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Percutaneous Bone-Anchored Hearing Implant Surgery: Do Syndromic Children Have More Adverse Perioperative Outcomes?
Samer Salameh1, Sabine El-Khoury2, Aren Bezdjian3
1Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada.
Insights
Percutaneous bone-anchored hearing implants (BAHI) are effective for syndromic children, but show higher risks of extrusion and skin issues. Transcutaneous implants may be a better option for this group.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Medical Devices
Background:
- Hearing loss is a significant challenge in pediatric populations.
- Bone-anchored hearing implants (BAHI) offer a surgical solution for hearing rehabilitation.
- Comparing outcomes in syndromic versus nonsyndromic pediatric patients is crucial for optimizing treatment.
Purpose of the Study:
- To compare perioperative outcomes of percutaneous bone-anchored hearing implant (BAHI) surgery in syndromic and nonsyndromic pediatric patients.
- To identify potential risks and benefits associated with BAHI in these distinct pediatric groups.
Main Methods:
- A retrospective cohort study was conducted at a major academic health center.
- Data from 41 pediatric patients (22 syndromic, 19 nonsyndromic) who underwent percutaneous BAHI surgery were analyzed.
- Outcomes included implant stability, soft tissue integrity, surgical revisions, and implant failure.
Main Results:
- Syndromic patients had higher American Society of Anesthesia (ASA) scores.
- All implant extrusions occurred in syndromic patients (n=4).
- Syndromic patients experienced significantly higher rates of severe skin reactions (Holgers Grade 4) compared to nonsyndromic patients (40.9% vs. 0%).
- Implant stability was generally similar, with slightly better scores in nonsyndromic patients at later time points.
Conclusions:
- Percutaneous BAHI surgery is a viable hearing rehabilitation strategy for syndromic pediatric patients.
- Syndromic children face increased risks of implant extrusion and postoperative skin complications.
- Novel transcutaneous bone conduction implants may offer an improved alternative for syndromic pediatric patients.
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.
