A systematic review on skin complications of bone-anchored hearing aids in relation to surgical techniques

Abstract

A systematic review to study the skin complications associated with the bone-anchored hearing aid in relation to surgical techniques. The following databases have been searched: MEDLINE, EMBASE, the Cochrane Library , Google scholar and the PubMed. The literature search date was from January 1977 until November 2013. Randomised controlled trials and retrospective studies were included. Initial search identified 420 publications. Thirty articles met the inclusion criteria of this review. The most common surgical techniques identified were full-thickness skin graft, Dermatome and linear incision techniques. The result shows that dermatome technique is associated with higher rate of skin complications when compared to linear incision and skin graft techniques. Based on the available literature, the use of a linear incision technique appears to be associated with lower skin complications; however, there is limited data available supporting this. Higher quality studies would allow a more reliable comparison between the surgical techniques.

Percutaneous bone-anchored hearing implant surgery: dermatome versus linear incision technique

“…In addition, only four (2.9 %) of all identified implants in adults placed during the study period had to be excluded. The combination of this very low exclusion rate and a presence of (adverse) soft tissue reaction that is comparable with other studies, though for dermatome technique somewhat lower, [16] suggests a representative sample.…”

“…In the field of the latter, both the dermatome and linear incision technique became popular in many centres. However, studies regarding the dermatome technique reported an overall higher rate of skin problems [35–37] compared to the linear incision technique [8, 19], although methodological variability could influence these outcomes and impair adequate comparison [16]. The linear incision technique is more and more used as the preferred technique in many clinics.…”

“…Various surgical techniques have been developed, which started with the free retroauricular full-thickness skin graft [13] and later the pedicled grafts [14]. Over the years, the dermatome and linear incision technique have been introduced with the goal to further minimize skin problems postoperatively [15, 16]. The dermatome technique was developed to standardize the pedicled flap technique and create a thinner skin graft.…”

“…Nevertheless, variability in setup, follow-up and surgical techniques among these studies may influence the rate of skin complications [16]. To our knowledge, there are only two comparative studies that evaluate major postoperative complications between these two techniques: one as part of a comparison of several techniques [24] and another with a limited follow-up without using the Holgers classification [25].…”

Minimal Reporting Standards for Active Middle Ear Hearing Implants

“…Late complications, (1 year or more postoperative) including implant or wire extrusion, dislocation of transducer/coupler assembly and loss of coupling (e.g., increase in in situ thresholds) need to be reported, as well as technical complications and device failures. If a revision surgery was necessary, it must be stated whether it was due to medical/ surgical (procedure) or device-related reasons [Ernst et al, 2016;Gavilan et al, 2015;Hobson et al, 2010;Lassaletta et al, 2016;Mohamad et al, 2016;Van Rompaey et al, 2011;Wazen et al, 2011;Zwartenkot et al, 2016].…”