% at 80 dB SPL, respectively.
Conclusion:
Power Stapes vibroplasty is a safe and effective treatment option for patients suffering from otosclerosis.

Hearing loss is often associated with a lower quality of life, leading to social isolation and stigma. Over the years, the scale of difficulties people face with hearing loss has driven professionals to seek advanced treatments. Technological advancements have enabled the development of implantable devices for patients who do not benefit from or cannot use traditional hearing aids. The Bonebridge implant is a major advancement in bone conduction technology, offering a safe and effective hearing loss solution. However, limited sample sizes in studies highlight the need for further research on its long-term efficacy and safety. The aim of this study is to evaluate the safety, efficacy, and audiological outcomes of the Bonebridge implant in a large cohort of patients with different types of hearing loss.
325 patients across a wide age range underwent Bonebridge implantation. Pre- and post-implantation evaluations included pure-tone audiometry, speech recognition tests, and free-field audiometry. Word recognition was measured using the Polish Monosyllabic Word Test, while speech reception in noise was assessed using the Polish Sentence Matrix Test. The subjective benefit was assessed using the APHAB questionnaire. Follow-up tests were performed 6 months after activation.
Due to complications, revision surgery was required in seven patients, including implant removal in one case. The APHAB questionnaire showed improved hearing function, and the performed hearing tests revealed significant improvement after implantation.
Active bone conduction implantation is an effective method for the rehabilitation of conductive hearing loss, mixed hearing loss, and unilateral deafness. The large cohort study confirms significant hearing improvements and subjective benefits.

Background: The VIBRANT SOUNDBRIDGE (MED-EL Medical Electronics, Austria) is an active middle ear implant for the treatment of sensorineural and mixed hearing loss. Its floating mass transducer (FMT) can be attached either to the ossicular chain for forward stimulation or to the round window (RW) membrane for reverse stimulation. Although laser Doppler vibrometry (LDV) is the gold standard for assessing output levels in forward stimulation mode, LDV is not considered reliable for reverse stimulation.

The aim of this study was to determine the output of FMT during reverse stimulation using intracochlear pressure difference (ICPD) and LDV measurement for comparison.

Methods: The output levels generated by the FMT coupled to the RW were determined in temporal bone specimens (N=10) using the Vibroplasty-RW-Coupler and the research RW-Precision-Coupler. The displacement of the stapes footplate was measured using LDV, while the ICPD across the basilar membrane was recorded simultaneously with fiber-optic pressure sensors.

Results: A comparison of both coupling configurations revealed a similar trend in the output level characteristics. The output level amplitude showed a high agreement between 500 Hz and 1.5 kHz. However, deviations between the two measurement methods were observed in the low-frequency range (between 300 and 500 Hz) as well as in the high-frequency range (between 1.5 and 8 kHz). The LDV estimated up to 15 dB lower output compared to the ICPD approach.

Conclusion: The findings from this study supports that the ICPD measurement method is more appropriate for characterizing reverse stimulation.