68 Chapter 3.1 Oticon wide implant. Overall adverse soft tissue reaction was noted in 19% of the patients and no revision surgery was required over the 12 months follow up. They only comprised 4.4% of all postoperative visits recorded indicating the transient nature of these reactions. In comparison with previous reports of adverse skin reactions in 17% of patients and revision surgery in 8% of patients (using similar implant widths but non-laser ablated surfaces), it is suggested that implant diameter does not influence the soft tissue outcome (27). Similar conclusions were reached in a review, demonstrating an equal incidence of adverse reactions (28%) in wide- and small-diameter implants (19). The reduced revision surgery rate in the present study in comparison with previous results in our center using the small diameter implant, 0% versus 8% (32), is in line with the results in the review (19). In contrast, this centre’s experience with the Cochlear BIA300 implant demonstrated a significant 77% skin reaction rate and 35% revision rate. However, it is important to consider that dermatome was applied in 57% of patients in the BAI300 study, a practice that was phased out when the Oticon wide system was introduced (29). Taken together, the present study therefore demonstrates significant improvement in the implant loss and revision surgery rates, as well as comparable soft tissue complications, compared with previous implant systems utilized at our center. Another important factor to consider is the continued use of BAHIs as this is an excellent indication of the real- world application of hearing aids. If patients or carers found skin complications intrusive, they would discontinue their use. Our previous reports have shown that 97% were wearing the system daily with audiological benefit (27). Although the present study concerns a 12-month follow-up, at the time of submission, we have had a 99.1% retention rate as of January 2021 (2–5 years follow up). The one nonuser was influenced by peer pressure and esthetics. The implant ISQ showed a nonsignificant increase between the first and second stages and an upward trend in the mean abutment level ISQ H and ISQ L, with statistical significance achieved from the 3-month review point onwards. Application of the ISQ is controversial, and previous publications support early loading in the pediatric population with ISQs above 60 and, similarly, in the adult population (10 –12). Nelissen et al. (25) suggest that conclusions cannot be drawn regarding individual ISQ values alone but rather that trends can be followed but only in individuals or groups in which variables remain the same, as implant systems vary widely in their designs. Hence, the application of absolute ISQ figures from one model of implant to another should be done with caution. Nevertheless, preclinical comparison of laser-modified BHX implants with machined implants failed to capture any difference in stability between the two implant types in terms of ISQ, despite a significantly higher removal torque required for the
RkJQdWJsaXNoZXIy MTk4NDMw