Background
Percutaneous Bone Conductive Implants (pBCI) still are a usual solution for conductive hearing loss. Unfortunately, this prosthesis has a largest number of complications, especially related to the skin around de implant. This situation leads to high number of non-users, more surgeries, and many extrusions of these.
Since the appearance of transcutaneous BCI (tBCI) in 2012 many patients preferred these, with similar functional gain and less complications. A multinational consensus group described 2 new surgical alternatives (BCI conversion I or II) for the replacement of the original prostheses according to the complication Holger’s Scale.
Methods
Five patients were under BCI conversion surgery. Two received BCI conversion type II, while three BCI type I. All patients had surgery in 2 stages due to the presence of biofilms over the abutment and the status of the skin, usually poor with bad blood supply. In the first step, the abutment and the osseo-integrated screw was removed with special forceps, continuing with a reparation of subdermal tissue using a muscular rotating flap. Five weeks to five months later on, a conventional surgery was done to implant the BCI.
Results
The presence of Staphilococcus’s biofilms in all screws was demonstrated using sonication, due to open skin. All patients recovered a good skin health in the original surgery area. No complications were suffering from patients after the 2 surgeries.
Conclusion
The conversion surgery (from pBCI to tBCI) needs 2 steps, reducing complications, especially with skin. The presence of biofilms and the skin situation justified the decision.

Background:This study evaluated single-stage auricular reconstruction and hearing rehabilitation in 68 children (7–12 years) with microtia at Shanghai Ninth People's Hospital. Methods:Patients were divided into three groups: 20 underwent auricle reconstruction with high-density polyethylene (Medpor) and traditional external auditory canal and middle ear repair (EACR), 8 received Medpor with bone conduction device (BB), and 40 had only Medpor auricle reconstruction. Results:Follow-ups (3–30 months) showed good auricle shape recovery in all groups, with no significant differences in auricle symmetry or fine structure scores (P>0.05). Hearing improvement was significantly better in the BB group (43.33 dB HL) compared to the EACR group (4.13 dB HL). Complications included sensorial hearing loss, framework fracture, and ear canal restenosis in the EACR group, and framework exposure and facial nerve injury in the auricle group. Conclusion:The study showed that single-stage auricular reconstruction and hearing rehabilitation are feasible, with BB recommended for patients with poor mastoid development for stable hearing outcomes.

Background: The aim of this study is to compare two surgical techniques for implantation of the Osia® system used in two European clinical centers (Poznań, Poland and Freiburg, Germany).

Methods: The material consists of 83 patients who underwent Osia® 2 and 3 implantation (89 implants), who were analyzed in terms of the course of the procedure, the healing process and the long-term aesthetic and local effects.

Results: In the clinic in Poznań, bone polishing was performed only when necessary, whereas in the clinic in Freiburg, the bone bed was routinely prepared before implantation of the BI300 implant. In most patients, no significant problems or complications were noted. Two cases required explantation, one following percutaneous dermatome Baha surgery in the medical history, due to abnormal wound healing (Freiburg) and the other due to auditory artifacts and unsatisfactory aesthetic effect (Poznań). Another case with recurrent seroma required reoperation (Freiburg). The mean long-term results for the surgical area were as follows: visibility of the incision line or scar (1 – best result, 3 – worst result): Poznań – 1.38, Freiburg – 1.56, retroauricular bump (1 – best result, 4 – worst result): Poznań – 2.23, Freiburg – 1.5; IPS scale results: Poznań I – 0.02, P – 0.26, S – 0.06, Freiburg I – 0, P - 0, S – 0.3.

Conclusion: Implantation of the Osia® 2 and 3 system is a safe surgical procedure. The surgical technique with routine bone bed creation allows for a reduction in the visibility and palpability of the retroauricular bump.

Background: Controlled elective retrieval of percutaneous bone-anchored implants is rare, restricting opportunities for comprehensive investigation of underlying mechanisms behind both implant success and failure. Thus, current understanding of the biological responses at the tissue-implant interface remains limited.

Methods: We analysed 21 explanted percutaneous bone-anchored hearing implants from 19 patients using a systematic retrieval and logistics framework. Clinical histories were correlated with (i) histological and immunohistochemical examinations, (ii) microbiological cultures, and (iii) structural evaluation, including micro-CT and histomorphometry.

