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Teunissen EM, Aukema TW, Banga R, Eeg-Olofsson M, Hol MKS, Hougaard DD, Tysome JR, Johansson ML, Svensson S, Powell HRF. Evaluation of Clinical Performance of Ponto Implantation Using a Minimally Invasive Surgical Technique-A Prospective Multicenter Study. Otol Neurotol 2024; 45:1037-1044. [PMID: 39186326 DOI: 10.1097/mao.0000000000004315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
OBJECTIVE To investigate the clinical outcomes of bone-anchored hearing implant surgery using the MONO procedure. STUDY DESIGN Multicenter, multinational, single-arm, prospective trial with a 12-month follow-up. SETTING Seven European university hospitals from the United Kingdom, Sweden, Denmark, and The Netherlands. PATIENTS Fifty-one adult patients requiring surgical intervention for bone conduction hearing. INTERVENTION Bone-anchored hearing implant surgery using the MONO procedure. MAIN OUTCOME MEASURES The primary endpoint assessed implant usability 3 months after surgery. Implant status, soft tissue reactions, pain and numbness, postoperative events, and sound processor usage were assessed at all follow-up visits. Hearing-related quality of life was evaluated using the Glasgow Benefit Inventory (GBI). RESULTS At 3 months, 94.2% of the implant/abutment complexes provided reliable anchorage for sound processor usage. No severe intraoperative complications occurred. Sixty-nine percent of surgeries were performed under local anesthesia, with surgery lasting 10 minutes on average. Four implants were lost due to trauma (n = 2), spontaneous loss of osseointegration (n = 1), or incomplete insertion (n = 1). Adverse soft tissue reactions occurred in 2.6% of visits, with a maximum Holgers grade of 3 (n = 1) and grade 2 (n = 5) across patients. Hearing-related quality of life at 3 months improved in 96% of patients. CONCLUSION The MONO procedure provides a safe and efficient surgical technique for inserting bone-anchored hearing implants with few and minor intra- and postoperative complications.
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Affiliation(s)
- Emma M Teunissen
- Department of Otorhinolaryngology-Head and Neck Surgery, Donders Center for Neuroscience, Radboud University Medical Center, Radboud University, Nijmegen
| | | | - Rupan Banga
- Department of Otorhinolaryngology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | | | | | - Dan D Hougaard
- Department of Otolaryngology, Head & Neck Surgery & Audiology, Aalborg University Hospital, Aalborg, Denmark
| | - James R Tysome
- Department of Otorhinolaryngology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | | | | | - Harry R F Powell
- Department of Otorhinolaryngology, St Thomas' Hearing Implant Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Teunissen EM, Caspers CJI, Vijverberg MA, Pennings RJE, Mylanus EAM, Hol MKS. Long-Term Outcomes of a Percutaneous Wide-Diameter Bone-Anchored Hearing Implant: A Clinical Evaluation of More than 800 Implants. Otol Neurotol 2024; 45:e435-e442. [PMID: 38728559 DOI: 10.1097/mao.0000000000004200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
OBJECTIVE This study evaluates the clinical outcomes of 807 percutaneous wide-diameter bone-anchored hearing implants (BAHIs) in 701 patients. In addition, it compares patient groups and examines bone conduction device (BCD) usage. STUDY DESIGN Retrospective cohort study. Mean follow-up period of 3.8 years. SETTING Tertiary referral center. PATIENTS All patients implanted with a percutaneous wide-diameter BAHI until December 2020 were included. Patients were divided into age groups, "loading-time" groups, and, if applicable, specific subgroups thought to be at risk for complications postsurgery, e.g., intellectual disability and comorbidities. MAIN OUTCOME MEASURES Soft tissue reaction, implant survival, revision surgery, and BCD usage. RESULTS In 9.1% of the 5,188 observations of 807 implants, an adverse soft tissue reaction was reported according to the Holgers' scale. Significantly more (adverse) soft tissue reactions were observed in children and intellectually disabled (ID) patients (p < 0.05). Comorbidity subgroups showed no significant differences in soft tissue reactions. Implant loss percentage, including explantations, was 6.2%. Implant survival was significantly worse in patients with ID (14.1%; p = 0.021). Pediatric age, early loading, or comorbidities did not significantly influence implant survival. At least 592 implants (73.4%) were used for bone conduction hearing, of which 65.4% were used daily. CONCLUSION Both children and ID patients are more prone to (adverse) soft tissue reactions, ID patients only have a higher risk of implant loss. The rate of implant loss in children seemed to be reduced compared to previous studies and thus more comparable to adults since using wide-diameter implants.
