Evaluation of Bone Conduction Implant Stability and Soft Tissue Status in Children in Relation to Age, Bone Thickness, and Sound Processor Loading Time

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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Long-term Subjective Benefit With a Bone Conduction Implant Sound Processor in 44 Patients With Single-Sided Deafness

Otology & Neurotology ◽

10.1097/mao.0000000000000297 ◽

2014 ◽

Vol 35 (6) ◽

pp. 1017-1025 ◽

Cited By ~ 21

Author(s):

Jolien Desmet ◽

Kristien Wouters ◽

Marc De Bodt ◽

Paul Van de Heyning

Keyword(s):

Bone Conduction ◽

Bone Conduction Implant ◽

Single Sided Deafness ◽

Sound Processor

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Bone conduction implants – a rapidly developing field

The Journal of Laryngology & Otology ◽

10.1017/s0022215115002042 ◽

2015 ◽

Vol 129 (10) ◽

pp. 936-940 ◽

Cited By ~ 18

Author(s):

R C Edmiston ◽

R Aggarwal ◽

K M J Green

Keyword(s):

Soft Tissue ◽

Surgical Technique ◽

Bone Conduction ◽

Surgical Techniques ◽

Bone Conduction Implant ◽

Hearing Devices ◽

Reduction Methods ◽

Tissue Reduction

AbstractBackground:Since their introduction in 1977, the technology and surgical techniques surrounding the use and application of bone-anchored hearing devices have developed considerably.Objective:This article reviews current developments in the use of bone-anchored hearing devices, looking at the possible options for patients, complications encountered and future possibilities.Conclusion:Advances in surgical technique are described, with the move towards the use of linear incisions and no soft tissue reduction. Methods for preventing complications are analysed, with review of different abutments and the introduction of the active bone conduction implant.

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Long-term hearing performance and soft tissue outcomes of Baha@ Attract system in patients with bilateral congenital microtia in a single center

10.22541/au.162851327.70681632/v1 ◽

2021 ◽

Author(s):

Ying Chen ◽

You-zhou Xie ◽

Liu-Jie Ren ◽

Na Gao ◽

Wen-xiu Gu ◽

...

Keyword(s):

Soft Tissue ◽

Skin Necrosis ◽

Bone Conduction ◽

Hearing Threshold ◽

Bone Conduction Implant ◽

Soft Tissue Complication ◽

One Year ◽

Auricle Reconstruction ◽

Baha Attract

Abstract： Background: Baha Attract System was designed as non-skin penetrating bone conduction implant to minimize skin complication. However, there were insufficient studies on its long-time acoustic outcome and safety in microtia patients with auricle reconstruction surgeries, who have thinner retroauricular subcutaneous layer and theoretically vulnerable skin at the implant side. Objectives: To analysis the long-term hearing performance and soft tissue complications of Baha@ Attract System in microtia population. Study Design & setting: A prospective cohort study at single tertiary referral center. Patients: Twenty Mandarin-speaking patients with congenital bilateral microtia who were underwent Baha@ Attract implantation with or without auricle reconstruction surgeries simultaneously. Main Outcome Measure(s): Comparative analysis of audiological test results including hearing thresholds and speech recognition in quiet and in noise were pre- and post-operatively performed. subjective benefit as measured with the SSQ Scale. Soft tissue outcomes were monitored and documented. Results: The mean follow-up time was 36.11±3.30 months. Significant and stable improvements in hearing threshold and speech understanding in noise and quiet were demonstrated with aided condition. Subject evaluation revealed high level of patients’ satisfaction with the amplification in all the subscales. Adverse events including skin necrosis increased after one year post-operatively. Soft tissue evolution including sin thinning, erythema, epidermis atrophy, soft tissue atrophy, skin necrosis was seen or once developed in most of the participants. However, prevalence of severe soft tissue complication was not higher to non-microtia population. Conclusions: Baha@ Attract System provides favorable and stable hearing improvements for microtia patients. Combining plastic surgeries with implantation will not increase the prevalence of soft tissue complication. However, long-term soft tissue problems should be highly aware of even after one year post implantation. Key words: Baha Attract, microtia, hearing, soft tissue, skin necrosis

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Accuracy of robot-assisted versus optical frameless navigated stereoelectroencephalography electrode placement in children

Journal of Neurosurgery Pediatrics ◽

10.3171/2018.10.peds18227 ◽

2019 ◽

Vol 23 (3) ◽

pp. 297-302 ◽

Cited By ~ 11

Author(s):

Julia D. Sharma ◽

Kiran K. Seunarine ◽

Muhammad Zubair Tahir ◽

Martin M. Tisdall

Keyword(s):

Soft Tissue ◽

Entry Point ◽

Electrode Placement ◽

Target Point ◽

Localization Error ◽

Bone Thickness ◽

Tissue Thickness ◽

Robot Assisted ◽

Soft Tissue Thickness ◽

Safety Margins

OBJECTIVEThe aim of this study was to compare the accuracy of optical frameless neuronavigation (ON) and robot-assisted (RA) stereoelectroencephalography (SEEG) electrode placement in children, and to identify factors that might increase the risk of misplacement.METHODSThe authors undertook a retrospective review of all children who underwent SEEG at their institution. Twenty children were identified who underwent stereotactic placement of a total of 218 electrodes. Six procedures were performed using ON and 14 were placed using a robotic assistant. Placement error was calculated at cortical entry and at the target by calculating the Euclidean distance between the electrode and the planned cortical entry and target points. The Mann-Whitney U-test was used to compare the results for ON and RA placement accuracy. For each electrode placed using robotic assistance, extracranial soft-tissue thickness, bone thickness, and intracranial length were measured. Entry angle of electrode to bone was calculated using stereotactic coordinates. A stepwise linear regression model was used to test for variables that significantly influenced placement error.RESULTSBetween 8 and 17 electrodes (median 10 electrodes) were placed per patient. Median target point localization error was 4.5 mm (interquartile range [IQR] 2.8–6.1 mm) for ON and 1.07 mm (IQR 0.71–1.59) for RA placement. Median entry point localization error was 5.5 mm (IQR 4.0–6.4) for ON and 0.71 mm (IQR 0.47–1.03) for RA placement. The difference in accuracy between Stealth-guided (ON) and RA placement was highly significant for both cortical entry point and target (p < 0.0001 for both). Increased soft-tissue thickness and intracranial length reduced accuracy at the target. Increased soft-tissue thickness, bone thickness, and younger age reduced accuracy at entry. There were no complications.CONCLUSIONSRA stereotactic electrode placement is highly accurate and is significantly more accurate than ON. Larger safety margins away from vascular structures should be used when placing deep electrodes in young children and for trajectories that pass through thicker soft tissues such as the temporal region.

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