Results: Pain (13/19) and infection (7/19) were the leading indications for retrieval, often co-occurring. Staphylococcus aureus was detected in five cases, four of which had pain as the primary reason for explantation—even in the absence of symptomatic infection. In contrast, Staphylococcus epidermidis was found in two patients: one with pain and infection, and another pain-free case with a resolved infection. Histological analysis revealed that S. aureus colonization was linked to pronounced inflammatory responses, including neutrophil infiltration, abundant iNOS+ cells indicative of proinflammatory (M1-like) macrophages, and numerous CD3+ and CD20+ lymphocytes. However, S. epidermidis in the resolved case was associated with minimal inflammation. Across this diverse cohort, no consistent correlation emerged between implant design, reason for explantation, bone integration, and tissue response.

Conclusion: Pain and infection—especially involving Staphylococcus spp.—were the main reasons for elective implant retrieval, often occurring without clear clinical signs of infection. These findings highlight the complexity of tissue-implant interactions and underscore the value of analysing electively removed implants to improve diagnostic precision and long-term outcomes.

Introduction
Bone conduction device (BCD) technology has advanced with the introduction of piezoelectric systems, offering improved sound quality, biocompatibility, and user comfort. Older electromagnetic systems, while functional, were often bulky, less efficient, and associated with discomfort due to pressure on the skin. Additionally, percutaneous BCDs carried risks of chronic skin reactions. Piezoelectric systems aim to overcome these limitations and enhance hearing outcomes.
Objective
To describe clinical, surgical, audiological, and subjective outcomes in patients transitioned from previous BCDs to the Osia®2 system.
Methods
Multicenter, retrospective study including patients who converted from previous BCDs to Osia®2 between 2020 and 2024. Data included hearing loss type, reason for conversion, skin complications (Holgers scale), surgical details, audiological measures—functional gain (FG) and effective gain (EG) at 12 months—and perceived benefit via the COSI questionnaire.
Results
A total of 179 patients were included: 90 with conductive hearing loss, 79 with mixed loss, and 10 with single-sided deafness. Nearly half (46.9%) opted for conversion to improve hearing, mainly from Baha®Connect (51.4%) and Sophono® (33%). Skin complications were the second most common reason; 30.7% presented Holgers grade 4. All surgeries were under general anesthesia; flap reduction was needed in only 5%. At 12 months, FG/EG averaged 39.8 dB/–9 dB (conductive) and 44.2 dB/2.9 dB (mixed). Most patients (64.7%) prioritized improved hearing in noise, with a COSI score of 4.42/5 and 100% reporting benefit.
Conclusion
Transition to Osia®2 proved safe and effective, with significant auditory and subjective improvements, even in cases with prior skin complications.

Background:

Initial surgical techniques for installing percutaneous bone anchored hearing systems (BAHS) often led to frequent skin reactivity and inflammation causing substantial medical and cosmetic problems. The introduction of the linear incision technique, particularly with tissue preservation, was less invasive and led to shorter surgery times, faster healing times, better cosmesis, and fewer soft tissue complications.
The first industry-standardized punch-only technique was introduced by Oticon Medical AB in 2015, called the Minimally Invasive Ponto Surgery (MIPS). Several studies have since confirmed significantly shorter surgical duration for MIPS, with no difference in surgical complication or implant loss rates, and better cosmetic outcomes and fewer revision surgeries than other techniques.

This multi-institutional prospective study aimed to better characterize a several implant and patient-related clinical outcomes over a one-year follow-up period across institutions in the US, Canada, and Spain.

Methods:

The study was a single-arm clinical investigation with a total of 64 adult patients undergoing installation of the Ponto Implant System using MIPS.

Results:

The average procedure duration was 10.5 minutes, and no severe intra-operative complications were reported. At three months following MIPS, 96.6% of patients had a reliable sound processor anchorage, 98.2% of implant sites were completely healed, 96.5% of patients had no adverse skin reactions and 89.5% reported no pain and 98.2% reported no numbness.

Conclusion:

MIPS continues to be a safe and efficient surgical technique for BAHS. Low intra- and post-operative complication rates paired with low rates of adverse skin reactions, pain, and numbness can be expected from the procedure.

