Auditory and Tinnitus Outcomes of Vibrant Soundbridge Implantation with the Incus Short Process Coupler in Older Male...

Background: Active middle ear implants (AMEIs) provide an alternative auditory rehabilitation strategy for patients who cannot tolerate conventional hearing aids. However, clinical data regarding the outcomes of Vibrant Soundbridge (VSB) implantation using the incus short process (SP) coupler in older adults remain limited. Objective: This study aimed to evaluate the audiological outcomes, patient-reported hearing benefits, tinnitus improvement, and surgical safety of VSB implantation using the SP coupler in older adults with bilateral sloping sensorineural hearing loss. Methods: This retrospective study included 45 older male veterans (mean age 76.1 ± 5.3 years) with bilateral sloping sensorineural hearing loss who underwent unilateral VSB implantation with the SP coupler between 2019 and 2023. Functional hearing gain was assessed using preoperative and postoperative sound-field pure-tone thresholds. Patient-reported outcomes were evaluated using the Speech, Spatial and Qualities of Hearing Scale (SSQ) and the Tinnitus Handicap Inventory (THI). Operative characteristics and postoperative complications were also analyzed. Results: Mean operative time was 40.2 ± 8.7 min. Functional hearing gain increased progressively across speech-critical frequencies, reaching +20 dB at 2 kHz and +30 dB at 4 kHz. The mean four-frequency pure tone average improved from 57.4 ± 8.3 dB HL preoperatively to 35.6 ± 6.9 dB HL postoperatively (p < 0.001). All SSQ subdomains showed significant improvement (p < 0.001). THI scores decreased significantly from 43.2 ± 8.4 to 17.1 ± 6.2 (p < 0.0001), with clinically meaningful tinnitus improvement observed in 75.6% of patients. No major surgical complications occurred. Conclusions: Vibrant Soundbridge implantation using the incus short process coupler provides effective auditory rehabilitation for older adults with sloping sensorineural hearing loss. The procedure yields meaningful high-frequency hearing gain, improved hearing-related quality of life, and significant tinnitus reduction while maintaining a favorable surgical safety profile. Restoration of auditory input through active middle ear implantation may also contribute to improved central auditory processing in older adults.