A one-stage surgical procedure for placement of percutaneous implants for the bone-anchored hearing aid

1994 ◽  
Vol 108 (12) ◽  
pp. 1031-1035 ◽  
Author(s):  
E. A. M. Mylanus ◽  
C. W. R. J. Cremers
Keyword(s):  
Hearing Aid ◽  
Bone Conduction ◽  
Titanium Implant ◽  
Clinical Results ◽  
Two Stage ◽  
Skin Reactions ◽  
One Stage ◽  
Bone Anchored Hearing Aid ◽  
Percutaneous Implants

AbstractThe bone-anchored hearing aid (BAHA) is an alternative to the conventional bone conduction hearing aid. The transducer is coupled to a percutaneous titanium implant which is traditionally inserted into the temporal bone in two stages. This study focusses on a one-stage surgical technique for the implantation of percutaneous implants. The preliminary clinical results of 33 one-stage implants in 33 patients are presented.Post-operative necrosis of the skin grafts did not occur. After a follow-up which varied from nine to 25 months, 31 out of the 33 fixtures (94 per cent) were anchored firmly in the skull. Twenty-six out of the 33 implants (79 per cent) remained free from potentially dangerous skin reactions. The results were statistically comparable to those obtained with two-stage implants at the same clinic. Although longer follow-up is needed before a general statement can be made about replacing the two-stage technique, the preliminary one-stage results are promising.

The Bone-Anchored Hearing Aid (BAHA) in Children with Auricular Malformations

1997 ◽  
Vol 76 (4) ◽  
pp. 238-247 ◽  
Author(s):  
Gösta Granström ◽  
Anders Tjellström
Keyword(s):  
Middle Ear ◽  
Hearing Aids ◽  
Hearing Aid ◽  
Adult Population ◽  
Bone Conduction ◽  
Middle Ear Surgery ◽  
Ear Reconstruction ◽  
Skin Reactions ◽  
Bone Anchored Hearing Aid ◽  
Middle Ear Reconstruction

A retrospective study was undertaken to evaluate the outcome of the use of the bone-anchored hearing aid (BAHA) in children. All patients included in the study had bilateral auricular malformations. Previous alternatives had been conventional hearing aids or surgical middle ear reconstruction. Thirty-seven patients under 16 years of age were studied. The most common syndrome in the group was Treacher Collins. Sixteen of the patients had earlier middle ear reconstruction, the results of which did not produce social hearing. Of 40 inserted fixtures to anchor the BAHA, three were lost during the follow-up period because of failed osseointegration. Skin reactions were graded according to a clinical scoring system and were determined to be comparable in number and severity to those of an adult population. All patients in the study considered the BAHA to be superior to earlier bone-conduction devices. It is concluded that the BAHA is an excellent alternative to bone-conduction devices in children with auricular malformations. Middle ear surgery can be postponed until adulthood or abandoned, especially in syndromic patients in whom it is known to be difficult and unpredictable.

Peri-operative cerebrospinal fluid leak during single-stage bone-anchored hearing aid implantation: case report

2014 ◽  
Vol 128 (12) ◽  
pp. 1111-1113
Author(s):  
G Dimbleby ◽  
A Mitchell-Innes ◽  
J Murphy
Keyword(s):  
Cerebrospinal Fluid ◽  
Case Report ◽  
Hearing Aid ◽  
Bone Conduction ◽  
Titanium Implant ◽  
Cerebrospinal Fluid Leak ◽  
Implant Placement ◽  
Bone Anchored Hearing Aid ◽  
Fluid Leak ◽  
Sound Processor

