Osseointegrated implants in the management of childhood ear abnormalities: with particular emphasis on complications

Abstract

Little has been published about the difficulties encountered during the insertion of osseointegrated implants for the attachment of bone anchored hearing aids (BAHA) and auricular prostheses in children. This study examines this issue in the first 51 children implanted at our centre. During surgery, the most common problem encountered was the presence of thin bone resulting in incomplete insertion of fixtures. Five fixtures had failed to integrate and six fixtures were lost in the long-term, however, only five children required revision surgery. The reason why few patients require revision was due to the judicious insertion of 'sleeper' fixtures. At follow-up, seven children required counselling for psychological problems. It is apparent from this study that osseointegrated implants in children are associated with difficulties, re-emphasizing that a paediatric osseointegration programme requires significant investment, and should only be undertaken by institutions that are committed to its success.

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

“…In a comparable paediatric study the one stage technique was found to be safe and effective with a low complication rate [6]. In other paediatric series with two-stage implantation 5-10% of implants failed to osseointegrate [10,11] and late fixture loss occurred in 9-10% [12,13]. Thus, although the two-stage procedure also has a low complication rate, the single stage is more favourable since a second anaesthetic can be avoided in this group.…”

Surgical Outcome of Bone Anchored Hearing Aid (Baha) Implant Surgery: A 10 Years Experience

“…This shows that the implant does not interfere with the bony skull growth. Most our patients (63.6 %) had two stage surgeries Some authors even advocate the implantation of sleepers that is more than one titanium fixture implant in cases of probable failed osseointegration [9,10]. There was only one patient where we put sleeper.…”

Bone anchored hearing aid in children—Prevention of complications

“…Yellon and only limited complications. Other groups have reported similar results in children [1][2][3][4][5][6]. The conclusions of this study are limited by the small number of patients and relatively short follow up period.…”

“…Although there is no prospective study, anecdotal reports (A. Tjellstrom, MD, PhD, personal communication 2005) suggest that a longer period (at least 6 months) between the two stage procedures allows for adequate osseointegration. The need for revision surgery for replacement of lost fixtures may be reduced by placement of a second ''sleeper'' fixture at the time of initial surgery that may be used if the primary fixture fails to osseointegrate [5]. Sleepers were not placed in this group of patients.…”