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Santopietro G, Fancello V, Fancello G, Bianchini C, Pelucchi S, Ciorba A. Cochlear Implantation in Children Affected by Single-Sided Deafness: A Comprehensive Review. Audiol Res 2024; 14:77-85. [PMID: 38247563 PMCID: PMC10801602 DOI: 10.3390/audiolres14010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/17/2023] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
Children with single-sided deafness (SSD) may experience delays in language and speech development. Reduced speech discrimination and poor sound localization abilities in young SSD patients may result in greater cognitive efforts required to focus and process auditory information, as well as increased listening-related fatigue. Consequently, these children can have a higher risk of academic failure and are often in need of extra help at school. Recently, cochlear implants (CIs) have been introduced as a rehabilitative option for these children, but their effectiveness is still a topic of debate. A literature review was performed according to PRISMA guidelines, searching the Medline database from inception to October 2023. The research identified nine papers that met the inclusion criteria. Data extracted from the selected studies included 311 children affected by SSD and cochlear implants. The reported audiological outcomes were further analyzed. Overall, a high level of satisfaction was described by parents of children with SSD and CI, and those who received a CI under the age of 3 presented better results. However, a proportion of patients did not use the device daily. Our review highlights the possible, and still controversial, role of CI for the hearing rehabilitation of children with unilateral deafness, underlining the need for further research in this field. To date, careful and comprehensive counseling with the child and the family is necessary before considering this option.
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Affiliation(s)
- Giuseppe Santopietro
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44121 Ferrara, Italy
| | - Virginia Fancello
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44121 Ferrara, Italy
| | - Giuseppe Fancello
- Department of Otorhinolaryngology, Careggi University Hospital, 50134 Florence, Italy
| | - Chiara Bianchini
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44121 Ferrara, Italy
| | - Stefano Pelucchi
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44121 Ferrara, Italy
| | - Andrea Ciorba
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44121 Ferrara, Italy
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Morelli L, Fancello V, Gaino F, Cagliero G, Caruso A, Sanna M. Cochlear implantation in single-sided deafness: a single-center experience of 138 cases. Eur Arch Otorhinolaryngol 2023; 280:4427-4432. [PMID: 37029803 DOI: 10.1007/s00405-023-07959-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/31/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVES Assess the outcomes in patients who underwent cochlear implant (CI) for single-sided deafness (SSD). METHODS All patients affected by SSD who underwent CI at Gruppo Otologico, Piacenza, from October 2012 to May 2022 with at least 6 months of follow-up were selected in the study group. The analysis included subjective and objective measures performed pre-operative and up to 24 months after surgery. Hearing threshold on both sides was evaluated with a weighted four-frequency average (PTA [0.5 kHz + 1 kHz + 2 kHz + 4 kHz]/4) on pure tone audiometry and speech audiometry (Speech Discrimination Score, SDS). The Speech Spatial and Qualities of Hearing scale (SSQ Questionnaire) for binaural hearing benefits and sound localization, the Tinnitus Handicap Inventory Questionnaire (THI) and Dizziness Handicap Inventory Questionnaire (DHI) were used for subjective assessment. RESULTS Data from 138 patients, 69 males and 69 females, (mean age 49 years, range 17-77 years) underwent CI for SSD were examined. Single-sided hearing deprivation average before undergoing CI surgery was 2.5 years (range 3 months-35 years). There was a significant reduction of THI and DHI scores compared to pre-operative scores alongside a referred improvement in social, physical, and emotional well-being through the SSQ questionnaire. CONCLUSIONS To the best of our knowledge, this paper descried the largest cohort of SSD who underwent CI in a single institution. According to our findings CI in patients affected by SSD represents a valuable tool for an overall improvement of tinnitus and dizziness but also quality of life, after at least 6 months of follow-up. Further studies are desirable to improve rehabilitation pathways and possibly set new standards of care of this condition.
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Affiliation(s)
- L Morelli
- Department of Neurotology and Skull Base Surgery, Gruppo Otologico, Piacenza-Rome, Italy
- Audiology Unit, Department of Clinical Sciences and Community Health, State University of Milano and Department of Specialistic Surgical Sciences, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Virginia Fancello
- Department of Neurotology and Skull Base Surgery, Gruppo Otologico, Piacenza-Rome, Italy.