AbstractBackground:A bone-anchored hearing aid uses the principle of bone conduction and osseointegration to transfer sound vibrations to a functioning inner ear. It consists of a permanent titanium implant, and removable abutment and sound processor. Informed consent requires discussion of the procedural benefits, alternatives and complications. The risks of bone-anchored hearing aid surgery include infection, soft tissue hypertrophy, skin graft or flap failure, osseointegration failure, and the need for further surgery.Case report:A case of cerebrospinal fluid leak in a patient undergoing bone-anchored hearing aid surgery is reported and discussed.Conclusion:Bone-anchored hearing aid surgery poses a risk of breaching the inner table of the temporal bone and dura, resulting in a cerebrospinal fluid leak; the risk of meningitis is rare but serious. The surgeon should discuss the possibility of cerebrospinal fluid leak when consenting patients. Pre-operative computerised tomography scanning should be considered in certain individuals to aid implant placement.

scholarly journals 209 A Comparison of Soft Tissue Reactions Seen with Different Bone Anchored Hearing Aid Abutments: Smooth-Titanium Vs Hydroxyapatite-Coated

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
R George ◽  
J Wasson
Keyword(s):  
Soft Tissue ◽  
Hearing Aids ◽  
Revision Surgery ◽  
Hearing Aid ◽  
Cohort Analysis ◽  
Bone Conduction ◽  
Skin Reactions ◽  
Soft Tissue Reactions ◽  
Bone Anchored Hearing Aid ◽  
Tissue Reactions

Abstract Aim Bone Anchored Hearing Aids allow hearing via stimulation of the cochlear through bone conduction. These devices are largely successful; however, soft tissue reactions often hinder their benefit. The type of abutment used could contribute to complications. We aimed to investigate whether using smooth-titanium abutments instead of hydroxyapatite-coated abutments reduced the rate of soft tissue reactions and need for revision surgery. Method A retrospective cohort analysis of all patients who received a Bone Anchored Hearing Aid during a 3-year period. An electronic database was screened for skin reactions and surgical revisions. A comparison was made between patients who received a hydroxyapatite-coated abutment and smooth-titanium abutments. The same surgical technique, linear incision skin preservation surgery, was used for inserting both abutments. Results Sixty-six patients received a Bone Anchored Hearing Aid. Forty-five patients received hydroxyapatite-coated abutments and twenty-one received smooth-titanium abutments, two patients had smooth-titanium inserted bilaterally. The groups were significantly similar with regards to age and gender. Significantly more patients who received hydroxyapatite-coated abutments recorded soft tissue reactions, 77.78% vs 23.81% (p < 0.0001). Significantly more patients who received hydroxyapatite-coated abutments required surgical revision, 40% vs 9.52% (p = 0.0197). 17.14% underwent skin revision and change of abutment. 5.7% had the abutments removed and were not immediately replaced. Conclusions When utilising skin preservation surgery for Bone Anchored Hearing Aid insertion smooth-titanium abutments have a favourable complication profile; with less soft tissue reactions and subsequent need for revision surgery, in comparison with hydroxyapatite-coated abutments. The reasons behind these differences warrant further investigations.

An approach to bilateral bone-anchored hearing aid surgery in children: contralateral placement of sleeper fixture

2008 ◽  
Vol 123 (5) ◽  
pp. 555-557 ◽  
Author(s):  
J M Bernstein ◽  
P Z Sheehan
Keyword(s):  
Hearing Loss ◽  
Hearing Aids ◽  
Conductive Hearing Loss ◽  
Hearing Aid ◽  
Contralateral Side ◽  
Two Stage ◽  
Calvarial Bone ◽  
Optimal Position ◽  
Bone Anchored Hearing Aid ◽  
Conductive Hearing

