Tag Archives: minimally invasive surgery

Why You Should Consider Implantation if You Use a Softband – Part 1

We are pleased to be able to offer options for people with hearing loss to benefit from our Ponto™ processors at all ages and with differing health conditions. Our processor can be worn on a hard headband, attached to a hat, or on a softband – the latter of which is particular popular with our juvenile wearers. However, the Ponto was developed as part of a complete bone anchored hearing system, meaning wearers will experience peak performance when it is attached via an abutment directly to their skull. And while children under five aren’t candidates for the implant surgery due to their developing skulls, we encourage all adults and parents of kids over five whose physical conditions don’t preclude the surgery to seriously consider implantation. Here’s why.

The MIPS procedure

The surgical method Oticon Medical uses is called MIPS (minimally invasive Ponto surgery). This procedure involves having a small titanium implant carefully inserted into the bone behind your ear. The operation can be performed under local anesthetic, and in most cases, it takes no more than a day or two to recover. Many older children and most adults can undergo MIPS successfully, unless they have a condition that affects skin or bone thickness. A consultation with a surgeon can help you determine whether you or your child is a qualified candidate.

It’s typical for people to have concerns about surgery of any kind, including the comparatively minor MIPS procedure. For example, you might have concerns about your post-surgical appearance. The good news is that MIPS was designed to create the smallest incision possible. The surgeon makes a circular incision that matches the abutment exactly using instruments specifically designed for the procedure. This leaves the skin around the incision intact, with no skin tissue or hair follicles removed from around the abutment – hence no bald spots. MIPS also removes the need for suturing, which eliminates scarring and fosters quicker healing.

Another concern might be the surgery itself – especially the use of general anesthesia, which always carries some level of risk. MIPS only takes about 15 minutes and is normally carried out under local anesthetic. And as for recovery, since the process preserves soft tissue the blood supply, micro-circulation, and nerves are left as intact as possible, thereby shortening the healing period. Most patients can return to work or school within a couple of days.

Why choose bone anchored surgery over softband?

Affixing the Ponto processor to a softband provides young children with early access to speech and sounds so they can explore and interact with the hearing world with greater ease. It also gives them a great foundation for speech development. It is a suitable solution for children with conductive or mixed hearing loss, or single-sided deafness. It can also be used by adults with these conditions who cannot benefit from conventional hearing aids or who have temporary ear problems, such as blockages or infections.

Because the adjustable softband is simply worn around the head, some wearers prefer it to having to go through any form of surgery. And it certainly works — when you attach the Ponto sound processor, it sends sound waves through the bone to the inner ear, giving the wearer access to our renowned, high quality Ponto sound. Wearing a Ponto on a softband is a valuable method of hearing rehabilitation for children too young for implantation and for adults receiving a preoperative assessment.

However, studies confirm that implantation of a bone anchored hearing device – also known as a percutaneous solution – provides the ultimate hearing improvement over wearing a processor on a softband. Hearing sensitivity through the skin with a softband, as compared to a skin-penetrating abutment, provides between eight and 20 decibels (dB) reduction in the frequency range from one to four kHz. In plain English, wearers hear better when their processor is worn on an abutment than when it is worn on a softband.

One concern is that when vibrations have to pass through the skin without an abutment, the static pressure between the softband and the skin must be high to provide the best transmission possible. The ideal requirement often causes discomfort and can result in problems in the skin and subcutaneous tissues between the processor and the bone, especially if used long-term. It can also trigger tension headaches.

Other challenges include attenuation and feedback. Attenuation refers to a reduction in sound amplification, which can affect speech understanding. Feedback, or the return of a portion of an outbound signal to the same device creating a distorted effect, occurs when sound radiates from the processor back to the microphone.

Other complaints about softbands include cosmetic appeal, and slippage that causes the processor to move out of its ideal placement. If these and the aforementioned discomforts persist, the user is less likely to wear their processor all day long, reducing the efficacy of the device. After all, you can only fully benefit from the better hearing provided by the processor if it is worn steadily – and this is particularly important for children who are still acquiring language.

In our next post on this subject, we’ll share two user experiences about upgrading from wearing processors on softbands to having MIPS and hearing with an implant.

Meet Dr. Lawrence Lustig, Chair of the Department of Otolaryngology—Head and Neck Surgery at the Columbia University College of Physicians

This post is part of a clinic feature series, where we highlight doctors and clinics who offer the Oticon Medical Bone Anchored Hearing System, the Ponto.

Dr. Lawrence Lustig, MD,  is one of the nation’s leading experts in hearing loss

Dr. Lawrence Lustig, Otolaryngologist-in-chief at New York-Presbyterian Hospital/Columbia University Medical Center

Dr. Lustig is the chair of the Department of Otolaryngology—Head and Neck Surgery at the Columbia University College of Physicians and Surgeons and otolaryngologist-in-chief at New York-Presbyterian Hospital/Columbia University Medical Center. Today, Dr. Lustig’s mission at New York City at Columbia University Medical Center & New York Presbyterian Hospital is to build a practice of the very best otolaryngology clinicians and research scientists.

