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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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Systematic and audiological indication criteria for bone conduction devices and active middle ear implants. Hear Res 2021; 421:108424. [PMID: 34987018 DOI: 10.1016/j.heares.2021.108424] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 12/02/2021] [Accepted: 12/22/2021] [Indexed: 01/11/2023]
Abstract
Certain patients with conductive or mixed hearing loss can benefit from bone-conduction hearing devices or active middle ear implants. Available devices differ in coupling site, energy transfer from the sound processor to the implant, and the active or passive actuator technology. The audiological benefit of those devices depends on the maximum stable power output and the noise floor of the device, the degree and expected stability of the sensorineural hearing loss and the coupling efficiency with the aim on achieving a minumum of 30-35 dB effective dynamic range. The choice of the device is often a trade-off between the optimal audiological solution with respect to the hearing loss, technical device-related parameters and the expected coupling efficiency, the optimal surgical solution with respect to patho-anatomical aspects, device dimensions and the coupling site, invasiveness or surgical risks, and other patient factors with respect to the patients' wish and expectations, social aspects, device usability and connectivity. This review article lists all currently available implantable and conventional bone-conduction hearing devices and active middle ear implants with respect to technical features like maximum power output, market availability, and the expected effective output dynamic range.
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De Stefano S, Mochi P, Murri A, Cuda D. Comparison between linear incision and punch techniques for bone anchored hearing aid surgery. ACTA OTORHINOLARYNGOLOGICA ITALICA 2021; 41:474-480. [PMID: 34734584 PMCID: PMC8569658 DOI: 10.14639/0392-100x-n1048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 03/13/2021] [Indexed: 11/23/2022]
Abstract
Objectives To evaluate mean surgical time, incidence of soft tissue reactions, implant survival and intraoperative complications in both minimally invasive ponto surgery (MIPS) and the linear incision with tissue preservation technique (LT). Methods A retrospective review was carried out on 48 bone anchored hearing system (BAHS) patients between 2014 and 2019: 13 patients had undergone LT and formed one group, while 35 patients had undergone MIPS and formed the second group. Mean surgical time, intraoperative complications, implant loss and skin reaction were assessed at each post-operative examination. The Mann-Whitney U test was used for statistical analysis. Results The difference in the mean surgical time of 15 mins for MIPS and 36 mins for LT was statistically significant. No intraoperative complications were reported and implant survival was 100% in both groups. The incidence of adverse skin reactions was 7.7% for the LT group and 0% for the MIPS group at first follow-up examination. Conclusions Surgical mean time is shorter for MIPS, making this procedure more suitable for local anaesthesia and more cost effective. Moreover, both LT and MIPS demonstrate good surgical outcomes in terms of skin reactions according to Holgers score and equally excellent implant survival.
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Affiliation(s)
- Sabrina De Stefano
- Department of Otorhinolaryngology and Otoneurosurgery, University Hospital of Parma, Parma, Italy
| | - Paolo Mochi
- Department of Otorhinolaryngology, "Guglielmo da Saliceto" Hospital, Piacenza, Italy
| | - Alessandra Murri
- Department of Otorhinolaryngology, "Guglielmo da Saliceto" Hospital, Piacenza, Italy
| | - Domenico Cuda
- Department of Otorhinolaryngology, "Guglielmo da Saliceto" Hospital, Piacenza, Italy
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Hwa TP, Locketz G, Ruckenstein MJ. Novel Surgical Technique in Active Bone Conduction: Minimally Invasive Approach to Fully Implantable Osseointegrated Implant. Otolaryngol Head Neck Surg 2021; 167:206-208. [PMID: 34637372 DOI: 10.1177/01945998211044408] [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: 11/17/2022]
Abstract
We report our experience using a novel minimally invasive surgical technique for implantation of a fully implantable active bone conduction implant. This was a retrospective review of 16 adults, including 10 women and 6 men. The mean age was 54 years. Hearing loss profiles included 8 with mixed hearing loss, 5 with conductive hearing loss, and 3 with single-sided deafness. Nine patients underwent placement through the standard approach and 7 with the minimally invasive approach. There were no postoperative complications at a mean follow-up of 6.5 months (SD, 4; range, 1.5-12), and all patients received audiologic benefit with objective improvement in sound-field thresholds upon activation. Mean operative time was shorter with the minimally invasive approach (64 vs 41 minutes, P = .01). The fully implantable bone-anchored auditory implant can be effectively placed via a minimally invasive incision, with potential benefits of decreased operative time, low risk for intra- and postoperative complications, and rapid healing.
