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Objectives: Discuss use of a linear incision for placement of a magnetically coupled bone anchored hearing implant. Methods: Case series. Results: Two patients underwent placement of magnetically coupled bone-anchored hearing implants (BAHI) through linear incisions. The first, a 40-year-old female with congenital single-sided deafness, previously had successful implantation of a percutaneous bone anchored hearing implant through a linear incision; unfortunately, she developed pain and intermittent drainage at her abutment site with time, resulting in a request for removal of her device. As an alternative to complete removal, we offered to replace the percutaneous implant with a magnetically coupled BAHI, employing the same linear incision previously. The second patient, a 53-year-old obese female with limited neck mobility and mixed hearing loss, underwent primary placement of a magnetically coupled BAHI through a linear incision. Limitations in neck mobility and patient body habitus precluded use of a traditional C-shaped incision. Both patients underwent surgery successfully, healed without incident, had their devices activated 6 weeks after their procedures, and are able to wear their implants more than 8 hours per day without discomfort. Conclusion: Surgical techniques for bone-anchored implants continue to evolve. Though manufacturers of magnetically coupled devices recommend using C-shaped incisions with large skin flaps, our first reported cases suggest that a small linear incision immediately overlying the implant magnet may be an acceptable alternative. Potential benefits include a smaller incision, less hair removal, smaller flap, decreased surgical time, and less postoperative pain.

In the twenty-first century, new cutting-edge osseointegration technology is improving quality of life. Osseointegration is a new technique to suspend an implant prosthetic device for individuals with a limb-loss. The science of osseointegration is not clearly understood although there appears to be a special relationship between pure titanium that promotes activation of our bone building cells and bone remodeling. Direct bone-anchored osseointegration to integrate a foreign device into the body without the body rejecting the prosthesis is the new technology lacking knowledge and research clinical cases for human translation. The objective of the case study was to review the science of bone-anchored osseointegration as a limb-salvaging technique and potential translation to humans using a canine model in a well-defined control study. Aims were to enhance knowledge technology, improve mobility, decrease pain to improve quality of life and influence health care practices. By the year 2050, the projected number of American amputees is expected to reach 3.6 million. Many people depend on artificial limbs to perform their activities of daily living. Often these limbs start developing complications associated with stump-socket designs such as separation from the human tissue, poor fit with repeated fittings, recurrent skin infections, ulcers and pressure sores due to non-uniform pressure distribution over the socket contact area and pain which decreases their mobility. Since 2001, close to 28,500 American troops have been wounded in combat in Iraq and Afghanistan. Greater than 24,600 of them have survived their injury, the highest survival rate of any war in the history of the United States. Sadly, 700 of these services members have lost at least one limb from amputations. Lower limb amputations are still performed above the knee as not enough bone can be preserved below the knee for prosthesis. Osseointegration with limb-salvaging techniques could enhance mobility and quality of life for those individuals who sacrifice their limbs defending our freedoms.

The purpose of this project has been to evaluate different candidate designs and make design adjustments on the implant in the bone-anchored hearing system (BAHS). This was performed to minimize the surgical procedure and at the same time contain high implant stability. New adjustable abutment concepts have been conceptualized in this project with the reason to create a product more customized for each patient.    The work has been carried out by following the Stanford design thinking model. Five stages were involved in the development process: empathize, define, ideate, prototype, and test. The empathize process generated data on existing components, including their advantages and disadvantages. The users have been identified and their requirements defined. Throughout the ideate process, ideas were developed through a variety of innovative methods. The idea phase produced four implant concepts and two abutment concepts, which were then refined in the concept phase. After the concept evaluation stage, the implant concepts were reduced to three, then modeled in 3D, manufactured, and tested. Due to project-related challenges and time constraints, the abutment concept designs were set aside for future development and were not manufactured nor tested.  The final product is called the Ponto C4.2 implant. The concept is 1 mm shorter in length and features a unique design, making it the smallest implant currently available for adults with promising ex vivo mechanical performance and stability in comparison with the currently available implants. The design results in decreased osteotomy by minimizing the pre-drilling in the skull bone, which reduces the risks during the implementation procedure and could potentially simplify the installation process.

