79 3.2 Clinical evaluation and resonance frequency analysis in Down Syndrome RFA with regards to BHAI is measured by the attachment of a Smart Peg to the implanted fixture. This small aluminium rod has a magnet at its apex which can be stimulated by a handheld device emitting a magnetic pulse. The device measures the resonance frequency of this rod which is converted into an Implant Stability Quotient (ISQ) scale (1–100). A higher number indicates increased stability. Two recordings are taken in perpendicular directions ISQ high (ISQ H) and ISQ low (ISQ L), which are generated due to the different bone characteristics in each direction [35]. ISQ of the attached abutments can be measured in an identical fashion by placement of the smart peg into the centre. 2. Methods 2.1 Objectives This study aims to review the morbidity associated with the Ponto BXH implant system, and to review the trends in ISQ over 12 months follow up period in children with DS. 2.2 Ethical consideration Approval through the research and development committee (REC ref 11/WM/1054, IRAS project ID 145812) was granted. 2.3 Study population A prospective, single-subject, repeat measure, cohort study in which each participant served as their own control. Participants aged between 5 and 16 years with unilateral or bilateral, conductive hearing loss eligible for BHAI were recruited from the patient body at Birmingham Children’s Hospital (Birmingham, UK). Following a formal consent process, 31 consecutive children awaiting a BAHI with a diagnosis of DS were offered a place on the study. Patient demographics and underlying medical conditions were recorded, as were the indications for implantation and surgical technique. In this paediatric centre, two stage implantation procedures are more commonly performed in younger children. Single stage procedures were performed on 3 patients (total 3 implants). In all cases, two fixtures were placed on the indicated side, one acting as a ‘sleeper’. Typically, the two- stage procedure utilised a 3-month healing (osseointegration) period between surgeries. All surgeries were performed by three consultant surgeons between Jan 2016–Jan 2019.
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