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Affiliation(s)
- Tiffany Peng Hwa
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Garrett Locketz
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael J Ruckenstein
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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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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Patient surgical satisfaction after da Vinci ® single-port and multi-port robotic-assisted radical prostatectomy: propensity score-matched analysis. J Robot Surg 2021; 16:473-481. [PMID: 34145537 PMCID: PMC8213039 DOI: 10.1007/s11701-021-01269-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/13/2021] [Indexed: 11/18/2022]
Abstract
The da Vinci® single-port (SP) and multiport (Xi) approaches to robotic-assisted radical prostatectomy (RARP) are described by different authors in the literature, primarily comparing short-term outcomes of both modalities. To our knowledge, this is the first article comparing the surgical perspective and satisfaction of patients who underwent RARP with the SP and Xi platforms. To determine the patient surgical perspective and satisfaction in terms of pain control, return to normal activity, and overall results of surgery for two groups who underwent SP and Xi radical prostatectomy. The data from 71 consecutive patients who underwent SP RARP in a single center from June 2019 to April 2020 was compared to 875 patients who underwent Xi RARP in the same period. A single surgeon performed all procedures with a transperitoneal technique. After a propensity score match, two groups of 71 patients (SP and Xi) were selected and compared in the study. Patients were contacted by phone by two interviewers and a questionnaire was administered in English or Spanish. Patients were instructed not to disclose the type of robotic surgery they underwent, as interviewers were blinded to that information. A validated Surgical Satisfaction Questionnaire (SSQ-8) was used, along with an additional question from our institution asking about the satisfaction with the number of incision sites (GRI-1). Data were analyzed as continuous and discrete variables to compare the differences between the Xi and SP cohorts. A response rate of 85.9% (n = 61) in the Xi group and 73.2% (n = 52) in the SP group was captured. Overall satisfaction with surgical results was 80% and 88% in the Xi and SP cohorts, respectively. No statistical difference in responses was found between the Xi and SP cohorts for SSQ-8. However, GRI-1 demonstrated a statistically significant difference (P < 0.001) in terms of number of scars that favors the SP approach. Limitations of this study are the small sample size and recall bias. We found no statistical difference between the groups regarding the answers for SSQ-8 questionnaire; both groups were very satisfied. When assessing the number of incision sites with the GRI-1 question, patients who underwent MP had lower satisfaction rates compared to SP. These patients perceived the number of scars and their appearance as reason for lower satisfaction. We believe that future studies should consider patient’s postoperative perspective when adopting new platforms in order to combine adequate treatment with patient expectations. We performed a study assessing the postoperative satisfaction and perspectives of two groups of patients who underwent radical prostatectomy with two different robots (SP and Xi). There was no difference in patient satisfaction with the results of either the da Vinci® SP or Xi RARP except for the patients’ perception on their number of scars, which favored the SP group.