He treats the full spectrum of ear disorders in adults and children, as well as skull base disease. His specialties include skull base surgery, Bone Anchored Hearing Systems (BAHS), cochlear implants, the genetics of hearing loss, cochlear gene therapy, surgery for chronic otitis media, balance disorders, and hair cell physiology.

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Minimally Invasive Procedure Increases Tissue Preservation for Better Patient Outcomes

Daniel H. Coelho, MD, FACSDaniel H. Coelho, MD, FACS specializes in Otologic & Neurotologic Surgery. He is assistant professor of Otolaryngology, Physiology and Biophysics, and he’s the director at the Cochlear Implant Center at Virginia Commonwealth University School of Medicine in Richmond, Virginia. Following his training in Otolaryngology, Dr. Daniel Coelho completed a two-year fellowship in skull-base surgery. He began practicing minimally invasive linear surgery 5 years ago, and was an early developer of the punch method about two years ago. 

“On day one of medical school we learned that you have to respect the tissue.”

Progressive surgeons like Dr. Coelho spend a great deal of their time studying outcomes and working together to improve surgical procedures. Yet, very few patients are aware of the surgical implant techniques used for bone anchored hearing devices. Many only know of the traditional skin-graft technique, which causes a visible scar and frequently results in skin overgrowth and post-surgical irritation. Today, we’re sharing information about a new technique that Dr. Coelho uses. It’s a minimally invasive technique to optimize tissue preservation.

The procedure takes about 10 minutes and is typically done under local anesthesia. As most users have experienced, patients can expect a bit of soreness for a few days afterward. But, with little pain and no narcotics, patients can go back to work or normal routines the day after the procedure. This is all because the whole process is designed with tissue preservation in mind.

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Tissue preservation is important for several reasons. It contributes to a very short amount of recovery time, and there’s little -to-no scaring and no hair removal. The bottom line is that the tissue preservation is minimally invasive, which improves overall results.

The fact that the procedure is minimally invasive is the most important aspect of a surgical procedure. “The more trauma there is, the more inflammation and scarring. While scarring isn’t ideal cosmetically, it also means less predictable tissue – the implant and the abutment are foreign objects that the tissue can work to reject,” Dr. Coelho explained.

Tissue preservation is incredibly important in function—it’s one of the most important aspects of the surgery. And it’s all possible since the introduction of longer abutments. “The Ponto is an excellent product and a major advancement was the development of the longer abutment. With a longer abutment, it’s no longer necessary to thin out the tissue to prevent the processor from touching the skin. If you’re going to be doing tissue thinning and suturing, those are traumatic to the skin and soft tissue and may result in an increased inflammation. Inflammation can lead to scarring, tissue overgrowth, loss of sound quality and eventually to non-use.” As as an added benefit, less tissue inflammation also yields excellent cosmetic outcomes.

In the 70-80’s, an abutment was 5 mm or less. “The only way to get the processors to function without rubbing against the skin (and compromising sound quality) was by undermining the skin” Dr. Coelho recalls. “Once the new, longer abutment came out, and the sound quality was shown to be equal, it showed that any additional skin manipulation was not necessary.” Oticon Medical was a leader in introducing the longer abutments, giving surgeons increased flexibility to adapt to individual variations in skin thickness and accommodating new clinical developments in surgical techniques, including tissue preservation.

The improved technology enables medical providers to focus on other factors like continuously iterating surgery to be as minimally invasive as possible. “Patients are happy with the functionality and the great cosmetic outcomes— it’s truly as minimally invasive as you can get.”

Melissa Tumblin, founder of Ear Community asked Dr. Coelho, “What are the common concerns about skin irritation? What do you recommend other than the cortisone cream and general cleanly maintenance?”

“First of all, hygiene shouldn’t be blamed for everything. Some people just have a more robust reaction to that foreign object—just like people have allergies worse than others.” Dr. Coelho explains that some people even clean too frequently, which can irritate the area even more.

Dr. Coelho has had no skin overgrowth, as of 2-year follow-ups, with his own patients that received their implant via the punch technique. When he does treat overgrowth, it’s in patients who had the traditional technique. For overgrowth, Dr. Coelho uses clobetasol cream, a topical steroid to help reduce the number of surgical revisions. But, he points out that there is a longer term solution. “Surgical revisions only buy time, they do not actually fix the underlying problem. But, the longer abutments theoretically do. Because it’s such a simple procedure to switch, people who were getting the steroid shots are now making the change. The abutment change procedure is done in the office and takes seconds—some insurance companies are covering the abutment switch.” Patients can also immediately go back to wearing their processor unlike some of the corrective treatments.

Overall, more surgeons are slowly, yet surely, implementing the minimally invasive procedure. Dr. Coelho predicts that within 5 years it will be the standard. “Surgeons learn from colleagues, conferences, journals and the industry as well. People expect to see a divide between industry and medical providers, but many technological advances are made by industry organizations or through a collaboration with clinical professionals – this open line of communication benefits everyone.”

Help us spread the word about tissue preservation by sharing this post. If you have questions about Ponto, bone anchored devices or implant surgery, let us know in the comments below or on Facebook or Twitter.