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"aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Ivo Joachim" "apellidos" => "Kruyt" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Myrthe Karianne Sophie" "apellidos" => "Hol" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Otorhinolaryngology and Head-Neck Surgery, University Medical Center Groningen, Graduate School of Medical Sciences, University of Groningen, Groningen, The Netherlands" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Otorhinolaryngology, Radboudumc, Nijmegen, The Netherlands" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author at: Department of Otorhinolaryngology and Head-Neck Surgery, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Comentario sobre “Complicaciones cutáneas y de tejidos blandos de los audífonos osteointegrados: Introducción de un nuevo sistema de clasificación”" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">With great interest we read the recently published article by Costa et al. introducing a new classification system – the Coutinho Classification – for the assessment of soft tissue complications that may accompany percutaneous bone-anchored hearing systems (BAHS).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The classification distinguishes six types of complications ranging from Type A to F, increasing from mild to severe (i.e., skin necrosis).</p><p id="par0010" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Comment:</span> The Coutinho Classification was designed by the authors to overcome some of the disadvantages of the commonly used Holgers classification,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> like inability to include skin hypertrophy, pain and granulation tissue combined with erythema/exudate. We agree with the authors that these disadvantages make the Holgers classification confined in its use and interpretation. Furthermore, the Holgers classification is also limited to only scoring complications in percutaneous BAHS.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Therefore, in 2017, Kruyt et al. introduced the IPS-scale<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> for both percutaneous and transcutaneous BAHS. Focusing on the percutaneous BAHS, the IPS-scale includes pain and skin height as a subscale, which are important variables since these are indications for elective implant removal or revision surgery but also might indicate muscle involvement in relation to the implant, soft-tissue complications, peri-implantitis or even occipital neuropathy.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> The authors state that self-reported subjective parameters like pain potentially increase variability in assessor’s interpretation, with increasing difficulties in children. In our clinical experience we hold the belief that patients are very well able to describe pain, especially since we have a standardized method of evaluating pain: the IPS-scale recommends to evaluate pain when the assessor manually, softly ticks on the abutment either with the a finger nail or with an instrument (e.g. counter torque wrench or screwdriver) or when checking if the abutment is still firmly attached using the counter torque wrench and screwdriver. This is an objective way to always score pain evenly. If pain occurs or increases performing either assessment, this for instance might indicate a peri-implantitis or serious adverse soft tissue complication. Furthermore, the IPS-scale guides clinicians in a systematic assessment of all soft tissue aspects around the implant, decreasing the change of missing information.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In our affiliated medical centers, the IPS-scale is standardized in clinical practice through the Electronic Patient Record. By using shortcuts allowing all scores to be clicked on, an automated total score plus standardized treatment advise is given afterwards. This is especially helpful for less experienced assessors.</p><p id="par0025" class="elsevierStylePara elsevierViewall">On critical note, we feel the three stages of Types C and D in the Coutinho classification leave too much room for interpretation. For example, C/D1: ‘below the level of the abutment’, could for example either mean that the fixture is visible, or a skin dehiscence is present. Type C/2D: ‘at the level of the abutment’, could mean that the skin varies from the very bottom of the fixture/abutment coupling point up to growing over the axilla of the abutment, potentially complicating sound processor coupling.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Finally, we believe to uniform new assessment scales and therefore advocate to optimize one scale. We would therefore like to actively and strongly advise the authors to further improve the internationally widely used IPS-scale.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Statements and declarations</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors state that there are none to report.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Statements and declarations" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Aukema TW, Kruyt IJ, Hol MKS. Comentario sobre “Complicaciones cutáneas y de tejidos blandos de los audífonos osteointegrados: Introducción de un nuevo sistema de clasificación”. Acta Otorrinolaringol Esp. 2023.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Skin and soft tissue complications of bone-anchored hearing aids: introducing a new classification system" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.R. Costa" 1 => "S. Costa" 2 => "T. Soares" 3 => "T. Feliciano" 4 => "E.S.C. Almeida" 5 => "M.B. Coutinho" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.otoeng.2022.01.004" "Revista" => array:7 [ "tituloSerie" => "Acta Otorrinolaringol Esp (Engl Ed)." "fecha" => "2023" "volumen" => "74" "numero" => "2" "paginaInicial" => "85" "paginaFinal" => "92" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/37005042" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Soft tissue reactions around percutaneous implants: a clinical study of soft tissue conditions around skin-penetrating titanium implants for bone-anchored hearing aids" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K.M. Holgers" 1 => "A. Tjellstrom" 2 => "L.M. Bjursten" 3 => "B.E. Erlandsson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Am J Otol." 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"fecha" => "2019" "volumen" => "40" "numero" => "10" "paginaInicial" => "1292" "paginaFinal" => "1298" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31725591" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735735/0000007500000002/v1_202403290637/S2173573523000996/v1_202403290637/en/main.assets" "Apartado" => array:4 [ "identificador" => "5870" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735735/0000007500000002/v1_202403290637/S2173573523000996/v1_202403290637/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173573523000996?idApp=UINPBA00004N" ]
Journal Information
Vol. 75. Issue 2.
Pages 133-134 (March - April 2024)
Vol. 75. Issue 2.
Pages 133-134 (March - April 2024)
Letter to the Editor
Comment on “Skin and soft tissue complications of bone-anchored hearing aids: Introducing a new classification system”
Comentario sobre “Complicaciones cutáneas y de tejidos blandos de los audífonos osteointegrados: Introducción de un nuevo sistema de clasificación”
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