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Affiliation(s)
- Emma M Teunissen
- Department of Otorhinolaryngology, Donders Center for Neurosciences, Radboud University Medical Center, Nijmegen
| | - Coosje J I Caspers
- Department of Otorhinolaryngology, Donders Center for Neurosciences, Radboud University Medical Center, Nijmegen
| | - Maarten A Vijverberg
- Department of Otorhinolaryngology, Donders Center for Neurosciences, Radboud University Medical Center, Nijmegen
| | - Ronald J E Pennings
- Department of Otorhinolaryngology, Donders Center for Neurosciences, Radboud University Medical Center, Nijmegen
| | - Emmanuel A M Mylanus
- Department of Otorhinolaryngology, Donders Center for Neurosciences, Radboud University Medical Center, Nijmegen
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Lindeboom JJ, Labbé N, Strijbos RM, van den Elsen-Hutten M, van Huffelen W, Teunissen EM, Hol MKS, Bom SJH. Long-Term Results of the Linear Incision Technique With Tissue Reduction Versus Tissue Preservation for Inserting Bone-Anchored Hearing Implants: The Ongoing Optimization in Bone Implant Surgery. Otol Neurotol 2024; 45:285-294. [PMID: 38361296 DOI: 10.1097/mao.0000000000004101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
OBJECTIVE To compare the long-term outcomes of the linear incision technique with tissue reduction (LIT-TR) and the linear incision technique with tissue preservation (LIT-TP) for inserting bone-anchored hearing implants (BAHIs). STUDY DESIGN Single-center retrospective cohort study. SETTING Large general teaching hospital. PATIENTS A total of 231 adult patients were included between August 2005 and October 2020, with a minimum follow-up time of 6 months. INTERVENTION The test group received a BAHI using the LIT-TP (N = 147). The control group underwent surgery using the LIT-TR (N = 84). MAIN OUTCOME MEASURES Soft tissue reactions, skin thickening, postoperative complications (e.g., wound dehiscence), and implant loss were compared between the test and control group. Furthermore, Cochlear Bone Anchored Solutions AB (Mölnlycke, Sweden) and Oticon Medical AB (Askim, Sweden) implants/abutments within the LIT-TP cohort were compared. Validated questionnaires were used to quantify patients' health-related quality of life (HRQoL). RESULTS Significantly more cases with wound dehiscence and adverse soft tissue reactions (Holgers ≥2) were observed in the LIT-TR cohort (p < 0.001). However, the LIT-TP cohort showed significantly more cases with skin thickening (requiring treatment) within the first 2 years after implantation. There were no differences in implant loss rates, overall soft tissue reactions (Holgers >1), and overall HRQoL between the two patient groups. Significant improvement in the patients' HRQoL after implementation of a BAHI was found in both techniques. The Ponto Wide implant/abutment showed less frequent skin thickening (requiring treatment) and fewer soft tissue reactions compared with the BIA400 implant/abutment. CONCLUSION This large-scale study demonstrates that the LIT-TP shows excellent long-term outcomes, including a low incidence of implant failure.
