gms | German Medical Science

Introduction: Hearing loss caused by middle ear effects is the most common sensory deficit affecting up to 538 million adults worldwide. Besides eradication of chronic middle ear disease, the reconstruction of the sound conduction apparatus is a major goal of modern ear surgery. Sophisticated titanium middle ear implants allowing individual adaptation to anatomical variations are widely used for this procedure. Numerous combinations of graft position, ossicular interposition, cartilage struts and various types of solid plastic or metal implants are used in the event of extensive destruction of the ossicular chain. Each technique in using passive middle ear implants (pMEI) is plagued with its own particular problem, but overall surgeons gained experience to handle most of them in the last years. Focus was given on expansion in surgical challenges, which means operative techniques such as 3D microscope and endoscopic surgery.

Furthermore, patients benefit from significant advancements in hearing-assistive technologies, conventional hearing aids and audiological rehabilitation techniques.

However, despite modern developments, hearing restoration with passive implants often faces its limitations due to tubal-middle-ear dysfunction or unsatisfactory audiological results. In addition 60% of patients cannot effectively use hearing aids due to complaints of occlusion, distortion or feedback. Here, implantable hearing aids, successfully used in cases of sensorineural hearing loss as well as for conductive or mixed hearing loss, offer a promising alternative. The majority of studies evaluating the safety and efficacy of active middle ear implant (aMEI) are retrospective in nature with often limited follow-up. While functional gain and word recognition improvement seems similar between conventional hearing aids and aMEI, patient-perceived outcome measures that aMEI provide enhanced sound quality and eliminate occlusion effect.

Currently, active middle ear implants seems to be a fine step forward in ear microsurgery. But we have to be aware of longterm complications, implant failure and revision surgery which are becoming increasingly more important than surgical complications.