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Zammit M, Chandrasekar B, Sweed A, Attlmayr B. Beyond the surface: exploring contributing factors to bone anchored hearing implant complications. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08867-8. [PMID: 39126510 DOI: 10.1007/s00405-024-08867-8] [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: 05/30/2024] [Accepted: 07/22/2024] [Indexed: 08/12/2024]
Abstract
INTRODUCTION Bone anchored hearing implants (BAHI) are considered for conductive and mixed hearing loss, relying on osseointegration of a titanium implant. Limitations relate to constant skin contact, with resultant percutaneous infections and granulation. This study investigates whether patient characteristics and implant-specifications contribute to BAHIs' skin complications in a cohort with a uniform surgical approach. METHODS A 10 year (2014-2024) retrospective cohort study was conducted on BAHI procedures that were undertaken using a tissue-preserving 'punch' technique. Data on patient demographics, co-morbidities, implant type, surgical approach, and complications were collected. Poisson regression analysis was used to identify predictors of complications. RESULTS A total of 53 patients undergoing 55 BAHI surgeries by three ENT consultants were included. Factors that greatly increased implant-related percutaneous infections included the Cochlear™ BIA400 implant when compared to the Ponto™ BHX implant (twofold, CI 2.03-2.16), abutment sizes ≤ 10 mm (fourfold, CI 3.99-4.12) and male gender (9%, CI 1.07-1.12). Granulation episodes were affected by cardiovascular disease (CVD) status (1.5-fold, CI 0.26-0.78), BIA400 implant (threefold, CI 8.8.-9.2) and abutment sizes ≤ 10 mm (fourfold, CI 3.6-3.73). Revision surgery episodes increased with diabetic status (1.2-fold, CI 0.06-0.37) and abutment sizes ≤ 10 mm (threefold, 3.303-3.304). CONCLUSIONS Larger cohort studies are required to confirm findings, particularly for implant and abutment size contributions. However, the findings suggest that using a larger abutment size when skin thickness meassuremets are borderline, improved hygiene education in male patients, pre-operative optimisation of CVD and diabetes, and adjusted patient follow-up based on risk stratification of the contributing factors to complication rates could reduce complication rates.
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Affiliation(s)
- Matthew Zammit
- ENT Department, Leighton Hospital, Middlewich Road, Crewe, UK
| | | | - Ahmed Sweed
- ENT Department, Leighton Hospital, Middlewich Road, Crewe, UK
- ENT Department, Ain Shams University, Cairo, Egypt
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Jiam NT, Formeister EJ, Chari DA, David AP, Alsoudi AF, Purnell S, Jiradejvong P, Limb CJ. Music Perception in Bone-Anchored Hearing Implant Users. Laryngoscope 2024; 134:1381-1387. [PMID: 37665102 DOI: 10.1002/lary.30919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/12/2023] [Accepted: 07/14/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE Music is a highly complex acoustic stimulus in both spectral and temporal contents. Accurate representation and delivery of high-fidelity information are essential for music perception. However, it is unclear how well bone-anchored hearing implants (BAHIs) transmit music. The study objective is to establish music perception performance baselines for BAHI users and normal hearing (NH) listeners and compare outcomes between the cohorts. METHODS A case-controlled, cross-sectional study was conducted among 18 BAHI users and 11 NH controls. Music perception was assessed via performance on seven major musical element tasks: pitch discrimination, melodic contour identification, rhythmic clocking, basic tempo discrimination, timbre identification, polyphonic pitch detection, and harmonic chord discrimination. RESULTS BAHI users performed comparably well on all music perception tasks with their device compared with the unilateral condition with their better-hearing ear. BAHI performance was not statistically significantly different from NH listeners' performance. BAHI users performed just as well, if not better than NH listeners when using their control contralateral ear; there was no significant difference between the two groups except for the rhythmic timing (BAHI non-implanted ear 69% [95% CI: 62%-75%], NH 56% [95% CI: 49%-63%], p = 0.02), and basic tempo tasks (BAHI non-implanted ear 80% [95% CI: 65%-95%]; NH 75% [95% CI: 68%-82%, p = 0.03]). CONCLUSIONS This study represents the first comprehensive study of basic music perception performance in BAHI users. Our results demonstrate that BAHI users perform as well with their implanted ear as with their contralateral better-hearing ear and NH controls in the major elements of music perception. LEVEL OF EVIDENCE 3 Laryngoscope, 134:1381-1387, 2024.
