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Percutaneous bone-anchored hearing implant surgery: linear incision technique with tissue preservation versus linear incision technique with tissue reduction

  • Otology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Objectives

To identify differences in skin thickening and soft tissue reactions between the linear incision technique with tissue reduction (LITT-R) and the linear incision technique with tissue preservation (LITT-P).

Study design

Retrospective cohort study.

Methods

All adult patients who underwent the LITT-R or LITT-P between August 2005 and December 2016 at a large general teaching hospital with a minimum follow-up of 6 months were included.

Results

A total of 83 implants were included using the LITT-R with a median follow-up of 74.0 months. In the LITT-P cohort 58 implants were included with a median follow-up of 16.5 months. Skin thickening was seen in seven implants (8.4%) in LITT-R cohort and 11 implants (19.0%) in the LITT-P cohort in the first 2 years of follow-up (p = 0.024). Skin thickening in need of treatment was registered in 5 (6.0%), respectively, 6 (10.3%) implants (p = 0.100). Moreover, treatment was successful in all cases. A soft tissue reaction (Holgers ≥ 1) was noticed in 28 (33.7%) implants in the LITT-R group compared to 16 implants (27.6%) in the LITT-P group (p = 0.679). An adverse soft tissue reaction (Holgers ≥ 2) was registered in 16 (19.2%), respectively, 2 (3.4%) implants. This difference was significant (p = 0.040).

Conclusion

LITT-P has a significantly higher rate of skin thickening and LITT-R has a significantly higher proportion of adverse soft tissue reactions. Nevertheless, combined with the advantages of LITT-P described in other studies, this can be advocated as the preferred technique.

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References

  1. Tjellström A, Lindström J, Hallén O, Albrektsson T, Brånemark PI (1981) Osseointegrated titanium implants in the temporal bone. A clinical study on bone-anchored hearing aids. Am J Otol 2(4):304–310

    PubMed  Google Scholar 

  2. de Wolf MJ, Hendrix S, Cremers CW, Snik AF (2011) Better performance with bone-anchored hearing aid than acoustic devices in patients with severe air-bone gap. Laryngoscope 121(3):613–616. https://doi.org/10.1002/lary.21167

    Article  PubMed  Google Scholar 

  3. Snik AF, Beynon AJ, Mylanus EA, van der Pouw CT, Cremers CW (1998) Binaural application of the bone-anchored hearing aid. Ann Otol Rhinol Laryngol 107(3):187–93. https://doi.org/10.1177/000348949810700301

    Article  PubMed  CAS  Google Scholar 

  4. Snik AF, Mylanus EA, Cremers CW (2002) The bone-anchored hearing aid in patients with a unilateral air-bone gap. Otol Neurotol 23(1):61–6

    Article  PubMed  Google Scholar 

  5. Hol MK, Kunst SJ, Snik AF, Bosman AJ, Mylanus EA, Cremers CW (2010) Bone-anchored hearing aids in patients with acquired and congenital unilateral inner ear deafness (Baha CROS): clinical evaluation of 56 cases. Ann Otol Rhinol Laryngol 119(7):447–54. https://doi.org/10.1177/000348941011900704

    Article  PubMed  Google Scholar 

  6. Tjellström A, Granström G (1995) One-stage procedure to establish osseointegration: a 0–5 years follow-up report. J Laryngol Otol 109(7):593–598

    Article  PubMed  Google Scholar 

  7. Tjellström A (1990) Osseointegrated implants for replacement of absent or defective ears. Clin Plast Surg 17(2):355–66

    PubMed  Google Scholar 

  8. Mylanus EA, Cremers CW (1994) A one-stage surgical procedure for placement of percutaneous implants for the bone-anchored hearing aid. J Laryngol Otol 108(12):1031–1035

    Article  PubMed  CAS  Google Scholar 

  9. Tjellström A, Granström G (2006) How we do it: Frequency of skin necrosis after BAHA surgery. Clin Otolaryngol 31(3):216–20. https://doi.org/10.1111/j.1749-4486.2006.01152.x

    Article  PubMed  Google Scholar 

  10. de Wolf MJ, Hol MK, Huygen PL, Mylanus EA, Cremers CW (2008) Clinical outcome of the simplified surgical technique for BAHA implantation. Otol Neurotol 29(8):1100–1108. https://doi.org/10.1097/MAO.0b013e31818599b8

