A Retrospective Cohort Study on the Influence of Comorbidity on Soft Tissue Reactions, Revision Surgery, and Implant Loss in Bone-anchored Hearing Implants

Besten, Christine A. den; Nelissen, Rik C.; Peer, Petronella G. M.; Faber, Hubert T.; Dun, Catherina A. J.; Wolf, Maarten J. F. de; Kunst, Henricus P. M.; Cremers, C.W.R.J.; Mylanus, Emmanuel A. M.; Hol, Myrthe K. S.

doi:10.1097/mao.0000000000000745

Cited by 25 publications

(30 citation statements)

References 20 publications

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“…In addition to the large cohort investigated in this study, other strengths are the representative characteristics of our sample. The rates of implant loss and revision surgery were similar or slightly better compared with previous studies in our centre [ 7 , 20 ] or according to other studies [ 8 , 13 ]. In addition, no differences in baseline characteristics between both groups were noticed.…”

Section: Discussionsupporting

confidence: 86%

“…Finally, the background characteristics mental retardation, dermatological disease and diabetes mellitus were registered, because recent studies focus on identification of these comorbidities as possible risk factors in the context of soft tissue reactions after BAHI surgery [ 7 , 18 – 20 ]. If there were no notes for these conditions in the medical chart or any correspondence within the chart of the patient, this comorbidity factor was considered absent.…”

Section: Methodsmentioning

confidence: 99%

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Percutaneous bone-anchored hearing implant surgery: inside or outside the line of incision?

Strijbos

Besten

Mylanus

et al. 2016

Eur Arch Otorhinolaryngol

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The objective of this historical cohort study was to compare soft tissue reactions in adults after bone-anchored hearing implant (BAHI) surgery when the percutaneous implant is placed inside or outside the line of incision. All adult patients who received a percutaneous BAHI between 1 January 2010 and 31 January 2014 in our tertiary referral centre were identified. Patients were selected if operated by two surgeons, who perform the same standardised linear incision technique with one of them placing the implant outside the incision while the other prefers placement inside the line of incision. A total of 202 patients and 211 implants were included in the case analysis. The results showed the registration of a soft tissue reaction Holgers ≥1 in 47 implants (49.0 %) placed outside the incision compared to 70 implants (60.9 %) which were placed inside the line of incision. An adverse soft tissue reaction, Holgers ≥2, was noticed in 17 implants (17.7 %), respectively, 20 implants (17.4 %). No significant differences were found between the two groups for both the presence of soft tissue reactions Holgers ≥1 (p = 0.322) and a Holgers score ≥2 (p = 0.951). During the follow-up three implants were lost (1.4 %) and in 18 of 211 implants one or multiple revisions were performed (8.5 %). In conclusion, this study did not show any differences in the presence of postsurgical (adverse) soft tissue reactions between placement of the percutaneous BAHI inside or outside the line of incision.

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Section: Discussionsupporting

confidence: 86%

Section: Methodsmentioning

confidence: 99%

Percutaneous bone-anchored hearing implant surgery: inside or outside the line of incision?

Strijbos

Besten

Mylanus

et al. 2016

Eur Arch Otorhinolaryngol

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“…Smoking, BMI and diabetes have all been postulated as factors for softtissue reactions or implant loss in BAHS and dental studies. [34][35][36] Recently, Sayardoust et al showed that smoking is associated with different gene profiles post-surgery for dental implants. 37 Here, we observed that, with intact skin, no gene expression differences were observed.…”

Section: Clinical Parametersmentioning

confidence: 99%

Cytokine expression profile in the bone‐anchored hearing system: 12‐week results from a prospective randomized, controlled study

