Abstract:This data shows pediatric temporal bone thickness is frequently greater than the recommended 3 mm, even in patients as young as one. Anatomically, concerns regarding temporal bone thickness in patients younger than five could be reliably addressed with imaging typically obtained in workup of hearing loss.
“…However, a review of temporal bone CT imaging in children aged 1–5.99 years showed the temporal bone thickness to be greater than 3 mm in all age groups, in normal and diseased ears. 2 This is in line with another study where the mean bone thickness lateral to the sinodural angle in the atretic ear in children aged less than six years was at least 4.8 mm, with a thickness of 4.1 mm in the non-atretic ear. 3 A bone-anchored hearing device can be implanted in patients with a chronically discharging ear who are unable to wear conventional hearing aidsPatients need to be aged over one year and have temporal bone thickness of at least 3 mm for device implantationIn patients with thin and irregular skull bone, a computed tomography guided three-dimensional template of the temporal bone can be craftedThis template can help identify an appropriate site for safe bone-anchored hearing device implantation…”
BackgroundImplantation of bone-anchored hearing devices is performed to improve hearing in patients with chronic suppurative otitis media who cannot wear a conventional hearing aid. The surgical procedure can be safely performed in children aged over five years.Case reportA 15-year-old patient with bilateral chronic suppurative otitis media and conductive hearing loss underwent the procedure to implant a bone-anchored hearing device but was found to have skull thickness of less than 2.5 mm and the procedure was abandoned. A computed tomography scan of the skull was undertaken and a three-dimensional template was reconstructed to identify appropriate thickness of the skull to implant the abutment during a second procedure.ConclusionBone-anchored hearing devices can be implanted by prior imaging and using a template to identify the area of appropriate skull thickness to implant the abutment safely.
“…However, a review of temporal bone CT imaging in children aged 1–5.99 years showed the temporal bone thickness to be greater than 3 mm in all age groups, in normal and diseased ears. 2 This is in line with another study where the mean bone thickness lateral to the sinodural angle in the atretic ear in children aged less than six years was at least 4.8 mm, with a thickness of 4.1 mm in the non-atretic ear. 3 A bone-anchored hearing device can be implanted in patients with a chronically discharging ear who are unable to wear conventional hearing aidsPatients need to be aged over one year and have temporal bone thickness of at least 3 mm for device implantationIn patients with thin and irregular skull bone, a computed tomography guided three-dimensional template of the temporal bone can be craftedThis template can help identify an appropriate site for safe bone-anchored hearing device implantation…”
BackgroundImplantation of bone-anchored hearing devices is performed to improve hearing in patients with chronic suppurative otitis media who cannot wear a conventional hearing aid. The surgical procedure can be safely performed in children aged over five years.Case reportA 15-year-old patient with bilateral chronic suppurative otitis media and conductive hearing loss underwent the procedure to implant a bone-anchored hearing device but was found to have skull thickness of less than 2.5 mm and the procedure was abandoned. A computed tomography scan of the skull was undertaken and a three-dimensional template was reconstructed to identify appropriate thickness of the skull to implant the abutment during a second procedure.ConclusionBone-anchored hearing devices can be implanted by prior imaging and using a template to identify the area of appropriate skull thickness to implant the abutment safely.
