Abstract
BackgroundBone conduction implants can be used in the treatment of conductive or mixed hearing loss. The BONEBRIDGE bone conduction implant (BB-BCI) is an active, transcutaneous device. BB-BCI implantation can be performed through either the transmastoid or retrosigmoid approach with their respective limitations. Here, we present a third, novel approach for BB-BCI implantation.ObjectiveDescribe the detailed surgical technique of BB-BCI implantation through a middle fossa approach with self-drilling screws and present preliminary audiometric outcome data following this approach.MethodsA single institution, retrospective chart review was completed for patients implanted with the BB-BCI via the middle fossa approach. Preoperative planning and modelling were performed using 3D Slicer. Audiological testing was performed pre- and post-operatively following standard audiometric techniques.ResultsForty patients underwent BB-BCI implantation using the middle fossa approach. Modelling techniques allowed for implantation through the use of external landmarks, obviating the need for intraoperative image guidance. The surgical technique was refined over time through experience and adaptation. Mean follow-up was 29 months (range 3–71 months) with no surgical complications, favourable cosmesis, and expected audiometric outcomes. An average functional gain of 39.6 dB (± 14.7 SD) was found.ConclusionThe middle fossa technique with self-drilling screws is a safe and effective option for BONEBRIDGE implantation. As a reference for other groups considering this approach, an annotated video has been included as a supplement to the study.
Highlights
Bone conduction implants (BCI) rely on vibratory excitation of the temporal bone which in turn stimulates the cochlea
Modelling techniques allowed for implantation through the use of external landmarks, obviating the need for intraoperative image guidance
Surgical technique A horizontal 3 cm incision is marked above the ear and centred on the implant position determined using Three -dimensional (3D) slicer (Fig. 3c)
Summary
Bone conduction implants (BCI) rely on vibratory excitation of the temporal bone which in turn stimulates the cochlea. These implants are used when conventional hearing aids cannot be worn because of medical or anatomic conditions such as recurrent. The bone anchored hearing aid (BAHA) is a commonly used percutaneous BCI [3]. The BAHA stimulates the temporal bone through a surgically implanted, osseointegrated titanium screw that is attached to an external sound processor. Bone conduction implants can be used in the treatment of conductive or mixed hearing loss. The BONEBRIDGE bone conduction implant (BB-BCI) is an active, transcutaneous device. We present a third, novel approach for BB-BCI implantation
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