- ENT and Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44121, Ferrara, Italy.
| | - F Gaino
- Department of Neurotology and Skull Base Surgery, Gruppo Otologico, Piacenza-Rome, Italy
- Department of Otorhinolaryngology, Head and Neck Surgery, IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Milan, Rozzano, Italy
| | - G Cagliero
- Department of Neurotology and Skull Base Surgery, Gruppo Otologico, Piacenza-Rome, Italy
| | - A Caruso
- Department of Neurotology and Skull Base Surgery, Gruppo Otologico, Piacenza-Rome, Italy
| | - M Sanna
- Department of Neurotology and Skull Base Surgery, Gruppo Otologico, Piacenza-Rome, Italy
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Strijbos RM, Straatman LV, Stegeman I, Holmberg M, Johansson ML, Stokroos RJ. Health Economic Cost Analysis for Percutaneous Bone Conduction Devices: The Minimally Invasive Ponto Surgery Versus Linear Incision Technique with Tissue Preservation. Otol Neurotol 2023:00129492-990000000-00325. [PMID: 37400140 DOI: 10.1097/mao.0000000000003939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
OBJECTIVES To identify differences in mean cost per patient between the Minimally Invasive Ponto Surgery (MIPS) and the linear incision technique with tissue preservation (LITT-P). STUDY DESIGN Health economic cost analysis. SETTING The analysis was performed in a randomized multicenter controlled trial cohort. PATIENTS Adult patients eligible for unilateral bone conduction device surgery. INTERVENTIONS MIPS versus LITT-P surgery for bone conduction device implantation. MAIN OUTCOME MEASURES Perioperative and postoperative costs were identified and compared. RESULTS The difference in mean cost per patient between both techniques was €77.83 in favor of the MIPS after 22 months follow-up. The mean costs per patient were lower in the MIPS cohort for surgery (€145.68), outpatient visits (€24.27), systemic antibiotic therapy with amoxicillin/clavulanic acid (€0.30) or clindamycin (€0.40), abutment change (€0.36), and abutment removal (€0.18). The mean costs per patient were higher for implant and abutment set (€18.00), topical treatment with hydrocortison/oxytetracycline/polymyxine B (€0.43), systemic therapy with azithromycin (€0.09) or erythromycin (€1.15), local revision surgery (€1.45), elective explantation (€1.82), and implant extrusion (€70.42). Additional analysis of scenarios in which all patients were operated under general or local anesthesia or with recalculation when using current implant survival rates showed that differences in mean cost per patient were also in favor of the MIPS. CONCLUSION The difference between the MIPS and the LITT-P in mean cost per patient was €77.83 in favor of the MIPS after 22 months of follow-up. The MIPS is an economically responsible technique and could be promising for the future.
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Kara A, Kalcioglu MT, Adigul Ç, Topcu MT, Koçoğlu M, Celik B, Yilmaz MS. Comparison of two different bone anchored hearing instruments. Eur Arch Otorhinolaryngol 2022; 280:2141-2147. [PMID: 36214870 DOI: 10.1007/s00405-022-07675-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/22/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To compare the audiological performances of Turkey's most up-to-date bone conduction implant processors. METHODS Twenty-six bone-anchored hearing instrument users, thirteen in each group, were evaluated for speech understanding in quiet and several signal-to-noise ratios. RESULTS We noticed the differences at 0.5 and 1 kHz measurements in free field frequency specific test, aided SRT scores, non-adaptive and adaptive matrix test results for a few conditions created a statistically significant difference in favor of Baha-6®. CONCLUSIONS Both processors offer positive gains to their users in noisy and silent conditions. However, the data showed statistically significant differences for some measurements that may be critical for patients in daily practice.
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Affiliation(s)
- Ahmet Kara
- Department of Otorhinolaryngology, Faculty of Medicine, Sakarya University, Korucuk, 54000, Sakarya, Turkey.
