La nueva solución auditiva de implante de estado estable osteointegrado activo (OSIA): Presentación del primer caso en el Hospital Universitario Río Hortega de Valladolid

Report of the First Case in Hospital Universitario Río Hortega

Abstract

Introduction and objective: During the last few years there has been a great advance in conduction and mixed hearing loss treatment due to the big development of bone conduction implants. Bone conduction implants or bone-anchored hearing aids are used to treat uni or bilateral hearing loss, conductive as well as mixed, and also in cases off single-sided deafness.There are two types of bone conduction systems: transcutaneous and percutaneous. In percutaneous devices there is a direct connection between the processor and the implant, which goes through the skin. However transcutaneous devices don’t break the skin barrier and processor and implant connect through a system of magnets. Piezoelectric Osia® is a newly developed transcutaneous system.The aim of this study is to present the new Osia® system in order of the first patient with this implant in our community.Method: We report the case of a 47 year old man, allergic to NSAID and iodine with no other medical history of interest. Diagnosed of bilateral chronic cholesteatomatous otitis media years ago. He underwent surgery in both ears, tympanoplasty with mastoidectomy on demand and reconstruction. Subsequently radical mastoidectomy with meatoplasty on his right ear due to a recurrence of the cholesteatoma. Liminar tonal audiometry shows a bilateral and almost symmetrical conductive hearing loss with a 40dB GAP in both ears. We decide to implant the transcutaneous piezoelectric Osia® system in his right side.Results: Surgery is performed under general anesthesia. Initially we plan over the skin where we will place the implant, approximately at the level of the meatus. We can mark the location of the screw with methylene blue. There are multiple incisions that can be used. In this case we use the same retroauricular incision from previous surgeries, enlarging it on its caudal border. We measure the skin thickness as it is recommended to be less than 9mm. In our patient we thin it since it was too thick for the magnets to connect properly. We complete a subperiostical pocket where the transducer will be placed. We identify the location of the screw and drill a hole of 3-4mm. After we have the screw in place, we make sure the surrounding bone is flat enough to place the transducer. Finally we place it and tighten the screw with 25 Newton and close the skin flap over the implant. In our case we didn’t experience any problems during or after the procedure.Discussion: Osia® is a new type of active piezoelectric device. In this kind of devices, the transcutaneous transmission between the processor and the transducer is produced by a digital signal, which later is transformed in vibrations by the transducer. This vibration will be transmitted to the bone...