applied sciences Article  
Medical Safety and Device Reliability of Active Transcutaneous Middle Ear and Bone Conducting Implants: A Long-Term Multi-Centre Observational Study  
[PERSON] 1,2,*, [PERSON] 1, [PERSON] 1, [PERSON] 3, [PERSON] 4, [PERSON] 4, [PERSON] 5, [PERSON] 6, [PERSON] 7, [PERSON] 7, [PERSON] 8, [PERSON] 9, [PERSON] 9, [PERSON] 10, [PERSON] 10, [PERSON] 11, [PERSON] 11, [PERSON] 12, [PERSON] 2,9 and VERS Clinical Support Team 4  
SOUND Lab, Clinical Neurosciences, University of Cambridge, Cambridge CB2 0 SZ, UK  
Faculty of Brain Sciences, University College London, London WC1E 68T, UK  
Auditory Implant Centre, Belfast Health and Social Care Trust, Belfast BT11 9 AE, UK  
Midlands Hearing Implant Programme, Queen Elizabeth Hospital, Birmingham B15 2 TH, UK  
Department of Otolaryngology, Ninewells Hospital NHS Tayside, Dundee DD1 9 SV, UK  
Hearing Implant Centre, Guy's and St Thomas' NHS Foundation Trust, London SE1 7 EH, UK  
EmEmEmeline Centre for Hearing Implants, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0 QQ, UK  
Royal National Ear, Nose and Throat Hospital, University College London Hospital NHS Foundation Trust, London WC1E 6 QJC, UK  
Vershire Auditory Implant Service, Bradford Teaching Hospital NHS Foundation Trust, Bradford BD9 6 RJ, UK  
The Hearing and Balance Centre, The Leeds Teaching Hospitals NHS Trust, Leeds LS14 6 UH, UK  
North East Regional Cochlear Implant Centre, The James Cook University Hospital, Middlesborough TS4 3 BW, [PERSON]; [PERSON]; [PERSON]; [PERSON] [PERSON]; [PERSON]; [PERSON]; [PERSON] [PERSON]; [PERSON]; et al. Medical Safety and Device Reliability of Active Transcutaneous Middle Ear and Bone Conducting Implants: A Long-Term Multi-Centre Observational Study. _Appl. Sci._**2023**, _13_, 8279. [[https://doi.org/10.3390/appl3148279](https://doi.org/10.3390/appl3148279)]([https://doi.org/10.3390/appl3148279](https://doi.org/10.3390/appl3148279))  
Academic Editors: [PERSON] and [PERSON]  
Received: 15 April 2023  
Revised: 25 June 2023  
Accepted: 26 June 2023  
Published: 18 July 2023  
Active bone-conducting hearing devices (aBCHD; e.g., MEDEL Bonebridge(r) (BB)) and active middle ear implants (aMEI; e.g., MEDEL Vibrant Soundbridge(r) (VSB)) use radio frequency transmission to send information from an external microphone and sound processor to an internally implanted transducer. These devices potentially have an advantage over devices with percutaneous links because the skin is closed over the implantable components, which should reduce the risk of skin problems and infection. On the other hand, surgical procedures are more complex, with a greater risk of damage due to surgery. The objectives of this research were to quantify the reliability and long-term survival of MEDEL VSB and BB devices, determine the adverse and serious adverse device-related complications, and consider associated causes. A multi-center observational retrospective and prospective study was conducted at eleven auditory implant centers in the United Kingdom. Data was collected using a surgical questionnaire and audiological reports. Data were obtained from patient notes or from prospective cases that had a minimum follow-up of one year post-implant. Consecutive patient records were reviewed. Datasets from 109 BB and 163 VSB were reviewed. Of these, 205 were retrospective case note reviews, and 67 were prospective cases. The mean follow-up was 4 and 6 years, respectively, for BB and VSB. Kaplan-Meier Survival analyses indicated that the BB survival was 97% and 93.3% at 1 and 5 years, respectively, and the VSB was 92.1% and 87% at the same time points. This is a large cohort study for the field and has indicated that BB and VSB are safe interventions. Care should be taken to monitor magnet strength in the first few months. For the majority of device-related effects, there was no apparent association with etiology.