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Six-Month Clinical Outcomes for Bone-Anchored Hearing Implants: Comparison Between Minimally Invasive Ponto Surgery and the Linear Incision Technique With Tissue Preservation. Otol Neurotol 2021; 41:e475-e483. [PMID: 32176135 DOI: 10.1097/mao.0000000000002562] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study is to investigate and compare the clinical outcomes of minimally invasive ponto surgery (MIPS) to the linear incision technique with soft tissue preservation (LIT-TP) for percutaneous bone-anchored hearing implants (BAHI). STUDY DESIGN Prospective cohort study with a historical control group. SETTING Tertiary referral center. PATIENTS Twenty-five patients were prospectively included in the test group. The control group consisted of 25 patients who previously participated in another clinical trial and already underwent BAHI surgery. INTERVENTION All patients were implanted with a 4.5-mm-wide implant, using MIPS in the test group and the LIT-TP in the control group. Follow-up visits were scheduled 7 days, 21 days (sound processor fitting), 12 weeks and 6 months after surgery. MAIN OUTCOME MEASURES The primary outcome measure was skin sensibility around the abutment 6 months after surgery. Secondary outcomes were subjective numbness, surgery time, wound healing, adverse soft tissue reactions, cosmetic outcomes, implant stability quotient (ISQ), implant survival, and sound processor use. RESULTS Skin sensibility, adverse soft tissue reactions, and sound processor use were comparable between groups. The test group had a shorter surgery time and better cosmetic outcomes. More skin dehiscences and a statistically nonsignificant higher implant loss rate (12% vs 0%, p = 0.079) were observed in the test group. CONCLUSION MIPS is comparable to the LIT-TP regarding skin sensibility at 6 months and soft tissue tolerability. With MIPS, surgery time is further reduced and better cosmetic outcomes are reported. More research into MIPS, exact drill protocol, used instruments, and associated implant loss is warranted.
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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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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: 4] [Impact Index Per Article: 1.3] [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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11
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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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12
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[Implantation of a new active bone conduction hearing device with optimized geometry. German version]. HNO 2020; 68:854-863. [PMID: 32504115 DOI: 10.1007/s00106-020-00876-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Here, we describe the surgical technique for implanting a new, active, transcutaneous bone conduction hearing aid. The implant technology is based on a system that has been in use reliably since 2012. The geometry of the new implant has been adapted based on experience with previously introduced implants. The surgery was feasible, standardized, and safe. Due to the optimized geometric design that improved the bone fit, it is not necessary to use specialized, detailed preoperative planning, except in challenging anatomical conditions; e.g., in young children, malformations, poor pneumatization, or after a canal wall down mastoidectomy.
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Abstract
PURPOSE OF REVIEW To discuss the different types of bone conduction implants available today and describe the types of hearing loss that could benefit from bone conduction implants. RECENT FINDINGS Bone conduction implants have been used successfully for over two decades. However, there have been barriers to their use because of skin complications and limited high-frequency hearing gains. Recently developed technologies, such as active bone conduction implants may overcome some of these limitations, potentially opening the door for improved aided benefit and increased patient satisfaction from bone conduction amplification. SUMMARY A variety of bone conduction implants currently exist, with suitable amplification options available for many different types and severities of hearing loss and patient preferences.
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Affiliation(s)
- John P Richards
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona College of Medicine, Tucson
| | - John T Symms
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona College of Medicine, Tucson
| | - Kerry Beasley
- Flagstaff Surgical Associates, Flagstaff, Arizona, USA
| | - Heather M S Coffman
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona College of Medicine, Tucson
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Abstract
Here, we describe the surgical technique for implanting a new, active, transcutaneous bone conduction hearing aid. The implant technology is based on a system that has been in use reliably since 2012. The geometry of the new implant has been adapted based on experience with previously introduced implants. The surgery was feasible, standardized, and safe. Due to the optimized geometric design that improved the bone fit, it is not necessary to use specialized, detailed preoperative planning, except in challenging anatomical conditions; e.g., in young children, malformations, poor pneumatization, or after a canal wall down mastoidectomy.
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Fan X, Ping L, Yang T, Niu X, Chen Y, Xia X, Gao R, Fan Y, Chen X. Comparative effects of unilateral and bilateral bone conduction hearing devices on functional hearing and sound localization abilities in patients with bilateral microtia-atresia. Acta Otolaryngol 2020; 140:575-582. [PMID: 32281462 DOI: 10.1080/00016489.2020.1745883] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Various amplification options are available for patients with congenital bilateral conductive hearing loss. Unilateral bone conduction hearing device (BCHD) is widely used for these patients, whereas benefits of bilateral BCHDs in certain subgroups of patients require further exploration.Objectives: To evaluate functional and directional hearing in patients with unilateral Bonebridge (MEDEL) and contralateral ADHEAR (MEDEL) devices.Materials and methods: This study included 32 patients (20 males, 12 females), of mean age 11.8 years (range 7-27 years). Hearing thresholds, speech perception and sound localization were tested three months after activation of the Bonebridge under three conditions: unaided, unilateral BHCD (Bonebridge) and bilateral BHCDs (Bonebridge plus contralateral ADHEAR). Patient acceptance of these devices in daily life was evaluated by questionnaire.Results: Compared with unaided, the mean hearing thresholds (0.5, 1, 2, and 4 kHz) and speech perception with unilateral BCHD and bilateral BCHDs were improved significantly (p < .05 each). Markers of directional hearing ability, including percentages of accurate responses, bias angles and RMS errors, were significantly better with bilateral BCHDs than unilateral BHCD (p < .05 each). Questionnaire revealed high patient satisfaction with both unilateral and bilateral devices.Conclusions: Functional hearing and sound localization abilities were better with bilateral BCHDs than unilateral BCHD.
