An alternative approach to mixed hearing loss in otosclerosis: stapes surgery combined with an active middle-ear implant

To report a novel management strategy for mixed hearing lossin advanced otosclerosis.A 50-year-old male was referred to St Thomas' Hearing Implant Centre with otosclerosis; he was no longer able to wear conventional hearing aids because of recurrent otitis externa. The patient underwent short process incusvibroplasty (using the Med-El Vibrant Soundbridge device), followed at a suitable interval (six weeks) by stapessurgery. The main outcome measures were: pure tone audiometry, functional gain and monosyllabic word recognitionscores.Post-operative pure tone audiometryshowed a reduction of the mean air-bone gap from 55 dB HL to 20 dB HL. The residual mixed hearing losswas rehabilitated with the Vibrant Soundbridge, with an average device gain of 32 dB. The monosyllabic word recognitionscores in quiet at 65 dB improved from 37 to 100 per cent when using the Vibrant Soundbridge at six months after switch-on of the device.Stapedotomy in conjunction with incusshort process vibroplasty (i.e. inner-ear vibroplasty) is a safe and promising procedure for managing advanced otosclerosiswith mixed hearing lossin selected patients.