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Objectives: Hearing loss is an area of unmet need, and industry is targeting this field with a growing range of surgically implanted hearing devices. Currently, there is no comprehensive UK registry capturing data on these devices; in its absence, it is difficult to monitor clinical and cost-effectiveness and develop national policy. Recognising that developing such a registry faces considerable challenges, it is important to gather opinions from stakeholders and patients. This paper builds on our systematic review on surgical registry development and aims to identify the specific requirements for developing a successful national registry of auditory implants., Design: Qualitative study., Participants: Data were collected in two ways: (1) semistructured interviews with UK professional stakeholders; and (2) focus groups with patients with hearing loss. The interview and focus group schedules were informed by our systematic review on registry development. Data were analysed using directed content analysis. Judges mapped the themes obtained against a conceptual framework developed from our systematic review on registry development. The conceptual framework consisted of five categories for successful registry development: (1) planning, (2) registry governance, (3) registry dataset, (4) anticipating challenges, (5) implementing solutions., Results: Twenty-seven themes emerged from 40 semistructured interviews with professional stakeholders and 18 themes emerged from three patient focus groups. The most important factor for registry success was high rates of data completion. Benefits of developing a successful registry of auditory implants include: strengthening the evidence base and regulation of auditory implants, driving quality and safety improvements, increased transparency, facilitating patient decision-making and informing policy and guidelines development., Conclusions: This study identifies the requirements for developing a successful national registry of auditory implants, benefiting from the involvement of numerous professional stakeholder groups and patients with hearing loss. Our approach may be used internationally to inform successful registry development., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives/hypothesis: To evaluate the long-term (5-year) results of the shape-memory nitinol stapes piston in the surgical treatment of otosclerosis., Study Design: Retrospective case review in a tertiary referral center., Methods: The patients were adults with clinically proven otosclerosis undergoing stapedotomy. Stapedotomy and ossicular chain reconstruction using a shape-memory nitinol stapes piston were performed. The main outcome measure was masked air and bone conduction audiometry., Results: Forty-eight out of a potential 58 ears had complete audiometric data. The mean preoperative air-bone gap was 29.2 dB (standard deviation [SD] 9.4). The postoperative gap at 1 year was 4.6 dB (SD 3.1), and P at 5 years was 7.0 dB (SD 6.2)., Conclusions: These data suggest that the Smart piston provides a stable long-term hearing result in the surgical treatment of otosclerosis.

Objective: To identify the 'stapedotomy' learning curve of 2 UK otolaryngologists., Study Design: A retrospective review of the outcome of the first 100 stapedotomy operations by each surgeon. Included in the study was a postal survey of the incidence of stapes surgery by UK otolaryngologists., Setting: Two tertiary referral centres., Patients: All ears in which primary stapedotomy was performed for otosclerosis. Non-otosclerotic cases and malleus stapedotomy cases were excluded., Intervention: One surgeon used the technique of small fenestra stapedotomy with either a Teflon wire or titanium piston, but without vein graft interposition, whilst the second employed the technique of stapedotomy with vein graft interposition, and a Teflon piston., Main Outcome Measures: The first 100 stapes operations performed by each surgeon were subdivided into consecutive groups of 10. Using a postoperative air-bone gap of 20 dB or better as a definition of 'success', the 'success rates' of each group were plotted on graphs - the learning curves. The end point of the learning curve was defined as the point 'where the curve reaches its plateau'., Results: The learning curves of both surgeons included 70-80 operations. Both surgeons had one 'dead ear' in their first 15 cases. The postal survey showed that some trainers only perform a small number of stapes surgeries, whereas some otolaryngologists who regularly perform stapedotomies were not trainers., Conclusions: This is a mismatch of trainers and trainees in stapes surgery. If the current trend of decline in stapes surgery continues, it will take many years for some otolaryngologists to complete their learning curves.