Clinical retrieval and analysis of percutaneous bone-anchored hearing implants using multiple analytical methodologies

• Introduction: The percutaneous bone-anchored hearing system (BAHS) is an established form of hearing treatment for conductive or mixed hearing loss and single sided deafness [1]. The system consists of a titanium implant inserted in the temporal bone and mounted with an abutment onto which a sound processor is attached. It is considered to be a successful treatment with generally good outcomes in terms of audiology and quality of life [2]. However, associated adverse outcomes, such as peri-abutment inflammation and infection, pain and numbness may necessitate intervention, device removal or implant loss [2, 3]. The clinician must rely on subjective clinical measurements, whereas information on the biological events at the tissue-BAHS interface remain inaccessible. Reports of analyses of planned, electively retrieved BAHS implants, performed under perfectly controlled circumstances, are rare [4, 5]. The aim with this study was to gain insight into the biological processes around percutaneous bone-conducting devices by analysing retrieved implants. Experimental methods: Through the establishment of a bilateral collaboration network with European clinics, a retrieval and analytical protocol have been implemented. This will allow correlation of the clinical data with the underpinning microbiological, molecular and morphological fingerprints at the tissue interface. Multiple analytical and correlative strategies have been used, enabling multiscale and multimodal investigation of the tissue interface. Different sampling procedures and analytical tools were employed, including X-ray micro-computed tomography (micro-CT), histology/histomorphometry, fluorescence in situ hybridization (FISH), microbiology, quantitative polymerase chain reaction (qPCR), backscattered electron scanning electron microscopy (BSE-SEM) and Raman spectroscopy. Results and discussions: So far, retrieval, preservation and investigation of six BAHS implants with surrounding tissue have been performed. Causes for removal (1-7 years after implantation) were chronic pain, recurrent inflammation, cancer and mechanical complications. After micro-CT analysis and the samples were embedded for histological and ultrastructural analyses. This presentation describes the sample preparation route allowing assessment of the different hierarchical levels of interest of the tissue interface. Examples of the results from the different analyses will be presented, with emphasis on correlating the clinical outcome with the analytical findings. Conclusions: The implementation of a retrieval protocol combined with a subsequent multi-scale analytical strategy enables a correlation between the clinical history of patients and the underpinning microbiological, molecular and morphological events in the tissues interfacing the electively removed or failed percutaneous bone-anchored hearing implants.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Medicinska och farmaceutiska grundvetenskaper -- Cell- och molekylärbiologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Basic Medicine -- Cell and Molecular Biology (hsv//eng)

TEKNIK OCH TEKNOLOGIER  -- Medicinteknik (hsv//swe)

ENGINEERING AND TECHNOLOGY  -- Medical Engineering (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kirurgi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Surgery (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Medicinska och farmaceutiska grundvetenskaper -- Mikrobiologi inom det medicinska området (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Basic Medicine -- Microbiology in the medical area (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Medicinsk bioteknologi -- Biomaterialvetenskap (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Medical Biotechnology -- Biomaterials Science (hsv//eng)

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