Bone-Anchored Hearing Aid Implant Location in Relation to Skin Reactions

Faber, Hubert T.; Wolf, Maarten J. F. de; Rooy, J.W.J. de; Hol, Myrthe K. S.; Cremers, C.W.R.J.; Mylanus, Emmanuel A. M.

doi:10.1001/archoto.2009.99

Cited by 29 publications

(42 citation statements)

References 26 publications

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“…However, neither study [3–4] examined the effect of varied soft tissue thickness at the implant site, which is known to differ considerably among patients [9]. Thus, the degree to which stimulation was reduced with varying soft tissue thickness was not explored.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, the degree to which stimulation was reduced with varying soft tissue thickness was not explored. A recent study by Faber et al revealed significant variability in soft tissue thickness (2–11 mm, mean of 5.5 mm) over a proposed implant site among 204 patients [9]. The importance of soft tissue thickness on stimulation effectiveness is therefore of critical importance to the surgeon when implanting the device.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, it is unclear how the intervening soft tissue affects the transfer of sound from the processor to the osseointegrated fixture. This issue is further compounded by individual patient factors, as significant differences have been shown in the thickness of skin behind the ear [9]. …”

Section: Introductionmentioning

confidence: 99%

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Effects of Skin Thickness on Cochlear Input Signal Using Transcutaneous Bone Conduction Implants

Mattingly¹,

Greene²,

Jenkins³

et al. 2015

Otology &Amp; Neurotology

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Hypothesis Intracochlear sound pressures (PIC) and velocity measurements of the stapes, round window, and promontory (VStap/RW/Prom) will show frequency dependent attenuation using magnet-based, transcutaneous bone-conduction implants (TCBCI) in comparison to direct-connect, skin-penetrating implants (DCBCI). Background TCBCIs have recently been introduced as alternatives to DCBCIs. Clinical studies have demonstrated elevated high-frequency thresholds for TCBCIs as compared to DCBCIs; however, little data exists examining the direct effect of skin thickness on the cochlear input signal using TCBCIs. Methods Using seven cadveric heads, PIC was measured in the scala vestibuli and tympani with fiber-optic pressure sensors concurrently with VStap/RW/Prom via laser Doppler vibrometry. Ipsilateral titanium implant fixtures were placed and connected to either a DCBCI or TCBCI. Soft tissue flaps with varying thicknesses (no flap, 3, 6, and 9 mm) were placed successively between the magnetic plate and sound processor magnet. A bone-conduction transducer coupled to custom software provided pure tone stimuli between 120 to 10240 Hz. Results Stimulation via the DCBCI produced the largest response magnitudes. The TCBCI showed similar PSV/ST and VStap/RW/Prom with no intervening flap, and a frequency-dependent, non-linear reduction of magnitude with increasing flap thickness. Phase shows a comparable dependence on transmission delay as the acoustic baseline, and the slope steepens at higher frequencies as flap thickness increases suggesting a longer group delay. Conclusions Proper soft tissue management is critical to optimize the cochlear input signal. The skin thickness related effects on cochlear response magnitudes should be taken into account when selecting patients for a TCBCI.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Effects of Skin Thickness on Cochlear Input Signal Using Transcutaneous Bone Conduction Implants

Mattingly¹,

Greene²,

Jenkins³

et al. 2015

Otology &Amp; Neurotology

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“…If all of these precautions are taken into consideration and therapy-resistant skin reactions still occur, recent studies have shown that changing to a larger 8.5-mm abutment can be beneficial [45][46][47]. A recent study by Faber et al [48] showed that implant location was not correlated with the frequency and severity of skin reactions around the abutment in 248 randomly selected Baha patients.…”

Section: Goals Of Surgerymentioning

confidence: 99%

An Overview of Different Systems: The Bone-Anchored Hearing Aid

Dun¹,

Faber²,

Wolf³

et al. 2011

Advances in Oto-Rhino-Laryngology

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In the past 30 years, a large amount of clinical and audiological research on bone conduction hearing devices has been performed. In this review, we give a brief history of the developments in indications, surgical techniques and sound processors with respect to implantable bone conduction devices like the bone-anchored hearing aid or Baha. Starting with the use of Baha in patients with bilateral conductive or mixed hearing loss (HL), the indications for such devices have been extended to patients with unilateral HL, children and moderate mentally retarded patients. Bilateral fitting has been shown to be beneficial in restoring binaural hearing in patients with bilateral acquired or congenital conductive HL. In addition, the surgical techniques used to implant the titanium fixture for Baha application have been modified and further developed to reach two main goals: (a) optimal osseointegration, and (b) preparation of the implant site to minimize the occurrence of soft tissue reactions. Currently, the most used techniques are the pedicled skin flap, dermatome and linear incision techniques. Several generations of the Baha(®) sound processor have been developed by Cochlear(TM) to provide sufficient amplification in different hearing situations. Improvements in sound quality, aesthetics and handling have been major points of interest. The Baha sound processors most often used today are the Baha(®) Divino, the Baha(®) Intenso and the Baha(®) Cordelle. Recently, the more flexible Baha(®) BP100 sound processor was launched.

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“…Children have a higher rate of implant loss [11]. Faber et al [12] propose the cause of the higher extrusion rate in children is that the child's skull is thinner and has a lower mineral content compared to the adult skull. Skull thickness is not just dependent on age, but also related to craniofacial abnormalities such as in Treacher-Collins' syndrome [13].…”

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confidence: 99%

Complications of Bone-Anchored Hearing Devices

Wazen

Wycherly

Daugherty³

2011

Implantable Bone Conduction Hearing Aids

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Complications of bone-anchored hearing devices occur with both soft tissue and bone. Soft tissue complications are much more common and most often involve irritation of the skin surrounding the implant. Other complications include: skin flap necrosis, wound dehiscence, bleeding or hematoma formation, and persistent pain. Bone complications are classified as either early or late. Early complications are due to failure of osseointegration, while late complications are usually the result of either chronic infection or trauma. Pediatric patients are a unique group of implant patients and are more likely to have complications of both soft tissue and bone. Most complications can be managed in the office with topical therapy and wound care, although revision surgery may be required in extensive skin overgrowth cases. Proper patient selection, meticulous surgical technique, and patient hygiene around the implant are the most critical aspects in minimizing complications in patients with osseointegrated implants.

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Bone-Anchored Hearing Aid Implant Location in Relation to Skin Reactions

Abstract: Implant location and skin thickness were not correlated with implant loss or the frequency or degree of adverse skin reactions around the abutment.

Cited by 29 publications

References 26 publications

Effects of Skin Thickness on Cochlear Input Signal Using Transcutaneous Bone Conduction Implants

Effects of Skin Thickness on Cochlear Input Signal Using Transcutaneous Bone Conduction Implants

An Overview of Different Systems: The Bone-Anchored Hearing Aid

Complications of Bone-Anchored Hearing Devices

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