| | - Mahmut Tayyar Kalcioglu
- Department of Otorhinolaryngology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Çağlayan Adigul
- Department of Otorhinolaryngology, Faculty of Medicine, Sakarya University, Korucuk, 54000, Sakarya, Turkey
| | - Merve Torun Topcu
- Department of Audiology, Faculty of Health Sciences, Istanbul Medeniyet University, Istanbul, Turkey
| | - Mehmet Koçoğlu
- Department of Otorhinolaryngology, Faculty of Medicine, Sakarya University, Korucuk, 54000, Sakarya, Turkey
| | - Bilgehan Celik
- Department of Otorhinolaryngology, Faculty of Medicine, Sakarya University, Korucuk, 54000, Sakarya, Turkey
| | - Mahmut Sinan Yilmaz
- Department of Otorhinolaryngology, Faculty of Medicine, Sakarya University, Korucuk, 54000, Sakarya, Turkey
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The Oticon Ponto System in Adults With Severe-to-Profound and Mixed Hearing Loss: Audiologic Outcomes and Patient Satisfaction. Otol Neurotol 2022; 43:987-994. [PMID: 36040042 PMCID: PMC9477862 DOI: 10.1097/mao.0000000000003664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To measure audiologic outcomes and self-assessed satisfaction with the Ponto system in a group of patients who had severe to profound and mixed hearing loss. STUDY DESIGN Retrospective case review. SETTING Tertiary referral center. PATIENTS Sixteen patients aged 21 to 74 years with severe-to-profound and mixed hearing loss (bone conduction thresholds, ≥45 dB HL). INTERVENTIONS Ponto implant surgery. MAIN OUTCOME MEASURES Pure-tone audiometry, free-field hearing thresholds, effective gain, word recognition score in quiet, and speech reception threshold (SRT) in noise were assessed. Patient-reported outcomes were collected using the Clinical Global Impression Scale, Glasgow Benefit Inventory, and Abbreviated Profile of Hearing Aid Benefit. Information concerning any medical complications was also gathered. RESULTS Both word recognition score and SRT were significantly better after 12 months compared with before surgery. At normal speech level (65 dB SPL), 12 of 16 users had speech discrimination ≥70%. However, at the 12-month follow-up, the average effective gain was -6.2 dB. In general, the self-report outcomes showed good satisfaction in most patients. Postoperatively, skin complications were noted in six patients, of whom two underwent reoperation. All patients were still using the Ponto after an average observation time of 2.7 years. CONCLUSION Although skin complications were not uncommon, the Ponto system seems to be an effective method of improving hearing performance and provides subjective satisfaction in real-life situations in patients with severe-to-profound and mixed hearing loss. However, considering the significantly increased bone conduction thresholds and the risk of their further deterioration, long-term follow-up is still needed.
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Topcu MT, Mutlu B, Celik S, Celikgun B, Mutlu A, Kalcioglu MT. Bone-Anchored Hearing Implants: Surgical and Audiological Comparison of Different Surgical Techniques. Int Arch Otorhinolaryngol 2022; 26:e649-e656. [DOI: 10.1055/s-0042-1742765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 12/02/2021] [Indexed: 10/18/2022] Open
Abstract
Abstract
Introduction The bone-anchored hearing implant system (BAHS) is an effective amplification system that transmits the sounds received by an external operating system to the inner ear by bypassing the middle ear placed in the temporal bone.
Objective This study compares the results of patients who underwent bone-anchored hearing implant system (BAHS) surgery using two different surgical methods in terms of preoperative and postoperative complications, surgical time, audiological findings, and patient satisfaction.
Methods The results of 22 patients who underwent BAHS were evaluated retrospectively from video records and audiological results, The Turkish Version of the Glasgow Benefit Inventory (GBI) questionnaire were evaluated. Two different surgical approaches were used for implantation: the linear incision technique (n = 9) and the punch technique (n = 13).
Results Mean surgical durations were 9.67 ± 2.85 and 47.65 ± 6.13 minutes for Groups A and B, respectively, and these were significantly different (p < 0.001). There were no significant differences between the groups' speech recognition scores for a signal-to-noise ratio (SNR) of +5 (p = 0.173), SNR of 0 (p = 0.315), or SNR of -5 (p = 0.360) and results of the GBI scores.
Conclusion The punch technique has a significant advantage due to a shorter surgery duration without increased surgical complications. Additionally, the punch technique showed no significant difference in hearing performance or satisfaction compared with linear incision.