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Affiliation(s)
| | - Nilou Labbé
- Department of Otorhinolaryngology, Deventer Hospital
| | | | | | | | - Emma M Teunissen
- Department of Otorhinolaryngology, Donders Center for Neurosciences, Radboud University Medical Center, Nijmegen
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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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King J, Leon I, Squires L. In-office Bone-Anchored Hearing Implants via Minimally Invasive Punch Technique in a Veteran Population. Otolaryngol Head Neck Surg 2022; 167:959-963. [PMID: 35349358 PMCID: PMC9720705 DOI: 10.1177/01945998221086841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Describe the feasibility and safety of completing bone-anchored hearing implants via the minimally invasive punch technique in the in-office setting. STUDY DESIGN This single-institution case series included 20 patients who underwent in-office bone-anchored hearing implant placement under local anesthesia from 2018 to 2021. SETTING Veterans Affairs Northern California Healthcare System. METHODS Following completion of the case series, patients were retrospectively surveyed regarding their satisfaction with this approach via a modified SSQ-8 (Surgical Satisfaction Questionnaire) to fit our purposes. RESULTS A total of 23 implants were completed in the in-office setting on 20 patients. Intra- and postoperative complication rates, including skin changes, irritation, infection, and poor wound healing, were similar to or better than currently published complication rates in the literature. In addition, patients reported overwhelmingly positive responses on the SSQ-8, almost universally stating that they were "very satisfied" with their clinic experience. CONCLUSION This case series suggests that it is feasible and safe to complete this procedure in the clinic under local anesthesia, but further prospective studies are needed to evaluate this in a more generalized population.
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Affiliation(s)
- Jackson King
- Department of Otolaryngology–Head and Neck Surgery, University of California–Davis Medical Center, Sacramento, California, USA,Veterans Affairs Northern California Healthcare System, Sacramento, California, USA
| | - Isabella Leon
- Department of Otolaryngology–Head and Neck Surgery, University of California–Davis Medical Center, Sacramento, California, USA
| | - Lane Squires
- Department of Otolaryngology–Head and Neck Surgery, University of California–Davis Medical Center, Sacramento, California, USA,Veterans Affairs Northern California Healthcare System, Sacramento, California, USA,Lane Squires, MD, Department of Otolaryngology–Head and Neck Surgery, School of Medicine, University of California–Davis, 2521 Stockton Blvd, Suite 7200, Sacramento, CA 95817, USA.
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6
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Strijbos RM, Salameh S, Bezdjian A, Daniel SJ, Thomeer HGXM. The Minimally Invasive Star-Shaped Incision Technique and the Linear Incision Technique With Tissue Preservation for Percutaneous Bone Conduction Devices: A Retrospective Cohort Study. Front Surg 2022; 9:863997. [PMID: 35756480 PMCID: PMC9231669 DOI: 10.3389/fsurg.2022.863997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To compare intra- and postoperative outcomes between the standard linear incision technique with tissue preservation (LITT-P) and the minimally invasive star-shaped incision (SSI). Study Design A retrospective cohort study. Methods Primary outcomes evaluated operative time, implant survival, and intra-operative complications. A secondary outcome evaluated soft tissue tolerability assessed by the Holger's classification. Results A total of 38 implants were placed (19 LITT-P; 19 SSI). The median and mean surgical duration for the LITT-P group was statistically shorter than the SSI group (p = 0.0001). No intra-operative complications were reported for both surgical approaches. Five implants were lost during postoperative follow-up: one in the LITT-P and four in the SSI cohort. Both cohorts showed favorable soft tissue tolerability. Less Holgers 1 and 2 and more Holgers 3 soft tissue reactions were observed after the LITT-P compared to the SSI. Conclusion The novel SSI approach could be an alternative option based on the theoretical benefits and found favorable (and similar) soft tissue outcomes. Implant loss and surgical time are aspects to investigate regarding long-term durability and warrant further research.
