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Background:  Active middle ear implants such as the vibrant sound bridge (VSB) have been placed on the round window (RW) in patients with conductive or mixed hearing loss, with satisfactory hearing results. Several observations show that the mechanism of RW stimulation is not completely understood. The purpose of the present study was to compare different coupling procedures between the transducer and the RW in order to contribute to an understanding of the mechanism of RW stimulation.

The mechanism of direct stimulation of the cochlea by vibrating the round window