156 / 264
Methods
Coupling Method
Coupling method was defined for each patient according to
whether they had an intact ossicular chain or an ossicular chain
remnant in which case the stapes or incus was used as an at-
tachment point. If the round window vibroplasty was employed,
then there was either (1) fascia interposed and fascial covering
FMT or (2) direct coupling with no fascia interposed but fascial
covering. In cases of direct coupling, FMT contact was further
delineated by either complete or partial contact. See Figure 1.
Four subjects had fascia interposed between the FMT and
RW as per the method of Colletti et al. (5). These patients had a
size mismatch between the RWM and the FMT, and a ‘‘coupler’’
in the form of soft tissue was required to establish a connection
between the transducer and the membrane. For patients where
TABLE 1.
Subject characteristics, implanted ear pathology, surgical history pre-VSB surgery, and VSB surgical technique
employed; 1) fascial recess approach to round window (Fascial Rec) and 2) round window placement in modified radical cavities
(RW in MRC); age (yr), four-frequency average (4FAHL) of implanted ear; bone and air conduction
Subject
No.
Pathology
No. of Surgeries
pre-VSB
VSB Surgical
Technique
FMT
Coupling
Age,
yr
Bone Conduction
4FAHL
Air Conduction
4FAHL
1
CSOM
4
RW in MRC Direct
Partial
61
10
41
2
Otosclerosis
1
Fascial Rec
Fascia
53
38
101
3
CSOM
4
RW in MRC Direct
Partial
57
29
68
4
CSOM
2
RW in MRC Fascia
28
23
70
5
CSOM + otosclerosis
4
RW in MRC Direct
Complete
47
20
51
6
CSOM
2
RW in MRC Fascia
73
21
78
7
CSOM
2
RW in MRC Direct
Partial
53
18
58
8
CSOM
3
RW in MRC Fascia
79
40
91
9
Otitis externa
1
Post crus of
stapes
Stapes
60
16.3
22
10
CSOM
1
Post crus of
stapes
Stapes
19
33
85
11 CSOM and congenital abnormality 0
Post crus of
stapes
Stapes
31
28.8
37.5
12
Otitis externa
1
Long process
of incus
Incus
60
15
27.5
13
CSOM
1
Post crus of
stapes
Stapes
74
21.3
80
14
CSOM
2
Post crus of
stapes
Stapes
64
20
26
15 External auditory meatus
V
non-healing
post-carcinoma removal
2
Post crus of
stapes
Stapes
78
45
60
16
CSOM
1
RW in MRC Partial
63
36.3
70
CSOM indicates chronic suppurative otitis media.
FIG. 1.
Diagrammatic representation of FMT positioning.
A
, incus placement.
B
, stapes placement
V
posterior crus.
C
, RW-FMT with
interposed fascia.
D
, RW-FMT with no interposed fascia.
DOES COUPLING & POSITIONING IN VIBROPLASTY MATTER?
Otology & Neurotology, Vol. 36, No. 7, 2015
135