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Long term observation in patients with Bone Anchored Hearing Aids (Baha)
Mrowka M. , Skarzynski P.H.
, Porowski M. , Olszewski L. , Pastuszak A. , Skarzynski H.
Institute of Physiology and Pathology of Hearing, World Hearing Center, Warsaw, Poland, 2Medical University of Warsaw, Ophtalmic
Diagnostics and Rehabilitation and Sensory Organs Department, Warsaw, Poland, 3Institute of Sensory Organs, Kajetany, Poland
Treatment of patients with conductive and mixed hearing loss in bilateral microtia with auditory canal atresia or
after chronic otitis media can be conducted with Bone Anchored Hearing Aids (BAHA).
Our aim was to assess the effects of using different surgical techniques in implantation of titanium fixtures (Ugraft, Dermatome and Linear incision) affecting postoperative healing and occurrence of early and late skin
reactions needing surgical intervention.
Our method of choice in treatment of hearing loss in presented various ear defects is attachment of titanium
implant to the temporal bone and removal of subcutaneous tissue. Three skin incision techniques were used: U graft, Dermatome, Linear incision. Tissue around attachment was thinned without collecting skin graft. Our
material consists of 124 patients from 3 y.o. to 67 y.o. Device fitting was performed after wound healing and
osseointegration of the fixtures (6 weeks - 6 months - depending on bone thickness, length of the fixtures, oneor two-stage surgical technique and condition of the wound). Universally adopted Holgers classification of skin
reactions was used to determine soft tissue reactions around the transcutaneous implants. In case of severe
infection of the soft tissue in the implant site (Grade 4, according to Holgers scale) tissue reoperation was
Assessing the results of treatment, 17 reoperations were performed due to inflammatory tissue reaction in the
implantation site (Grade 4), including 15 in patients after U-graft technique, one reoperation in a patient after
Dermatome and one after Linear incision. It was observed that the skin incision technique affects significantly
occurrence of reoperations (p = 0,00167). In the groups where Linear incision or U-graft techniques were used
nearly 20% of patients required reoperation, and in the group operated using Dermatome technique reoperation
was necessary in little above 2% of cases. Comparison of hearing thresholds for BAHA type device applied on
titanium fixture (direct stimulation of bone) with results from the same hearing device applied on BAHA test band
(percutaneous stimulation of bone that muffles sound via skin and subcutaneous tissue) indicated that lower
thresholds levels were obtained for the BAHA device. Differences for the single frequencies were approximately:
500 Hz - 8 dB, 1000 Hz - 6 dB, 2000 Hz - 6 dB, 4000 Hz - 8 dB.
Assessment of the effects of different surgical techniques in titanium fixtures implantation (U-graft technique,
Dermatome technique and Linear incision technique) on postoperative wound healing and early and late skin
reactions shows that the best results can be obtained using the Dermatome technique. Gain assessment of the
hearing aid on a titanium fixture comparing to universally used Baha test band using bone percutaneous
stimulation reveals that use of Baha directly stimulating bone provides lower hearing thresholds.