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Affiliation(s)
- Ruben M. Strijbos
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
- Brain Center UMC Utrecht, Utrecht, Netherlands
| | - Samer Salameh
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Aren Bezdjian
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Departments of Experimental Surgery and Pediatric Surgery, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Sam J. Daniel
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Department of Otolaryngology–Head, Neck Surgery, and Pediatric Surgery, Faculty of Medicine, McGill University, The Montreal Children's Hospital, Montreal, QC, Canada
| | - Hans GXM. Thomeer
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
- Brain Center UMC Utrecht, Utrecht, Netherlands
- *Correspondence: Hans GXM. Thomeer
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Strijbos RM, Straatman LV, Stokroos RJ, Johansson ML. Ex vivo Evaluation of a New Drill System for Placement of Percutaneous Bone Conduction Devices. Front Surg 2022; 9:858117. [PMID: 35388366 PMCID: PMC8977416 DOI: 10.3389/fsurg.2022.858117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
The procedure for installation of a percutaneous bone-conducting device has undergone significant improvements since its introduction 40 years ago. Today, the linear incision technique with tissue preservation (LITT-P) and the minimally invasive procedure (MIPS) are the most commonly used approaches. In both these techniques, a gradual increase of the osteotomy using a three-step drilling sequence is utilized, as this approach can allow a stepwise deepening and widening of the osteotomy in the mastoid and can prevent bone overheating. A new minimally invasive procedure (MONO) has been developed that allows an osteotomy to be performed and enables complete removal of the bone volume in one single drill step for a 4 mm implant using a novel parabolic twist drill. Here, the feasibility of the MONO procedure was qualitatively and quantitatively evaluated in terms of the dura response to drill trauma in comparison with the outcomes achieved with guide drills used for the LITT-P and MIPS techniques. Fresh frozen temporal bone from a human cadaver was subjected to penetration by three drills beyond the base of the mastoid bone to different depths. The sites were evaluated, and the damage to and possible penetration of the dura were determined. The results showed that for a drill depth exceeding mastoid bone thickness by not more than 1 mm, damage to the dura was limited or nonexistent, whereas for a drill depth exceeding bone thickness by 2 mm, damage increased, or the dura was penetrated. There was a trend toward more damage and penetration for both the round burr and MIPS guide drill compared with the MONO drill bit. From this experimental ex vivo study, it can be concluded that if the dura is encountered, the MONO system is not more inclined to penetrate the dura than the conventional LITT-P and MIPS systems.
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Affiliation(s)
- Ruben M. Strijbos
- Department of Otorhinolaryngology, 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, Head and Neck Surgery, University Medical Centre Utrecht, Utrecht, Netherlands
- University Medical Centre Utrecht Brain Centre, University of Utrecht, Utrecht, Netherlands
| | - Robert J. Stokroos
- Department of Otorhinolaryngology, 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
- Research and Technology, Oticon Medical AB, Askim, Sweden
- *Correspondence: Martin L. Johansson
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8
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Caspers CJI, Kruyt IJ, Mylanus EAM, Hol MKS. A Clinical Evaluation of Minimally Invasive Ponto Surgery With a Modified Drill System for Inserting Bone-Anchored Hearing Implants. Otol Neurotol 2021; 42:1192-1200. [PMID: 34191785 PMCID: PMC8867490 DOI: 10.1097/mao.0000000000003195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To compare 6-months outcomes of the modified minimally invasive Ponto surgery (m-MIPS) to both the linear incision technique with soft tissue preservation (LIT-TP), and original MIPS (o-MIPS) for inserting bone-anchored hearing implants (BAHIs). STUDY DESIGN Exploratory pilot study with one test group and two historical control groups. SETTING Tertiary referral center. PATIENTS In the test group, 24 patients (25 implants) were prospectively included. Each control group comprised 25 patients (25 implants) who participated in previously conducted clinical trials. INTERVENTIONS The test group received a BAHI using m-MIPS. The two control groups underwent surgery using the LIT-TP and o-MIPS, respectively. MAIN OUTCOME MEASURES Implant survival, implant stability, and surgery-related variables were compared between the test and control groups. Soft tissue status, skin sensibility, and subjective numbness were compared between m-MIPS and LIT-TP only. RESULTS Implant survival was comparable between m-MIPS and LIT-TP, whereas implant stability measurements were slightly lower for m-MIPS. M-MIPS resulted in comparable adverse skin reactions and skin sensibility, significantly reduced surgical time and slightly improved subjective numbness, compared with LIT-TP. Between m-MIPS and o-MIPS, no statistically significant differences in implant survival, implant stability and surgical time were observed. CONCLUSIONS A trend toward lower implant loss rates after m-MIPS was observed, when compared with o-MIPS. M-MIPS seems to be a good alternative to LIT-TP for inserting BAHIs, since most clinical outcomes were either comparable or slightly better for m-MIPS. Upon deciding on which technique to use, larger studies on implant survival should be performed. Furthermore, other aspects such as costs, training aspects and surgical experience should be evaluated.