    Article  PubMed  Google Scholar 

  11. Strijbos RM, Bom SJ, Zwerver S, Hol MK (2016) Percutaneous bone-anchored hearing implant surgery: dermatome versus linear incision technique. Eur Arch Otorhinolaryngol 274(1):109–117. https://doi.org/10.1007/s00405-016-4210-3

    Article  PubMed  PubMed Central  Google Scholar 

  12. Wigren S, Pettersson P (2012) A novel Cochlear™ Baha® abutment to enable surgery without soft tissue reduction. Cochlear. https://pdfs.semanticscholar.org/29d7/371e9b722c67d16c1de78fb3acd8a4f0c80e.pdf. Accessed 30 Apr 2018

  13. Mowinckel MS, Møller MN, Wielandt KN, Foghsgaard S (2016) Clinical outcome of a wide-diameter bone-anchored hearing implant and a surgical technique with tissue preservation. Otol Neurotol 37(4):374–379. https://doi.org/10.1097/MAO.0000000000000990

    Article  PubMed  PubMed Central  Google Scholar 

  14. Westerkull P, Jinton L (2012) The new wide Ponto implant design - clinical and surgical aspects. Oticon Medical. https://www.oticonmedical.com/-/media/medical/main/files/bahs/surgical-materials/papers/eng/wide-ponto-implant-clinical-paper---english---m51162.pdf?la=en. Accessed 30 Apr 2018

  15. den Besten CA, Stalfors J, Wigren S et al (2016) Stability, survival, and tolerability of an auditory osseointegrated implant for bone conduction hearing: long-term follow-up of a randomized controlled trial. Otol Neurotol 37(8):1077–1083. https://doi.org/10.1097/MAO.0000000000001111

    Article  Google Scholar 

  16. Nelissen RC, den Besten CA, Mylanus EA, Hol MK (2016) Stability, survival, and tolerability of a 4.5-mm-wide bone-anchored hearing implant: 6-month data from a randomized controlled clinical trial. Eur Arch Otorhinolaryngol 273(1):105–11. https://doi.org/10.1007/s00405-015-3593-x

    Article  PubMed  Google Scholar 

  17. Dun CA, Hol MK, Mylanus EA, Cremers CW (2011) Fitting of an 8.5-millimeter abutment for bone conduction devices: indications and postintervention course. Ann Otol Rhinol Laryngol 120(6):386–90. https://doi.org/10.1177/000348941112000607

    Article  PubMed  Google Scholar 

  18. Hultcrantz M (2011) Outcome of the bone-anchored hearing aid procedure without skin thinning: a prospective clinical trial. Otol Neurotol 32(7):1134–1139. https://doi.org/10.1097/MAO.0b013e31822a1c47

    Article  PubMed  Google Scholar 

  19. Husseman J, Szudek J, Monksfield P, Power D, O’Leary S, Briggs R (2013) Simplified bone-anchored hearing aid insertion using a linear incision without soft tissue reduction. J Laryngol Otol 127(Suppl 2):S33–8. https://doi.org/10.1017/S0022215113000741

    Article  PubMed  Google Scholar 

  20. Singam S, Williams R, Saxby C, Houlihan FP (2014) Percutaneous bone-anchored hearing implant surgery without soft-tissue reduction: up to 42 months of follow-up. Otol Neurotol 2014 35(9):1596–600. https://doi.org/10.1097/MAO.0000000000000522

    Article  Google Scholar 

  21. Hultcrantz M (2015) Stability testing of a wide bone-anchored device after surgery without skin thinning. Biomed Res Int. https://doi.org/10.1155/2015/853072

    Article  PubMed  PubMed Central  Google Scholar 

  22. Caruso A, Giannuzzi AL, Sozzi V, Sanna M (2016) Bone anchored hearing implants without skin thinning: the Gruppo Otologico surgical and audiological experience. Eur Arch Otorhinolaryngol 274(2):695–700. https://doi.org/10.1007/s00405-016-4305-x

    Article  PubMed  Google Scholar 

  23. Altuna X, Navarro JJ, Palicio I, Álvarez L (2015) Bone-anchored hearing device surgery: linear incision without soft tissue reduction. A prospective study. Acta Otorrinolaringol Esp 66(5):258–63. https://doi.org/10.1016/j.otorri.2014.09.007