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Affiliation(s)
- Merve Torun Topcu
- Department of Audiology, Istanbul Medeniyet University, School of Health Sciences, Istanbul, Turkey
| | - Basak Mutlu
- Department of Audiology, Istanbul Medeniyet University, School of Health Sciences, Istanbul, Turkey
| | - Serdal Celik
- Department of Otorhinolaryngology, Istanbul Medeniyet University School of Medicine, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Bahtiyar Celikgun
- Marmara University, Health Sciences Institutes, Audiology Program, Istanbul, Turkey
| | - Ahmet Mutlu
- Department of Otorhinolaryngology, Istanbul Medeniyet University School of Medicine, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - M. Tayyar Kalcioglu
- Department of Otorhinolaryngology, Istanbul Medeniyet University School of Medicine, Goztepe Training and Research Hospital, Istanbul, Turkey
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Economic Evaluation of Percutaneous Titanium Implants for Bone Conduction Hearing: A Cost-benefit Analysis. Otol Neurotol 2021; 41:580-588. [PMID: 31977762 DOI: 10.1097/mao.0000000000002616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Developments in bone-anchored hearing implants have resulted in fewer complications, and, thus, lower complication-related costs. However, a weighing of the potential clinical benefits with higher implant purchase price is lacking. METHODS A mathematical Markov model was used to evaluate the total costs (complication costs, implant purchase price, and standard costs) of three widely used current generation implants with expected similar outcomes, compared to a previous generation implant in adult patients over a 10-year time horizon from a healthcare perspective. Parameter estimates were derived from published clinical literature. Missing parameter estimates were based on expert opinion. Implant costs were derived from manufacturer catalogues, while standard and complication costs related to the BAHI were derived from a Dutch University Hospital and Dutch guideline for cost-effectiveness research. RESULTS The average total costs of the treatment with a previous generation implant was &OV0556;4.967 (SD ± &OV0556;134) per patient over a 10-year time horizon, compared to &OV0556;4.678 (SD ± &OV0556;83) with a current generation implant. This implant type is potentially up to &OV0556;506 more beneficial per patient over a 10-year horizon. By further improving implant survival, an additional &OV0556;645 (SD ± &OV0556;86) per patient could be saved over 10 years. CONCLUSION Despite a higher initial purchase price, the current generation implants are potentially cost-beneficial compared with previous generation implants. More data on current generation implants is needed to be able to determine which of the newer implants is most cost-beneficial. Focussing future developments on improving implant survival is likely to have more impact on costs compared with developments on improving soft tissue tolerability.
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Johansson ML, Calon TGA, Omar O, Shah FA, Trobos M, Thomsen P, Stokroos RJ, Palmquist A. Multimodal Analysis of the Tissue Response to a Bone-Anchored Hearing Implant: Presentation of a Two-Year Case Report of a Patient With Recurrent Pain, Inflammation, and Infection, Including a Systematic Literature Review. Front Cell Infect Microbiol 2021; 11:640899. [PMID: 33859952 PMCID: PMC8042154 DOI: 10.3389/fcimb.2021.640899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 03/03/2021] [Indexed: 12/04/2022] Open
Abstract
Osseointegration is a well-established concept used in applications including the percutaneous Bone-Anchored Hearing System (BAHS) and auricular rehabilitation. To date, few retrieved implants have been described. A systematic review including cases where percutaneous bone-anchored implants inserted in the temporal bone were retrieved and analyzed was performed. We also present the case of a patient who received a BAHS for mixed hearing loss. After the initial surgery, several episodes of soft tissue inflammation accompanied by pain were observed, leading to elective abutment removal 14 months post-surgery. Two years post-implantation, the implant was removed due to pain and subjected to a multiscale and multimodal analysis: microbial DNA using molecular fingerprinting, gene expression using quantitative real-time polymerase chain reaction (qPCR), X-ray microcomputed tomography (micro-CT), histology, histomorphometry, backscattered scanning electron microscopy (BSE-SEM), Raman spectroscopy, and fluorescence in situ hybridization (FISH). Evidence of osseointegration was provided via micro-CT, histology, BSE-SEM, and Raman spectroscopy. Polymicrobial colonization in the periabutment area and on the implant, including that with Staphylococcus aureus and Staphylococcus epidermidis, was determined using a molecular analysis via a 16S-23S rDNA interspace [IS]-region-based profiling method (IS-Pro). The histology suggested bacterial colonization in the skin and in the peri-implant bone. FISH confirmed the localization of S. aureus and coagulase-negative staphylococci in the skin. Ten articles (54 implants, 47 patients) met the inclusion criteria for the literature search. The analyzed samples were either BAHS (35 implants) or bone-anchored aural epitheses (19 implants) in situ between 2 weeks and 8 years. The main reasons for elective removal were nonuse/changes in treatment, pain, or skin reactions. Most samples were evaluated using histology, demonstrating osseointegration, but with the absence of bone under the implants’ proximal flange. Taken together, the literature and this case report show clear evidence of osseointegration, despite prominent complications. Nevertheless, despite implant osseointegration, chronic pain related to the BAHS may be associated with a chronic bacterial infection and raised inflammatory response in the absence of macroscopic signs of infection. It is suggested that a multimodal analysis of peri-implant health provides possibilities for device improvements and to guide diagnostic and therapeutic strategies to alleviate the impact of complications.
