Transmastoid implantability of an active transcutaneous bone conduction implant in adults with regard to the underlying pathology: a radiological simulation study

Abstract

Objectives: To compare the feasibility of transmastoid implantation of an active transcutaneous bone conduction device (BCD) in the most important pathologies of the temporal bone and the impact of implant lifts in adulthood.

Methods: First, clinical predominant pathologies for implantation of this BCD were evaluated by a literature review. Then, high-resolution CT of 240 temporal bones with neuro-otologic diseases (NOD), chronic otitis media (COM), or cholesteatoma, respectively, were investigated regarding their implantability, using a radiological simulation program.

Results: Chronic inflammatory diseases (CID) of the temporal bone with or without cholesteatoma account for most adults scheduled for an active BCD. Complete implantation was possible in almost all cases with NOD as well as COM, requiring an implant lift in 50% of COM and 20% of NOD (p = .025) cases. In contrast, in subjects with cholesteatoma, implantation required an additional tool in 92% of cases, leading to 59% implantability rate in these temporal bones.

Conclusion: Adult subjects with CID of the temporal bone show more limiting anatomical conditions for transmastoid placement of an active transcutaneous BCD than those with single-sided deafness. Implant lifts increase the implantability significantly in subjects with COM and particularly in those with cholesteatoma.

Chinese abstract

目的：比较颞骨最重要的病变中的活性经皮骨传导装置（BCD）的经乳突植入的可行性及成年期植入体提升的影响。

方法：首先, 通过文献回顾来评估该BCD植入的主要临床病理学。然后, 使用放射学模拟程序, 分别对240例患有神经耳病（NOD）、慢性中耳炎（COM）或胆脂瘤的颞骨进行高分辨率CT检查, 以确定其可植入性。

结果：有或无胆脂瘤的颞骨慢性炎症性疾病（CID）是大多数安排活性BCD的成年人的原因。几乎所有的NOD和COM都可能进行完全植入, 50%的COM和20%的NOD病例（p = 0.025）需要植入体提升。相反, 在胆脂瘤患者中, 92%的病例接受植入时需要额外的工具, 导致这些颞骨内的可植入率达59%。

结论：颞骨CID的成人受试者比单侧耳聋患者显示具有更为有限的活性经皮骨传导装置（BCD）的经乳突植入的解剖条件。植入体提升可显著提高COM患者的可植入性, 对胆脂瘤患者尤其如此。

Keywords:

• Active bone conduction implant
• bonebridge
• transmastoid implantation
• feasibility
• lifts

Acknowledgments

We are grateful to Dr. Imme R. Haubitz for statistical support & Noelani Peet (MED-EL) for language editing on a version of this manuscript.

Disclosure statement

No financial interest or benefit has arisen from the direct applications of our research.

In accordance with Taylor & Francis policy and our ethical obligation as a researcher, we report that J.P.T. has received travel expense support and payment for lectures from Med-El, for K.A. no conflict of interest was declared, S.D. has received third-party funds, payment for lectures, and travel expense support from Med-El, I.T. and A.P. declared no conflict of interest, C.V. has received travel expense support from Med-El.