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Affiliation(s)
- Nicole T Jiam
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Eric J Formeister
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Divya A Chari
- Department of Otolaryngology, University of Massachusetts School of Medicine, Worcester, Massachusetts, USA
| | - Abel P David
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Amer F Alsoudi
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Stephanie Purnell
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Patpong Jiradejvong
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Charles J Limb
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
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Aukema TW, Teunissen EM, Janssen AM, Hol MKS, Mylanus EAM. Post-implantation clinical cost analysis between transcutaneous and percutaneous bone conduction devices. Eur Arch Otorhinolaryngol 2024; 281:117-127. [PMID: 37421428 PMCID: PMC10764476 DOI: 10.1007/s00405-023-08099-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/27/2023] [Indexed: 07/10/2023]
Abstract
INTRODUCTION Bone conduction devices (BCD) are effective for hearing rehabilitation in patients with conductive and mixed hearing loss or single-sided deafness. Transcutaneous bone conduction devices (tBCD) seem to lead to fewer soft tissue complications than percutaneous BCDs (pBCD) but have other drawbacks such as MRI incompatibility and higher costs. Previous cost analyses have shown a cost advantage of tBCDs. The purpose of this study is to compare long-term post-implantations costs between percutaneous and transcutaneous BCDs. MATERIALS AND METHODS Retrospective data from 77 patients implanted in a tertiary referral centre with a pBCD (n = 34), tBCD (n = 43; passive (tpasBCD; n = 34) and active (tactBCD; n = 9) and a reference group who underwent cochlear implantation (CI; n = 34), were included in a clinical cost analysis. Post-implantation costs were determined as the sum of consultation (medical and audiological) and additional (all post-operative care) costs. Median (cumulative) costs per device incurred for the different cohorts were compared at 1, 3 and 5 years after implantation. RESULTS After 5 years, the total post-implantation costs of the pBCD vs tpasBCD were not significantly different (€1550.7 [IQR 1174.6-2797.4] vs €2266.9 [IQR 1314.1-3535.3], p = 0.185), nor was there a significant difference between pBCD vs tactBCD (€1550.7 [1174.6-2797.4] vs €1428.8 [1277.3-1760.4], p = 0.550). Additional post-implantation costs were significantly highest in the tpasBCD cohort at all moments of follow-up. CONCLUSION Total costs related to post-operative rehabilitation and treatments are comparable between percutaneous and transcutaneous BCDs up to 5 years after implantation. Complications related to passive transcutaneous bone conduction devices appeared significantly more expensive after implantation due to more frequent explantations.
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Affiliation(s)
- Tjerk W Aukema
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands.
- Research School of Behavioral and Cognitive Neurosciences, Graduate School of Medical Sciences, University of Groningen, Groningen, The Netherlands.
- Department of Otorhinolaryngology/Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Emma M Teunissen
- Department of Otorhinolaryngology/Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Center for Neuroscience, Radboud University, Nijmegen, The Netherlands
| | - Arno M Janssen
- Department of Otorhinolaryngology/Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Center for Neuroscience, Radboud University, Nijmegen, The Netherlands
| | - Myrthe K S Hol
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
- Research School of Behavioral and Cognitive Neurosciences, Graduate School of Medical Sciences, University of Groningen, Groningen, The Netherlands
| | - Emmanuel A M Mylanus
- Department of Otorhinolaryngology/Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Center for Neuroscience, Radboud University, Nijmegen, The Netherlands
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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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Power output and hearing performance in osseointegrated auditory devices. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022; 73:96-103. [PMID: 35397830 DOI: 10.1016/j.otoeng.2021.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 01/03/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Osseointegrated auditory devices are hearing gadgets that use the bone conduction of sound to produce hearing improvement. The mechanisms and factors that contribute to this sound transmission have been widely studied, however, there are other aspects that remain unknown, for instance, the influence of the processor power output. The aim of this study was to know if there is any relationship between the power output created by the devices and the hearing improvement that they achieve. MATERIALS Y METHODS 44 patients were implanted with a percutaneous Baha® 5 model. Hearing thresholds in pure tone audiometry, free-field audiometry, and speech recognition (in quiet and in noise) were measured pre and postoperatively in each patient. The direct bone conduction thresholds and the power output values from the processors were also obtained. RESULTS The pure tone average threshold in free field was 39.29 dB (SD = 9.15), so that the mean gain was 29.18 dB (SD = 10.13) with the device. This involved an air-bone gap closure in 63.64% of patients. The pure tone average threshold in direct bone conduction was 27.6 dB (SD = 10.91), which was 8.4 dB better than the pure tone average threshold via bone conduction. The mean gain in speech recognition was 39.15% (SD = 23.98) at 40 dB and 36.66% (SD = 26.76) at 60 dB. The mean gain in the signal-to-noise ratio was -5.9 dB (SD = 4.32). On the other hand, the mean power output values were 27.95 dB µN (SD = 6.51) in G40 and 26.22 dB µN (SD = 6.49) in G60. When analysing the relationship between bone conduction thresholds and G40 and G60 values, a correlation from the frequency of 1000 Hz was observed. However, no statistically significant association between power output, functional gain or speech recognition gain was found. CONCLUSIONS The osseointegrated auditory devices generate hearing improvement in tonal thresholds and speech recognition, even in noise. Most patients closed the air-bone gap with the device. There is a direct relationship between the bone conduction threshold and the power output values from the processor, but only in mid and high frequencies. However, the relationship between power output and gain in speech recognition is weaker. Further investigation of contributing factors is necessary.