    Article  PubMed  Google Scholar 

  24. Hultcrantz MLA (2014) A five-year follow-up on the osseointegration of bone-anchored hearing device implantation without tissue reduction. Otol Neurotol 35(8):1480–1485. https://doi.org/10.1097/MAO.0000000000000352

    Article  PubMed  Google Scholar 

  25. Høgsbro M, Agger A, Johansen LV (2015) Bone-anchored hearing implant surgery: randomized trial of dermatome versus linear incision without soft tissue reduction-clinical measures. Otol Neurotol 36(5):805–11. https://doi.org/10.1097/MAO.0000000000000731

    Article  PubMed  Google Scholar 

  26. Wilson DFKH. (2013) A minimally invasive technique for the implantation of bone-anchored hearing devices. Otolaryngol Head Neck Surg 149(3):473–477. https://doi.org/10.1177/0194599813492946

    Article  PubMed  Google Scholar 

  27. Martínez P, López F, Gómez JR (2015) Cutaneous complications in osseointegrated implants: comparison between classic and tissue preservationtechniques. Acta Otorrinolaringol Esp 66(3):148–53. https://doi.org/10.1016/j.otorri.2014.07.003

    Article  PubMed  Google Scholar 

  28. van Hoof M, Wigren S, Blechert JI et al (2016) A multi-center randomized controlled trial of soft tissue preservation using a hydroxyapatite-coated abutment in percutaneous bone conduction hearing implant surgery—1-year clinical outcomes. J Laryngol Otol 130(S3):81–82. https://doi.org/10.1017/S0022215116003388

    Article  Google Scholar 

  29. den Besten CA, Bosman AJ, Nelissen RC, Mylanus EA, Hol MK (2016) Controlled clinical trial on bone-anchored hearing implants and a surgical technique with soft-tissue preservation. Otol Neurotol 37(5):504–12. https://doi.org/10.1097/MAO.0000000000000994

    Article  Google Scholar 

  30. Strijbos RM, den Besten CA, Mylanus EAM, Hol MKS (2016) Percutaneous bone-anchored hearing implant surgery: inside or outside the line of incision? Eur Arch Otorhinolaryngol 273(11):3713–3722. https://doi.org/10.1007/s00405-016-4020-7

    Article  PubMed  PubMed Central  Google Scholar 

  31. Kunst SJ, Hol MK, Snik AF, Mylanus EA, Cremers CW (2006) Rehabilitation of patients with conductive hearing loss and moderate mental retardation by means of a bone-anchored hearing aid. Otol Neurotol 27(5):653–658. https://doi.org/10.1097/01.mao.0000224088.00721.c4

    Article  PubMed  Google Scholar 

  32. den Besten CA, Nelissen RC, Peer PG et al (2015) A retrospective cohort study on the influence of comorbidity on soft tissue reactions, revision surgery, and implant loss in bone-anchored hearing implants. Otol Neurotol 36(5):812–818. https://doi.org/10.1097/MAO.0000000000000745

    Article  Google Scholar 

  33. Horstink L, Faber HT, de Wolf MJ, Dun CA, Cremers CW, Hol MK (2012) Titanium fixtures for bone-conduction devices and the influence of type 2 diabetes mellitus. Otol Neurotol 33(6):1013–1017. https://doi.org/10.1097/MAO.0b013e318259b36c

    Article  PubMed  Google Scholar 

  34. Holgers KM, Tjellström A, Bjursten LM, Erlandsson BE (1988) Soft tissue reactions around percutaneous implants: a clinical study of soft tissue conditions around skin-penetrating titanium implants for bone-anchored hearing aids. Am J Otol 9(1):56–9

    PubMed  CAS  Google Scholar 

  35. Reinfeldt S, Håkansson B, Taghavi H, Eeg-Olofsson M (2015) New developments in bone-conduction hearing implants: a review. Med Devices (Auckl) 8:79–93. https://doi.org/10.2147/MDER.S39691

