Tag Archives: transcutaneous

The Holger’s Scale vs the IPS-Score

A Review of Percutaneous Implant Complication Scores for Audiologists

What is the Holger’s Scale?

The Holger’s Scale was created as a measure of the clinical status of soft tissue surrounding a titanium implant, such as the Ponto™ System. Its goal was to evaluate the frequency and magnitude of adverse reactions more effectively in this population in future research.1

How was it developed?

The foundation of the Holger’s Scale was a comprehensive study that examined 60 patients who received 67 abutments/implants. Patients were followed for periods ranging from three to 96 months. Over this period, only one implant was removed for reasons associated with skin complications.1

Why is this relevant for audiologists?

The Holger’s Scale is a simple tool that clinicians can use to record any adverse skin reactions ranging from swelling and redness to skin overgrowth and implant removal. Additionally, this measure is often utilized in research regarding percutaneous implants.1

Where do most patients lie on the Holger’s scale post-Ponto implantation?

Studies show that Ponto implant patients, when undergoing the MIPS or MONO procedures, typically have minimal skin-related complications as noted by a Holgers Score of ≤2.2,3 Remarkably, 97 percent of patients exhibit no or minor skin reactions post-operatively.

Are there any limitations to the Holger’s Scale?

Kruyt et al. (2017) suggest several limitations to the Holger’s Scale despite its simplicity and usability.4 These include:

  • The scale can be used to indicate treatment, but these decisions are not standardized.
  • The scale was designed to evaluate skin reactions three months post-operatively, and thus cannot evaluate complications in healing.
  • The scale does not evaluate any pain reported by the patient.
  • Skin height, in regards primarily to skin overgrowth, is not noted in the original Holger’s scale. Often, skin overgrowth can lead to abutment changes or revision surgery.

Additionally, it does not describe possible complications of transcutaneous implants. Due to these limitations, a new scale, the IPS-Scale, was developed to evaluate complications related to percutaneous and transcutaneous implants.4

In response to these limitations, the IPS-Scale was developed to provide a more comprehensive evaluation of complications related to both percutaneous and transcutaneous implants. The IPS-Scale differentiates between the two types of implants and assigns scores for specific categories, such as inflammation, pain, and skin height (for percutaneous implants) or skin numbness (for transcutaneous implants). These individual scores are then combined to generate the IPS-Score, offering a more nuanced guide for treatment selection.

The three scores are then combined to generate the IPS-Score, which then can be used to guide treatment selection.4

No matter which scale you utilize, Ponto implantation patients experience minimal complications post-operatively, and thus benefit from excellent skin outcomes, favorable aesthetic results, and fast recovery times with few complications.5,6

References

  1. Holgers KM, Tjellstrom A, Bjursten LM, Erlandsson BE. Soft tissue reactions around percutaneous implants: a clinical study on skin-penetrating titanium implants used for bone-anchored auricular prostheses. Int J Oral Maxillofac Implants. 1987 Winter;2(1):35-9. PMID: 3471713.
  2. Holmes, S., Hamiter, M., Berry, C., & Mankekar, G. (2021). Tissue preservation techniques for bone-anchored hearing aid surgery. Otology & Neurotology42(7), 1044-1050.
  3. Data on file at Oticon Medical, Clinical study BC108
  4. Kruyt, I.J., Nelissen, R.C., Johansson, M.L., Mylanus, E.A.M. and Hol, M.K.S. (2017), The IPS-scale: A new soft tissue assessment scale for percutaneous and transcutaneous implants for bone conduction devices. Clin Otolaryngol, 42: 1410-1413. https://doi.org/10.1111/coa.12922
  5. Oticon Medical Whitepaper – The MONO procedure
  6. Lagerkvist H, Carvalho K, Holmberg M, Petersson U, Cremers C, Hultcrantz M. Ten years of experience with the Ponto bone-anchored hearing system—A systematic literature review. Clin Otolaryngol. 2020; 45: 667–680. https://doi.org/10.1111/coa.13556