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DeafnessNCT01796236

Clinical and Health Economic Evaluation With a New Baha® Abutment Combined With a Minimally Invasive Surgical Technique

A study testing Minimally invasive surgery and BA400 and Traditional surgery and BA300 in people with Deafness and Hearing Loss, run by Cochlear Bone Anchored Solutions at 7 sites in 4 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

To demonstrate that the minimally invasive surgical procedure in combination with the use of the Cochlear Baha BA400 abutment is associated with a reduction of inflammation/infection, overgrowth, pain and numbness at the site of implantation compared to the traditional surgical procedure in combination with the use of… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Deafness, Hearing Loss, Hearing Loss, Conductive
What is being tested?
Minimally invasive surgery and BA400 and Traditional surgery and BA300
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
106 participants
Where
7 sitesin 4 countries
Study dates
Feb 2013to Nov 2017
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Eligible for the Baha system
  • Signed informed consent

Who cannot join

  • Patient scheduled for simultaneously bilateral implant surgery
  • Uncontrolled diabetes as judged by the investigator
  • Condition that could jeopardize osseointegration and/or wound healing, e.g. osteoporosis, psoriasis and use of corticosteroids
  • Unable to follow the cleaning instruction
  • Unable to follow investigational procedures, e.g. to complete quality of life scales
  • Participation in another investigation with pharmaceuticals and/or device
  • Condition that may have an impact on the outcome of the investigation as judged by the investigator
  • Suitable implant position for the 4 mm implant not found during surgery due to insufficient bone quality and/or bone thickness

Trial locations and contacts

7 sites in 4 countries.

7 sites in 4 countries

Netherlands4 sites
  • KNO arts, Amphia Ziekenhuis

    Breda

  • Deventer Ziekenhuis

    Deventer

  • Dept. ENT/KNO

    Eindhoven, 5623

  • NT department

    Maastricht, 6202

Other trials in Netherlands

France1 site
  • Service ORL

    Toulouse, 31059

Other trials in France

Spain1 site
  • Otorhinolaryngology, Hospital Clinico Universitario De Valencia

    Valencia, ES-46010

Other trials in Spain

Sweden1 site
  • ENT Clinic

    Gothenburg, 411 35

Other trials in Sweden

About this study

Official title: Clinical and Health Economic Evaluation of a New Baha® Abutment, With a Minimally Invasive Surgical Technique. An International Multicentre, Open, Randomised, Comparative, Parallel Group, Investigation. 1y Investigation, 2y Follow-up

To demonstrate that the minimally invasive surgical procedure in combination with the use of the Cochlear Baha BA400 abutment is associated with a reduction of inflammation/infection, overgrowth, pain and numbness at the site of implantation compared to the traditional surgical procedure in combination with the use of the standard Baha abutment (Cochlear Baha BA300 Abutment).

To demonstrate that the minimally invasive surgical procedure in combination with the use of the Cochlear Baha BA400 abutment is associated with a reduction in direct medical costs, due to shorter surgical procedures, faster wound healing and less complications compared to the traditional surgical procedure in combination with the use of the standard Baha abutment (Cochlear Baha BA300 Abutment).

Read the detailed description

Despite extensive soft tissue reduction, the most common complications associated with Baha implants are related to adverse skin reactions around the abutment. The reduction of the skin also adds complexity to the surgical procedure that is otherwise a routine type of skin incision. A less invasive surgical technique avoiding reducing the thickness of the skin would render a simpler and shorter procedure and would be aesthetically appealing to the patients, as permanent hair removal in the area around the abutment would not be required. Faster healing and less numbness (sensory loss/ paraesthesia) at the implant site may also be expected if the soft tissue thickness is left intact.

The Cochlea Baha BA300 Abutment together with a surgical procedure that includes soft tissue reduction was CE marked in April 2010. The test abutment, Cochlear Baha BA400, together with a surgical procedure that does not require soft tissue reduction was CE marked in June 2012.

The rationale behind this investigation was to make a 'head-to-head' comparison between the BA300 and BA400 Abutment and the associated surgical techniques in order to collect information regarding complications (inflammation/infection, numbness and pain), aesthetic outcome and utilisation of direct medical cost associated with surgery.