Calon

Tongeren

Omar

et al. 2018

Clin Implant Dent Rel Res

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ObjectiveTo study the effect of implanting the percutaneous bone‐anchored hearing system (BAHS) itself and inflammation of the peri‐abutment skin warrant clarification. In this study, we aimed to acquire further insight into the immune responses related to BAHS surgery and peri‐implant skin inflammation.Materials and MethodsDuring surgery and 12 weeks post‐implantation, skin biopsies were obtained. If applicable, additional biopsies were taken during cases of inflammation. The mRNA expression of IL‐1β, IL‐6, IL‐8, TNFα, IL‐17, IL‐10, TGF‐ß, MIP‐1α, MMP‐9, TIMP‐1, COL1α1, VEGF‐A, FGF‐2 TLR‐2, and TLR‐4 was quantified using qRT‐PCR.ResultsThirty‐five patients agreed to the surgery and 12‐week biopsy. Twenty‐two patients had mRNA of sufficient quality for analysis. Ten were fitted with a BAHS using the minimally invasive Ponto surgery technique. Twelve were fitted with a BAHS using the linear incision technique with soft‐tissue preservation. Five biopsies were obtained during episodes of inflammation. The post‐implantation mRNA expression of IL‐1β (P = .002), IL‐8 (P = .003), MMP9 (P = .005), TIMP‐1 (P = .002), and COL1α1 (P < .001) was significantly up‐regulated. IL‐6 (P = .009) and FGF‐2 (P = .004) mRNA expression was significantly down‐regulated after implantation. Within patients, no difference between post‐implantation mRNA expression (at 12 weeks) and when inflammation was observed. Between patients, the expression of IL‐1β (P = .015) and IL‐17 (P = .02) was higher during cases of inflammation compared with patients who had no inflammation at 12‐week follow‐up.ConclusionsAs part of a randomized, prospective, clinical trial, the present study reports the molecular profile of selected cytokines in the soft tissue around BAHS. Within the limit of this study, the results showed that 12 weeks after BAHS implantation the gene expression of some inflammatory cytokines (IL‐8 and IL‐1β) is still relatively high compared with the baseline, steady‐state, expression. The up‐regulation of anabolic (COL1α1) and tissue‐remodeling (MMP‐9 and TIMP1) genes indicates an ongoing remodeling process after 12 weeks of implantation. The results suggest that IL‐1β, IL‐17, and TNF‐α may be interesting markers associated with inflammation.

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“…Finally, the background characteristics gender, body mass index, diabetes mellitus, mental retardation, smoking and cardiovascular comorbidity were registered, following recent studies focusing on identification of these comorbidities as (potential) risk factor for soft tissue reactions or implant loss [8, 30–34]. In addition, some characteristics may be associated with skin flap necrosis or impaired wound healing [26–28].…”

Section: Methodsmentioning

confidence: 99%

Percutaneous bone-anchored hearing implant surgery: dermatome versus linear incision technique

Strijbos

Bom

Zwerver

et al. 2016

Eur Arch Otorhinolaryngol

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The objective of this historical cohort study is to identify if there are differences in soft tissue reactions and skin thickening between implantation of the percutaneous bone-anchored hearing implant (BAHI) using the dermatome or linear incision technique. All adult patients who received a BAHI between August 2005 and January 2013 were selected. One surgeon performed all procedures and only the dermatome and linear incision technique were used. A total of 132 patients/implants were included and significantly more patients with risk factors were seen in the linear incision cohort. A soft tissue reaction Holgers ≥1 was present in 18 patients (40.9 %) in the dermatome compared to 36 patients (40.9 %) in the linear incision group. A Holgers ≥2 was noticed in 9 (20.5 %) and 19 (21.6 %) patients, respectively. Skin thickening was described in 14 (31.8 %) and 11 patients (12.5 %) in, respectively, the dermatome and linear incision cohort, which was a significant difference (p = 0.001). Nevertheless, therapeutic interventions were effective. In conclusion, there was no significant difference in (adverse) soft tissue reactions; however, skin thickening was more present in the dermatome technique. In addition, significantly more patients with risk factors were allocated to the linear incision technique. Based on these results, the linear incision is advocated as preferred technique.

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A Retrospective Cohort Study on the Influence of Comorbidity on Soft Tissue Reactions, Revision Surgery, and Implant Loss in Bone-anchored Hearing Implants

Abstract: Retrospective analysis of comorbidity factors and clinical outcomes revealed risk factors for postoperative complications after BAHI surgery.

Cited by 25 publications

References 20 publications

Percutaneous bone-anchored hearing implant surgery: inside or outside the line of incision?

Percutaneous bone-anchored hearing implant surgery: inside or outside the line of incision?

Cytokine expression profile in the bone‐anchored hearing system: 12‐week results from a prospective randomized, controlled study

Percutaneous bone-anchored hearing implant surgery: dermatome versus linear incision technique

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