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Affiliation(s)
- Martin L Johansson
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Research and Technology, Oticon Medical AB, Askim, Sweden
| | - Tim G A Calon
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Omar Omar
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Furqan A Shah
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Margarita Trobos
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Peter Thomsen
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Robert J Stokroos
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands.,Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Anders Palmquist
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Strijbos RM, Straatman LV, Calon TGA, Johansson ML, de Bruijn AJG, van den Berge H, Wagenaar M, Eichhorn E, Janssen M, Jonhede S, van Tongeren J, Holmberg M, Stokroos R. Long-Term Outcomes of the Minimally Invasive Ponto Surgery vs. Linear Incision Technique With Soft Tissue Preservation for Installation of Percutaneous Bone Conduction Devices. Front Neurol 2021; 12:632987. [PMID: 33716934 PMCID: PMC7945693 DOI: 10.3389/fneur.2021.632987] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/19/2021] [Indexed: 12/19/2022] Open
Abstract
Objective: Comparing the surgical outcomes of the Minimally Invasive Ponto Surgery (MIPS) technique with the linear incision technique with soft tissue preservation (LITT-P) for bone conduction devices after a follow-up of 22 months. Methods: In this multicenter randomized controlled trial, there was the inclusion of 64 adult patients eligible for unilateral surgery. There was 1:1 randomization to the MIPS (test) or the LITT-P (control) group. The primary outcome was an (adverse) soft tissue reaction. Secondary outcomes were pain, loss of sensibility, soft tissue height/overgrowth, skin sagging, implant loss, Implant Stability Quotient measurements, cosmetic scores, and quality of life questionnaires. Results: Sixty-three subjects were analyzed in the intention-to-treat population. No differences were found in the presence of (adverse) soft tissue reactions during complete follow-up. Also, there were no differences in pain, wound dehiscence, skin level, soft tissue overgrowth, and overall quality of life. Loss of sensibility (until 3-month post-surgery), cosmetic scores, and skin sagging outcomes were better in the MIPS group. The Implant Stability Quotient was higher after the LITT-P for different abutment lengths at various points of follow-up. Implant extrusion was nonsignificantly higher after the MIPS (15.2%) compared with LITT-P (3.3%). Conclusion: The long-term results show favorable outcomes for both techniques. The MIPS is a promising technique with some benefits over the LITT-P. Concerns regarding nonsignificantly higher implant loss may be overcome with future developments and research. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT02438618.
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Affiliation(s)
- Ruben M Strijbos
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Centre Utrecht, Utrecht, Netherlands.,University Medical Centre Utrecht Brain Centre, University of Utrecht, Utrecht, Netherlands
| | - Louise V Straatman
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Centre Utrecht, Utrecht, Netherlands.,University Medical Centre Utrecht Brain Centre, University of Utrecht, Utrecht, Netherlands
| | - Tim G A Calon
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Centre Utrecht, Utrecht, Netherlands.,University Medical Centre Utrecht Brain Centre, University of Utrecht, Utrecht, Netherlands
| | - Martin L Johansson
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Oticon Medical AB, Askim, Sweden
| | | | - Herbert van den Berge
- Department of Otorhinolaryngology, Medisch Centrum Leeuwarden, Leeuwarden, Netherlands
| | - Mariette Wagenaar
- Department of Otorhinolaryngology, Medisch Centrum Leeuwarden, Leeuwarden, Netherlands
| | - Edwin Eichhorn
- Department of Otorhinolaryngology, Medisch Centrum Leeuwarden, Leeuwarden, Netherlands
| | - Miranda Janssen
- Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, Netherlands.,Department of Methodology and Statistics, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | | | - Joost van Tongeren
- Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | | | - Robert Stokroos
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Centre Utrecht, Utrecht, Netherlands.,University Medical Centre Utrecht Brain Centre, University of Utrecht, Utrecht, Netherlands
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10
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Kellermeyer B, Lange L, Wazen JJ. Post-operative infection rates in linear vs. punch technique for bone anchored hearing systems. Am J Otolaryngol 2020; 41:102745. [PMID: 33198052 DOI: 10.1016/j.amjoto.2020.102745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 09/12/2020] [Indexed: 11/15/2022]
