OBJECTIVE: Surgery can often eradicate chronic middle ear disease in patients with recurrent cholesteatoma, tubal dysfunction, and others; however, in many cases, social hearing cannot be restored even after multiple revision tympanoplasties. A hearing aid is then recommended. Placement of an implantable hearing aid with its advantage of an unoccluded ear canal, irrespective of middle ear function, seems to be a promising alternative.

STUDY DESIGN: After establishing the biomechanics of the ear in our temporal bone laboratory, various locations and attachments of a Vibrant transducer were investigated. These experiments resulted in the development of a new titanium clip holder for a Vibrant integrated total ossicular replacement prosthesis assembly with placement on the footplate. Four patients with permanent severe combined hearing loss were implanted with this device after multiple revision tympanoplasties. The first case is described in detail.

RESULTS: Placing a transducer directly on the footplate via a rod transmission gave a better gain for the high frequencies than in the round window location. The acoustic results of the patients showed an improved gain in speech understanding, unobtainable by a conventional hearing aid.

CONCLUSION: The concept of a total ossicular replacement prosthesis-vibroplasty establishes a straightforward procedure in the tympanic cavity similar to a normal tympanoplasty. The open ear canal and its superior acoustic performance offer a promising perspective for revision operations in cases of incurable middle ear dysfunction.