1 3 Eur Arch Otorhinolaryngol DOI 10.1007/s00405-014-2993-7 OTOLOGY Evaluation of a minimally invasive surgical fixation technique for young children with the Concerto Pin cochlear implant system Johannes Schnabl · Astrid Wolf-Magele · Stefan Marcel Pok · Christoph Url · Patrick Zorowka · Georg Sprinzl Received: 4 December 2013 / Accepted: 1 March 2014 © Springer-Verlag Berlin Heidelberg 2014 implant bed constitute a good option for patients with thin- ner bone, such as children. This clinical study shows the safety and stability of the Concerto Pin implant system using a minimally invasive surgical technique. Keywords Cochlear implant · Minimally invasive surgery · Concerto Pin · Children Introduction Since the introduction of cochlear implants (CI) for patients suffering from severe to profound hearing loss, there have been great strides made in the devices themselves as well as the surgical techniques. These days, cochlear implanta- tion is considered to be a safe procedure, with many differ- ent surgical techniques in use [1, 2]. Usually, the implant receiver is anchored in a deep implant bed on the temporal bone and fixed with tie-down sutures. When drilling a deep implant bed and the holes for the sutures, the dura mater can be damaged, especially in children and older adults due to their thinner skull bone. This population is, therefore, more vulnerable to dural injury [1, 3]. More and more, less invasive and less time-consuming surgical techniques are being developed [2–5], and alterna- tive fixation methods, such as the use of titanium screws and different types of meshes instead of sutures, have been established [6–8]. In a multicenter study evaluating a fixa- tion system with titanium screws, Guevara et al. [9] con- cluded that the usage of these screws was safe and would not increase the risk of implant dislocation or be signifi- cantly time-consuming. The usage of only a periosteal pocket with no sutures or drilled holes without any disloca- tion observed has also been described in the literature [4, 10–13]. However, since children have higher activity levels Abstract In 2011, Med-El (Innsbruck, Austria) intro- duced a new cochlear implant system, designed to require a minimally invasive surgical technique and allow greater positional flexibility for its fixation on the skull. The Con- certo Pin implant system is a good option for patients with thinner bone, such as children and elderly. The aim of this study was to investigate the implant’s stability in children using our minimally invasive surgical technique. This was a prospective, longitudinal study with a single-subject, repeated-examination design. Six children, implanted with a Concerto Pin using our minimally invasive surgical tech- nique between October 2011 and September 2012, were assessed 1, 3 and 6 months after surgery. In each case, the implant remained in a stable position and no adverse events or problems with healing were observed at any time dur- ing the investigation. The minimally invasive technique and the method of implant fixation that bypass drilling a deep J. Schnabl (*) · A. Wolf-Magele · S. M. Pok · G. Sprinzl (*) Department of Otorhinolaryngology, Karl Landsteiner University Hospital St. Pölten, Propst Führer-Straße 4, 3100 St. Pölten, Austria e-mail: Johannes.Schnabl@stpolten.lknoe.at G. Sprinzl e-mail: georg.sprinzl@stpolten.lknoe.at J. Schnabl · G. Sprinzl Karl Landsteiner Institut für Implantierung elektronischer Hörsysteme, St. Pölten, Austria C. Url Department of Otorhinolaryngology, Medical University Innsbruck, Innsbruck, Austria P. Zorowka Department of Hearing, Speech and Voice Disorders, Medical University Innsbruck, Innsbruck, Austria