Abstract
PURPOSE This study investigates the post-operative infection rates between two surgical approaches: linear incision and the punch technique for bone anchored hearing systems. Secondarily, it investigates the impact of smoking, comorbid disease, and operative conditions on post-operative skin reactions and infections. METHODS A retrospective study was conducted at a single tertiary care institution. A single surgeon completed either of the two techniques on adult patients with mixed, conductive hearing loss, or single sided-deafness. Patients included had at least 6 months follow-up, and were evaluated for preexisting illnesses, perioperative complications, length of surgery, and post-operative complications including infection after surgery. Post-operative soft tissue around the abutment was assessed with Holgers Classification scale. RESULTS Fifty-one patients were included in this study, 28 female and 23 males with an average age of 68.8. Thirty-three patients underwent linear incision surgery and 18 had the punch technique. Overall 9 patients (17.6%) had post-operative infections requiring topical or oral antibiotic treatment. Six (18.2%) were in the linear group and 3 (16.7%) in the punch group. There was no statistically significantly difference (p = 1). A multivariate analysis compared age, sex, obesity, DM, operative time, skin thickness, and abutment size to post-operative skin infection rates requiring treatment. Only DM was statistically correlative with infection (p = 0.02). CONCLUSION No significant differences in post-operative infections were identified comparing linear incision and the punch techniques. Patients with diabetes had a higher incidence of post-operative skin infections rates.
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Affiliation(s)
- Brian Kellermeyer
- Ear Research Foundation, 1901 Floyd Street, Sarasota, FL 34239, United States of America.
| | - Linda Lange
- Ear Research Foundation, 1901 Floyd Street, Sarasota, FL 34239, United States of America
| | - Jack J Wazen
- Ear Research Foundation, 1901 Floyd Street, Sarasota, FL 34239, United States of America
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Lagerkvist H, Carvalho K, Holmberg M, Petersson U, Cremers C, Hultcrantz M. Ten years of experience with the Ponto bone-anchored hearing system-A systematic literature review. Clin Otolaryngol 2020; 45:667-680. [PMID: 32386454 PMCID: PMC7496709 DOI: 10.1111/coa.13556] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/18/2020] [Indexed: 12/17/2022]
Abstract
Background Bone‐anchored hearing systems (BAHSs) are widely used for hearing rehabilitation and are indicated in cases of conductive and mixed hearing loss and in single‐sided deafness. The Ponto system, that is one available option, has been on the market since 2009. Objective of review The aim of this study is to systematically review the literature reporting on the Ponto system, with regard to audiological and surgical outcomes and patient's quality‐of‐life scores. Type of review A systematic literature search was performed in the PubMed database 2009‐July 2019. Search strategy Search term: ((osseointegrated hearing aid) OR (bone conduction implant) OR (bone anchored hearing) OR BAHA OR BAHS OR BAHI). Pre‐defined inclusion and exclusion criteria were applied. Evaluation method English‐language articles reporting original clinical data (audiological, surgical or quality‐of‐life outcomes) on the Ponto system were included. Articles reporting on Ponto and another BAHS system where the results on Ponto constituted less than 50% of the patient population or including only results on testband or softband devices were excluded. Results Audiological outcomes were discussed in 20 publications. Improvement against the unaided thresholds was demonstrated. The functional improvement was on average 33.9 dB. The effective gain or remaining air‐bone gap was on average 6.7 dB. All evaluated data showed aided speech reception thresholds significantly below normal speech level. Twenty‐seven publications reported surgical and follow‐up data for the Ponto system. Implant survival was 97.7%, adverse skin reactions (Holgers ≥ 2) were 5% across visits and 15% across patients. No complications were life‐threatening, causing permanent disability/damage or requiring a hospitalisation. Five studies reported quality of life using the Glasgow benefit inventory, 98% reported an improvement when analysing the score on an individual level. Conclusions The outcomes of this systematic review confirm that percutaneous systems provide consistent audiological benefits and improved quality of life for patients. Further, the review demonstrates that the percutaneous systems are safe, with relatively low complication rates. Skin‐related complications are the most common complication type and are experienced by approximately one patient out of seven, or in less than one of 20 follow‐up visits.
