Bone-anchored Hearing Aid Implantation Research Articles

Bone‐Anchored Hearing Aid Implantation Using the Cochlear BA400 System: Early Experience and Patient‐Reported Outcomes

Objectives: Several contemporary bone-anchored hearing aid (BAHA) surgical techniques have been described with the common goal of minimizing soft-tissue reduction, which may benefit patients, surgeons, and audiologists alike. Recently, the hydroxyapatite coated Cochlear BA400 abutment was introduced, the first designed specifically for soft tissue preservation. We present our early experience of this system with corresponding patient-reported outcomes. Methods: Data were collected prospectively on the first 25 patients implanted with the BA400 system at our institution (February-September 2013). The Glasgow Benefit Inventory (GBI) was subsequently used to evaluate patient-perceived quality of life in all patients 4 months following sound processor fitting. Results: Mean patient age was 61 years (range, 23-91 years). BAHA was indicated for single-sided deafness in 6 cases (24%) and for conductive or mixed loss when a conventional aid was contraindicated in the remainder. Procedures were performed under local anaesthetic in all but 1 case. Mean operating time was 14 minutes (range, 9-22 minutes). Four patients (16%) suffered implant site soft tissue reactions which were all successfully managed conservatively and graded as follows: Holger’s grade 1 (n = 2), 2 (n = 1), and 3 (n = 1). No other complications were observed. Respective overall, general health, social support, and physical health GBI benefit mean scores were +33 (95% confidence interval [CI]; 27-39), +46 (95% CI; 37-55), +15 (95% CI; 5-25), and 0 (95% CI; –8 to 8). Conclusions: Our data support use of the soft tissue preserving Cochlear BA400 implant system, with shorter operating times, comparable soft-tissue outcomes, and favorable patient-reported quality-of-life when compared with conventional BAHA implantation techniques.

Bone-Anchored Hearing Aid vs. Reconstruction of the External Auditory Canal in Children and Adolescents with Congenital Aural Atresia: A Comparison Study of Outcomes

Objectives/hypothesis: Congenital aural atresia is a rare condition affecting 1 in 10,000–20,000 children a year. Surgery is required to restore hearing to facilitate normal development. The objective of this study was to compare outcomes in hearing, complications, and quality of life of surgical reconstruction of the external auditory canal reconstruction (EACR) and bone-anchored hearing aid (BAHA) in a pediatric population with congenital aural atresia.Study design: Subjects were children who had a diagnosis of congenital aural atresia or stenosis and who received either BAHA or EACR.Methods: The medical records of 68 children were reviewed for operative complications and audiometric results. A quality of life questionnaire was prospectively administered to a subset of subjects.Results: Pre-operatively, air conduction threshold was not significantly different between groups at 500, 1000, 2000, and 4000 Hz (p > 0.05). Post-operatively, the BAHA group (44.3 ± 14.3 and 44.5 ± 11.3) demonstrated a significantly larger hearing gain than the EACR group (20.0 ± 18.9 and 15.3 ± 19.9) in both the short and long-term periods (p < 0.001). Overall, the incidence of complications and need for revision surgery were comparable between groups (p > 0.05). Quality of life assessment revealed no statistical significance between the two groups (p > 0.05).Conclusion: Although the quality of life and incidence of surgical complications between the two interventions was not significantly different, BAHA implantation appears to provide a better, more reliable audiologic outcome than EACR.

Risk analysis of unilateral severe-to-profound sensorineural hearing loss in children

ObjectiveTo explore the etiology of pediatric unilateral severe-to-profound sensorineural hearing loss (USPSNHL) and the risk of hearing loss in the contralateral ear. MethodsPediatric patients with USPSNHL referred to a tertiary children's hospital for unilateral bone-anchored hearing aid implantation were identified for study. Clinical charts, audiograms, and radiographic imaging of the temporal bones were reviewed. ResultsEighty-four children with USPSNHL were reviewed (40 male, 44 female). The etiology of USPSNHL could be identified in 35 patients (41.7%), with perinatal events (16.2%) and family history of hearing loss (10.0%) being the most common identifiable risk factors. Forty percent of children with available newborn hearing screens passed in both ears but later developed USPSNHL. Progressive unilateral hearing loss leading to USPSNHL was found in 21% percent of patients. No patient experienced worsening hearing in the contralateral ear (mean follow-up=31.9 months). Of the 49 temporal bone scans available for review, 40.8% demonstrated aberrant inner ear anatomy, including semicircular canal dysplasia (10.2%), cochlear aperture stenosis (10.2%), hypoplastic cochlea (8.1%), enlarged vestibular aqueduct (14.3%), incomplete partition I/II (6.1%), and anomalous internal auditory canal (2.0%). ConclusionPediatric USPSNHL can be attributed to a variety of sources with a cause identifiable in approximately 40% of patients. Temporal bone CT scan acquisition appears to be relatively high yield in this patient population, but only rarely do results have clinical implications. Early follow-up suggests that this population of children with USPSNHL does not appear to have a significantly increased risk for hearing loss in the contralateral ear.

