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ENT
Bone-Anchored Hearing Implants
Built from Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
What’s inside
11 sections · 116 slides
Rationale for bone conduction
- Scope of bone conduction hearing
- Uptake of conventional hearing aids
- Clinical situations that prevent hearing aid use
- Advantages of bone conduction devices
- Candidate populations
Background and history
- Early observations on conduction through solids
- Nineteenth century tooth-conduction devices
- Limitations of skin-worn bone conduction devices
- Persisting indications for non-implanted devices
- Branemark and the discovery of osseointegration
- From dental fixtures to percutaneous implants
- Clinical translation of percutaneous fixtures
- Percutaneous bone conduction implant components
Transcutaneous implants
- Drivers for transcutaneous systems
- Classification of bone conduction systems
- Passive transcutaneous implants
- Outcomes of passive transcutaneous devices
- Active transcutaneous implants
- MED-EL BONEBRIDGE
- Cochlear Osia
- Oticon Medical Sentio
- Active transcutaneous device components
- Osia signal pathway to the cochlea
- BONEBRIDGE signal pathway to the cochlea
Osseointegration
- Definition of osseointegration
- Histological requirements for osseointegration
- Bone-to-implant interface histology
- Requirements of the ideal implant material
- Titanium and its surface oxide layer
- Mechanical and toxicological profile of titanium
- Implant microstructure
- Implant macrostructure and thread design
- Determinants of successful osseointegration
- Host bone factors affecting integration
- Timing implantation around radiotherapy
- Stability during the healing phase
Percutaneous implant surgery
- Setting and anaesthesia
- Goal of the classical soft tissue technique
- Selection of the implant site
- Marking the implant site relative to the pinna
- Conditions for a reaction-free skin-implant interface
- Raising and thinning the skin flap
- Full-thickness skin grafting
- The punch technique variation
- Minimally Invasive Ponto Surgery
- Measuring soft tissue and selecting abutment length
- Drilling the pilot hole
- Countersink recess in the outer table
- Insertion of the implant
- Avoiding thermal injury to bone
- Drilling axis and irrigation during insertion
- Sequence of bone preparation
- Completion of the percutaneous procedure
- Postoperative course and loading
- Continuing variations in technique
Active transcutaneous surgery
- General principles for active transcutaneous implants
- Osia: planning and incision
- Osia: incision options and pocket
- Osia: fixture placement and closure
- BONEBRIDGE: preparing the transducer bed
- BONEBRIDGE: dura, sinus and lifts
- BONEBRIDGE: fixation and closure
- Sentio: incision and pocket
- Sentio: transducer recess and fixation
- Sentio: implant bending limits
Implants in young children
- Bone conduction options under 5 years
- Two-stage implantation in young children
- Second stage and paediatric outcomes
- Abutment site behind the pinna
- Abutment and surrounding scalp at close range
- Sound processor coupled to the abutment
Complications
- Skin and soft tissue reactions
- Prevention of soft tissue reactions
- Osseointegration failure
- Revision and implant loss rates
- Other reasons for implant removal
- Minimally invasive and tissue preservation techniques
- Imaging with a bone conduction implant in place
- Implanted magnets and MRI
Outcomes
- Ten-year Swedish experience
- Subjective outcome by cochlear reserve
- Speech discrimination scores
- Candidacy thresholds
- Paediatric outcomes
- Indications in the first US series
- Audiometric gain in the US series
- Cost-effectiveness
- Emerging evidence for active transcutaneous devices
Single-sided deafness
- Rationale in single-sided deafness
- Comparison with contralateral routing of signal
- Mechanism of the speech-in-noise advantage
- Cochlear implantation in single-sided deafness
Conclusions
- Potential advantages over conventional hearing aids
- Trade-offs to weigh in counselling
- Summary of key numbers
- References
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- References (continued)
- Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
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