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Affiliation(s)
- Coosje Jacoba Isabella Caspers
- Department of Otorhinolaryngology, Donders Center for Neurosciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ivo Joachim Kruyt
- Department of Otorhinolaryngology, Donders Center for Neurosciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Emmanuel Antonius Maria Mylanus
- Department of Otorhinolaryngology, Donders Center for Neurosciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Myrthe Karianne Sophie Hol
- Department of Otorhinolaryngology, Donders Center for Neurosciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Research School of Behavioral and Cognitive Neurosciences, Graduate School of Medical Sciences, University of Groningen, Groningen, Netherlands
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Holmes S, Hamiter M, Berry C, Mankekar G. Tissue Preservation Techniques for Bone-Anchored Hearing Aid Surgery. Otol Neurotol 2021; 42:1044-1050. [PMID: 34260508 DOI: 10.1097/mao.0000000000003157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Compare outcomes of surgical techniques in percutaneous bone-anchored hearing implant surgery. STUDY DESIGN Matched retrospective cohort study. SETTING Tertiary referral center. PATIENTS Electronic review of adult and pediatric patients who underwent bone conduction device surgery by either the Minimally-invasive Ponto Surgery (MIPS) technique or the linear incision with no soft tissue removal (LnSTR) technique or between August 2015 and April 2018 at our facility. INTERVENTION Patients in MIPS group underwent Minimally invasive Ponto Surgery (MIPS) technique, while those in LnSTR group underwent LnSTR technique. MAIN OUTCOME MEASURE Major outcome was presence/severity of localized skin reaction. Secondary outcomes included cosmetic outcome, revision surgery, minor adverse events, device utilization, and postoperative aided speech recognition thresholds (SRTs) across 250 to 4000 Hertz (Hz). RESULTS Fifty patients met inclusion criteria. There was a significantly lower rate of localized cutaneous reactions for the MIPS group (4.5%) compared with LnSTR group (33.3%; p = 0.026). Rate of revision surgery was significantly less for MIPS (13.6%) compared with LnSTR (20.8%; p = 0.008). Occurrence of poor cosmetic outcome was noted significantly less for the MIPS group (9.1%) compared with LnSTR patients (20.8%; p = 0.005). Minor adverse events and aided SRTs were comparable between groups. CONCLUSIONS MIPS leads to a statistically significant decrease in localized cutaneous reaction compared with LnSTR. Both the LnSTR and MIPS techniques are safe and effective in the treatment of hearing loss, however MIPS may be superior in certain cases by offering improved healing, decreasing needs for wound care, and possibly decreasing need for frequent follow up.