The long-term outcomes of subjects fitted with a bone anchored hearing aid (BAHA) for a unilateral profound sensorineural hearing loss (UPSHL) are still evolving. Previous studies have focused on the comparison between shortterm outcomes obtained with hard-wired contralateral routing of signal (CROS) hearing aids and those obtained with BAHA devices. Published results on subjects who have worn their BAHA devices for UPSHL for more than twelve months are limited. This study explored the long-term outcomes of adults fitted with a BAHA for UPSHL. The aims were firstly to examine subjects' pre-operative and postoperative speech perception in quiet and noise, as well as administer two standardised questionnaires, the Abbreviated Profile of Hearing Benefit (APHAB) and the Glasgow Hearing Aid Benefit Profile (GHABP). The second aim was to evaluate the responses of implanted subjects following the preoperative test protocols using a supplementary questionnaire, the Single Sided Deafness Questionnaire (SSDQ). The third aim was to monitor the subjects' implant or repair issues. In addition, questionnaire results were compared to subjects who underwent pre-operative assessment but were not implanted. All subjects had a UPSHL resulting from various aetiologies including vestibular schwannoma or other skull base tumour removal, viral infections, cochlear trauma, idiopathic sudden hearing loss, and Meniere's disease. There was a significant difference between the implanted groups' pre- and post-operative outcomes measures, indicating a treatment effect from the fitting of the BAHA device. No significant changes were found with the non-implanted groups' longterm outcome measures in regards to their perceived hearing difficulties. No significant correlations were found between outcome measures and gender, age of fitting, length of deafness, or ear affected for either group.

Orientador: Maria Aparecida Neves [Unesp] Jardini / Resumo: A utilização de estimulação biofísica através da modalidade de campo eletromagnético pulsado (CEMP) para o tratamento de diversas condições no tecido ósseo tem despertado o interesse científico há décadas. Entretanto, a grande variedade nos parâmetros e protocolos utilizados e a divergência de resultados na literatura dificultam o estabelecimento de uma metodologia que seja eficaz no contexto da terapia com implantes osseointegrados. Dessa forma, torna-se importante avaliar o efeito de diferentes tempos de aplicação do CEMP padronizado em diferentes momentos no processo de osseointegração de implantes de titânio inseridos em tíbias de ratos. Para isso, foram utilizados 60 animais (Rattus norvegicus, variação albinus, Wistar), randomizados em três grupos experimentais: controle, teste A (GTA) submetidos por 3 horas de CEMP, e teste B (GTB) com 1 hora de CEMP, sendo que, a exposição ocorreu em 5 dias semanalmente durante o período experimental. Todos os animais receberam implantes em ambas as tíbias, e a aplicação do CEMP ocorreu apenas nos grupos teste com parâmetros fixos de ± 1 mT, 15 Hz, com 25 ciclos repetidos por 200 microssegundos. Após a eutanásia as peças foram separadas e preparadas para o teste mecânico, análises histomorfométricas, microtomografia computadorizada (µCT) e ensaios biológicos in vitro. Os dados foram tabulados e a análise de variância ANOVA foi aplicada, com nível de significância de 5%. Os resultados obtidos revelaram que, GTB apresentou melhores resu... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The use of biophysical stimulation through the pulsed electromagnetic field modality (PEMF) for the treatment of various conditions in bone tissue has aroused scientific interest for decades. However, the wide variety of parameters and protocols used and the divergence of results in the literature make it difficult to establish a methodology that is effective in the context of therapy with osseointegrated implants. Thus, it is important to evaluate the effect of different application times of the standardized PEMF at different times in the osseointegration process of titanium implants inserted in tibiae of rats. For this, 60 animals (Rattus norvegicus, variation albinus, Wistar) were used, randomized in three experimental groups: control, test A (GTA) submitted for 3 hours of CEMP, and test B (GTB) with 1 hour of PEMF, and the exposure occurred in 5 days weekly during the trial period. All animals received implants in both tibiae, and the application of PEMF only occurred in the test groups with fixed parameters ± 1 mT, 15 Hz, with 25 cycles repeated for 200 microseconds. After euthanasia, the pieces were separated and prepared for mechanical testing, histomorphometric analysis, computed microtomography (µCT) and in vitro biological tests. Data were tabulated and ANOVA analysis of variance was applied, with a significance level of 5%. The results obtained revealed that, GTB presented better results in comparison to GTA in the removal torque tests in 07 days; in bone volume an... (Complete abstract click electronic access below) / Doutor