Bone-anchored hearing aids: Percutaneous versus transcutaneous attachments – a health economics comparison in paediatric patients

Abstract

IntroductionBone anchored hearing aids (BAHA) are a useful support when conventional hearing aids are not suitable. The two types of attachment of the aid are onto a percutaneous abutment or a transcutaneous magnet. Anecdotally, the abutment requires more care, revision procedures and causes more infections than magnet-based devices. MethodsA multicentre, retrospective review was conducted of all patients that underwent a BAHA since our programme began, identified through a prospectively maintained database of patients. Patients’ charts were audited for outpatient clinic visits, skin complications and revision surgeries. Developmental delay was also recorded. Patients were censored if the hearing aid was removed, replaced or the patient reached 16 years old. Bilateral or reimplanted patients were recorded as separate implants. Statistical analysis was performed using SAS version 9.4. Results150 implants were assessed over 126 patients: 115 transcutaneous and 35 percutaneous. Percutaneous patients had significantly more outpatient clinic attendances (Least square mean 4.19 vs. 1.39 p = 0.00), skin complications (mean 4.82 v 0.11 p = 0.00) and theatre visits (mean 2.8 vs. 1.03 p = 0.00) compared to transcutaneous patients. 77 implants were in patients that had developmental delay; having same made no significant difference to above outcomes. ConclusionThere is a significant difference in healthcare burden between percutaneous and transcutaneous systems in a paediatric population. The increased cost of the percutaneous implant to the healthcare system and inconvenience to the patient is cause to consider a transcutaneous system in the first instance.