AbstractObjective:Bone-anchored hearing aid surgery in younger children is a two-stage procedure, with a titanium fixture being allowed to osseointegrate for several months before an abutment is fitted through a skin graft. In the first procedure, it has been usual to place a reserve or sleeper fixture approximately 5 mm from the primary fixture as a backup in case the primary fixture fails to osseointegrate. This ipsilateral sleeper fixture is expensive, is often not used, and is placed in thinner calvarial bone where it is less likely to osseointegrate successfully. The authors have implanted the sleeper fixture on the contralateral side, with the additional objective of reducing the number of procedures for bilateral bone-anchored hearing aid implantation, providing a cost-effective use for the sleeper.Methods:The authors implanted the bone-anchored hearing aid sleeper fixture in the contralateral temporal bone instead of on the ipsilateral side in seven successive paediatric cases with bilateral conductive hearing loss requiring two-stage bone-anchored hearing aids, treated at the Royal Manchester Children's Hospital, UK.Results:The seven patients ranged in age from five to 15 years, with a mean age of 10 years; in addition, a 20-year-old with learning disability was also treated. In each case, the contralateral sleeper fixture was not needed as a backup fixture, but was used in four patients (57 per cent) as the basis for a second-side bone-anchored hearing aid.Conclusions:In children with bilateral conductive hearing loss, in whom a bilateral bone-anchored hearing aid is being considered and the second side is to be operated upon at a later date, we recommend placing the sleeper fixture on the contralateral side at the time of primary first-side surgery. Our technique provides a sleeper fixture located in an optimal position, where it also offers the option of use for a second-side bone-anchored hearing aid and reduces the number of procedures needed.

A Speech-to-Noise Ratio Test with the Bone-Anchored Hearing Aid: A Comparative Study

1986 ◽  
Vol 94 (4) ◽  
pp. 421-426 ◽  
Author(s):  
Peder Carlsson ◽  
Bo Håkansson ◽  
Ulf Rosenhall ◽  
Anders Tjellström
Keyword(s):  
Hearing Aid ◽  
Bone Conduction ◽  
Ratio Test ◽  
Speech Discrimination ◽  
Impaired Hearing ◽  
Minor Surgery ◽  
Bone Anchored Hearing Aid ◽  
Bone Conduction Hearing ◽  
Noise Ratio ◽  
Bone Conduction Hearing Aid

Hitherto, for persons with impaired hearing who cannot use an air conduction hearing aid, the only alternative has been a conventional spring-loaded bone conduction hearing aid. Now, with minor surgery, a titanium screw can be implanted in the bone behind the ear and a coupling, which penetrates the skin, can be attached, giving a new kind of hearing aid—the “bone-anchored hearing aid.” Improved quality of sound is one of the patients’ subjective assessments. Improvement was not confirmed by a standard speech-discrimination test. With new speech material consisting of sentences in noise, the speech-to-noise ratio (SN) has been determined for 24 patients. Patients who previously used a conventional bone conduction hearing aid improved their SN on the average by 3.3 dB. The most important difference between the two aids related to improved SN is probably the increased audibility between 600 and 6000 Hz.

One-Stage vs Two-Stage Laparoscopic Roux-en-Y Gastric Bypass in Obese Patients with Body Mass Index >55 Kg/m2; 5-YEAR FOLLOW UP

2016 ◽  
Vol 27 (4) ◽  
pp. 955-960 ◽  
Author(s):  
María Díaz-Tobarra ◽  
Norberto Cassinello Fernández ◽  
Pablo Jordá Gómez ◽  
Mohammad Nebih Nofal ◽  
Raquel Alfonso Ballester ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Gastric Bypass ◽  
Body Mass ◽  
Obese Patients ◽  
Two Stage ◽  
One Stage

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

2008 ◽  
Vol 123 (2) ◽  
pp. 170-176 ◽  
Author(s):  
K Badran ◽  
A K Arya ◽  
D Bunstone ◽  
N Mackinnon
Keyword(s):  
Hearing Aids ◽  
Revision Surgery ◽  
Hearing Aid ◽  
Retrospective Case ◽  
Tertiary Referral Centre ◽  
Skin Reactions ◽  
Operative Complications ◽  
Adults And Children ◽  
Bone Anchored Hearing Aid

AbstractObjectives: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.

