Bone anchored hearing aid in children—Prevention of complications

SummaryTo report results with the bone anchored hearing aid (BAHA) in children. Retrospective medical record review. Tertiary care children's hospital. Fourteen children with microtia/aural atresia underwent BAHA surgery. Mean age was 5.8 years. Data were collected concerning age, diagnoses, surgery, success of implantation, hearing, complications use of BAHA, speech reception thresholds (SRT), complications BAHA surgeries and revisions. Fifteen implants were placed by the author in 13 children. Eleven of 13 (84.6%) children are successfully using BAHAs (one bilateral) with a mean post operative SRT of 18.5 dB (range 14–25 dB). Mean interval between first and second stages was 7.3 months (n = 12). Three unilateral implants were placed by a different surgeon in a child with severe hemifacial microsomia who developed complications treated by the author. Complications included poor healing requiring removal of three implants in one child, recurrent cellulitis of flap requiring revision (n = 4), loss of implant (n = 2), tearing of flap with dermatome due to tenting by healing screw (n = 1), thin skull necessitating multiple drilling sites (n = 1). BAHA surgery has a high success rate in children. The following recommendations may decrease complications: (1) 6-month period between stages in children with thin skulls, (2) thin flap with scalpel when it is tented by healing screw or infiltrate flap with local anesthetic to balloon it prior to using the dermatome for second stage cases, and (3) create extremely thin flap to prevent cellulitis.