The transcanal approach for the Vibrant Soundbridge: the experience of the clinic in Pisa

Introduction. The Vibrant Soundbridge (VSB) is a middle ear implant for the treatment of the sensorineural hearing loss, for patients who can not benefit from conventional hearing aids. The standard approach for VSB implantation includes a post-auricular S-shaped incision, mastoidectomy whit posterior tympanotomy, the fixation of the implant to the temporal bone, and crimping of the vibrator on the incus through the posterior tympanotomy. Objectives. The goal of this presentation is to suggest a minimal surgical procedure to place the VSB. Methods. We place the VSB in four patients adapting a minimal post-auricular S-shaped incision. The vibrator was crimped on the incus through a transcanal approach. A small channel in the external wall was drilled in order to position the cable. Results. All patients were tested following a standard evaluation protocol. The preliminary results are described and discussed for each single case. Conclusion. The possibility of the transcanal approach for the VSB can reduce the risk of the facial nerve damage if special care is taken on the channel for the cable. Moreover, the technique may reduce the time needed to perform the surgery and reduce potential flap complications being a good cosmetic solution at the same time.