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

Tim G A Calon, Marc van Hoof, Herbert van den Berge, Arthur J G de Bruijn, Joost van Tongeren, Janny R Hof, Jan Wouter Brunings, Sofia Jonhede, Lucien J C Anteunis, Miranda Janssen, Manuela A Joore, Marcus Holmberg, Martin L Johansson, Robert J Stokroos, Tim G A Calon, Marc van Hoof, Herbert van den Berge, Arthur J G de Bruijn, Joost van Tongeren, Janny R Hof, Jan Wouter Brunings, Sofia Jonhede, Lucien J C Anteunis, Miranda Janssen, Manuela A Joore, Marcus Holmberg, Martin L Johansson, Robert J Stokroos

Abstract

Background: Over the last years, less invasive surgical techniques with soft tissue preservation for bone conduction hearing implants (BCHI) have been introduced such as the linear incision technique combined with a punch. Results using this technique seem favorable in terms of rate of peri-abutment dermatitis (PAD), esthetics, and preservation of skin sensibility. Recently, a new standardized surgical technique for BCHI placement, the Minimally Invasive Ponto Surgery (MIPS) technique has been developed by Oticon Medical AB (Askim, Sweden). This technique aims to standardize surgery by using a novel surgical instrumentation kit and minimize soft tissue trauma.

Methods: A multicenter randomized controlled trial is designed to compare the MIPS technique to the linear incision technique with soft tissue preservation. The primary investigation center is Maastricht University Medical Center. Sixty-two participants will be included with a 2-year follow-up period. Parameters are introduced to quantify factors such as loss of skin sensibility, dehiscence of the skin next to the abutment, skin overgrowth, and cosmetic results. A new type of sampling method is incorporated to aid in the estimation of complications. To gain further understanding of PAD, swabs and skin biopsies are collected during follow-up visits for evaluation of the bacterial profile and inflammatory cytokine expression. The primary objective of the study is to compare the incidence of PAD during the first 3 months after BCHI placement. Secondary objectives include the assessment of parameters related to surgery, wound healing, pain, loss of sensibility of the skin around the implant, implant extrusion rate, implant stability measurements, dehiscence of the skin next to the abutment, and esthetic appeal. Tertiary objectives include assessment of other factors related to PAD and a health economic evaluation.

Discussion: This is the first trial to compare the recently developed MIPS technique to the linear incision technique with soft tissue preservation for BCHI surgery. Newly introduced parameters and sampling method will aid in the prediction of results and complications after BCHI placement.

Trial registration: Registered at the CCMO register in the Netherlands on 24 November 2014: NL50072.068.14 . Retrospectively registered on 21 April 2015 at ClinicalTrials.gov: NCT02438618 . This trial is sponsored by Oticon Medical AB.

Keywords: BAHA; Bone conduction device (BCD); Bone conduction hearing implant (BCHI); MIPS; Randomized Controlled Trial (RCT); Soft tissue preservation.

Figures

Fig. 1
Fig. 1
Surgical implantation techniques. a Implant positioning. b Schematic presentation of the linear incision technique with soft tissue preservation. (I) Linear incision. (II) Opening of skin. (III) Initial hole drilling. (IV) Countersink drilling. (V) Eccentric skin punch to uncover abutment. (VI) Result. c Schematic presentation of Minimally Invasive Ponto Surgery (MIPS) technique. (I) Incision hole. (II) Removal of periost and soft tissue. (III) Placement of cannula. (IV) Drilling procedure (cannula guide drill and cannula widening drill). (V) Implant placement with the insertion indicator. (VI) Result
Fig. 2
Fig. 2
Study design and study flow chart

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