Hearing Rehabilitation with Combined Electroacoustic Stimulation and Ossiculoplasty

Abstract

We report a case of hearing rehabilitation following combined cochlear implantation and ossiculoplasty. A 71-year-old patient visited the clinic for right-sided mixed hearing loss. We targeted neural and conductive components, performing two different operations simultaneously. At two months post-operative, the patient showed satisfactory results with respect to hearing threshold and speech comprehension. Our experience suggests that careful evaluation of patients and consideration of the diverse array of available treatment strategies can be used to provide personalized rehabilitation with maximal effectiveness. To the best of our knowledge, this is the first report to take such an integrated approach to treat hearing impairment and is thus likely to have clinical importance for otologists.

Keywords: Cochlear implants; Hearing impaired rehabilitation; Mixed hearing loss; Ossicular replacement.

Fig. 1.

Initial findings of the right ear. (A) The mastoid cavity was canal wall downed, and the tympanic membrane was well tympanized. (B) Pure-tone average showed mixed hearing loss in the right ear, with an average air-bone gap of 25 dB and an average air conduction threshold higher than 80 dB. Low frequencies from 250 hertz (Hz) to 1,000 Hz showed a serviceable hearing threshold with a hearing aid. (C) Computed tomography scan showing canal wall downed mastoidectomy status. The oval window was well opened (arrow), but the ossicles were not apparent. (D) The middle ear cavity was well aerated through a widely opened Eustachian tube (arrow).

Fig. 2.

Electrode inserted through the round window. The total ossicular replacement prosthesis was placed on the stapes footplate.

Fig. 3.

Postoperative two-month pure-tone average. Bone conduction hearing was well preserved, and the air-bone conduction gap was decreased after combined electroacoustic stimulation and ossiculoplasty. The patient was capable of perceiving acoustic stimuli at frequencies lower than 500 Hz and electrical stimuli greater than 500 Hz, demonstraing serviceable hearing.