Tissue Preservation Techniques for Bone-Anchored Hearing Aid Surgery

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.

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

“…Subsequent studies comparing the MIPS technique to the LITT-P showed similar favorable outcomes, even with longer follow-up, regarding soft tissue reactions (27)(28)(29)(30)(31)(32)(33). Moreover, a shorter surgical time (27)(28)(29)(30)(31)(32)(33), better cosmetic appearance (28,29), and improved sensibility (28) were reported in favor of the MIPS technique compared with the LITT-P approach. However, implant loss was mentioned as a concern after the MIPS procedure with a couple of studies showing nonsignificantly more implant extrusion (28,29).…”

“…Also, there was an implant survival rate of >95% at the 20-week follow-up (26). Subsequent studies comparing the MIPS technique to the LITT-P showed similar favorable outcomes, even with longer follow-up, regarding soft tissue reactions (27)(28)(29)(30)(31)(32)(33). Moreover, a shorter surgical time (27)(28)(29)(30)(31)(32)(33), better cosmetic appearance (28,29), and improved sensibility (28) were reported in favor of the MIPS technique compared with the LITT-P approach.…”

“…Nowadays, the less invasive linear incision technique with tissue preservation (LITT-P) is advocated based on similar or less (adverse) soft tissue reactions (10)(11)(12)(13)(14)(15)(16) as well as favorable outcomes in surgical time, cosmetics, and numbness (15)(16)(17)(18)(19)(20)(21). Recently, minimally invasive punch-only techniques have been introduced to reduce soft tissue trauma (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33). A standardized approach was developed by Oticon Medical AB (Askim, Sweden): the minimally invasive Ponto surgery (MIPS) (26).…”

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

“…In addition to providing benefits to patients, improvements in clinical efficiency using MIPS have been reported in cost analysis studies ( 32 ). While several studies have reported comparable implant survival rates for MIPS compared to LITT-P ( 27 – 29 , 31 , 33 ), lower implant survival for MIPS has also been reported ( 25 , 26 , 34 ). Possible reasons can be the reduced visibility during the procedure, introducing a potential risk of angulated insertion or interposing soft tissue.…”

“…The results of the MIPS technique are encouraging, and several recent studies have compared the clinical outcome of MIPS with that of the commonly used LITT-P ( 25 – 29 ). While both techniques show favorable soft tissue outcomes compared with the outcomes of previous tissue reduction approaches, MIPS is also associated with improvements in terms of surgery time, cosmetics and preservation of skin sensibility ( 25 – 31 ). In addition to providing benefits to patients, improvements in clinical efficiency using MIPS have been reported in cost analysis studies ( 32 ).…”