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Affiliation(s)
| | | | | | | | - Cor Cremers
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
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Minimal invasive pocket technique for magnet bone implant hearing aid without fixation. Eur Arch Otorhinolaryngol 2019; 277:715-725. [PMID: 31811384 PMCID: PMC7031225 DOI: 10.1007/s00405-019-05746-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 11/27/2019] [Indexed: 11/11/2022]
Abstract
Introduction The BAHA (bone-anchored hearing aid) Attract is a magnetic transcutaneous bone conduction device anchored into the temporal bone. The standard surgical technique for BAHA Attract is a multi-tools time-consuming process, which requires a large cutaneous incision. The objective of this study is to describe and test the feasibility of a minimally invasive pocket (MIP) technique for Magnet Bone Implant Hearing Aid (MBIHA) with a modified magnet of BAHA Attract without fixation and without any tissue reduction. We use a 3-cm vertical skin incision and a subperiosteal pocket. Method A study of 10 patients with conductive or mixed hearing loss who benefited from a MBIHA using the MIP technique is presented. The pure tone average (PTA) (dB) for air-conduction thresholds and the speech recognition threshold (SRT) (dB) in speech audiometry in quiet are calculated. The Entific Medical Systems (EMS) questionnaire and the postoperative clinical outcomes are realized. Results We found a significant improvement of 33.8 dB on average for the PTA and 44.8 dB for the SRT with MBIHA at 3 months, compared with unaided situation. No implant was removed or displaced after 2 years of follow-up. The skin condition remains intact in all the cases. Conclusion The minimally subperiosteal pocket surgical technique MIP without fixation and with tissue preservation for the MBIHA is safe, rapid and effective for patients with conductive or mixed hearing loss. It opens new perspectives of development and modify conventional concept in magnetic coupling of bone-conducted device. Electronic supplementary material The online version of this article (10.1007/s00405-019-05746-5) contains supplementary material, which is available to authorized users.
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Kara A, Guven M, Sinan Yilmaz M, Demir D, Adigul Ç, Durgut M, Elden H, Mutlu F, İseri M. Comparison of two different bone anchored hearing instruments: Baha-5 vs Ponto-plus. Acta Otolaryngol 2019; 139:517-521. [PMID: 30957608 DOI: 10.1080/00016489.2019.1590637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND To our knowledge, there is no study comparing Ponto Plus® (Oticon Medical AB, Askim, Sweden) and Baha® 5 (Cochlear Bone Anchored Solutions AG, Mölnlycke, Sweden) available in the literature. AIMS/OBJECTIVES The primary aim was to compare the performance of the Baha 5 with the Ponto Plus device in terms of speech understanding in quiet and in noise. In addition, to determine statistically whether or not the difference between the abutment systems created any variation in terms of skin reaction. MATERIALS AND METHODS Twenty bone-anchored hearing instrument users, ten in each group, were evaluated for speech understanding in quiet and several signal-to-noise ratios using the Turkish Matrix Test in a two-speaker setup. The Holger classifications were also reviewed to determine adverse skin reactions. RESULTS It was revealed that the hearing results of both devices were similar and, when the skin reactions were compared, there was no statistically significant difference between the two-implant systems. CONCLUSIONS AND SIGNIFICANCE Because of the similar results of the groups, it can be interpreted as the key different device features such as the size, weight, colour alternatives, and the ease of use of the devices might be important in terms of device preference.
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Affiliation(s)
- Ahmet Kara
- Department of Otorhinolaryngology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Mehmet Guven
- Department of Otorhinolaryngology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Mahmut Sinan Yilmaz
- Department of Otorhinolaryngology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Deniz Demir
- Department of Otorhinolaryngology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Çağlayan Adigul
- Department of Otorhinolaryngology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Merve Durgut
- Department of Otorhinolaryngology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Halil Elden
- Department of Otorhinolaryngology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Fatih Mutlu
- Department of Otorhinolaryngology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Mete İseri
- Department of Otorhinolaryngology, Kocaeli Medical Park Hospital, Kocaeli, Turkey
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DI Giustino F, Vannucchi P, Pecci R, Mengucci A, Santimone R, Giannoni B. Bone-anchored hearing implant surgery: our experience with linear incision and punch techniques. ACTA ACUST UNITED AC 2019; 38:257-263. [PMID: 29984803 DOI: 10.14639/0392-100x-1694] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 12/12/2017] [Indexed: 11/23/2022]
Abstract
SUMMARY In recent years, bone-anchored hearing implants (BAHIs) have found wider application in the treatment of conductive and mixed hearing loss. Several surgical techniques have been developed to reduce complications, enhance healing and improve audiological and aesthetic results. We report our experience on the use of three BAHI surgery techniques: Group 1, linear incision with thinning of the subcutaneous tissue; Group 2, linear incision without thinning of the subcutaneous tissue; Group 3, punch technique (Minimally Invasive Ponto Surgery, MIPS). We retrospectively analysed patients undergoing BAHI surgery; results were evaluated on the basis of any intra-operative complication, duration of surgery and occurrence of adverse effects at the implantation site over 1 year of follow-up. We collected a total of 30 implantations (12 for Group 1, 8 for Group 2, 10 for Group 3) with an intra-operative complication rate of 25%, 0% and 10%, respectively. The average surgical time was 62.08 minutes, 34.37 minutes and 18.7 minutes respectively. During follow-up, we reported the occurrence of adverse effects in 10.63% of observations in Group 1, 3.12% in Group 2 and 2.5% in Group 3. This study confirms the low rate of intra and postoperative complications during BAHI surgery and documents the simplicity of execution of the novel MIPS technique, with a significant reduction in surgical time compared to the other two techniques, and positive effects in terms of health care costs.