Ethnic Disparity in Skin Complications following Bone-Anchored Hearing Aid Implantation

Sound processor loading after implantation of a bone-anchored hearing aid is often delayed by skin-site complications. This study examined the frequency of skin-site complications in various ethnic groups and determined factors that may lead to higher rates of skin-site complications resulting in delayed processor loading. Adult, English-speaking patients who underwent implantation of a bone-anchored hearing aid between 2007 and 2010 were reviewed. Demographic data including ethnicity, tobacco use, diabetes mellitus, immunosuppression, and long-term steroid use were determined. Major and minor skin-site complications and the time to processor loading were recorded. The mean time to processor loading was 9.5 weeks, and the mean follow-up time was 23 months. There were no cases of osseointegration failure. African American patients had a significantly higher rate of major skin-site complications (p < 0.005) and a longer time to processor loading (mean, 17.6 weeks; p < 0.05) than the other ethnic groups. There was no significant difference in minor skin complication rates. There was no correlation between diabetes mellitus, long-term immunosuppression, or tobacco use and skin-site complications. Skin complications can delay processor loading following implantation of a bone-anchored hearing aid. There is a higher rate of major skin-site complications in African American patients, and these often delay processor loading. The risk of skin-site complications is not correlated with smoking, diabetes mellitus, or immunosuppression. An increased risk of skin-site complications is an important consideration for preoperative counseling.

Bone-anchored hearing aid (BAHA): indications, functional results, and comparison with reconstructive surgery of the ear.

Summary Introduction: The bone-anchored hearing aid (BAHA) is a bone conduction hearing device that transmits sound directly into the inner ear. It is mainly used in patients with conductive hearing loss associated with aural atresia, but it is also used in those with mixed and sensorineural hearing loss. Goals: To review the main indications for BAHA, to analyze the audiometric results and its benefits for patients and compare them with other treatment modalities, and to compare the literature data with our sample of 13 patients. Method: The research was performed using a database covering works in English, Spanish, and Portuguese, with no limitations in the years when the procedures were performed. We compared the literature data with our results for the 13 patients who underwent BAHA implantation between the years 2000 and 2009. Results: Most of the studies showed that BAHA has great advantages over reconstructive surgery in terms of hearing results, complications, and disease recurrence. The postoperative results for our 13 patients were satisfactory and comparable with the results from the literature, with closure of the air-bone gap in 7 patients and achieving an air-bone gap of 10 dB in 6 patients. No postoperative complications were observed. Conclusion: BAHA is a better treatment option than reconstructive surgery for patients with bilateral deafness. It is a relatively simple surgical procedure with few complications and good hearing results. Recent studies have examined its use in conductive and unilateral sensorineural hearing loss.

Bone-anchored hearing aids and chronic pain: a long-term complication and a cause for elective implant removal

To report a case series of elective removal of bone-anchored hearing aid implants, and reasons for removal. Retrospective review of a prospectively collected database. Two tertiary referral centres in the Manchester area: Manchester Royal Infirmary and Salford Royal University Hospital. A series of 499 adults and children who had undergone a total of 602 implant insertions (1984-2008). Implant removal rates, and reasons. Twenty-seven of the 602 implants (4.5 per cent) required removal. Of these, 12 were due to pain (2.0 per cent), seven to persistent infection (1.2 per cent), three to failure of osseointegration (0.5 per cent), three to trauma (0.5 per cent) and two to other reasons (0.4 per cent). Chronic implant site pain represents the main reason why implants are removed electively, and affects 2 per cent of all implants. This complication has important medico-legal implications and should be discussed when obtaining informed consent for implantation.

