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Biofilm formation on bone-anchored hearing aids

  • P Monksfield (a1), I L C Chapple (a2), J B Matthews (a2), M M Grant (a2), O Addison (a3), A P Reid (a1), D W Proops (a1) and R L Sammons (a3)...



To investigate microbiological biofilm contamination of retrieved bone-anchored hearing aids.

Materials and methods:

Nine failed, retrieved bone-anchored hearing aids and 16 internal screws were examined by scanning electron microscopy. A fixture from a failing implant, which had been removed and disassembled under aseptic conditions, was cultured. Finally, an internal screw from a new, unimplanted fixture was examined by scanning electron microscopy.


Debris was seen on the fixture and abutment of all bone-anchored hearing aids, and on the heads of the 16 internal screws. On eight screws, biofilm extended down the shaft to the threads, where it was several micrometres thick. Culture of a failing fixture yielded staphylococcus. The new, unimplanted fixture internal screw showed evidence of scratching and metallic debris on the threads, which may interfere with close fitting of the screw and subsequently facilitate microleakage.


There may be a link between internal microbial contamination and failure of bone-anchored hearing aids.


Corresponding author

Address for correspondence: Dr R L Sammons, University of Birmingham School of Dentistry, St Chad's Queensway, Birmingham B4 6NN, UK Fax: +44 (0)121 237 2932 E-mail:


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1House, JW, Kutz, JW Jr. Bone-anchored hearing aids: incidence and management of postoperative complications. Otol Neurotol 2007;28:213–17
2Ricci, G, Della Volpe, A, Faralli, M, Longari, F, Gulla, M, Mansi, N et al. Results and complications of the Baha system (bone anchored hearing aid). Eur Arch Otorhinolaryngol 2010;267:15391945
3Doshi, J, McDermott, AL, Reid, A, Proops, D. The use of bone-anchored hearing aid Baha® in children with severe behavioural problems – the Birmingham Baha® programme experience. Int J Pediatr Otorhinolaryngol 2010;74:608–10
4Dun, CAJ, de Wolf, MJF, Mylanus, EAM, Snik, AF, Hol, MKS, Cremers, C. Bilateral bone-anchored hearing aid application in children: the Nijmegen experience from 1996–2008. Otol Neurotol 2010;31:615–23
5De Wolf, MJF, Shival, MLC, Hol, MKS, Mylanus, EAM, Cremers, C, Snik, AFM. Benefit and quality of life in older bone-anchored hearing aid users. Otol Neurotol 2010;31:766–72
6Holgers, KM, Paulsson, M, Bjursten, LM, Tjellström, A, Ljungh, Å. Selected microbial findings in association with percutaneous titanium implants. Int J Oral Maxillofac Implants 1994;5:565–70
7Gillett, D, Fairley, JW, Chandrashaker, TS, Bean, A, Gonzalez, J. Bone-anchored hearing aids: results of the first eight years of a programme in a district general hospital, assessed by the Glasgow benefit inventory. J Laryngol Otol 2006;120:537–42
8Holgers, KM, Ljungh, Å. Cell surface characteristics of microbiological isolates from human percutaneous titanium implants in the head and neck. Biomaterials 1999;20:1319–26
9Lustig, LR, Arts, HA, Brackmann, DE, Francis, HF, Molony, T, Megerian, CA et al. Hearing rehabilitation using the BAHA bone-anchored hearing aid: results in 40 patients. Otol Neurotol 2001;22:328–34
10Grant, MM, Monksfield, P, Proops, D, Brine, M, Addison, O, Sammons, RL et al. Fluid exudates from inflamed bone-anchored hearing aids demonstrate elevated levels of cytokines and biomarkers of tissue and bone metabolism. Otol Neurotol 2010;31:433–9
11Post, CJ. Role of biofilms in otolaryngologic infections: update 2007. Curr Opin Otolaryngol Head Neck Surg 2007;15:347–51
12Macassey, E, Dawes, P. Biofilms and their role in otorhinolaryngological disease. J Laryngol Otol 2008;122:1273–8
13Fey, PD. Modality of bacterial growth presents unique targets: how do we treat biofilm-mediated infections? Curr Opin Microbiol 2010;13:610–15
14Fux, CA, Stoodley, P, Hall-Stoodley, L, Costerton, JW. Bacterial biofilms: a diagnostic and therapeutic challenge. Expert Rev Anti Infect Ther 2003;1:667–83
15Stewart, PS, Franklin, MJ. Physiological heterogeneity in biofilms. Nat Rev Microbiol 2008;6:199210
16Wilson, M. Bacterial biofilms and human disease. Sci Prog 2001;84:235–54
17Cos, P, Tote, K, Horemans, T, Maes, L. Biofilms: an extra hurdle for effective antimicrobial therapy. Curr Pharm Des 2010;16:2279–95
18do Nascimento, C, Barbosa, RES, Issa, JPM, Watanabe, E, Ito, IY, Albuquerque, RF Jr. Bacterial leakage along the implant-abutment interface of premachined or cast components. Int J Oral Maxillofac Surg 2008;37:177–80
19Baldwin, L, Hunt, J. Host inflammatory response to NiCr, CoCr, and Ti in a soft tissue implantation model. J Biomed Mater Res 2006;79:574–81
20Quirynen, M, Bollen, CM, Eyssen, H, van Steenberghe, D. Microbial penetration along the implant components of the Branemark System. Clin Oral Implants Res 1994;5:239–44
21Quirynen, M, van Steenberghe, D. Bacterial colonization of the internal part of two-stage implants. Clin Oral Implants Res 1993;4:158–61
22Håkansson, B, Reinfeld, S, Eeg-Olofsson, M, Östli, P, Taghavi, H, Adler, J et al. A novel bone conduction implant (BCI): engineering aspects and pre-clinical studies. Int J Audiol 2010;49:203–15


Biofilm formation on bone-anchored hearing aids

  • P Monksfield (a1), I L C Chapple (a2), J B Matthews (a2), M M Grant (a2), O Addison (a3), A P Reid (a1), D W Proops (a1) and R L Sammons (a3)...


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