Objective: To evaluate possible increases in bone conduction (BC) hearing thresholds in patients undergoing subtotal petrosectomy (SP) with fat obliteration and blind sac closure of the outer ear canal and subsequent round window vibroplasty. Patients and Interventions: Between 1997 and 2013, 43 patients (45 ears) with combined hearing loss and recurrent chronic otitis or status post formation of a radical cavity underwent SP around 6 months prior to implantation of a Vibrant SoundbridgeTM. Pure tone audiograms (0.5, 1, 1.5, 2, 3, 4, and 6 kHz) prior to SP, after SP, prior to implantation, after implantation, and at first fitting around 5 weeks after implantation were collected and statistically analyzed. Results: The comparison between BC thresholds before SP and at first fitting showed an overall decline during the two-step procedure between 2.8 and 6 dB that was significant (p < 0.05, Student t test) at 2, 3, 4, and 6 kHz. Conclusion: In some cases, SP is the only way to eradicate chronic otitis and to achieve a suitable environment for the implantation of active middle ear implants. The present data demonstrate a relatively small but significant decline in BC thresholds throughout the whole procedure. Knowledge of its extent is mandatory for a correct indication for later implantation of a Vibrant SoundbridgeTM.

1.
Colletti V, Soli SD, Carner M, Colletti L: Treatment of mixed hearing losses via implantation of a vibratory transducer on the round window. Int J Audiol 2006; 45: 600–608.
2.
Busch S, Lenarz T, Maier H: Comparison of alternative coupling methods of the Vibrant Soundbridge floating mass transducer. Audiol Neurootol 2016; 21: 347–355.
3.
Edfeldt L, Rask-Andersen H: Round window vibroplasty in chronic ear surgery: comparison with conventional hearing rehabilitation. Acta Otolaryngol 2013; 133: 814–825.
4.
Luers JC, Hüttenbrink KB, Zahnert T, Bornitz M, Beutner D: Vibroplasty for mixed and conductive hearing loss. Otol Neurotol 2013; 34: 1005–1012.
5.
Skarzynski H, Olszewski L, Skarzynski PH, Lorens A, Piotrowska A, Porowski M, Mrowka M, Pilka A: Direct round window stimulation with the Med-El Vibrant Soundbridge: 5 years of experience using a technique without interposed fascia. Eur Arch Otorhinolaryngol 2014; 271: 477–482.
6.
Canale A, Dagna F, Cassandro C, Giordano P, Caranzano F, Lacilla M, Albera R: Oval and round window vibroplasty: a comparison of hearing results, risks and failures. Eur Arch Otorhinolaryngol 2014; 271: 2637–2640.
7.
Olszewski L, Jedrzejczak WW, Piotrowska A, Skarzynski H: Round window stimulation with the Vibrant Soundbridge: comparison of direct and indirect coupling. Laryngoscope 2017; 127: 2843–2849.
8.
Lyutenski S, Schwab B, Lenarz T, Salcher R, Majdani O: Impact of the surgical wound closure technique on the revision surgery rate after subtotal petrosectomy. Eur Arch Otorhinolaryngol 2016; 273: 3641–3646.
9.
Lassaletta L, Calvino M, Sánchez-Cuadrado I, Pérez-Mora RM, Muñoz E, Gavilán J: Pros and cons of round window vibroplasty in open cavities: audiological, surgical, and quality of life outcomes. Otol Neurotol 2015; 36: 944–952.
10.
Issing PR, Schönermark MP, Winkelmann S, Kempf HG, Ernst A: Cochlear implantation in patients with chronic otitis: indications for subtotal petrosectomy and obliteration of the middle ear. Skull Base Surg 1998; 8: 127–131.
11.
Bendet E, Cerenko D, Linder TE, Fisch U: Cochlear implantation after subtotal petrosectomies. Eur Arch Otorhinolaryngol 1998; 255: 169–174.
12.
Casserly P, Friedland PL, Atlas MD: The role of subtotal petrosectomy in cochlear implantation. J Laryngol Otol 2016; 130(suppl 4):S35–S40.
13.
MED-EL: Vibrant Soundbridge® System: including the SAMBATM audio processor, the VORP 503 and the Vibroplasty Couplers. http://s3.medel.com/downloadmanager/downloads/soundbridge_prof/de-DE/28477.pdf (accessed March 6, 2018).
14.
Verhaert N, Mojallal H, Schwab B: Indications and outcome of subtotal petrosectomy for active middle ear implants. Eur Arch Otorhinolaryngol 2013; 270: 1243–1248.
15.
Henseler MA, Polanski JF, Schlegel C, Linder T: Active middle ear implants in patients untergoing subtotal petrosectomy: long-term follow-up. Otol Neurotol 2014; 35: 437–441.
16.
Linder T, Schlegel C, DeMin N, van der Westhuizen S: Active middle ear implants in patients undergoing subtotal petrosectomy: new application for the Vibrant Soundbridge device and its implication for lateral cranium base surgery. Otol Neurotol 2009; 30: 41–47.
17.
Fisch U, Mattox D (eds): Microsurgery of the Skull Base. Stuttgart, Thieme, 1998.
18.
Grossöhmichen M, Schwab B, Salcher RB, Lenarz T, Maier H: Exploring the effect of mastoid obliteration to the output of electro-mechanical transducers. Biomed Tech (Berl) 2014; 59: 768.
19.
Maier H, Hinze AL, Gerdes T, Busch S, Salcher R, Schwab B, Lenarz T: Long-term results of incus vibroplasty in patients with moderate-to-severe sensorineural hearing loss. Audiol Neurootol 2015; 20: 136–146.
20.
Kazikdas KC, Onal K, Yildirim N: Sensorineural hearing loss after ossicular manipulation and drill-generated acoustic trauma in type I tympanoplasty with and without mastoidectomy: a series of 51 cases. Ear Nose Throat J 2015; 94: 378–398.
21.
Müller M, Salcher R, Lenarz T, Maier H: The Hannover Coupler: controlled static prestress in round window stimulation with the floating mass transducer. Otol Neurotol 2017; 38: 1186–1192.
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