Simplified bone-anchored hearing aid insertion using a linear incision without soft tissue reduction

2013 ◽  
Vol 127 (S2) ◽  
pp. S33-S38 ◽  
Author(s):  
J Husseman ◽  
J Szudek ◽  
P Monksfield ◽  
D Power ◽  
S O'Leary ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissues ◽  
Hearing Aid ◽  
Skin Flap ◽  
Standard Technique ◽  
Modified Technique ◽  
Skin Reactions ◽  
Invasive Approach ◽  
Bone Anchored Hearing Aid ◽  
Tissue Reduction

AbstractBackground:Numerous techniques have been described to manage the skin and other soft tissues during bone-anchored hearing aid insertion. Previously, generally accepted techniques have sometimes led to distressing alopecia and soft tissue defects. Now, some surgeons are rejecting the originally described split skin flap in favour of a less invasive approach.Objective:To investigate bone-anchored hearing aid placement utilising a single, linear incision with either no or minimal underlying soft tissue reduction.Patients and methods:Thirty-four adults were prospectively enrolled to undergo single-stage bone-anchored hearing aid placement with this modified technique. A small, linear incision was used at the standard position and carried down through the periosteum. Standard technique was then followed with placement of an extended length abutment. Patients were reviewed regularly to assess wound healing, including evaluation with Holgers' scale.Results:Only 14.7 per cent of patients had a reaction score of 2 or higher. Most complications were limited to minor skin reactions that settled with silver nitrate cautery and/or antibiotics. None required revision surgery for tissue overgrowth, and there were no implant failures.Conclusion:Our results suggest this to be a simple and effective insertion technique with favourable cosmesis and patient satisfaction.

Surgical and audiological evaluation of the Baha BA400

2015 ◽  
Vol 129 (1) ◽  
pp. 32-37 ◽  
Author(s):  
M Iseri ◽  
K S Orhan ◽  
M H Yarıktaş ◽  
A Kara ◽  
M Durgut ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Surgical Technique ◽  
Hearing Aid ◽  
Tertiary Care ◽  
Case Series ◽  
Retrospective Case ◽  
Skin Reactions ◽  
Bone Anchored Hearing Aid ◽  
The One ◽  
Tissue Reduction

AbstractObjective:Despite extensive soft tissue reduction, the most common complications associated with bone-anchored hearing aid systems, also known as bone-anchored hearing implants, are related to adverse skin reactions around the abutment. The necessary soft tissue reduction also adds complexity to the surgical procedure. This study aimed to evaluate the surgical and audiological outcomes of a new connective interface of the Cochlear™ Baha® BA400 device implanted using the one-stage surgical technique.Method:A multicentre, retrospective case series is presented, including data collected from three tertiary care institutions.Results:In total, 16 patients who had undergone bone-anchored hearing aid surgery over a 10- to 12-month period were assessed for hearing performance, implant stability and surgical complications.Conclusion:This case series indicates that new abutments with a hydroxyapatite coating can be implanted percutaneously without soft tissue reduction. Furthermore, device implantation using this surgical technique may have some advantages compared with a conventional device and procedure combination over 12- to 16-months of follow up.

Has the use of the linear incision reduced skin complications in bone-anchored hearing aid implantation?

2016 ◽  
Vol 130 (6) ◽  
pp. 541-544 ◽  
Author(s):  
R Roplekar ◽  
A Lim ◽  
S S M Hussain
Keyword(s):  
Soft Tissue ◽  
Wound Infection ◽  
Hearing Aid ◽  
Skin Flap ◽  
Complication Rates ◽  
Tissue Removal ◽  
Bone Anchored Hearing Aid ◽  
Group 2 ◽  
One Year ◽  
Group 1

AbstractObjective:To compare the skin-related complications of the traditional skin flap method with a linear incision method of implantation.Method:All cases of bone-anchored hearing aid surgery performed by a single surgeon (n= 117) were compared over two periods: 1999–2011, when the traditional method of skin flap and soft tissue removal was used (group 1;n= 86), and 2012–2013, when linear incision without soft tissue removal was used (group 2;n= 31). All patients were followed up for one year and complications were recorded for that period.Results:There were 21 (24.4 per cent) skin-related complications in group 1 (skin overgrowth = 12, wound infection = 8 and numbness = 1) and 3 (9.7 per cent) complications in group 2 (wound infection = 3). Analysis using independentt-tests showed the results to be significant (p< 0.05; 95 per cent confidence interval = 0.0800–0.4473).Conclusion:The linear incision without soft tissue removal method for bone-anchored hearing aid implantation reduces skin complication rates.

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 &lt; 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.

