“Punch” Method for Bone-Anchored Hearing Aid Placement

Abstract

Objective: Various techniques have been described for bone anchored hearing system placement. Alterations to the initial technique have helped lower complication rates. Additional modifications can continue to improve postoperative results. A safe, streamlined approach for bone anchored hearing system placement to limit these known complication rates will be presented.

Method: A retrospective chart review of 15 consecutive adult patients from an otology/neurotology practice was performed. Patients underwent the “Punch” method for placement using a 4-mm implant with the longer 9-mm abutment. The initial incision is performed using a 12-mm punch biopsy with variations to the standard procedure.

Results: Fifteen of 15 patients had successful placement of the bone anchored device. Ten were Oticon Ponto® systems, and 5 were the Cochlear BAHA® systems. There were no cases of tissue overgrowth, failure of osseointegration, or major postoperative infections. The only complications were minor skin infections that were treated with oral and topical antibiotic. All operative times were recorded and found to be less than 15 minutes. Postoperative follow-up ranged from 10 to 24 months. All implants were found to be well integrated.

Conclusion: Bone-anchored hearing system placement with longer abutments may reduce postoperative tissue overgrowth. Using the “Punch” method decreases major postoperative infections, reduces incision length, improves cosmesis, and decreases operative time. Larger studies are needed to determine if the low complication rate demonstrated in this study will continue.