Efficacy in patients with outer and middle ear deformities of using bone-anchored hearing aids

To evaluate the efficacy and satisfaction of bone-anchored hearing aids (BAHA) in patients with outer and middle ear deformities. Seven patients with bilateral microtia and aural atresia, and three patients with unilateral microtia and bilateral middle ear malformation were fitted with soft-band BAHA for a few months, followed by receiving unilateral BAHA implantation. Mean pure-tone thresholds and speech audiometry tests results were compared among patients without hearing aid, with soft-band BAHA, and with implanted BAHA. Scores from the BAHA users' questionnaires and Glasgow children's benefit inventory (GCBI) were used to measure patient satisfaction and subjective health benefit. The mean pure-tone thresholds of the patients were (64.8 ± 5.9) dBHL for those without hearing aid, (30.2 ± 3.7) dBHL for those with soft-band BAHA, and (20.3 ± 3.9) dBHL for those with implanted BAHA. The average decline in pure-tone threshold was (36.2 ± 8.0) dBHL for those with soft-band BAHA, and an additional decline of (12.2 ± 3.4) dBHL was achieved with implanted BAHA. The average gains in speech discrimination scores (SDS) were (3.00 ± 1.07)% for those without hearing aids and (89.39 ± 5.83)% for those with implanted BAHA in sound field of 45dBHL. SDS were (57.55 ± 10.30)% for those without hearing aids and (91.19 ± 4.16)% for those with implanted BAHA in sound field of 65dBHL. The average gains in SDS were (88.21 ± 6.86)% and (38.04 ± 7.56)% tested with 45dBHL and 65dBHL respectively. Sound reception thresholds (SRT) without hearing aids were (63.1 ± 5.9) dBHL and (24.7 ± 3.5) dBHL for those with implanted BAHA. The average gains in SRT was (39.6 ± 6.2) dBHL. The BAHA application questionnaire demonstrated excellent patient satisfaction. The general benefit score was 35.59 ± 14.35. BAHA remains one of the most reliable methods of auditory rehabilitation and improves quality of life for patients with ear deformities.

Congenital aural atresia: Bone-anchored hearing aid vs. external auditory canal reconstruction

Objective To compare the audiologic outcome and feasibility of bone-anchored hearing aid (BAHA) and external auditory canal reconstruction (EACR) surgeries in pediatric patients presenting a congenital aural atresia (CAA). Methods A retrospective chart review of 40 patients operated in our tertiary pediatric care center between 2002 and 2010 was performed. 20 patients underwent EACR, whereas another 20 patients were implanted with a BAHA device. Air conduction (AC), bone conduction (BC), pure tone average (PTA) and speech discrimination score (SDS) were compared preoperatively, and hearing gain (HG) postoperatively at 6 and at 12 months at frequencies of 500, 1000, 2000 and 4000 Hz. Operative time, complications and associated microtia were documented as well. EACR patients were graded retrospectively upon Jahrsdoerfer's classification. Results Preoperative AC were significantly different between groups, at 500, 1000 and 2000 Hz but not at 4000 Hz. BAHA group compared postoperatively to EACR group showed significantly a superior HG of 46.9 ± 7.0 dB ( p < 0.001) and of 39.8(7) ± 7.2(6.9) dB ( p < 0.001) at 6 months and at 1 year, respectively. Moreover, aided air thresholds from the EACR group revealed an audiologic status similar to those of the BAHA group patients, at 6 months and one year postoperatively. Both groups had a similar evolution of their BC, as well as of the incidence of complications. We report one case of transient facial paralysis in the EACR group. Total operative time is significantly lower ( p < 0.001) for a BAHA implantation (56 ± 21 min) than for EACR surgery (216 ± 174 min). No preoperative or postoperative correlation (Pearson correlation test; p > 0.05) was found between patient's Jahrsdoerfer's score and their audiologic outcome. HG does not seem to be influenced by the presence of microtia. Conclusion EACR, although constituting an attractive option, does not give acceptable results alone. It can however, when combined to conventional air conduction hearing aids, provide excellent audiologic outcomes comparable to BAHA. BAHA implantation is a reliable, safe and efficient therapeutic option that allows a significantly better audiologic outcome when compared to unaided EACR for patients with CAA.