“…2). This result is different from the previous study in Caucasians, suggesting that BAHDs should not be routinely applied to patients younger than 5 years of age [11]. Our results are in line with many previous studies showing that skull bone thickness is less than 3 mm in patients younger than 5.…”
Section: Discussionsupporting
confidence: 50%
“…One previous study investigated temporal bone thickness in Caucasians to assess the benefit of BAHD implantation in children younger than 5 years of age. The result of that study showed the average squamous temporal bone thickness was thicker than 3 mm in all age groups, which means that BAHD implantation could be considered for patients younger than 5 years of age [11]. However, no previous studies have investigated BAHD indications with respect to calvarial bone thickness in Korean groups and the present study is the first to establish a safe guideline for Korean groups.…”
Section: Discussionmentioning
confidence: 68%
“…One neuro-otologist measured the skull bone thickness on the axial image at a point 1 cm posterior to the right sigmoid sinus and 1 cm superior to the superior margin of the right external auditory canal, where BAHA implantation is recommended ( Fig. 1 ) [ 11 , 12 ]. Results were analyzed using SAS ver.…”
Section: Methodsmentioning
confidence: 99%
“…Especially in children, bone thickness is an essential factor to consider and this is one of the reasons why there is no current approval for bone-anchored hearing device (BAHD) use in patients younger than 5 years of age. To investigate whether the age guideline is reasonable, one U.S. group measured temporal bone thickness in pediatric patients and showed that pediatric temporal bone thickness in patients under 5 years old is generally thicker than 3 mm in Caucasians [11]. However, there have been no specific studies investigating skull bone thickness for BAHDs in Korean populations.…”
Objectives. Bone-anchored hearing device (BAHD) is contraindicated in patients younger than 5 years because their calvarial bones are not thick enough to be implanted site. However, it has not been studied in the Korean population. This study was not only to establish a safe guideline for depth of implant device in all age groups who undergo BAHD implant surgery, but also to investigate whether implantation of currently used BAHDs could be done safely in Korean children, especially those younger than 5.Methods. Two hundred eighty patients, who underwent high-resolution temporal bone computed tomography (TBCT) images between August 2010 and October 2018 were randomly enrolled in all ages. We retrospectively reviewed TBCT imaging to measure skull bone thickness at the recommended BAHD implant site.Results. The average skull bone thickness was 2.87 mm in patients younger than 5 years and 6.72 mm in patients older than 5 years, respectively, which conforms to the current guideline. The results indicate nearly 50% of calvarial bone thicknesses were less than 3 mm in patients under 5 years old, while 92.78% of the patients older than 5 years of age showed bone thickness greater than 4 mm. Of note, calvarial bone thickness was thicker than 3 mm in all patients who are older than 6 years.Conclusion. This study confirms that the currently approved BAHD implantation guideline is suitable in the Korean population. For safety, we suggest taking TBCTs prior to surgery, especially in pediatric patients. Besides, noninvasive applications are recommended for patients younger than 5.
Purpose
In children and adolescents, preoperative planning for a semi-implantable bone conduction device (SIBCD) is crucial. The geometric changes of the new version of a common SIBCD should enable a higher rate of successful implantation due to its flatter actuator. Thus, this radioanatomic study compared the rate of successful implantation of both device versions at the traditional mastoidal localization and two alternative sites, retrosigmoidal, and parietal, and investigated parameters helping to estimate the feasibility.
Methods
A retrospective analysis of 136 CT scans of 0 to 20-year-old patients, evaluation of demographic parameters, radioanatomy, and assessment of head diameter was conducted. The feasibility was investigated for certain age groups at three implantation sites. Prediction of feasible implantation by means of different parameters was calculated.
Results
A significant higher implantation rate was observed with the new device for all three sites and age groups. The age group of 6–8 years (n = 19) had most striking differences with a 58.1% rate of successful implantation with the new device without spacer (80% with spacer) at the mastoidal localization, whereas none with the old implant. Head diameter was identified as the most predictive parameter regarding all implantation sites (mastoidal: p = 0.030; retrosigmoidal: p = 0.006; parietal: p < 0.0001), age for the mastoidal (p < 0.0001) and retrosigmoidal (p < 0.0001), and gender for the parietal site (p = 0.001).
Conclusion
The geometric changes of the actuator lead to a higher rate of successful implantation in all age-groups and all three localizations with reducing the requirement for spacers. Parameters age and head diameter might aid in estimating the rate of successful implantation in young patients and may be a novel tool to assist in the decision-making process for a SIBCD.
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