Intralesional triamcinolone acetonide injection in hypertrophic skin surrounding the percutaneous titanium implant of a bone-anchored hearing aid

2008 ◽  
Vol 122 (12) ◽  
pp. 1368-1370 ◽  
Author(s):  
J B Van Rijswijk ◽  
E A M Mylanus
Keyword(s):  
Case Report ◽  
Triamcinolone Acetonide ◽  
World Literature ◽  
Hearing Aid ◽  
Titanium Implant ◽  
Scar Tissue ◽  
Intralesional Injections ◽  
Bone Anchored Hearing Aid ◽  
Surplus Skin ◽  
Subsequent Relapse

AbstractObjective:We present a patient with persistent hypertrophic skin surrounding the percutaneous implant of a bone-anchored hearing aid system, successfully treated with intralesional applied corticosteroids.Method:Case report and review of the world literature concerning bone-anchored hearing aid implantation and intralesional applied corticosteroids for the treatment of hypertrophic scars and keloids.Results:Eight weeks after revision surgery to reduce surplus skin and subcutaneous scar tissue overgrowing the abutment, skin and subcutaneous scar tissue overgrowth reoccurred. As an alternative to yet another surgical procedure, the hypertrophic skin was treated with intralesional injections of triamcinolone acetonide. Three weeks after the treatment, a satisfying result was seen, and no subsequent relapse was observed.Conclusion:To our knowledge, this is the first, photographically well documented case report of a patient with persistent hypertrophic skin surrounding a percutaneous bone-anchored hearing aid implant, successfully treated with intralesional applied corticosteroids.

Can audiometric results predict qualitative hearing improvements in bone-anchored hearing aid recipients?

2013 ◽  
Vol 128 (1) ◽  
pp. 35-42
Author(s):  
M L McNeil ◽  
M Gulliver ◽  
D P Morris ◽  
F M Makki ◽  
M Bance
Keyword(s):  
Pure Tone ◽  
Hearing Aid ◽  
Subjective Evaluation ◽  
Bone Conduction ◽  
Hearing Threshold ◽  
Sound Field ◽  
Hearing Aid Fitting ◽  
Pure Tone Average ◽  
Hearing Handicap ◽  
Bone Anchored Hearing Aid

AbstractIntroduction:Patients receiving a bone-anchored hearing aid have well-documented improvements in their quality of life and audiometric performance. However, the relationship between audiometric measurements and subjective improvement is not well understood.Methods:Adult patients enrolled in the Nova Scotia bone-anchored hearing aid programme were identified. The pure tone average for fitting the sound-field threshold, as well as the better and worse hearing ear bone conduction and air conduction levels, were collected pre-operatively. Recipients were asked to complete the Speech, Spatial and Qualities of Hearing questionnaire; their partners were asked to complete a pre- and post-bone anchored hearing aid fitting Hearing Handicap Inventory for Adults questionnaire.Results:Forty-eight patients who completed and returned the Speech, Spatial and Qualities of Hearing questionnaire had partners who completed the Hearing Handicap Inventory for Adults questionnaire. The results from the Speech, Spatial and Qualities of Hearing questionnaire correlated with the sound-field hearing threshold post-bone-anchored hearing aid fitting and the pure tone average of the better hearing ear bone conduction (total Speech, Spatial and Qualities of Hearing Scale to the pre-operative better hearing ear air curve (r = 0.3); worse hearing ear air curve (r = 0.27); post-operative, bone-anchored hearing aid-aided sound-field thresholds (r = 0.35)). An improvement in sound-field threshold correlated only with spatial abilities. In the Hearing Handicap Inventory for Adults questionnaire, there was no correlation between the subjective evaluation of each patient and their partner.Conclusion:The subjective impressions of hearing aid recipients with regards to speech reception and the spatial qualities of hearing correlate well with pre-operative audiometric results. However, the overall magnitude of sound-field improvement predicts an improvement of spatial perception, but not other aspects of hearing, resulting in hearing aid recipients having strongly disparate subjective impressions when compared to those of their partners.

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