Long-Term Follow-up of a Wide-Diameter Bone-Anchored Hearing Implant: 10-Year Experience on Stability, Survival, and Tolerability of an Implant-Abutment Combination.

OBJECTIVE: To compare stability, survival, and soft tissue reactions between a wide-diameter (test) and previous-generation small-diameter (control) bone-anchored hearing implant and to ascertain the safety of loading the test implant 3 weeks after surgery, at a long-term follow-up of 10 years. STUDY DESIGN: This study is a continuation of two previously completed, multicenter, randomized, controlled trials and consisted of one to two additional follow-up visits until 10 years after surgery. PATIENTS: Fifty-one of the 72 participants from the previous trials were included. Patients received a test or control implant. All control implants were loaded 6 weeks after surgery (group A). Test implants were loaded 3 (group B) or 6 weeks (group C) after surgery. RESULTS: The test implant showed significantly higher implant stability quotient (ISQ) values than the control implant throughout the 10-year follow-up. At 10 years, the mean ISQ-high values for both implants were higher than at the first follow-up visit. No significant differences in change of ISQ-high from baseline to 10 years were noticed between both implants and loading groups. Soft tissue reactions were rarely seen. At 10-year follow-up, no patients presented with adverse soft tissue reactions. Excluding explantations, the implant survival rate was 78.6% (group A), 100% (group B), and 90.0% (group C). CONCLUSIONS: The test implant showed superior mean ISQ values and significantly better implant survival throughout 10-year follow-up. In addition, the current study concludes that it is safe to load the test implant at 3 weeks after surgery, as long-term results show high ISQ values and good implant survival.

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

OBJECTIVE: To compare 6-months outcomes of the modified minimally invasive Ponto surgery (m-MIPS) to both the linear incision technique with soft tissue preservation (LIT-TP), and original MIPS (o-MIPS) for inserting bone-anchored hearing implants (BAHIs). STUDY DESIGN: Exploratory pilot study with one test group and two historical control groups. SETTING: Tertiary referral center. PATIENTS: In the test group, 24 patients (25 implants) were prospectively included. Each control group comprised 25 patients (25 implants) who participated in previously conducted clinical trials. INTERVENTIONS: The test group received a BAHI using m-MIPS. The two control groups underwent surgery using the LIT-TP and o-MIPS, respectively. MAIN OUTCOME MEASURES: Implant survival, implant stability, and surgery-related variables were compared between the test and control groups. Soft tissue status, skin sensibility, and subjective numbness were compared between m-MIPS and LIT-TP only. RESULTS: Implant survival was comparable between m-MIPS and LIT-TP, whereas implant stability measurements were slightly lower for m-MIPS. M-MIPS resulted in comparable adverse skin reactions and skin sensibility, significantly reduced surgical time and slightly improved subjective numbness, compared with LIT-TP. Between m-MIPS and o-MIPS, no statistically significant differences in implant survival, implant stability and surgical time were observed. CONCLUSIONS: A trend toward lower implant loss rates after m-MIPS was observed, when compared with o-MIPS. M-MIPS seems to be a good alternative to LIT-TP for inserting BAHIs, since most clinical outcomes were either comparable or slightly better for m-MIPS. Upon deciding on which technique to use, larger studies on implant survival should be performed. Furthermore, other aspects such as costs, training aspects and surgical experience should be evaluated.

Patient Preferences in Sound Processor Loading Time After BAHI Surgery.

OBJECTIVE: Sound processor loading times after bone-anchored hearing implant (BAHI) surgery have gradually decreased over time. This study assessed patient preferences in loading time. STUDY DESIGN: Prospective patient questionnaire study. SETTING: Tertiary referral center. PATIENTS: Patients indicated for BAHI surgery received two questionnaires preoperatively: the validated Glasgow Health Status Inventory (GHSI) and a nonvalidated questionnaire that assessed patient preference for loading time and the rationale behind it. This preference questionnaire was also provided immediately, 7 days and 3 weeks (moment of sound processor loading at our center) postoperatively. MAIN OUTCOME MEASURES: The preoperative and postoperative preferred loading time and the postoperative changes in preference were determined. Correlations between preference and patient-specific variables were assessed. RESULTS: Sixty patients were included. Preoperatively, 70% preferred loading within 1 week after surgery. Of all patients, 43% preferred loading on the day of surgery, mainly motivated by the fast hearing rehabilitation and practical considerations. These preferences were not correlated with the total GHSI score or duration of hearing loss. Directly postoperatively, no change in preference was observed. However, 7 days and 3 weeks after surgery, significantly more patients preferred loading at a later moment. At 7 days and at 3 weeks, 50 and 40% preferred loading within 1 week, and 12.5 and 7.5% preferred loading on the day of surgery, respectively. CONCLUSION: The preference for the timing of sound processor loading varied among patients and differed pre- and postoperatively. Despite the postoperative decline in patients preferring earlier loading, approximately half of all patients preferred sound processor loading within 1 week after BAHI surgery.

Clinical Presentation, Management, and Outcomes of Idiopathic Pain in Percutaneous Bone-anchored Hearing Implants.

OBJECTIVE: To identify clinical features and investigate treatment outcomes of patients with idiopathic pain related to a percutaneous bone-anchored hearing implant (BAHI) and to propose management recommendations. STUDY DESIGN: Retrospective chart analysis. SETTING: Tertiary referral center. PATIENTS: The clinical data of 14 patients who were treated for idiopathic pain around their percutaneous BAHI between May 2007 and February 2018 at our tertiary referral center were reviewed. MAIN OUTCOME MEASURES: Pain after treatment and implant loss. RESULTS: All 14 patients received treatment with oral antibiotics. Nine patients received oral antibiotic combination therapy for 4 weeks, whereafter pain resolved in 4. Out of the five other patients, receiving either antibiotic monotherapy or shortened antibiotic combination therapy, pain resolved in two. In case of persistent pain (57.1%) after initial treatment, other pain management therapies were attempted, however all with only limited effect. Six patients (42.8%) underwent elective removal of the implant. In two patients spontaneous implant loss occurred. In two of the four patients who underwent reimplantation, pain relapsed. In one of these, pain resolved after the removal of the new implant. In the other patient, pain persisted, despite abutment removal. With exception of this latter patient, all other 13 patients were pain free at the latest follow-up. Cone beam computed tomography did not offer additional information regarding diagnosis or treatment. CONCLUSION: Idiopathic pain in BAHI is a rare but bothersome symptom which can result in implant removal. After oral antibiotic combination treatment, symptoms resolved in approximately 40% of patients. Therefore, we think conservative treatment with these antibiotics before implant removal surgery, is worth considering.