Outcome of the Bone-Anchored Hearing Aid Procedure Without Skin Thinning

To evaluate the outcome of Bone-Anchored Hearing Aid surgery without skin thinning, a test group with direct implantation without such thinning was compared with a control group that underwent the traditional procedure. This was a single-center, prospective clinical trial designed to evaluate a novel approach to Bone-Anchored Hearing Aid implantation. Eligible patients were enrolled consecutively in the test group or selected to be age-matched controls. University Hospital. Eighteen adult patients, suffering from hearing loss, suitable for implantable hearing aid. Single-step surgery was performed on 18 patients under local anesthesia. In 9 of these, a linear incision was made, a hole was punched through the skin above the bone-anchored implant, and a longer abutment (8.5-12 mm) was introduced, whereas the other 9 were subjected to the standard protocol, using a dermatome and skin thinning. All of the patients were followed for 12 months. The test group exhibited good preservation of the tissue, no increasing skin reactions and no adverse events. The time required for this surgery was reduced, as was their healing time. These patients also experienced less numbness and pain in the surrounding area and had an improved cosmetic outcome. MAIN OUTCOME AND CONCLUSION: This clinical trial indicates that introduction of the abutment to the osseointegrated screw directly through the skin, without skin thinning, could be beneficial. This approach had fewer negative effects than the conventional procedure during the 12- month follow-up period.

Implant survival rate in bone-anchored hearing aid users: long-term results

To investigate the long-term survival rate of bone-anchored hearing aid implants, and to assess the number of patients who stop using their bone-anchored hearing aid. Patients who underwent bone-anchored hearing aid surgery between September 1977 and December 1986 were identified from a prospective database. Data were collected from patient records. During the study period, 143 patients were fitted with a bone-anchored hearing aid. Records from 132 patients were found, with a mean follow up of nine years. A total of 150 implants were installed in these patients. A total of 41 implants (27 per cent) were lost during follow up: 17 lost osseointegration, 16 were removed and eight were lost due to direct trauma. At the end of follow up, 119/132 (90 per cent) patients were still using their bone-anchored hearing aid. Despite a high incidence of implant loss over time, a large number of patients still continued to use their bone-anchored hearing aid.

Complications of bone-anchored hearing aids in pediatric patients

Objective To describe the range and rate of complications related to bone-anchored hearing aids in pediatric patients. Method We conducted a retrospective review all children 16 years of age or less who were implanted with a bone-anchored hearing aid from 2002 to 2009. The main outcome measures were post Baha ® implantation complications including infection, soft tissue hypertrophy, loss of osseointegration, and need for further surgery. Results Thirty-one patients were identified and 27 had sufficient follow up for complete analysis. Soft tissue reactions were seen in 24 patients (89%), half of which were considered minor. Ten patients (37%) had major complications defined as requiring revision surgery or removal of the implant. Soft tissue overgrowth and infection at the abutment required removal in 5 children (19%) and three implants (11%) failed to osseointegrate. Recurrent antibiotic treatment was required in eight patients (30%). Seven patients (26%) had a history of trauma and one of them lost the implant. To date, three of the children (11%) have been unable to use the device because of chronic infection and overgrowth of the abutment. There was a statistically significant increased risk for major complications in patients from socioeconomically deprived backgrounds and obesity appears to incur additional risk. Conclusions Complications of bone-anchored hearing aid implants are common in our experience and obesity and socioeconomic factors appear to contribute to a higher risk for complications. Frequent follow up and meticulous care of the implant site may minimize complications but can be challenging in this population.

Long-Term Benefit Perception, Complications, and Device Malfunction Rate of Bone-Anchored Hearing Aid Implantation for Profound Unilateral Sensorineural Hearing Loss

Long-Term Benefit Perception, Complications, and Device Malfunction Rate of Bone-Anchored Hearing Aid Implantation for Profound Unilateral Sensorineural Hearing Loss

Long-Term Benefit Perception, Complications, and Device Malfunction Rate of Bone-Anchored Hearing Aid Implantation for Profound Unilateral Sensorineural Hearing Loss

