Unusual complication following trauma to a bone-anchored hearing aid: case report and literature review

Abstract

Provision of bone-anchored hearing aids involves many clinicians. All clinicians involved in this procedure must be aware of the need to monitor their patients carefully, and to remember that unusual and unexpected complications, although rare, do happen. The patient's need for care continues long after the surgery is complete.

Management of repeated trauma to bone-anchored hearing aids in a paediatric patient

“…This rationale was based on the two reports (in the international literature) of intrusion trauma to BAHAs, in which the dura was intact before and after the removal of the implant. 12,13 When the child sustained a 3.3 mm intrusion injury to the replacement abutment two years later, we could not refer to the literature or personal experience, as a case like this had not been encountered before. It was originally decided that the damaged screws would be removed from the patient's temporal region.…”

“…We decided not to remove the intruded BAHA for two reasons. Firstly, the two other reports of intrusion trauma to a BAHA note that the dura was intact even after removal of the implants 12 , 13 . Secondly, the parents felt that their child would not cope with the surgical wound of a mini-craniotomy because of his behavioural problems.…”

“…Firstly, the two other reports of intrusion trauma to a BAHA note that the dura was intact even after removal of the implants. 12,13 Secondly, the parents felt that their child would not cope with the surgical wound of a mini-craniotomy because of his behavioural problems. In order to aid his hearing, a second abutment was uneventfully inserted on the same side, anterior to the first abutment ( Figure 1c).…”

“…However, trauma renders approximately 3–26 per cent of all titanium fixtures in children lost or unusable, 6 – 10 which is higher than the frequency in adult patients (1 per cent) 11 . More serious complications of trauma include intrusion injuries, 12 intracerebral abscess after BAHA abutment replacement 13 and epidural haematoma 14 . These complications are very rare indeed.…”

Response to: Comment on “Original Solution for Middle Ear Implant and Anesthetic/Surgical Management in a Child with Severe Craniofacial Dysmorphism”

“…The skull bone thickness was less than 3 mm (measured on the axial CT slices at 1 cm posterior to the sigmoid sinus, at the superior margin of the bony canal). As trauma to the head is always a possibility and the bone is very thin, the additional risk of percutaneous bone conduction implants causing intracranial intrusion of fixture or other severe risks also needed to be considered [20–23]. …”