Bone-anchored hearing aid A single-stage procedure in children

Objective: The bone-anchored hearing aid (BAHA) is an essential part of the armamentarium of the modern otolaryngologist dealing with ear disorders. A two-stage approach for implantation in children is recommended by the manufacturers. In our practice we implant BAHA in children as a single procedure. We describe our technique and results. Method: We performed a review of all children having a BAHA between 1997 and 2005. Surgery was performed by taking a post-auricular split skin graft and excising the underlying soft tissues. Drilling, tapping and fixture placement were performed as per the manufacturer's instructions. The skin graft was then sutured in place and perforated in its centre and the abutment placed. Ten to twelve weeks were allowed for osseointegration before the hearing aid attachment. Results: Thirty children were implanted. Age at implantation ranged from 3 to 15 years (mean 9.1 and median 8.1 years). Main indications included recurrent otorrhoea, conductive hearing loss and aural atresia. Follow-up was at 4-6 weeks review initially, curtailing to 6 monthly reviews and then annual review. Early complications of skin infection occurred in two patients. Late complications such as skin hypertrophy and chronic infection occurred in two patients. Two patients lost the fixture due to trauma, both were subsequently reimplanted. There was no incidence of implant failure to osseointegrate. Twenty-eight children (93%) implanted wear their BAHAs. Conclusion: Our results show that a single-stage technique is associated with a low rate of early complications, with no reports of fixture loss due to osseointegration failure. (C) 2009 Elsevier Ireland Ltd. All rights reserved.