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Affiliation(s)
- Sean Holmes
- Department of Otolaryngology, Ochsner Health Louisiana State University Shreveport, Shreveport, Louisiana
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10
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French G, Lee KH, Yunker WK. A retrospective evaluation of minimally invasive ponto surgery (MIPS) in two pediatric centers. Cochlear Implants Int 2021; 22:265-269. [PMID: 33784936 DOI: 10.1080/14670100.2021.1903712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Percutaneous bone anchored hearing systems have been used effectively for over forty years with low rates of complications. Minimally Invasive Ponto Surgery (MIPS) is a surgical technique performed through a puncture hole that has been reported to minimize soft tissue trauma and decrease operative time. Due to it being a relatively new procedure there remains a paucity of pediatric outcomes data. METHODS Pediatric patients from two tertiary pediatric otolaryngology centers between 2016 and 2019 who underwent MIPS were included in this study. Charts were retrospectively reviewed for indications for surgery, implant and abutment type, overlying skin thickness, skin-to-skin time, Holgers score at three, six and twelve months, revision surgery and time to abutment fitting. RESULTS Fourteen patients, two with bilateral procedures met inclusion criteria (mean age = 8.07 ± 2.87years). The mean overlying skin thickness was 5.13 ± 3.18mm. 9.44% of visits had an adverse skin reactionOne patient required surgery forskin overgrowth. One implant loss (6.3%) was reported, following trauma to the abutment. Mean MIPS skin to skin times were 12.4 ± 2.6 min, markedly different that the Baha® Attract and Connect which were 56 and 53 min, respectively. CONCLUSION This study represents the largest pediatric MIPS cohort to date, and our results are similar to published adult studies.
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Affiliation(s)
- Gabrielle French
- Section of Otolaryngology - Head & Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,RRDTC - ENT Clinic RM 21304E, Calgary, AB, Canada
| | - Kenneth H Lee
- Department of Otolaryngology, University of Texas Southwestern Medical Center, Children's Health Dallas and Plano, TX, USA
| | - Warren K Yunker
- Section of Otolaryngology - Head & Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,RRDTC - ENT Clinic RM 21304E, Calgary, AB, Canada.,Section of Pediatric Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, AB, Canada
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11
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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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Xiao Q, Gong F, Wang N, Hu W. Punch vs open surgical techniques for placement of bone-anchored hearing implants: a systematic review and meta-analysis of skin reactions and operating time. Eur Arch Otorhinolaryngol 2021; 278:3171-3180. [PMID: 33389004 DOI: 10.1007/s00405-020-06511-9] [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: 09/14/2020] [Accepted: 11/19/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Several authors have reported their experience with the punch technique as compared to open surgical methods for bone-anchored hearing implants (BAHI). However, no study has attempted to aggregate current evidence. We aimed to compare post-operative skin complications and operating time between punch and open surgical techniques of BAHI via a systematic review and meta-analysis. METHODS Databases of PubMed, Embase, Scopus, BioMed Central, Ovoid, and CENTRAL were screened up to 15th February 2020 to include studies comparing punch and open surgical technique for BAHI. RESULTS Eight studies were included. Punch technique was compared with dermatome and linear incision techniques with and without soft tissue reduction. There was no difference in normal-to-moderate skin reaction between the punch and open surgical techniques (OR: 0.86 95% CI 0.23, 3.28 I2 = 0%). The incidence of adverse skin reactions were also not different between the two groups. Meta-regression for different follow-up periods did not demonstrate any statistically significant results. Our results also indicated that punch technique requires less operating time, however, the inter-study heterogeneity in the analysis was very high. Similar results were seen on sub-group analysis based on the type of open surgical technique. CONCLUSION There may be no difference in skin tolerance between the punch technique and open surgical techniques. Operating time may be significantly reduced with the punch technique. Strong conclusions cannot be drawn owing to a limited number of studies. Further large-scale randomized trials are required.
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Affiliation(s)
- Qianyu Xiao
- Department of Nursing, Hunan Provincial People's Hospital, the First-Affiliated Hospital of Hunan Normal University, 61 Jiefang West Road, Changsha, Hunan, China.
| | - Fanghua Gong
- Department of Nursing, Hunan Provincial People's Hospital, the First-Affiliated Hospital of Hunan Normal University, 61 Jiefang West Road, Changsha, Hunan, China
| | - Ning Wang
- Department of ENT & HN Surgery, Hunan Provincial People's Hospital, the First-Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Weihua Hu
- Department of Nursing, Hunan Provincial People's Hospital, the First-Affiliated Hospital of Hunan Normal University, 61 Jiefang West Road, Changsha, Hunan, China
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