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One-stage vs. two-stage BAHA implantation in a pediatric population
Issam Saliba1, Patrick Froehlich, Sarah Bouhabel
1Division of Otorhinolaryngology Head & Neck Surgery, University of Montreal, Otology and Neurotology, Sainte-Justine University Hospital Center (CHU SJ), and University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada. issam.saliba@umontreal.ca
Insights
One-stage bone-anchored hearing aid (BAHA) implantation is a safe and effective option for pediatric patients, reducing operating time compared to the two-stage procedure. This approach offers reliable results and could become the standard of care for children requiring BAHA.
Area of Science:
- Otolaryngology
- Neurosurgery
- Pediatric Surgery
Background:
- Pediatric bone-anchored hearing aid (BAHA) implantation traditionally involves a two-stage surgical approach.
- Evaluating alternative surgical methods is crucial for optimizing patient outcomes and care standards.
Purpose of the Study:
- To compare the safety and efficacy of one-stage versus two-stage BAHA implantation in pediatric patients.
- To determine the optimal standard of care for pediatric BAHA surgery.
Main Methods:
- A retrospective review of 55 pediatric patients undergoing BAHA implantation between 2005 and 2010.
- Comparison of complication incidence, severity, operating time, and follow-up between one-stage (n=26) and two-stage (n=29) BAHA insertion groups.
Main Results:
- No significant differences in minor, moderate, or severe complications between one-stage and two-stage BAHA implantation.
- One-stage BAHA surgery demonstrated a significantly shorter operating time (mean 54 min) compared to two-stage surgery (mean 79 min).
- All pediatric BAHA insertions in the study were performed as same-day surgery.
Conclusions:
- One-stage BAHA implantation is a reliable, safe, and efficient procedure for pediatric patients.
- The one-stage approach offers reduced operating time and is suitable for same-day surgery.
- One-stage BAHA implantation should be considered a potential standard of care for pediatric patients.
Objectives:
BAHA implantation surgery in a pediatric population is usually done in two-stage surgeries. This study aims to evaluate the safety and possible superiority of the one-stage over the two-stage BAHA implantation and which one would be the best standard of care for our pediatric patients.
Methods:
A retrospective chart review of 55 patients operated in our tertiary care institutions between 2005 and 2010 was conducted. The actual tendency in our institutions, applied at the time of the study, is to perform a one-stage surgery for all operated patients (pediatric and adult), except for patients undergoing translabyrinthine surgeries for cerebellopontine tumor excision. These patients indeed had a two-stage insertion. 26 patients underwent one-stage surgery (group I) while 29 patients had a two-stage (group II) BAHA insertion. A period of 4 months was allowed for osseointegration before BAHA processor fitting. As for the safety assessment of the one-stage surgery, we compared both groups regarding the incidence and severity (minor, moderate and major) of encountered complications, as well as the operating time and follow-up. The operating time of the two-stage surgery includes the time of the first and of the second stage.
Results:
The mean age at surgery was 8.5 years old for the group I and 50 years old for the group II patients. There was no difference in the incidence of minor (p=0.12), moderate (p=0.41) nor severe (p=0.68) complications between groups I and II. Two cases of traumatic extrusion were noted in the group I. Furthermore, the one-stage BAHA implantation requests a significantly lower operating time (mean: 54 [32-100] min) than the two-stage surgery (mean: 79 [63-148] min) (p=0.012). All pediatric cases of BAHA insertion were performed in a one day surgery. The mean postoperative follow-up was 114 and 96 weeks for groups I and II respectively (p=0.058).
Conclusions:
One-stage BAHA insertion surgery in the pediatric population is a reliable, safe and efficient therapeutic option that allows a good result in a significantly lower operating time compared to the two-stage insertion and is achieved in a one day surgery. It could therefore be considered as a standard of care for pediatric patients.
