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Pediatric Calvarial Bone Thickness in Patients With and Without Aural Atresia
Andrew R Tomlinson1, Michael L Hudson, Karl L Horn
1*University of New Mexico Health Sciences Center †Presbyterian Ear Institute, Albuquerque, New Mexico.
Insights
Children generally have adequate temporal bone thickness for bone-anchored hearing aids, regardless of aural atresia. Bone thickness increases with age, suggesting suitability for hearing implants in most pediatric cases.
Area of Science:
- Otolaryngology
- Pediatric Audiology
- Medical Imaging
Background:
- Bone-anchored hearing aids (BAHA) require sufficient temporal bone thickness for osseointegration.
- Assessing temporal bone thickness in children, particularly those with aural atresia, is crucial for BAHA candidacy.
Purpose of the Study:
- To compare temporal bone thickness at potential osseointegrated implant sites in children with and without aural atresia.
- To evaluate bone thickness in relation to age and atresia status for BAHA suitability.
Main Methods:
- Retrospective review of computed tomographic (CT) imaging in children under 11 years.
- Three-dimensional reconstruction of temporal bone to measure thickness at 12 defined implant sites.
- Statistical analysis to compare bone thickness between groups, controlling for age and atresia.
Main Results:
- 93% of children had >50% of measured sites with at least 2mm bone thickness.
- Temporal bone thickness did not significantly differ between children with and without aural atresia when adjusted for age.
- Bone thickness at most sites increased with age, with a higher likelihood of reaching 4mm in older children.
Conclusions:
- Most children possess adequate temporal bone thickness (>2mm) at potential BAHA implant sites, irrespective of aural atresia.
- Age is a significant factor influencing temporal bone thickness, with older children showing greater bone depth.
- Findings support the use of BAHA in pediatric populations, with careful consideration of age for optimal implant site selection.
Objective:
To compare temporal bone thickness along a three-dimensional arc of potential osseointegrated implant sites for bone-anchored hearing aids in children with and without aural atresia using computed tomographic imaging (CT).
Study Design:
Retrospective case review.
Setting:
Tertiary children's hospital.
Patients:
Children with or without aural atresia aged less than 11 years who had a temporal bone CT.
Intervention (S):
Calvarial bone volume on CT was rendered in three-dimensional and thickness was reconstructed and measured at up to 12 defined sites along an arc of recommended implant sites.
Main Outcome Measure (S):
Determining whether a majority of observed potential implant sites have 2, 3, or 4 mm of bone thickness while controlling for age differences and atresia status.
Results:
A total of 40 atretic (from 34 patients) and 34 control (from 34 patients) temporal bones were compared using CT. Likelihood ratio tests indicated that diagnosis did not have a statistically significant effect on whether patients reached thresholds of 2, 3, or 4 mm at most observed sites (p = 0.781, 0.773, and 0.529, respectively) when adjusting for age. For all children measured, 93% had >50% of measured points greater than or equal to 2 mm thick.
Conclusion:
Most children had greater than 2 mm of temporal bone thickness at >50% of the sites measured regardless of age or atresia diagnosis. The likelihood of reaching 4 mm of thickness at most sites improves with age. In unilateral patients, there was not a significant difference in thickness between affected and unaffected sides. There was also no significant difference in thickness when comparing patients with atresia to those without.
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