The Birmingham bone anchored hearing aid programme: surgical methods and complications

1996 ◽  
Vol 110 (21) ◽  
pp. 7-12 ◽  
Author(s):  
David W. Proops
Keyword(s):  
Soft Tissue ◽  
Hearing Aids ◽  
Hearing Aid ◽  
Surgical Method ◽  
Surgical Methods ◽  
Bone Anchored Hearing Aid

AbstractSince 1988, 309 patients have been referred to the Birmingham bone anchored hearing aid programme for assessment. One hundred and eighty-eight have been fitted with bone anchored hearing aids (BAHA). Of these 169 have been fitted with a BAHA alone and 20 with a BAHA and auricular prosthesis(es).Only four (2.1 per cent) are not wearing their BAHAs. Three cases because the hearing had continued to deteriorate and in one case because of repeated failure to integrate. Nineteen patients (10.1 per cent) have lost fixtures but all but one of these have been successfully reimplanted. Of these 19 patients 10 (52.6 per cent) were syndromal and 10 (52.6 per cent) were under 16 years of age.A surgical method has been evolved both to cope with predictable failure of integration and soft tissue control.

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.

Soft tissue overgrowth in bone-anchored hearing aid patients: use of 8.5 mm abutment

2011 ◽  
Vol 125 (6) ◽  
pp. 576-579 ◽  
Author(s):  
S Pelosi ◽  
S S Chandrasekhar
Keyword(s):  
Soft Tissue ◽  
Hearing Aids ◽  
Revision Surgery ◽  
Wound Care ◽  
Hearing Aid ◽  
Tissue Growth ◽  
First Line ◽  
Tertiary Referral Centre ◽  
Number Of Patients ◽  
Bone Anchored Hearing Aid

AbstractObjective:To review outcomes following implantation of an 8.5 mm bone-anchored hearing aid abutment, as regards post-operative management of scalp soft tissue overgrowth.Study design:Retrospective chart review of paediatric and adult patients implanted with bone-anchored hearing aids between 2003 and 2008 who subsequently underwent revision surgery for excessive soft tissue growth.Setting:A tertiary referral centre and a private otology and neurotology clinic.Subjects:A total of 80 patients underwent bone-anchored hearing aid placement between 2003 and 2008. Of these patients, 14 had significant scalp soft tissue overgrowth unresponsive to first-line, nonsurgical local wound care.Results:Fourteen patients underwent an average of 2.1 surgical procedures each for soft tissue overgrowth around their bone-anchored hearing aid abutment. The mean time between initial implantation and revision surgery was 13.6 months. Of these 14 patients, 11 were eventually fitted with an 8.5 mm abutment. Following placement of the longer abutment, only one patient required additional surgical reduction of soft tissue overgrowth (mean follow-up time 11.8 months). All patients were able to use their bone-anchored hearing aid.Conclusion:The 8.5 mm bone-anchored hearing aid abutment is successful in preventing the need for additional surgical intervention in the small but significant number of patients with post-implantation soft tissue overgrowth. Early consideration should be given to this option when first-line soft tissue care is inadequate.

scholarly journals Modified Incisions for Reduction of Soft Tissue for One-Stage, Bone-Anchored Hearing Aid Implantation

2000 ◽  
Vol 110 (9) ◽  
pp. 1584-1585 ◽  
Author(s):  
T. Narayana Reddy ◽  
Sunil N. Dutt ◽  
Kunal Gangopadhyay
Keyword(s):  
Soft Tissue ◽  
Hearing Aid ◽  
One Stage ◽  
Bone Anchored Hearing Aid

Z-plasty for skin complications of bone-anchored hearing aid implantation

2015 ◽  
Vol 129 (6) ◽  
pp. 604-606
Author(s):  
M S Miura ◽  
M N Rios
Keyword(s):  
Case Report ◽  
Surgical Treatment ◽  
Skin Reaction ◽  
Granulation Tissue ◽  
Conservative Therapy ◽  
Hearing Aid ◽  
Implantation Technique ◽  
Skin Reactions ◽  
Bone Anchored Hearing Aid ◽  
Disease Free

AbstractBackground:The bone-anchored hearing aid implantation technique is associated with post-operative skin reactions, which require conservative therapy and, in some cases, replacement of the abutment. Z-plasty is a technique that allows resection of the granulation tissue, thus ensuring that disease-free skin will be in contact with the abutment.Case report:Use of the Z-plasty technique for resection of the peri-abutment granulation tissue is described. In the case presented herein, the episodes of skin reaction became very frequent and the patient was unable to use his bone-anchored hearing aid for 2 to 3 days a week. We opted for surgical treatment with Z-plasty for management of the skin complications.Conclusion:Use of the Z-plasty technique is recommended for the management of skin reactions associated with bone-anchored hearing aid implantation.

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.

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.

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