Anaesthesia for insertion of bone‐anchored hearing aids in children: a 7‐year audit

Abstract

SummaryForty-three children, aged 23 months to 14 years, received 102 anaesthetics for insertion of boneanchored hearing aids, each lasting approximately 30±60 min. Forty of the children had a recognised syndrome involving the head and neck, including Goldenhar's and Treacher Collin's syndrome. The incidence of congenital heart disease was 19%. Pre-existing conditions, anaesthetic technique, grade of intubation, complications and discharge were audited. Sixteen of the patients were classified as Grade 3 or 4 intubations. Over the 7 years, laryngeal mask airway usage increased for airway maintenance rather than tracheal intubation, as did the use of propofol for induction rather than inhalational methods. Intra-operative complications (5.9%) were related to the airway, and postoperative ones (17.6%) mainly to nausea and vomiting. Surgery was performed as a day case in 71% of the patients despite some long-distance travel. Children with conductive deafness are usually fitted with conventional hearing aids at an early age. This is impossible in children with congenital absence of the ears or external auditory canals, and in those with a chronic suppurative discharge.Unilateral microtia may be associated with various malformations involving the first and second branchial arch such as Goldenhar's syndrome (oculoauricularvertebral syndrome) [1]; 20% of children with Goldenhar's syndrome also have congenital heart disease. Bilateral microtia is often associated with Treacher Collin's syndrome (mandibular dysostosis) along with micrognathia, aplastic zygomatic arches, microstomia and choanal atresia [2]. Abnormalities of the auditory canals are sporadically found among children with other craniofacial and musculoskeletal abnormalities.The fitting of a bone-anchored hearing aid (BAHA) in these children, especially if performed early, allows them to hear and develop normal speech. BAHAs rely on osseointegration, which is defined as direct contact between living bone and a loaded implant surface. They were developed first in Sweden in 1977 [3] following earlier work involving fixation of missing teeth. The suitability of a patient to be fitted with a BAHA requires extensive multidisciplinary assessment. There should be maximal conductive hearing loss, and good cochlear reserve. A limiting factor is age as bone thickness may not be adequate before 2 years of age.The surgery involves two operations, each lasting 30± 60 min. The patient is supine with the head slightly raised and tilted to one side, supported by a sandbag. A titanium fixture, 3±4 mm in diameter, is implanted into the mastoid bone behind the ear. Frequently, two are inserted to allow for failure or traumatic loss. After 3±6 months, osseointegration should have occurred and at the second operation the skin flap over the implant is thinned and an abutment, designed to carry the hearing aid, is placed over the fixture. After healing, the hearing aid is fitted in outpatients. The overall failure rate, with two fixtures, in Birmingham is 8% [4]. 777BAHA surgery w...

Bone-anchored hearing aid A single-stage procedure in children

“…The main advantage of this is the avoidance of a second anaesthetic for abutment fitting. This is especially important since some series have reported over grade 3 or 4 intubations in over a third of their children requiring BAHAs [9].…”

Complications of regional and general anaesthesia in obstetric practice

“…[24] Ephedrine has been recommended as the vasopressor of choice for the hypotensive obstetric patient. [26] However, evidence-based analysis has shown that ephedrine and α-adrenergic agonists (phenylephrine) appear to be equally efficacious. [27]…”

Bone-Anchored Hearing Aids versus Conventional Hearing Aids

“…In addition to this the paediatric population is a more complex group of patients with complex anaesthetic needs. A large proportion of children will have recognised syndromes, cardiac problems and other medical comorbidities, making them a challenging group to anesthetise [31].…”