title: Osseointegrated hearing implant surgery using a novel hydroxyapatite-coated concave abutment design.
abstract: OBJECTIVE
  Recently, a novel hydroxyapatite-coated concave bone-anchored hearing device abutment was introduced, the first designed specifically to improve outcomes in soft-tissue preservation osseointegrated hearing implant surgery. We sought to evaluate our early experience with this abutment.
  
  
  METHODS
  A single-center case series with planned data collection including patient-reported outcomes.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  The first 30 consecutive patients undergoing osseointegrated hearing implant surgery using the Cochlear DermaLock (BA400) abutment at our institution (February-September 2013) were studied. Follow-up was for a minimum of 6 months. The following data were collected: operative duration; wound healing; postoperative complications, chiefly soft-tissue reactions graded by Holger's classification; and postintervention patient-perceived health-related quality of life, as assessed by the Glasgow Benefit Inventory (GBI).
  
  
  RESULTS
  The mean operating time was 16 minutes (range, 9-22 minutes). Favorable and rapid wound healing was observed in all cases. Three patients (10%) reported transient periabutment paraesthesia. Four patients (13.3%) suffered adverse soft-tissue reactions, all of which were successfully managed conservatively and graded as follows: Holger's grade 1 (n = 2), 2 (n = 1), and 3 (n = 1). Respective overall general health, social support, and physical health GBI mean scores were +38 (95% confidence interval [CI], 31 to 45), +51 (95% CI, 42 to 60), +19 (95% CI, 8 to 30), and +8 (95% CI, -1 to 17).
  
  
  CONCLUSIONS
  Our preliminary clinical and patient-reported outcomes support soft-tissue preservation surgery and indicate that the technology on which the Cochlear DermaLock (BA400) abutment is based may enhance soft-tissue outcomes in this context. We recommend further appraisal of this approach on a larger scale with more extensive follow-up.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Countess of Chester Hospital, Chester, United Kingdom mdwilkie@doctors.org.uk.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Wilkie
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Countess of Chester Hospital, Chester, United Kingdom.
authors.forename: Kalyan M
authors.initials: KM
authors.lastname: Chakravarthy
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Countess of Chester Hospital, Chester, United Kingdom.
authors.forename: Constantinos
authors.initials: C
authors.lastname: Mamais
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Countess of Chester Hospital, Chester, United Kingdom.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Temple
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020099:Coated Materials, Biocompatible; D015331:Cohort Studies; D016001:Confidence Intervals; D017886:Durapatite; D005260:Female; D005500:Follow-Up Studies; D006310:Hearing Aids; D034381:Hearing Loss / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D016348:Osseointegration / Q000502:physiology*; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D019919:Prosthesis Implantation / Q000379:methods; D018570:Risk Assessment; D053441:Suture Anchors; D016896:Treatment Outcome; D006113:United Kingdom; D055815:Young Adult
chemical_list: D020099:Coated Materials, Biocompatible; D017886:Durapatite
keywords: abutment; bone-anchored hearing implant; hydroxyapatite; minimal invasive surgery; osseointegrated implant; surgical technique