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Otology/Neurotology

BAHA Long-term Results: Abutment Survival Rate Related to Skin Reactions

Wednesday, October 4, 2023
9:51 AM - 9:57 AM East Coast USA Time
Location: 104BC

    Presenting Author(s)

  • Sara-Ivana Calce, MD

    Resident Physician
    University of Montreal Hospital Center
    Montreal, Quebec, Canada

    • Senior Author(s)

  • Issam Saliba, MD, FRCSC

    Professor of Otology, Neurotology & skull base surgery
    University of Montreal Hospital Center (CHUM)
    Montreal, QC, Canada

    • Co-Author(s)

  • JS

    Joe Saliba, MD

    Assistant Professor, Neurotology and Skull Base Surgery
    University of Montreal Hospital Center
    Montreal, QC, Canada

  • Nasser M. Al Tamami, MD

    Consultant ENT
    Ministry of Health
    Sur, Oman

Disclosure(s):
Sara-Ivana Calce, MD: No relevant relationships to disclose.
Issam Saliba, MD, FRCSC: No relevant relationships to disclose.
Introduction: Common problems in BAHAs include soft tissue overgrowth and recurrent skin infection, which often lead to a negative experience. The objectives were to determine which surgical techniques and skin complications are related to a shorter abutment survival rate as well as a lack of patient satisfaction.

Methods: Tertiary care monocentric retrospective chart review in adults operated for a BAHA implant from 2002 to 2021. Electronic surveys on subjective hearing assessment (Abbreviated Profile of Hearing Aid Benefit (APHAB)) and quality of life (Glasgow Benefit Inventory (GBI)) were sent. Kaplan Meier survival curves with cox regressions for modified, removed, tightened, and fallen abutments were produced. Independent variables assessed include preoperative comorbidities, known surgical techniques related to an increase rate of adverse skin reactions, and post-operative complications.

Results: Patients (n = 167 ears) were followed for an average of 8.3 years (range = 0.5-20.9). Abutment substitutions (n = 9.6%) occur on average at 55.5 months (range = 5.2-138.0 months) and earlier in presence of skin overgrowth (hazard ratio [95% CI] = 49.46 [6.51-375.87], p < 0.001) and when an oral antibiotic is prescribed for a local infection (4.14 [1.43-11.98], p = 0.009). Abutments entirely comprised of titanium (3.01 [0.83-10.94]), the dermatome technique (2.84 [0.79-10.24]) and soft tissue removal (2.53 [0.70-9.10]) present marginal differences. Abutment removals (n = 11.4%) arise at 56.2 months (range = 3.1-220.2) and are related to persistent local pain (2.56 [1.04-6.31], p = 0.041) and headaches (4.39 [1.68-11.49], p = 0.003) rather than local complications. According to the APHAB survey (n = 77), the BAHA presents a significant advantage when worn (t-test with p < 0.001 in all subgroups except aversiveness). None of the independent variables reduced APHAB and GBI scores.

Conclusions: Patient satisfaction of the BAHA implant is not directly related to chronic adverse skin reactions, but rather idiopathic local pain and headaches.