Clinical Outcome of the Simplified Surgical Technique for BAHA Implantation

Objective: To evaluate the clinical outcome of a simplified surgical technique for BAHA implantation, in terms of implant failure and its causes. Design: Retrospective analysis. Methods: Analysis of a consecutive cohort of 142 patients (150 loaded implants) fitted with the BAHA implant between January 1, 1997, and December 31, 1999. The simplified surgical Nijmegen technique comprises a longitudinal postauricular incision, extensive subcutaneous tissue reduction, and removal of the periosteum. Clinical outcomes were the rate of implant failures, its causes for this, and skin reactions around the percutaneous implants classified according to Holgers. Clinical results were compared with other BAHA series. Results: Mean follow-up was 5.6 ± 2.7 years (range, 0-10.5 yr). Holgers grade 2 or more severe skin reactions were seen in 6.5% of the 1,038 follow-up visits. Extrusion of the implants occurred as a result of failed osseointegration (n = 3), trauma (n = 5), infection (n = 1), and (other) medical reasons (n = 5 explanations). Total extrusion rate was 9.3%. Only 3% (1 and 3) were due to failed osseointegration or infection around the percutaneous implant. Conclusion: The modified Nijmegen surgical technique is a simple straightforward surgical procedure without the use of a pedicled skin flap. Surgery takes approximately 20 minutes. Meticulous performance of the procedure is considered important to achieve optimal results in the long-term. Particularly the soft tissue reduction has to be done with great care. In terms of the low rates of implant failure and adverse tissue reactions, the Nijmegen surgical technique proved to be a good alternative to other techniques.

[1]  E. Mylanus,et al.  Percutaneous Implants in the Temporal Bone for Securing a Bone Conductor: Surgical Methods and Results , 1999, The Annals of otology, rhinology, and laryngology.

[2]  Eugene N. Myers,et al.  Evaluation of implant losses and skin reactions around extraoral bone-anchored implants: A 0- to 8-year follow-up , 2000, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[3]  D. Proops The Birmingham bone anchored hearing aid programme: surgical methods and complications , 1996, The Journal of Laryngology & Otology.

[4]  R. Snyder,et al.  Applying split-thickness skin grafts: a step-by-step clinical guide and nursing implications. , 2001, Ostomy/wound management.

[5]  D. Meikle,et al.  Bone‐Anchored Hearing Aid Quality of Life Assessed by Glasgow Benefit Inventory , 2001, The Laryngoscope.

[6]  G. Granström,et al.  One-stage procedure to establish osseointegration: a zero to five years follow-up report , 1995, The Journal of Laryngology & Otology.

[7]  G. Granström,et al.  How we do it: Frequency of skin necrosis after BAHA surgery , 2006, Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery.

[8]  L. Bjursten,et al.  Soft tissue reactions around percutaneous implants: a clinical study of soft tissue conditions around skin-penetrating titanium implants for bone-anchored hearing aids. , 1988, The American journal of otology.

[9]  J. W. House,et al.  Bone-Anchored Hearing Aids: Incidence and Management of Postoperative Complications , 2007, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[10]  A. Snik,et al.  Audiometric Results of Bilateral Bone‐Anchored Hearing Aid Application in Patients With Bilateral Congenital Aural Atresia , 1998, The Laryngoscope.

[11]  G Granström,et al.  Bone-anchored hearing aids: current status in adults and children. , 2001, Otolaryngologic clinics of North America.

[12]  M. Scholz,et al.  Intracerebral Abscess after Abutment Change of a Bone Anchored Hearing Aid (BAHA) , 2003, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[13]  C. Cremers,et al.  A one-stage surgical procedure for placement of percutaneous implants for the bone-anchored hearing aid , 1994, The Journal of Laryngology & Otology.

[14]  A. Snik,et al.  Percutaneous titanium implantation in the skull for the bone-anchored hearing aid. , 1994, Journal of investigative surgery : the official journal of the Academy of Surgical Research.

[15]  A Tjellström,et al.  The bone-anchored hearing aid. Design principles, indications, and long-term clinical results. , 1995, Otolaryngologic clinics of North America.

[16]  A Tjellström,et al.  Five-year experience with skin-penetrating bone-anchored implants in the temporal bone. , 1983, Acta oto-laryngologica.

[17]  D. Gillett,et al.  Bone-anchored hearing aids: results of the first eight years of a programme in a district general hospital, assessed by the Glasgow benefit inventory , 2006, The Journal of Laryngology & Otology.

[18]  G Granström,et al.  Long-Term follow-up with the Bone-Anchored Hearing Aid: A Review of the First 100 Patients between 1977 and 1985 , 1994, Ear, nose, & throat journal.

[19]  M. Rothera,et al.  The implant-site split-skin graft technique for the bone-anchored hearing aid. , 1999, Clinical otolaryngology and allied sciences.

[20]  P. Branemark,et al.  Analysis of the mechanical impedance of bone-anchored hearing aids. , 1980, Acta oto-laryngologica.

[21]  S. Marzo,et al.  Perioperative Complications with the Bone-Anchored Hearing Aid , 2006, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.