Long-Term Outcomes of the Minimally Invasive Ponto Surgery vs. Linear Incision Technique With Soft Tissue Preservation for Installation of Percutaneous Bone Conduction Devices

R.M. Strijbos*, L.V. Straatman, T.G.A. Calon, M.L. Johansson, A.J.G. de Bruijn, H. van den Berge, M. Wagenaar, E. Eichhorn, M. Janssen, S. Jonhede, J. van Tongeren, M. Holmberg, R. Stokroos

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Objective: Comparing the surgical outcomes of the Minimally Invasive Ponto Surgery (MIPS) technique with the linear incision technique with soft tissue preservation (LITT-P) for bone conduction devices after a follow-up of 22 months.Methods: In this multicenter randomized controlled trial, there was the inclusion of 64 adult patients eligible for unilateral surgery. There was 1:1 randomization to the MIPS (test) or the LITT-P (control) group. The primary outcome was an (adverse) soft tissue reaction. Secondary outcomes were pain, loss of sensibility, soft tissue height/overgrowth, skin sagging, implant loss, Implant Stability Quotient measurements, cosmetic scores, and quality of life questionnaires.Results: Sixty-three subjects were analyzed in the intention-to-treat population. No differences were found in the presence of (adverse) soft tissue reactions during complete follow-up. Also, there were no differences in pain, wound dehiscence, skin level, soft tissue overgrowth, and overall quality of life. Loss of sensibility (until 3-month post-surgery), cosmetic scores, and skin sagging outcomes were better in the MIPS group. The Implant Stability Quotient was higher after the LITT-P for different abutment lengths at various points of follow-up. Implant extrusion was nonsignificantly higher after the MIPS (15.2%) compared with LITT-P (3.3%).Conclusion: The long-term results show favorable outcomes for both techniques. The MIPS is a promising technique with some benefits over the LITT-P.Concerns regarding nonsignificantly higher implant loss may be overcome with future developments and research.
Original languageEnglish
Article number632987
Number of pages14
JournalFrontiers in Neurology
Publication statusPublished - 24 Feb 2021


  • hearing loss
  • bone conduction device (BCD)
  • surgical technique
  • minimally invasive ponto surgery
  • MIPS
  • tissue preservation
  • surgical outcomes
  • soft tissue reactions

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