Percutaneous Bone-Anchored Hearing Implant Surgery: Do Syndromic Children Have More Adverse Perioperative Outcomes?

Abstract

Objective To evaluate and compare perioperative outcomes of percutaneous bone-anchored hearing implant (BAHI) surgery in syndromic and nonsyndromic pediatric patients. Study Design Retrospective cohort study Setting McGill University Health Centre in Montreal, Quebec, Canada. Patients Forty-one pediatric patients (22 syndromic, 19 nonsyndromic) who underwent percutaneous BAHI surgery between March 2008 and April 2021. Intervention Percutaneous BAHI surgery. Main Outcome Measures Patient demographics (age at surgery, gender, implant laterality), operative information (American Society of Anesthesia [ASA] score, anesthesia type, surgical technique, implant/abutment characteristics), and postoperative outcomes (implant stability, soft tissue integrity, surgical revisions, implant failure). Results The most frequent syndromes among implanted patients were Treacher Collins (27.3%), Goldenhar (13.6%), Trisomy 21 (13.6%), and Nager (9.1%). Syndromic patients were more frequently given higher ASA scores: 2 (p = 0.003) and 3 (p = 0.014). All cases of implant extrusion were in syndromic patients: two posttraumatic and two failures to osseointegrate. Nine (40.9%) syndromic patients experienced a Holgers Grade 4 skin reaction at one of their postoperative follow-up visits as compared to 0% of nonsyndromic patients (p < 0.001). Implant stability was similar between cohorts at all postoperative time-points, except for significantly greater nonsyndromic implant stability quotient scores at 16 weeks (p = 0.027) and 31+ weeks (p = 0.016). Conclusions Percutaneous BAHI surgery is a successful rehabilitation option in syndromic patients. However, it presents a relatively higher incidence of implant extrusion and severe postoperative skin reactions as compared to nonsyndromic patients. In light of these findings, syndromic patients may be great candidates for novel transcutaneous bone conduction implants.

Systematic Review of Current Audiological Treatment Options for Patients with Treacher Collins Syndrome (TCS) and Surgical and Audiological Experiences of an Otorhinolaryngologist with TCS

“…In the percutaneous passive bone-anchored hearing aid, an abutment screwed in the temporal bone protrudes through the skin, and the audio processor is attached to it. For the transcutaneous model, the implant is embedded in the bone under the skin and the signals from the audio processor are transmitted passively through the skin [12]. However, there are also active transcutaneous bone-anchored hearing aids, such as the Bonebridge from the company MED-EL (MED-EL, Innsbruck, Austria), which transmits the vibrations of the sounds directly to the skull bone, thus enabling hearing [13].…”