To longitudinally evaluate short- and long-term subject satisfaction/benefit perception, device usage rates, complication rates, and external device repair rates of bone-anchored hearing aid (BAHA) implantation on a cohort of adult subjects with profound unilateral sensorineural hearing loss (PUSHL). Prospective clinical trial. Tertiary referral center. Fifty-six adults with PUSHL, 21 of which underwent BAHA implantation (followed for an average of 3.2 years after implantation; range, 0.8-4.6 yr). Short- and long-term satisfaction/benefit perception outcomes consisting of the Glasgow Hearing Aid Benefit Profile, Abbreviated Profile of Hearing Aid Benefit, and Single-Sided Deafness Questionnaire, including a comparison of results between implanted and nonimplanted subjects. Short- and long-term device usage rates, complications, and device failure issues also were carefully documented. There were statistically significant improvements in nearly all measures of benefit perception documented as well as a high rate of long-term device usage (81%). Although satisfaction and benefit perception outcomes generally tended to regress over time when compared with initial short-term outcomes, long-term scores still tended to be significantly improved nevertheless as compared with preoperative levels. Approximately 38% of implants experienced severe local skin reactions (Grade 2 and above) around the implant site at some point throughout the follow-up period, whereas only one (4.8%) required implant removal. 66.7% of subjects required repair of their external sound processor. BAHA implantation seems to provide a high level of short- and long-term perceived benefit and satisfaction in subjects with PUSHL and high rate of long-term device usage. Implant site adverse local skin reactions and repairs of the external sound processor were quite common.

Skin reactions following BAHA surgery using the skin flap dermatome technique

The objectives of the study were to determine the incidence of skin reactions and complications associated with bone-anchored hearing aid (BAHA) implantation. The study is a retrospective case review done in a tertiary referral center. One hundred thirty-eight consecutive patients between 1998 and 2008 underwent implantation of a BAHA and were regularly seen for follow-up. Indications included conductive or mixed hearing loss where a hearing aid cannot be used and since 2000 also had contralateral single-sided perceptive hearing loss. BAHA implantation was done by creating a pedicled flap using the skin flap dermatome technique. Postoperative incidence of skin reactions and complications were measured. Significant postoperative complications requiring revision surgery occurred 37 times in 30 patients. Normal skin healing was seen in 52 patients (63.4%), while abnormal skin healing occurred in 30 patients (36.6%). This study showed that skin problems occur more often than expected. Because of the skin problems with the skin flap technique, the authors have switched to the linear incision technique, hoping to decrease the incidence of skin problems.

Bone-anchored hearing aids in children and young adults: the Freeman Hospital experience

To investigate the utilisation of bone-anchored hearing aids and Softband, as well as the effects on quality of life, amongst the paediatric and young adult population of Freeman Hospital, Newcastle Upon Tyne, UK. Retrospective, anonymised, cross-sectional survey using the Glasgow Benefit Inventory and Listening Situation Questionnaire (parent version), administered at least three months following the start of bone-anchored hearing aid or Softband use. One hundred and nine patients were included, of whom syndromic children made up a significant proportion (22 of 109). Patients using bone-anchored hearing aids obtained significant educational and social benefit from their aids. The mean Listening Situation Questionnaire difficulty score was 17 (15 patients), which is below the trigger score of 22+ at which further reassessment and rehabilitation is required. 87% (of 15 patients) did not require further intervention. The overall mean GBI score for the 22 patients (syndromic and non-syndromic) was +29. The use of bone-anchored hearing aids and Softband results in significant improvements in quality of life for children and young adults with hearing impairment. There is significant under-utilisation of bone-anchored hearing aids in children with skull and congenital abnormalities, and we would advocate bone-anchored hearing aid implantation for these patients.

BAHA in Single-Sided Deafness

Despite most patients with single-sided deafness (SSD) after operation for acoustic neuroma (AN) perceiving a significant hearing handicap, less than 25% are interested in bone-anchored hearing aid (BAHA) implantation. We evaluated the treatment compliance of BAHA in SSD and the effect of BAHA on the subjective handicap. Part 1: It was determined, from our first study, how many of the SDD patients after operation for AN (n = 59) and interested in BAHA (n = 14) had been implanted. Part 2: Of 23 BAHA-implanted patients with SSD due to various causes, including the implanted patients from the previous study, 21 answered a questionnaire on the BAHA treatment compliance and the subjective handicap with and without BAHA. Part 1: Of the 14 patients from our first study who were interested in implantation for BAHA, 11 had been implanted (18.6% of all 59 patients). Part 2: Of the 21 patients with SSD, 95% still used BAHA, and of these, 81% used it more than 8 hours a day. Of the patients, 90% considered BAHA a moderate to significant aid; it reduced the subjective hearing handicap from 7.4 to 2.3 arbitrary units on a visual analog scale. Despite the subjective handicap perception among most patients with SSD after AN surgery, less than 20% chose treatment with BAHA. Conversely, patients with SSD choosing implantation had high treatment compliance and felt that BAHA reduced their handicap. Thus, when selected by the patients after testing, BAHA is effective in SSD and results in a high patient compliance.

