Perioperative considerations for children undergoing bone anchored hearing device surgery: an observational study
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Rupan Banga1, Andrew P Reid, David W Proops
1Department of ENT, The Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B46NH, UK, rupan@doctors.org.uk.
Insights
Perioperative management for pediatric bone anchored hearing device (BAHD) surgery has evolved, with increased use of laryngeal masks and fewer syndromic cases. Specialized pediatric airway support remains crucial for complex cases.
Area of Science:
- Pediatric Anesthesiology
- Otolaryngology
- Surgical Innovation
Background:
- Bone anchored hearing device (BAHD) surgery is increasingly performed in children.
- Understanding perioperative management is crucial for optimizing outcomes in pediatric BAHD procedures.
- Previous studies provide a baseline for evaluating changes in practice over time.
Purpose of the Study:
- To identify key factors in the perioperative management of pediatric BAHD surgery.
- To compare current practices with a previous study from 2000.
- To assess changes in patient demographics and anesthetic techniques.
Main Methods:
- Retrospective review of 134 pediatric BAHD cases (2008-2011).
- Comparison of data with a prior study conducted in the same center before 2000.
- Analysis of patient comorbidities, anesthetic techniques, and complications.
Main Results:
- 194 pediatric BAHD surgeries identified; 134 case notes reviewed.
- 45.5% of children had syndromes/dysmorphisms; 17% had congenital heart anomalies.
- Laryngeal mask airway (LMA) used in 83.3% of cases; 11.9% intraoperative and 4.8% postoperative complications.
- Compared to 2000, fewer syndromic children and increased LMA use.
- Congenital heart disease rates remained stable; reduction in head/neck syndromes.
Conclusions:
- Pediatric BAHD perioperative management has evolved, with expanded indications and increased use of LMAs.
- While LMAs are effective even in complex cases, specialized pediatric airway expertise is essential.
- The trend suggests a shift towards less invasive airway management, but vigilance for complex cases is necessary.
Abstract:
The objective of the study was to identify important factors in the perioperative management of children undergoing bone anchored hearing device (BAHD) surgery in a paediatric tertiary centre. We also aim to compare current practice and identify any changes in practice with the previous study carried out in the same paediatric tertiary centre in 2000. Children undergoing BAHD surgery between January 2008 and January 2011 were identified on a departmental database. A retrospective case note review was performed and compared with data collected prior to 2000. In the study period, 194 children were identified to have had BAHD surgery. 134 case notes were available for analysis and of these children, 353 anaesthetics were identified. 45.5% of the children had a recognised syndrome or dysmorphism and 17% had a congenital cardiac anomaly. 16% of the children were classified as a grade 3 or 4 laryngoscopy, but 83.3% were managed with a laryngeal mask. 11.9% of the children had an intraoperative complication and 4.8% a postoperative complication. 88.4% of children were managed as day cases. Compared with the previous study in 2000, there was a smaller proportion of syndromic or dysmorphic children and a larger proportion of children were managed with a laryngeal mask. As BAHD surgery has become more common and as its indications have expanded, the perioperative management has evolved. The proportion of children with congenital heart disease has remained constant, but there has been a marked reduction in the number of children with syndromes involving the head and neck. We have found that even in complex craniofacial cases, the laryngeal mask is increasingly being used with good results. However, advanced paediatric airway experience was still required in a small number of cases, heightening the awareness that specialised paediatric support services are necessary for a comprehensive BAHD programme.