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Affiliation(s)
- Xinmiao Fan
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lu Ping
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tengyu Yang
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaomin Niu
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yushan Chen
- Department of Otolaryngology, The Ohio State University, Columbus, OH, USA
| | - Xin Xia
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ruzhen Gao
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue Fan
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaowei Chen
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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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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Gettelfinger JD, Paulk PB, Schmalbach CE. Patient Safety and Quality Improvement in Otolaryngology-Head and Neck Surgery: A Systematic Review. Laryngoscope 2020; 131:33-40. [PMID: 32057101 DOI: 10.1002/lary.28538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 12/04/2019] [Accepted: 01/03/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The current landscape of patient safety/quality improvement (PS/QI) research dedicated to Otolaryngology-Head and Neck Surgery (OHNS) has not been established. This systematic review aims to define the breadth and depth of PS/QI research dedicated to OHNS and to identify knowledge gaps as well as potential areas of future study. METHODS The study protocol was developed a priori using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) process. A computerized Ovid/Medline database search was conducted (January 1, 1965-September 30, 2019). Similar computerized searches were conducted using Cochrane Database, PubMed, and Google Scholar. Articles were classified by year, subspecialty, PS/QI category, Institute of Medicine (IOM) Crossing the Chasm categories, and World Health Organization (WHO) subclass. RESULTS Computerized searches yielded 11,570 eligible articles, 738 (6.4%) of which met otolaryngology PS/QI inclusion criteria; 178 (24.1%) were not specific to any one subspecialty. The most prevalent subspecialty foci were head and neck (29.9%), pediatric otolaryngology (16.9%), and otology/neurotology (11.0%). Studies examining complications or risk factors (32.0%) and outcomes/quality measures (16.3%) were the most common foci. Classification by the IOM included effective care (31.4%), safety (29.9%), and safety/effective care (25.3%). Most research fell into the WHO categories of understanding causes (28.5%) or measuring harm (28.3%). CONCLUSION Most OHNS PS/QI projects (32.0%) focus on reporting complications or risk factors, followed by outcomes/quality measures (16.3%). Knowledges gaps for future research include healthcare disparities, multidisciplinary care, and the WHO category of studies translating evidence into safer care. LEVEL OF EVIDENCE NA Laryngoscope, 131:33-40, 2021.
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Affiliation(s)
- John D Gettelfinger
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - P Barrett Paulk
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Cecelia E Schmalbach
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana.,University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
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Bennett A, Sawant R. Comparison of soft tissue preservation techniques for BAHA insertion in 41 patients: ‘Bus‐stop’ (open approach) vs MIPS (minimally invasive approach). Clin Otolaryngol 2019; 44:1120-1123. [DOI: 10.1111/coa.13409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 06/18/2019] [Accepted: 07/07/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Alex Bennett
- ENT Department University of Edinburgh Edinburgh UK
- ENT Department Royal Infirmary of Edinburgh Edinburgh UK
| | - Rupali Sawant
- ENT Department Royal Infirmary of Edinburgh Edinburgh UK
- ENT Department ENT ST3 Edinburgh UK
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Standardization of the Punch Technique for the Implantation of Bone Anchored Auditory Devices: Evaluation of the MIPS Surgical Set. Otol Neurotol 2019; 40:e631-e635. [DOI: 10.1097/mao.0000000000002291] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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