A Clinical Evaluation of Minimally Invasive Ponto Surgery With a Modified Drill System for Inserting Bone-Anchored Hearing Implants

Caspers, Coosje Jacoba Isabella; Kruyt, I.J.; Mylanus, Emmanuel A. M.; Hol, Myrthe K. S.

doi:10.1097/mao.0000000000003195

Cited by 6 publications

(11 citation statements)

References 22 publications

(69 reference statements)

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“…MIPS represents a promising minimally invasive, punch-only, surgical technique for BCD implantation. Comparable or improved soft tissue outcomes in combination with better results registered in surgical time, cosmetics, skin sensibility and in the field of cost analysis compared with the outcomes of traditional techniques can corroborate this statement ( 25 – 29 , 32 , 33 , 37 ). These encouraging features make this technique relevant to improve and to further streamline the procedure to install a BCD.…”

Section: Discussionmentioning

confidence: 78%

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Ex vivo Evaluation of a New Drill System for Placement of Percutaneous Bone Conduction Devices

et al. 2022

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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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Section: Discussionmentioning

confidence: 78%

“…Since the introduction of MIPS, the drill components in the surgical kit have been updated with the aim of reducing the heat generated during drilling ( 36 ). A recent clinical study reported a trend toward an improved implant survival rate using this updated MIPS system in comparison with the original drill system ( 37 ).…”

Section: Introductionmentioning

confidence: 97%

Ex vivo Evaluation of a New Drill System for Placement of Percutaneous Bone Conduction Devices

et al. 2022

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“…This scenario showed a €62.49 difference in mean cost per patient between both techniques in favor of the MIPS after complete follow-up (Table 3). In the final scenario, the more realistic implant loss of 4.0% for the MIPS was used, based on the latest study using the modified MIPS drill system (36). This more representative number of implant loss showed a difference in mean cost per patient of €154.43 in favor of the MIPS (Table 4).…”

Section: Resultsmentioning

confidence: 99%

“…Moreover, the MIPS was introduced only shortly before the start of this study, so this MIPS cohort reflects the first group of procedures and patients operated on with the MIPS. A recent study of Caspers et al (36) showed that implant loss with the MIPS using the new modified drill system is only 4.0%. Reduced implant loss will lead to lower costs per patient for the MIPS and an even larger difference between the MIPS and the LITT-P.…”

Section: Discussionmentioning

confidence: 98%

“…In the last scenario, the number of implant loss was recalculated by using more representative current implant survival rates. In this scenario, the most recent data for implant loss were applied, when using the modified MIPS drill system, because a trend toward less implant extrusion was observed with implementation of this drill system (36).…”

Section: Type Of Health Economic Evaluationmentioning

confidence: 99%

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Health Economic Cost Analysis for Percutaneous Bone Conduction Devices: The Minimally Invasive Ponto Surgery Versus Linear Incision Technique with Tissue Preservation

et al. 2023

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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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Long-Term Outcomes of a Percutaneous Wide-Diameter Bone-Anchored Hearing Implant: A Clinical Evaluation of More than 800 Implants

Teunissen,

Caspers,

Vijverberg

et al. 2024

Otol Neurotol

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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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A Clinical Evaluation of Minimally Invasive Ponto Surgery With a Modified Drill System for Inserting Bone-Anchored Hearing Implants

Abstract: Supplemental Digital Content is available in the text

Cited by 6 publications

References 22 publications

Ex vivo Evaluation of a New Drill System for Placement of Percutaneous Bone Conduction Devices

Ex vivo Evaluation of a New Drill System for Placement of Percutaneous Bone Conduction Devices

Health Economic Cost Analysis for Percutaneous Bone Conduction Devices: The Minimally Invasive Ponto Surgery Versus Linear Incision Technique with Tissue Preservation

Long-Term Outcomes of a Percutaneous Wide-Diameter Bone-Anchored Hearing Implant: A Clinical Evaluation of More than 800 Implants

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