Long term follow-up demonstrating stability and patient satisfaction of minimally invasive punch technique for percutaneous bone anchored hearing devices

Abstract

ObjectiveMinimally Invasive Ponto Surgery (MIPS) was recently described to facilitate the placement of percutaneous bone anchored hearing devices. As early adopters of this new procedure, we sought to perform a quality assurance project using our own small prospective cohort to justify this change in practice. We chose to examine device stability and to gauge our patients’ perspective of the surgery and their overall satisfaction with the process.MethodsA total of 12 adult patients who underwent MIPS between 2016 and 2017 with a minimum post-operative follow-up of 12 months were included in this study. A prospective MIPS research clinic was used to follow patients, assess the implant site soft tissue status and gather qualitative information through patient interviews and surveys.ResultsThe mean (SD) soft tissue status score averages using the IPS Scale were low for inflammation 0.1 (0.1), pain 0.1 (0.1), skin height 0.2 (0.1) and total IPS score 0.4 (0.3) indicating minimal soft tissue changes. Patient experiences with MIPS were overwhelmingly positive in reports through the MIPS modified SSQ-8. All patients reported speedy recoveries and no long-term complications. There were zero device losses.ConclusionThe series presented in this paper represents the first MIPS cohort with long term follow-up to be published to date in North America. Our findings conclude both device stability and patient satisfaction with no loss of fixtures. Consequently, we have adopted MIPS as our procedure of choice for the placement of all percutaneous BAHDs.

Comparison of soft tissue preservation techniques for BAHA insertion in 41 patients: ‘Bus‐stop’ (open approach) vs MIPS (minimally invasive approach)

“…None of these studies used a cannular as part of the procedure. Published results of MIPS without a control group report either no loss Sardiwalla et al or a 96% (74/77) survival rate with 2 losses at 2 and 8 weeks, respectively occurring without any evidence of inflammation. These were attributed to incorrect drilling technique and CSF leak, respectively, Johansson et al The only study comparing MIPS with an open soft tissue‐preserving technique demonstrated a 12.1% loss rate in the MIPS group compared with a 3.3% loss rate in the other at 12 weeks, Calon et al All their losses occurred between 25 and 90 days with possible causes of angulated or incomplete insertion and overheating mentioned in the discussion.…”

Long-Term Outcomes of the Minimally Invasive Ponto Surgery vs. Linear Incision Technique With Soft Tissue Preservation for Installation of Percutaneous Bone Conduction Devices

“…Nevertheless, implant extrusion was mentioned several times as a warrant for further research ( 29 – 33 , 35 , 39 ). Also, there were limited long-term results with only one small cohort study ( 36 ). Moreover, a standardized procedure was lacking.…”

“…Nonetheless, a nonsignificant increase in implant extrusion rate was found when using the MIPS technique ( 35 ). Besides these encouraging short-term results, however, there is only one small prospective cohort study of Sardiwalla et al ( 36 ) with a longer follow-up (minimal 12 months). This study concluded device stability and patient satisfaction with the MIPS procedure ( 36 ).…”

Patient Safety and Quality Improvement in Otolaryngology–Head and Neck Surgery: A Systematic Review

“…Examples include studies looking at surgical outcomes, studies investigating patient satisfaction outcomes, and studies examining quality indicators. [17][18][19][20][21][22] Residency/ education-specific PS/QI was previously examined in depth by our research team 5 ; major focus areas include use of simulation for risk-free surgical training [23][24][25] and development of methodologies for evaluating surgical competency. [26][27][28] The greatest areas of research need identified in this OHNS dedicate PS/QI systematic review were: 1) examination of the existence and impact of multidisciplinary care, and 2) investigation of healthcare disparities.…”