title: Minimally Invasive Surgery for Osseointegrated Auditory Implants: A Comparison of Linear versus Punch Techniques.
abstract: OBJECTIVE
  (1) To describe the benefits of the minimally invasive punch technique without soft tissue reduction (PT) for the placement of percutaneous osseointegrated auditory implants. (2) To compare and contrast techniques and outcomes from PT with the linear technique with soft tissue reduction (LT).
  
  
  METHODS
  Case series with chart review
  
  
  METHODS
  Performed at a tertiary otology practice at an academic medical center.
  
  
  METHODS
  LT was used until 2012 when a switch was made for all patients to PT. Preoperative variables recorded included age, sex, BMI, smoking status, indication, device selected, and abutment length. Outcomes measures included surgical time, skin reaction grading by Holgers score at 1 week and at most recent follow-up, and any other complications. Two-sample t test and χ(2) was used to compare.
  
  
  RESULTS
  A total of 51 patients (34 LT, 17 PT) were identified. Surgical time was found to be significantly shorter for the PT group (LT, 49.2 min; PT, 13.4 min; P < .001). There were no statistically significant differences between LT and PT for mean Holgers at first (LT, 0.24; PT, 0.47; P = .87) or final follow-up (LT, 0.62; PT, 0.41; P = .22).
  
  
  CONCLUSIONS
  The punch technique offers several potential surgical and cosmetic advantages over the linear technique without compromising skin-reactivity outcomes. This study supports a growing trend toward minimally invasive percutaneous auditory implant surgery.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Gordon
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA dcoelho@mcvh-vcu.edu.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Coelho
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006310:Hearing Aids; D034381:Hearing Loss / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D061646:Operative Time; D016348:Osseointegration / Q000502:physiology*; D019919:Prosthesis Implantation / Q000379:methods*; D018570:Risk Assessment; D053441:Suture Anchors; D062606:Tertiary Care Centers; D016896:Treatment Outcome
keywords: Baha; minimally invasive surgery; osseointegrated auditory implant; punch technique