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Affiliation(s)
- F DI Giustino
- Audiology Unit, AOU Careggi, Department of Surgery and Translational Medicine, University of Florence, Italy
| | - P Vannucchi
- Audiology Unit, AOU Careggi, Department of Surgery and Translational Medicine, University of Florence, Italy
| | - R Pecci
- Audiology Unit, AOU Careggi, Department of Surgery and Translational Medicine, University of Florence, Italy
| | - A Mengucci
- Audiology Unit, AOU Careggi, Department of Surgery and Translational Medicine, University of Florence, Italy
| | - R Santimone
- Audiology Unit, AOU Careggi, Department of Surgery and Translational Medicine, University of Florence, Italy
| | - B Giannoni
- Audiology Unit, AOU Careggi, Department of Surgery and Translational Medicine, University of Florence, Italy
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van der Stee EHH, Strijbos RM, Bom SJH, Hol MKS. Percutaneous bone-anchored hearing implant surgery: linear incision technique with tissue preservation versus linear incision technique with tissue reduction. Eur Arch Otorhinolaryngol 2018; 275:1737-1747. [PMID: 29846791 DOI: 10.1007/s00405-018-5005-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/16/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To identify differences in skin thickening and soft tissue reactions between the linear incision technique with tissue reduction (LITT-R) and the linear incision technique with tissue preservation (LITT-P). STUDY DESIGN Retrospective cohort study. METHODS All adult patients who underwent the LITT-R or LITT-P between August 2005 and December 2016 at a large general teaching hospital with a minimum follow-up of 6 months were included. RESULTS A total of 83 implants were included using the LITT-R with a median follow-up of 74.0 months. In the LITT-P cohort 58 implants were included with a median follow-up of 16.5 months. Skin thickening was seen in seven implants (8.4%) in LITT-R cohort and 11 implants (19.0%) in the LITT-P cohort in the first 2 years of follow-up (p = 0.024). Skin thickening in need of treatment was registered in 5 (6.0%), respectively, 6 (10.3%) implants (p = 0.100). Moreover, treatment was successful in all cases. A soft tissue reaction (Holgers ≥ 1) was noticed in 28 (33.7%) implants in the LITT-R group compared to 16 implants (27.6%) in the LITT-P group (p = 0.679). An adverse soft tissue reaction (Holgers ≥ 2) was registered in 16 (19.2%), respectively, 2 (3.4%) implants. This difference was significant (p = 0.040). CONCLUSION LITT-P has a significantly higher rate of skin thickening and LITT-R has a significantly higher proportion of adverse soft tissue reactions. Nevertheless, combined with the advantages of LITT-P described in other studies, this can be advocated as the preferred technique.
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Affiliation(s)
- E H H van der Stee
- Department of Otorhinolaryngology, Deventer Hospital, Nico Bolkesteinlaan 75, 7416 SE, Deventer, The Netherlands
| | - R M Strijbos
- Department of Otorhinolaryngology, Radboud University Medical Center, Philips van Leydenlaan 15, 6525 EX, Nijmegen, The Netherlands
| | - S J H Bom
- Department of Otorhinolaryngology, Deventer Hospital, Nico Bolkesteinlaan 75, 7416 SE, Deventer, The Netherlands.
| | - M K S Hol
- Department of Otorhinolaryngology, Radboud University Medical Center, Philips van Leydenlaan 15, 6525 EX, Nijmegen, The Netherlands
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