Being tested
Minimally invasive surgery and BA400, Traditional surgery and BA300
Keywords
Bone anchored hearing aid, Bone anchored implant, Abbreviated Profile of Hearing Aid Benefit (APHAB), Health Utility Index (HUI), Holgers Index, Implant stability
Medical subject headings
Deafness, Hearing Loss, Hearing Loss, Conductive, Hearing Loss, Mixed Conductive-Sensorineural

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Minimally invasive surgery and BA400Device

    The Cochlear Baha BA400 Abutment has been designed with a concave shape at the lower aspect of the abutment. The abutment is made of commercially pure titanium and is coated with a hydroxyapatite layer on the entire soft tissue-contacting surface of the abutment up to 3 mm below the top surface (2 mm below the top surface on 6 mm abutments).

  • Traditional surgery and BA300Device

    The BA300 abutment is made of commercially pure titanium and is available in two different lengths (6 mm and 9 mm).

Study groups in NCT01796236
Study groupRoleWhat they receive
Minimally invasive surgery and BA400Active comparatorThis arm involves no soft tissue reduction around the BA400 implant.
Receives: Device: Minimally invasive surgery and BA400
Traditional surgery and BA300Active comparatorThis arm involves traditional soft tissue reduction around the BA300 implant
Receives: Device: Traditional surgery and BA300

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Number of Participants With Local Adverse Events as a Measure of Safety and Tolerability

    Combined endpoint of infection/inflammation, overgrowth, pain and numbness will be evaluated, as the sum of the following four events:

    1. Holgers Index >=2 any time between 3 weeks to 1 year
    2. Any overgrowth any time between 3 weeks to 1 year
    3. Pain (scar/neuropathic) according to POSAS >=3 any time between 3 weeks to 1 year
    4. Any numbness any time between 3 weeks to 1 year Each medical event is counted only once per subject resulting in a score of 0 to 4 for every subject.

    Measured: 12 months

  2. Number of Participants With Local Adverse Events as a Measure of Safety and Tolerability

    Combined endpoint of infection/inflammation, overgrowth, pain and numbness will be evaluated, as the sum of the following four events:

    1. Holgers Index >=2 any time between 3 weeks to 1 year
    2. Any overgrowth any time between 3 weeks to 1 year
    3. Pain (scar/neuropathic) according to POSAS >=3 any time between 3 weeks to 1 year
    4. Any numbness any time between 3 weeks to 1 year Each medical event is counted only once per subject resulting in a score of 0 to 4 for every subject.

    Measured: 36 months

Secondary outcomes (12)
  1. Surgery Time

    Surgery time (minutes) was recorded

    Measured: Day 0

  2. Wound Healing

    A surgeon or a surgical nurse determined if the wound was healed or not healed.

    Measured: Day 10, Weeks 3, 6, 12 and 24

  3. Inflammation - Max of Holgers Index

    Max of Holgers index from day 10 to month 12, and to month 36 was recorded, using the Holgers scale from 0 - 4, where 0 = no inflammation and 4 = removal of abutment/implant necessary due to infection.

    1. No irritation
    2. Slight redness. Local temporary treatment, if needed
    3. Red and slightly moist tissue. No granulation formation, local treatment and extra controls as indicated*
    4. Reddish and moist; sometimes granulations tissue, revision surgery is indicated* R. Removal of the abutment / implant necessary due to infection* R Removal of implant for reasons not related to skin problems*

    Measured: From Day 10 to 12 Months, and to 36 Months

  4. Inflammation - Holgers Index by Visit

    Infection and inflammation were evaluated by the holgers index at visits 3-10 (Day 10, Weeks 3, 6, 12, 24, months 12, 24 and 36) and the following scale was used:

    1. No irritation. Epidermal debris removed, if present
    2. Slight redness. Local temporary treatment, if needed
    3. Red and slightly moist tissue. No granulation formation, local treatment and extra controls as indicated*
    4. Reddish and moist; sometimes granulations tissue, revision surgery is indicated*
    5. Removal of the abutment / implant necessary due to infection* R. Removal of implant for reasons not related to skin problems*

    Measured: Day 10, Weeks 3, 6, 12, 24, months 12, 24 and 36

  5. Max Numbness

    Subjects were asked if they experience any numbness around the abutment at each visit. The maximum numbness each subject experienced is summarized in this analysis. The following scale will be used:

    1. No numbness
    2. Numbness within 2 cm from the abutment
    3. Numbness within and beyond 2 cm from the abutment

    Measured: 12 & 36 months

  6. Pain in the Scar and Neuropathic Pain

    The subject rated the following questions 'has the scar been painful the past few weeks' and 'have you had any neuropathic pain during the past weeks' on the 1-10 scale were 1 = no, not at all and 10 = yes, very much.

