Learning Objectives:
Objectives: To determine the relationship between surgical outcomes and incision, soft tissue technique and implant types.
Method: A retrospective study of paediatric / adult patients receiving Cochlear® BAHA (April 2010 -March 2013). Age 6–89 years. The outcome compared for a single surgeon. Patients were divided into 3 groups according to technique:
Group 1: Inferiorly based scalp flap raised by dermatome for Cochlear® BI300 abutments (n = 20). Group 2: Sheffield incision (short ‘lazy S’ within hairline, soft tissue reduction) for Cochlear® BI300 abutments (n = 35). Group 3: Short linear incision, non-soft tissue reduction technique for the Cochlear® BI400 hydroxyapatite coated abutments (n = 35) Group 4: BAHA Attract (inferiorly based “C” shaped flap). (n = 20).
Results: Group 1: Bald patch with wide numbness in all. Soft tissue complications: overall 14%, flap related problem (14% flap breakdown, 13% granulations) and 8% fixture los. Surgical time 1.5 hours. Group 2: Aesthetically pleasing. No bald patch. Divot formation. Significant numbness. No major complications like flap necrosis or fixture loss. One patient had a wound haematoma and dehiscence which needed closure. Minor granulations (13%), skin redness (9%) (Holgers 2), small wound dehiscence (3%). All settled conservatively. Surgical time 45 min. Group 3: Aesthetically pleasing. No bald patch. No divot. No granulations. Smaller area of numbness. Wound breakdown in one (abutment placed in incision line) needing secondary suture. Surgical time 25 min. Group 4: Aesthetically pleasing. No bald patch. No divot. No granulations. Larger area of numbness. No wound breakdown. Maintenance free. Surgical time 40 min.
Conclusions: The introduction of newer abutments as well as transcutaneous techniques with minimal soft tissue mobilisation / handling has reduced surgical time, post operative care, complications and patient morbidity and has increased throughput and patient satisfaction with percutaneous hearing implants.