Hearing and quality of life in a south European BAHA population

Conclusion: The overall results show a high ratio of satisfaction in the sample population, which is in accordance with a successful BAHA counselling and rehabilitation of their hearing impairment. Objectives: The acceptance of a bone anchored hearing aid (BAHA) device by a south European population, which could be expected to have some reticence for wearing this device, has been investigated. Methods: The outcome of BAHA implantation was assessed in 24 patients with bilateral and unilateral hearing loss by administration of several questionnaires, such as the Handicap Hearing Inventory (HHI), Client Oriented Scale of Improvement (COSI), Open and General Glasgow Benefit Inventory and Entific Medical System QoL, along with a complete audiological test battery. Results: Speech reception threshold (SRT) in bilateral cases improved both in quiet and in noise. In unilateral cases, word perception and accuracy of sound localization improved when sound was presented from the back. COSI scores, at both the intermediate and the final evaluations, showed a fair adaptation level of the patients and their satisfaction for prefixed targets.

A Novel Method of Translabyrinthine Cranioplasty Using Hydroxyapatite Cement and Titanium Mesh: A Technical Report

We report a novel technique for closure using titanium mesh cranioplasty in addition to hydroxyapatite cement and abdominal fat graft for acoustic neuroma. We reviewed 15 patients who underwent translabyrinthine craniectomy for resection of acoustic neuroma. Hearing loss was documented prior to surgical procedure. Over 2 years, patients underwent titanium mesh and hydroxyapatite cranioplasty with abdominal fat graft. Participants included seven men and eight women, age range 38 to 65. Main outcome measures included cosmetic outcome and incidence of cerebrospinal fluid (CSF) leak. The lesion was right-sided in seven patients and left-sided in eight. Cosmetic outcome was excellent in all. There were no cases of CSF leak. Closure used one-third the hydroxyapatite required for traditional closure. Our technique yields cosmetic results equivalent to hydroxyapatite cement alone and a comparable incidence of CSF leakage without leaving a drain in place postoperatively. The technique is easy to adopt, is more cost-effective than hydroxyapatite cement cranioplasty alone, offers greater ease of access for reoperation, and does not preclude later implantation of bone-anchored hearing aid.

Bone-Anchored Hearing Aid

To determine which bone-anchored hearing aid (BAHA) implantation surgical technique is associated with the fewest major postoperative complications and shortest time between surgery and use of the BAHA. The techniques evaluated were 1) a free retroauricular "full-thickness" skin graft, 2) a pedicled parieto-occipital epidermal graft, 3) a dermatome-pedicled parieto-occipital dermal graft, and 4) two broad pedicled local epidermal skin envelopes/skin flaps. Retrospective case study. Tertiary referral center. One hundred forty-three patients who received a BAHA at Maastricht University Medical Center between November 1996 and January 2007. Number and mean age of patients in each group: Technique 1 (n = 30; mean age, 55 yr), Technique 2 (n = 45; mean age, 54 yr), Technique 3 (n = 47; mean age, 55 yr), and Technique 4 (n = 21; mean age, 54 yr). Cumulative proportion of implants that remained free of major complications versus follow-up interval, time between surgery and use of BAHA. Technique 4 (2 broad pedicled local epidermal envelopes/skin flaps) has a significantly higher proportion of implants that remained free of major complications during first year of follow-up (91%; p = 0.021). Pairwise comparisons revealed that Technique 4 also has a significantly shorter time until use (2 mo) than Techniques 1 (2.5 mo), 2, and 3 (both 2.3 mo). Two broad pedicled, local epidermal envelopes/flaps are associated with significantly fewer major complications and have one of the shortest times between surgery and use of the BAHA. The use of a dermatome is not associated with fewer major complications. We recommend Technique 4 as the preferred standard in BAHA surgery to minimize complications, postoperative medication, discomfort, and cost.

Complications of bone-anchored hearing aid implantation

Bone-anchored hearing aid implantations have been performed in Manchester for over 20 years. This study examined a range of variables that can occur during the implantation process, and the effect they may have on successful outcome. Retrospective study and literature review. Tertiary referral centre in central Manchester. Details of 602 bone-anchored hearing aid implantation procedures were retrieved from the departmental database. The overall complication rate was 23.9 per cent. The rate of revision surgery was 12.1 per cent. This study involved a significantly larger number of patients than any previously reported, similar study. Possible reasons for differences in outcomes, and recommendations for best practice, are discussed.