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Calvo-Gómez J, Pla-Gil I, Latorre Monteagudo E, Pitarch Ribas MI, Marco Algarra J. Power output and hearing performance in osseointegrated auditory devices. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021; 73:S0001-6519(21)00039-X. [PMID: 34082922 DOI: 10.1016/j.otorri.2021.01.004] [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: 07/07/2020] [Revised: 11/23/2020] [Accepted: 01/03/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Osseointegrated auditory devices are hearing gadgets that use the bone conduction of sound to produce hearing improvement. The mechanisms and factors that contribute to this sound transmission have been widely studied, however, there are other aspects that remain unknown, for instance, the influence of the processor power output. The aim of this study was to know if there is any relationship between the power output created by the devices and the hearing improvement that they achieve. MATERIALS AND METHODS Forty-four patients were implanted with a percutaneous Baha® 5 model. Hearing thresholds in pure tone audiometry, free-field audiometry, and speech recognition (in quiet and in noise) were measured pre and postoperatively in each patient .The direct bone conduction thresholds and the power output values from the processors were also obtained. RESULTS The pure tone average threshold in free field was 39.29dB (SD 9.15), so that the mean gain was 29.18dB (SD 10.13) with the device. This involved an air-bone gap closure in 63.64% of patients. The pure tone average threshold in direct bone conduction was 27.6dB (SD 10.91), which was 8.4dB better than the pure tone average threshold via bone conduction. The mean gain in speech recognition was 39.15% (SD 23.98) at 40dB and 36.66% (SD 26.76) at 60dB. The mean gain in the signal-to-noise ratio was -5.9dB (SD 4.32). On the other hand, the mean power output values were 27.95dB μN (SD 6.51) in G40 and 26.22dB μN (SD 6.49) in G60. When analysing the relationship between bone conduction thresholds and G40 and G60 values, a correlation from the frequency of 1,000Hz was observed. However, no statistically significant association between power output, functional gain or speech recognition gain was found. CONCLUSIONS The osseointegrated auditory devices generate hearing improvement in tonal thresholds and speech recognition, even in noise. Most patients closed the air-bone gap with the device. There is a direct relationship between the bone conduction threshold and the power output values from the processor, but only in mid and high frequencies. However, the relationship between power output and gain in speech recognition is weaker. Further investigation of contributing factors is necessary.
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Affiliation(s)
- Jordi Calvo-Gómez
- Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, España.
| | - Ignacio Pla-Gil
- Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, España
| | - Emilia Latorre Monteagudo
- Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, España
| | - María Ignacia Pitarch Ribas
- Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, España
| | - Jaime Marco Algarra
- Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, España
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Amaral MSAD, Santos FRD, Danieli F, Massuda ET, Reis ACMB, Hyppolito MA. Surgical and audiological results of bone-anchored hearing aids: comparison of two surgical techniques. Braz J Otorhinolaryngol 2020; 88:533-538. [PMID: 32888895 PMCID: PMC9422553 DOI: 10.1016/j.bjorl.2020.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/17/2020] [Accepted: 07/15/2020] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION The bone-anchored hearing system has become the most viable treatment option for subjects with conductive or mixed hearing loss, who are unable to benefit from conventional hearing aids or middle ear surgery. OBJECTIVE To compare the surgical and audiological outcomes between the minimally-invasive Ponto surgery and a linear incision with soft tissue preservation techniques in bone-anchored hearing system recipients. METHODS A retrospective study was carried out from January 2017 to June 2018. Forty-two adult patients eligible for unilateral bone-anchored hearing system surgery with the Ponto system were included in the study. The implant and abutment lengths used varied from 3 to 4mm and from 6 to 14mm, according to the bone and skin thickness of the participants, respectively. RESULTS Twenty-two surgeries were performed using the minimally invasive Ponto surgery technique (52.4%) and 20 (47.6%) using the linear incision. The mean age of the subjects implanted with minimally invasive Ponto surgery and linear incision techniques were 42.0 and 33.3 years old, respectively. Ten male (45,5%) and 14 (70%) female patients were implanted using minimally invasive Ponto surgery and the linear incision techniques, respectively. There were no differences between pure tone audiometric thresholds and monosyllabic word recognition scores of the subjects, when comparing both surgical techniques. The minimally invasive Ponto surgery technique significantly reduced the surgical time compared to the linear incision technique. There were no differences between both surgical techniques for skin-related complications; they occurred in 45% of the subjects, regardless of the surgical technique employed. Subjects included in the minimally invasive Ponto surgery technique group showed a superior cosmetic outcome, with no surgical scar or additional sutures. CONCLUSION The surgical and audiological outcomes were satisfactory and were not correlated to the surgical technique selected in all subjects. When compared to the linear incision, the minimally invasive Ponto surgery technique showed reduced surgical time and superior esthetic outcomes in the postoperative follow-up.
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Affiliation(s)
- Maria Stella Arantes do Amaral
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Divisão de Otorrinolaringologia, Ribeirão Preto, SP, Brazil.
| | | | - Fabiana Danieli
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil; Oticon Medical Brasil, São Paulo, SP, Brazil
| | - Eduardo T Massuda
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | | | - Miguel Angelo Hyppolito
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
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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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