    Measured: Day 10, Weeks 3, 6, 12, 24, Months 12 and 36

  7. Pain - Maximum of Neuropathic and Scar Pain

    The maximum neuropathic pain and the maximum scar pain experienced at any time throughout the study up until and including 12 months.

    Measured: 12 months

  8. Pain - Maximum of Neuropathic and Scar Pain

    The maximum neuropathic pain and the maximum scar pain experienced at any time throughout the study up until and including 36 months.

    Measured: 36 months

  9. Pain by Visit - Categorical

    The subject rated the following questions 'has the scar been painful the past few weeks' and 'have you had any neuropathic pain during the past weeks' on the 1-10 scale were 1 = no, not at all and 10 = yes, very much.

    Pain scale was categorised as 1='no pain', 2-3='mild pain', 4-6='moderate pain', 7-10='severe pain'.

    Measured: Day 10, Weeks 3, 6, 12, 24, Months 12, 24 and 36

  10. Soft Tissue Thickening/Overgrowth

    The investigator rated the implant site in regards to soft tissue thickening/overgrowth at visits 3-10 according to the following scale:

    1. No soft tissue thickening or overgrowth
    2. Slight soft tissue thickening or overgrowth
    3. Moderate soft tissue thickening or overgrowth. Local treatment and extra controls as indicated*
    4. Marked/distinct soft tissue thickening or overgrowth. Revision surgery is indicated.*
    • Should also be reported on the AE page in the CRF

    Measured: Day 10, Weeks 3, 6, 12, 24, Months 12, 24 and 36

  11. Visible Abutment Length by Visit for Patients With no Change of Abutment

    The investigator measured the visible abutment length at each visit. The length of BA400 test abutments initially placed were longer than BA300 control abutments places. A direct comparison between the groups is not relevant.

    In some cases of increased soft tissue thickening or overgrowth, the abutment was exchanged for a longer abutment. The results presented here are only for patients with no change of abutment

    Measured: Day 10, Weeks 3, 6, 12, 24, Months 12, 24 and 36

  12. The Aesthetic Outcome of Surgery, the 'Patient and Observer Scar Assessment Scale' Consisted of Two Parts - a Patient and an Observer Scale, Week 12, Month 12 and 36.

    The patient scale contains six items (pain, itching, color, stiffness, thickness and irregularity) scored 1-10.

    The observer scale contains six items (vascularity, pigmentation, thickness, relief, pliability and surface area) scored 1-10. Besides the 10-step scale, category boxes are available to score nominal parameters (e.g. type of color).

    Both patient and observer should also score the overall opinion of the scar on the 1-10 scale.

    For all above scales 1=normal skin, 10 worst scar imaginable.

    Total score is the sum of the variables pain, itching, color, stiffness, thickness and irregularity (patient) and vascularity, pigmentation, thickness, relief, pliability and surface area (observer). The scale ranges from 6 to 60 (6 normal, 60 worst scar imaginable).

    The "pain not with in the scar" variable ranges from 1 to 10. 1 being no pain at all and 10 being very much pain

    Measured: Week 12, Months 12 and 36

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted21 Feb 2013 (estimated)
  2. Study startFeb 2013
  3. Primary completionJun 2015
  4. Study completionNov 2017

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
106 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01796236
Sponsor's protocol ID
CBAS5439
Status last verified
Feb 2019
First submitted
16 Jan 2013
Last updated
26 Feb 2019
Data monitoring committee
No

Publications

  • van Hoof M, Wigren S, Ivarsson Blechert J, Molin M, Andersson H, Mateijsen DJM, Bom SJH, Calmels MN, van der Rijt AJM, Flynn MC, van Tongeren J, Hof JR, Brunings JW, Anteunis LJC, Marco Algarra J, Stokroos RJ, Joore MA. A Multinational Cost-Consequence Analysis of a Bone Conduction Hearing Implant System-A Randomized Trial of a Conventional vs. a Less Invasive Treatment With New Abutment Technology. Front Neurol. 2020 Mar 13;11:106. doi: 10.3389/fneur.2020.00106. eCollection 2020.

    PubMed 32231633

Questions about this trial

What is this clinical trial studying?

A study testing Minimally invasive surgery and BA400 and Traditional surgery and BA300 in people with Deafness and Hearing Loss, run by Cochlear Bone Anchored Solutions at 7 sites in 4 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 26 Feb 2019. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 7 sites in Netherlands, France, Spain, Sweden. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 22 Dec 2015). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Number of Participants With Local Adverse Events as a Measure of Safety and Tolerability (time frame: 12 months). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01796236, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 26 Feb 2019.

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