The development of a BAHA program: A review of complications and outcomes, 1991–2002

Abstract

Problem: The aim of this study was to evaluate the problems encountered in the development of a Bone Anchored Hearing Aid (BAHA) program in a district general hospital, over a period of 11 years. Patient satisfaction was also assessed. Methods: Patient records and a patients’ database were evaluated retrospectively. Demographics, pre- and postoperative audiogram, surgical technique, and surgical and skin complications were recorded and analyzed. Patient satisfaction was assessed prospectively using a visual analog questionnaire. Results: BAHAs have been fitted to wide age group of patients (ranging from 7 to 80 years). Indications for surgery are congenital abnormalities in children and following mastoid surgery/CSOM (74%) in adults. The remainder is due to chronic otitis externa or otosclerosis. Half of these patients were tertiary referrals. Intially surgery was carried out in 2 stages (43%), Now all are performed in 1 stage with a local skin flap. Complications requiring further surgery (18%) have been due to trauma, primary failure to integrate, or as a result of late infections. Forty-one percent of patients have had no complications, including skin reactions. Review of patient questionnaires showed that 91% express their complete satisfaction with their device. Over 88% use their BAHA every day and for more than 8 hours. Ninety-five percent felt that one-on-one conversation was better with a BAHA. Most were pleased with the cosmetics of the abutment, ease of use of aid, with only 15% expressing difficulty cleaning the abutment. We had no nonusers in the study. Conclusion: Surgical complications were higher than other published data in the early stages of program development. Patient satisfaction was generally high, but improved significantly with the introduction of a multidisciplinary team approach. Significance: The BAHA service has developed steadily over the years. Surgical techniques have improved. Complications, especially skin problems have been reduced by the development of a specialized team approach involving the surgeon, nurse, audiologist, and patient. Support: None reported.