Background:
Bone-anchored hearing devices (BAHD) are a potential option for hearing rehabilitation in patients with conductive or mixed hearing loss and in those with single-sided deafness (SSD). Evaluating the outcomes of these devices is crucial for determining appropriate indications, particularly in the context of long-term results."
Methods:
We evaluated the outcomes of BAHD implantation in patients implanted between 2008 and 2025 at the Department of Otorhinolaryngology and Head and Neck Surgery First Faculty of Medicine, Charles University and Motol University Hospital.
Results:
All patients enrolled in the study were contacted electronically and asked to complete a questionnaire. Of the 105 patients, 26 had single-sided deafness (SSD), while 79 were implanted for more traditional indications, such as combined or conductive hearing loss due to chronic otitis or atresia/stenosis of the external ear canal.
The mean duration of use was 167 months (14 years, range 2-16 years). We observed differences based on the indication for implantation. In the SSD group, 69% of respondents remained regular BAHD users, compared to 83% in the traditional indication group, after 14 years of follow-up. Overall, 48% of patients reported using their BAHD for more than 10 hours per day. Patients indicated that they experienced the most significant benefits when communicating in noisy environments.
Conclusion:
We summarized the long-term outcomes of hearing rehabilitation with the BAHD system, enabling us to assess the significant benefits it provides, refine the indication process, and reduce the percentage of potential non-users.
Funding: NW24J-06-00119

Background: There are currently three transcutaneous active bone conduction hearing devices (BCHDs) available for conductive hearing loss (CHL) or single-sided deafness (SSD). Until recently, regulatory approval was limited to implantation of individuals aged 12 and up. A clinical trial is underway to lower the candidacy age for one device (BONEBRIDGE, MED-EL GmbH, Innsbruck, Austria) to age 3. It is vital to negotiate the anatomy of the pediatric skull in these patients. Herein, a technique is presented to optimize placement and audiologic outcomes for this unique population.
Methods: Retrospective review.
Results: Under the study protocol, 6 patients (median age 7.8, range 6-11) were implanted using a temporal burr hole technique. All patients had unilateral conductive hearing loss due to microtia and canal atresia. The technique consisted of a 4 cm incision over the temporal line 5 cm posterior to the pinna. A burr hole was fashioned to accommodate the transducer. Lifts or emergency screws were not required in any case. There were no complications. Median surgical time was 38 minutes. Audiologic outcomes will be reported upon completion of the trial. A video of the technique will be shown as part of the presentation.
Conclusion: The temporal burr hole technique provides optimal device placement for the BONEBRIDGE device. The advantages include a lower device profile, zero contact with the cartilaginous framework of the pinna, and ideal bone stock for screw placement in contrast to the thin pediatric mastoid cortex.

Background: Implant design is crucial for long-term success of percutaneous bone-anchored hearing implants, and has driven various design changes. Wider-diameter implants like the Ponto Wide (Oticon Medical) improve performance by increasing bone-to-implant contact, enhancing stability and longevity. Early results show high implant survival, better stability and soft tissue complication rates comparable to earlier designs. To evaluate whether these favourable results persist, this study presents follow-up data on the Ponto Wide implant ≥10 years post-implantation.

Methods: Data were collected on implant loss, implant stability measured by resonance frequency analysis (RFA), soft tissue reactions using Holgers classification and IPS-scale, and quality of life evaluated with the International Outcome Inventory for Hearing (IOI-HA) and Glasgow Benefit Inventory (GBI) questionnaire.

Results: 48 patients with 49 implants (originally 60 patients) were included. The 10-year implant survival rate was 96.6%, excluding explantations. ISQ-high values showed an overall upward trend over time compared to baseline measured post-surgery. Skin reactions occurred in 3 patients (7.9%). One patient presented with a Holgers grade 1 and an IPS-score of I1P0S0, while two patients had IPS-scores of I0P0S1. No adverse skin reactions of Holgers grade ≥2 were reported. Hearing-related quality of life improved in 92.6% of patients (GBI), and the mean total IOI-HA score was 4.2 (SD 0.6), indicating high satisfaction.

Conclusion: The Ponto Wide implant shows excellent long-term outcomes, characterized by high implant survival, increasing stability, very low soft tissue complications, and strong patient-reported satisfaction. These results confirm that the early advantages of the Ponto Wide implant persist over extended follow-up.