Donders Institute for Brain, Cognition and Behaviour
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Thesis defense Ivo Kruyt (Donders series 434)

16 June 2020

Promotors: prof. dr. H. Marres, prof. dr. E. Mylanus (University Gent, Belgium)
Co-promotor: dr. M. Hol

Bone Conduction Devices – Reviewing the past, evaluating the present, considerations for the future

Since the first bone conduction device was implanted in 1977, modifications to the original surgical technique and the implant itself have been evaluated in clinical research in order to achieve optimal survival rates and soft tissue tolerability. Especially in the last decade, developments in terms of implant devices and surgical techniques have taken flight. In the first part of current thesis, the clinical safety and long-term effectiveness of some of these developments in percutaneous and transcutaneous implant designs and different surgical techniques have been evaluated. Almost all evaluated developments in percutaneous implant design and surgical technique have proved beneficial in terms of reduction of the complications rates. Furthermore, the transcutaneous implant has proved to be an viable alternative to the percutaneous implant if the latter is not tolerated by the patients skin or is deemed cosmetically unacceptable by the patient. The second part of the thesis aimed to critically review previously published studies regarding BCD surgery in children, evaluate the cost-benefit of different implants, and develop a new soft tissue assessment scale for transcutaneous and percutaneous BCDs. Further improving clinical outcomes in the healthy adults will be difficult due to the limited remaining headroom and the large sample sizes that are needed to evaluate the superiority of new developments. However, we have identified other areas that need to be investigated, such as new developments in children as well as more extensive cost-effectiveness studies. As such, this thesis also provides considerations for future research in the field of bone conduction devices.