Daily Archives: April 23, 2013

Great Minds Discuss the Future of Bone Anchored Hearing


In March, we held the annual meeting of great minds, the Oticon Medical Scientific Meeting. The topic: Tissue Preservation Surgery. Experts from all over the world came together to discuss surgical techniques that yield better results for patients. 

Who better to host such an event than Ravi Sockalingam, PhD FAAA and Director of Clinical Research and Professional Relations at Oticon Medical. We interviewed Ravi to take you behind the scenes of the event. Here’s your look into the future of bone anchored hearing.

RaviWhat’s the mission of Oticon Medical’s Scientific Meeting?
“The mission is to bring together top surgeons so they can share experiences and exchange knowledge about tissue preservation in bone anchored hearing implant surgery. We had 40 surgeons attend from North America, Europe, Israel and Turkey.”

Which implantation techniques were examined?

  • Traditional Dermatome technique
  • Linear Incision with tissue reduction
  • Linear incision with no skin thinning, and no/minimal tissue reduction
  • The Punch Technique: a minimally invasive, tissue-sparing technique with extended length abutments
  • Single Stage Osseointegrated Hearing Impact Surgery in Children: comparing outcomes between a single stage versus two-stage surgery in children between 5 and 18 years old

All of these methods can be done with local anesthesia. Linear incision with no skin thinning and tissue reduction, and the biopsy punch techniques are minimally invasive as they better preserve the soft tissue compared to Dermatome and Linear with tissue reduction technique.

Tell us a bit more about who attended. Who are the experts? You mentioned “legends of the field” – who are they?

Cor Cremers, MD PhD
Professor Emeritus of ENT-Otology at the Radboud University in Nijmegen, The Netherlands
Professor Cor Cremers has been doing surgery since the 80s and has published numerous papers on bone anchored surgery and bone anchored hearing aids. At the Scientific Meeting, he spoke about the long-term history of the Linear Incision technique which he and his team pioneered. He and his colleagues started using this technique in the early 90s, and he has data on over 1,000 patients, including children. [LINK TO PAPER: Assessment of More Than 1,000 Implanted Percutaneous Bone Conduction Devices: Skin Reactions and Implant Survival]

Peter Roland, MD
UT Southwestern Medical Center
Peter Roland, Professor and Chair of the Department of Otolaryngology-Head and Neck Surgery at UT Southwestern Medical Center, as well as Professor of Neurological Surgery, covered Single Stage Osseointegrated Hearing Implant Surgery in Children. Instead of a two-stage implantation, Professor Roland has been performing one-stage surgery in children. In his presentation, he showed findings that build a solid case that one-stage surgery is safe for children.

Johan Wolfaardt, BDS MDent
(Prosthodontics) PhD
University of Alberta, Edmonton, Canada
Professor Gohn Wolfaardt—from the University of Alberta and Director of Clinics at the Institute of Reconstructive Sciences in Medicine studies skin response after bone conduction implantation. He examines skin inflammation to determine how it happened, how the patients are treated, and if they require revision surgery. He works to understand how we could manage skin inflammation in the longe term as he has a special interest in quality management.

“Wolfaardt talked about establishing a network where surgeons could come together and talk about how to accurately describe and define skin reactions. There is a current scale called the Holger’s scale. Jon talks about how this scale doesn’t capture data accurately, and he is calling for a better system to define skin reactions in a better way.”

Dr Daniel Coelho, MD, FACS
Virginia Commonwealth University School of Medicine in Richmond, Virginia
Professor Coelho presented his work with the Punch Technique. He presented data on 30 adult patients who underwent bone anchored hearing aid implant placement with the punch technique.

Day two of the meeting included round table sessions—what topic came up the most?
“A lot of the conversation at the round tables consistent of talking about the use of a wider implant. While most implants are 3.75mm, there is an implant that’s been out for a year now that has a diameter of 4.5mm. The wider diameter improves the stability of the implant in the bone. Because of this improved stability, we can put the hearing device on sooner than what we are now [3 months].”

What conclusions can you make about the future based on the Scientific Meeting?
“Techniques are really based on the surgeon’s personal preferences and who their mentors are—methods are based on philosophy and what implant technique information he/she has access to—that’s why meetings such as this are so important if we are to change the way we do things for the better. The conclusion I can make is though long-term data on tissue preservation surgery is still lacking, the short-term outcomes are promising. Going forward, I believe surgeons will continue to study and collect data with the goal of achieving the absolute best results possible for our patients.”