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Long-term complications of bone-anchored hearing aids: a 14-year experience

Published online by Cambridge University Press:  20 May 2008

K Badran ,
A K Arya ,
D Bunstone  and
N Mackinnon
K Badran
Affiliation:
Department of Otolaryngology, Countess of Chester Hospital, Chester, UK
A K Arya*
Affiliation:
Department of Otolaryngology, Countess of Chester Hospital, Chester, UK
D Bunstone
Affiliation:
Department of Otolaryngology, Countess of Chester Hospital, Chester, UK
N Mackinnon
Affiliation:
Department of Otolaryngology, Countess of Chester Hospital, Chester, UK
*
Address for correspondence: Mr A K Arya, 35 Hopkinson Court, Chester CH1 4LE, UK. Fax: +44 (0)1244 366 423 E-mail: Arvind7@tesco.net
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Abstract

Objectives:

To report cases of long-term surgical complications, implant failure and revision surgery, within a large bone-anchored hearing aid programme.

Study design:

Retrospective, case–cohort study.

Setting:

Tertiary referral centre.

Patients:

One hundred and sixty-five adults and children who had undergone a total of 177 bone-anchored hearing aid implantations.

Intervention:

Diagnosis and explanation of adverse events and device failure.

Main outcome measures:

Operative complications and survival analysis, surgical challenges related to revisions, and causes of failure.

Results:

Twenty-one per cent of patients (3.4 per cent of those observed) suffered from skin reactions; this rate did not increase over time. Seventeen per cent had loss of osseointegration at a median interval of 6.3 months. Loss of osseointegration was observed more frequently in patients with a 3 mm compared with a 4 mm fixture (p < 0.001). Intra-operatively, the only complication was bleeding, occurring in 3 per cent of patients. Post-operative complications included: primary bleeding (2 per cent); severe skin reactions requiring intravenous antibiotics, cautery or grafting (8 per cent); thickening or overgrowth of skin requiring excision (8 per cent); failure of osseointegration requiring a new fixture (18 per cent); and graft necrosis requiring revision (1 per cent). In two patients, it was necessary to explore the area to remove overgrowth of bone. In 16 patients (10 per cent), the bone-anchored hearing aid had to be abandoned due to failure of osseointegration (n = 4), dissatisfaction with the aid (n = 6), intolerable pain (n = 4), hair growth around the abutment (n = 1) or recurrent infections (n = 1). In 12 of these patients, the bone-anchored hearing aid was removed surgically. Overall, 57 patients (34 per cent) underwent revision surgery.

Conclusion:

Awareness of complications is becoming increasingly important in bone-anchored hearing aid programme. A substantial workload of device maintenance should be anticipated, and patients should be appropriately counselled beforehand. Ninety per cent of our patients chose to persevere with this form of hearing rehabilitation.

Keywords

Implants and ProsthesesHearing AidsDeafnessComplications
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 123 , Issue 2 , February 2009 , pp. 170 - 176
Copyright
Copyright © JLO (1984) Limited 2008

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References

1Adell, R, Lekholm, U, Rockler, B, Branemark, PI. A 15-year study of osseointegrated implants in the treatment of the edentulous jaw. Int J Oral Surg 1981;10:387–416Google Scholar
2Tjellstrom, A, Hakansson, B. The bone-anchored hearing aid. Design principles, indications, and long-term clinical results. Otolaryngol Clin North Am 1995;28:53–72Google Scholar
3Hakansson, B, Liden, G, Tjellstrom, A, Rosenhall, U, Jacobsson, M, Carlsson, P et al. Ten years of experience with the Swedish bone-anchored hearing system. Ann Otol Rhinol Laryngol 1990;99(suppl 151):1–16Google Scholar
4Tjellstrom, A, Granstrom, G. Long-term follow-up with the bone-anchored hearing aid: a review of the first 100 patients between 1977 and 1985. Ear Nose Throat J 1994;73:112–14CrossRefGoogle ScholarPubMed
5Wazen, JJ, Caruso, M, Tjellstrom, A. Long-term results with the titanium bone-anchored hearing aid: the US experience. Am J Otol 1998;19:737–41Google Scholar
6Hakansson, B, Tjellstrom, A, Rosenhall, U, Carlsson, P. The bone-anchored hearing aid. Principal design and a psychoacoustical evaluation. Acta Otolaryngol 1985;100:229–39Google Scholar
7Snik, AF, Dreschler, WA, Tange, RA, Cremers, CW. Short- and long-term results with implantable transcutaneous and percutaneous bone-conduction devices. Arch Otolaryngol Head Neck Surg 1998;124:265–8CrossRefGoogle Scholar
8Mylanus, EA, Cremers, CW, Snik, AF, van den Berge, NW. Clinical results of percutaneous implants in the temporal bone. Arch Otolaryngol Head Neck Surg 1994;120:81–5CrossRefGoogle ScholarPubMed
9Lustig, LR, Arts, HA, Brackmann, DE, Francis, HF, Molony, T, Megerian, CA et al. Hearing rehabilitation using the BAHA bone anchored hearing aid: results in 40 patients. Otol Neurotol 2001;22:328–34Google Scholar
10Holgers, KM, Tjellstrom, A, Bjursten, LM, Erlandsson, BE. Soft tissue reactions around percutaneous implants: a clinical study of soft tissue conditions around skin-penetrating titanium implants for bone-anchored hearing aids. Am J Otol 1988;9:56–9Google Scholar
11Tjellstrom, A, Rosenhall, U, Lindstrom, J, Hallen, O, Albrektsson, T, Branemark, PI. Five-year experience with skin-penetrating bone-anchored implants in the temporal bone. Acta Otolaryngol 1983;95:568–75Google Scholar
12Tjellstrom, A. Osseointegrated systems and their application in the head and neck. Advances in Otolaryngology Head and Neck Surgery 1989;3:39–70Google Scholar
13Mylanus, EA, Cremers, CW. A one-stage surgical procedure for placement of percutaneous implants for the bone-anchored hearing aid. J Laryngol Otol 1994;108:1031–5Google Scholar
14Woolford, TJ, Morris, DP, Saeed, SR, Rothera, MP. The implant-site split-skin graft technique for the bone-anchored hearing aid. Clin Otolaryngol 1999;24:177–80Google Scholar
15Proops, DW. The Birmingham bone anchored hearing aid programme: surgical methods and complications. J Laryngol Otol 1996;21:7–12Google Scholar
16Badran, K, Bunstone, D, Arya, AK, Makkinon, N. Patient satisfaction with the bone-anchored hearing aid: a 14 year experience. Otol Neurotol 2006;27:659–66Google Scholar