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Standardization of the Punch Technique for the Implantation of Bone Anchored Auditory Devices

Evaluation of the MIPS Surgical Set

Kim, Harold Hyon Soo*; Kari, Elina; Copeland, Benjamin J.; Moore, Gary F.§; Shaia, Wayne T.||; Cosetti, Maura K.; Wazen, Jack J.#; Wanna, George B.; Chang, Chin-Yen Joseph**

doi: 10.1097/MAO.0000000000002291
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Objective: To describe and assess intraoperative and postoperative outcomes in the insertion of osseointegrated auditory implants with a newly designed surgical instrumentation set through a punch type technique.

Study Design: Retrospective case series.

Methods: Patients who underwent bone anchored auditory implant surgery using the Minimally Invasive Ponto Surgery (Oticon Medical, Somerset, NJ) surgical set through a punch technique at nine neurotology tertiary referral based practices were identified. Demographic data, skin thickness at implant site, implant used, duration of surgery, adverse intraoperative events, and postoperative outcomes were recorded.

Results: Seventy-five patients comprised the study cohort (32 males, 43 females). Most patients (57. 3%) were aged 51 to 75 years while 30.7% of the cohort comprised those aged 18 to 50 years and 12% were over 75 years. All but two patients received 4 mm fixtured implants and 68% received the Oticon Medical BioHelix implant. Two patients received 3 mm fixture implants and 32% received the Oticon Medical Wide Ponto implant. Mean surgical time was 12.2 minutes (6–45 min, standard deviation of 6.88 min). In three instances, surgery was converted to a linear incision to control brisk bleeding. Skin condition was Holgers 0 to 1 in 91.8%, while 5.5% had Holgers 2, and 2.7% had Holgers 3 at the first postoperative visit. At second postoperative visit, 94.3% had Holgers 0 to 1, 4.3% had Holgers 2, and 1.4% had Holgers 3. All instances of adverse skin reactions were treated with topical or systemic antibiotics and/or local debridement. There were no instances of implant loss. One patient had his implant traumatically displaced to a 45-degree angle necessitating implant replacement at a second site.

Conclusion: Punch technique placement of osseointegrated auditory implants using the Minimally Invasive Ponto Surgery surgical set represents a safe technique that further simplifies a progressively minimally invasive surgery.

*NW Ear Institute, PC, Portland, Oregon

Department of Surgery, University of California-San Diego School of Medicine, San Diego, California

Otolaryngology Associates, LLC, Indianapolis, Indiana

§Central Plains ENT and Audiology, Omaha, Nebraska

||Virginia Hearing Center, Richmond, Virginia

Department of Otolaryngology, NY Eye and Ear Infirmary, New York, New York

#Silverstein Institute, Sarasota, Florida

**Texas Ear Center, Houston, Texas

Address correspondence and reprint requests to Harold Hyon Soo Kim, M.D., NW Ear Institute, 2230 NW Pettygrove Street, Suite 120, Portland, OR 97214; E-mail:

H.H.S.K. is a consultant for Oticon Medical (Somerset, NJ).

The authors disclose no conflicts of interest.

Copyright © 2019 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company