Why won’t good bone conduction candidates get implanted?

One of the most common challenges our hearing care professionals face is encouraging patients to undergo surgery to implant the Ponto™ implant system. It is understandable that many individuals balk when they hear the word “surgery,” particularly if they are parents of children old enough to be implanted. From my substantial experience in medical device sales, I’ve learned that the best way to overcome user objections is with facts. Fortunately, when it comes to minimally invasive Ponto surgery (MIPS), we have substantial data on the benefits of wearing processors on an abutment.

With that in mind, here are five of the most common objections to having minimally invasive Ponto surgery (MIPS) and our suggested responses.

Objection 1: I don’t want to have general anesthesia.

As any credible medical professional will tell you, there is always some risk associated with general anesthesia. Parents often express this concern with regards to their child undergoing implantation. You can help your patient (or their parent) feel better about undergoing the procedure by explaining that MIPS usually only takes about 15-30 minutes and is often performed using other types of anesthesia. In many cases, the procedure may not even be done in a hospital.

Objection 2: If I don’t need surgery for the Ponto to work, then why should I have it?

While it is true that patients who wear their Ponto processor on a softband still receive hearing benefits, implantation increases these benefits significantly. You can explain that when worn on an abutment your patient can expect better results. The Ponto on an abutment uses Direct Sound Transmission, which prevents sound dampening—a common issue with magnet and softband systems. It also allows Ponto devices to reproduce a greater variety of sounds. The sound waves are mechanical, and the signal is transmitted with minimal loss when the source of the signal and its receiver are directly connected by a conductor like our titanium implant. In comparison, sound transmission from a processor on a softband results in signal loss, as it transmits through skin, fascia, and other tissue on its way to the bone.

You can also show your patient this video to illustrate the differences between hearing through a Ponto on a softband vs. an abutment.

Objection 3:  I don’t want to lose time recovering from surgery.

Nobody wants to take significant time away from work or their home/social life for a long surgical recovery. Fortunately, you can reassure your patient that this is a small, usually outpatient procedure with an expectation of same-day admission and release. This is particularly true when utilizing the MIPS or MONO drill technique, which further simplifies treatment and reduces surgical time and the risks associated with surgery. In most cases, it takes no more than a day or two to recover from the procedure. After surgery, the patient can expect to wear a bandage or other protective covering for a couple of days during which time the biggest inconvenience will be not washing their hair.

Objection 4:  I don’t want to risk any potential side effects or negative outcomes.

Although there is never zero risk of side effects or other issues from any kind of surgery, you can reassure your patient by explaining that this is a minimally invasive technique that eliminates the need for suturing by using a smaller incision. This allows for fast recovery and fewer complications. In 95 percent of follow-up visits, no skin-related aftercare treatment was required. Plus there is a 98 percent implant survival rate with the Ponto implants.[1]

As for cosmetic concerns, MIPS was designed to avoid the need for stitches, which reduces scarring and allows the patient’s hair to grow back as it was before surgery.

Objection 5:  I don’t want the expense of a surgical procedure.

This one can be tricky, as coverage for any surgical procedure will vary depending on the kind of insurance your patient has. You can feel free to contact your Oticon Medical representative for general guidance on insurance coverage or you can direct your patients on a case-by-case basis to contact their insurance company directly or speak to our Insurance Support Team to find out what their insurer will or won’t cover.

Have you run into these objections or others when it comes to bone anchored implantation surgery? Share what you’ve heard and how you’ve managed them in the comments below! And if you need more advice on counseling your patients for PONTO MIPS procedures, please contact your Oticon Medical representative.

[1] Lagerkvist H, et al. Ten years’ experience with the Ponto bone anchored hearing system – a systematic literature review. Clin Otolaryngol 2020 Sep; 45(5): 667–680.