    Article  Google Scholar 

  36. de Wolf MJ, Hol MK, Mylanus EA, Cremers CW (2009) Bone-anchored hearing aid surgery in older adults: implant loss and skin reactions. Ann Otol Rhinol Laryngol 118(7):525–31. https://doi.org/10.1177/000348940911800712

    Article  PubMed  Google Scholar 

  37. Wilkie MD, Chakravarthy KM, Mamais C, Temple RH (2014) Osseointegrated hearing implant surgery using a novel hydroxyapatite-coated concave abutment design. Otolaryngol Head Neck Surg 151(6):1014–1019. https://doi.org/10.1177/0194599814551150

    Article  PubMed  Google Scholar 

  38. Hawley KHT (2013) Osseointegrated hearing implant surgery: outcomes using a minimal soft tissue removal technique. Otolaryngol Head Neck Surg 148(4):653–657. https://doi.org/10.1177/0194599812473414

    Article  PubMed  Google Scholar 

  39. Iseri M, Orhan KS, Yarıktaş MH et al (2015) Surgical and audiological evaluation of the Baha BA400. J Laryngol Otol 129(1):32–7. https://doi.org/10.1017/S0022215114003284

    Article  PubMed  CAS  Google Scholar 

  40. Verheij E, Bezdjian A, Grolman W, Thomeer HG (2016) A systematic review on complications of tissue preservation surgical techniques in percutaneous bone conduction hearing devices. Otol Neurotol 37(7):829–37. https://doi.org/10.1097/MAO.0000000000001091

    Article  PubMed  Google Scholar 

  41. Calon TG, van Hoof M, van den Berge H et al (2016) Minimally Invasive Ponto Surgery compared to the linear incision technique without soft tissue reduction for bone conduction hearing implants: study protocol for a randomized controlled trial. Trials 17(1):540. https://doi.org/10.1186/s13063-016-1662-0

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  42. Alshehri H, Alsanosi A, Majdalawieh O (2016) Modified Baha punch technique: least invasive, shortest time and no suturing. Indian J Otolaryngol Head Neck Surg 68(1):80–6. https://doi.org/10.1007/s12070-015-0929-1

    Article  PubMed  Google Scholar 

  43. Goldman RA, Georgolios A, Shaia WT (2013) The punch method for bone-anchored hearing aid placement. Otolaryngol Head Neck Surg 148(5):878–80. https://doi.org/10.1177/0194599813476666

    Article  PubMed  Google Scholar 

  44. Bennet AMD, Banigo A, Lovergrove D, Wood MDY (2017) Comparison of non soft tissue reduction techniques for BAHA insertion: ‘Bus-stop’ or linear incision (open approach) vs MIPS or ‘punch and go’ (limited acces approach); poster pitch presented at: OSSEO2017. 6th international congress on bone conduction hearing and related technologies; 2017 May 17–20; Nijmegen, The Netherlands

  45. Flanagan N, Savage Jones H, Frawley TM (2017) Minimally invasive Ponto surgery—MIPS: A 2 year single centre review of the technique; presentation presented at: OSSEO2017. 6th international congress on bone conduction hearing and related technologies; 2017 May 17–20; Nijmegen, The Netherlands

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Deventer Hospital, Nico Bolkesteinlaan 75, 7416 SE, Deventer, The Netherlands

    E. H. H. van der Stee & S. J. H. Bom

  2. Department of Otorhinolaryngology, Radboud University Medical Center, Philips van Leydenlaan 15, 6525 EX, Nijmegen, The Netherlands

    R. M. Strijbos & M. K. S. Hol

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  1. E. H. H. van der Stee
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Corresponding author

Correspondence to S. J. H. Bom.

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Conflict of interest

M. Hol reports financial support to the authors’ institution (Radboudumc) for conducting clinical studies from Oticon Medical AB (Askim, Sweden) and from Cochlear Bone Anchored Solutions AB (Mölnlycke, Sweden), outside the submitted work. The authors declare that they have no other conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Not mandatory in case of this retrospective cohort-study without any intervention.

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van der Stee, E.H.H., Strijbos, R.M., Bom, S.J.H. et al. Percutaneous bone-anchored hearing implant surgery: linear incision technique with tissue preservation versus linear incision technique with tissue reduction. Eur Arch Otorhinolaryngol 275, 1737–1747 (2018). https://doi.org/10.1007/s00405-018-5005-5

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