The Longitudinal Impact of Radiotherapy on Osseointegrated Hearing Aid Outcomes and Complications

To evaluate the impact of radiotherapy on osseointegrated hearing aids (OIHA) complications.

Retrospective review of percutaneous OIHA performed from 2006 to 2021 at an academic institution. Implant and abutment-related complications were evaluated and stratified by radiation parameters. Main outcome measures were abutment, implant, and major complications assessed using the modified Holgers and IPS grading scales.

Total of 190 OIHA were included; 124 (65%) were placed in bones that previously or subsequently received radiation. Total of 84 (44%) OIHA experienced at least one complication at mean 43.3 months. Radiation cohort had greater rates of having any complication (p = 0.032), major complication (p = 0.014), implant complication (p = 0.007), and abutment complication (p = 0.032). IPS score distribution was significantly different between groups (p = 0.011). Subgroup analysis of periauricular skin and parotid tumors demonstrated a significant association between any complication and abutment size (p = 0.005) and length of follow-up (p < 0.001) on logistic regression. Notably, every 1 mm increase in abutment size decreased the risk of any complication by 23%, and every 1-year increase in follow-up increased the risk of any complication by 67%. There was a trend toward more implant and abutment complications with higher radiation doses. Cumulative incidence plots demonstrate a greater discrepancy in complication rates between groups as time increases.

Radiation significantly increases the risk of both abutment and implant-related OIHA complications, particularly in the long term. Ongoing surveillance for complications in this population is critical. The IPS grading scale may be more sensitive for cataloging complications. Increasing the abutment size and decreasing radiation dosages may decrease complications.