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An approach to bilateral bone-anchored hearing aid surgery in children: contralateral placement of sleeper fixture

Published online by Cambridge University Press:  17 October 2008

J M Bernstein  and
P Z Sheehan
J M Bernstein*
Affiliation:
Department of Paediatric Otolaryngology, Central Manchester and Manchester Children's University Hospitals, UK
P Z Sheehan
Affiliation:
ENT and Hearing Clinic for Individuals with Down Syndrome, Department of Paediatric Otolaryngology, Central Manchester and Manchester Children's University Hospitals, UK
*
Address for correspondence: Mr J M Bernstein, Specialist Registrar in Otolaryngology, Department of Paediatric Otolaryngology, Central Manchester and Manchester Children's University Hospitals, Charlestown Road, Manchester M9 7AA, UK. Fax: +44 161 918 5039 E-mail: jbernstein2001@hotmail.com
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Abstract

Objective:

Bone-anchored hearing aid surgery in younger children is a two-stage procedure, with a titanium fixture being allowed to osseointegrate for several months before an abutment is fitted through a skin graft. In the first procedure, it has been usual to place a reserve or sleeper fixture approximately 5 mm from the primary fixture as a backup in case the primary fixture fails to osseointegrate. This ipsilateral sleeper fixture is expensive, is often not used, and is placed in thinner calvarial bone where it is less likely to osseointegrate successfully. The authors have implanted the sleeper fixture on the contralateral side, with the additional objective of reducing the number of procedures for bilateral bone-anchored hearing aid implantation, providing a cost-effective use for the sleeper.

Methods:

The authors implanted the bone-anchored hearing aid sleeper fixture in the contralateral temporal bone instead of on the ipsilateral side in seven successive paediatric cases with bilateral conductive hearing loss requiring two-stage bone-anchored hearing aids, treated at the Royal Manchester Children's Hospital, UK.

Results:

The seven patients ranged in age from five to 15 years, with a mean age of 10 years; in addition, a 20-year-old with learning disability was also treated. In each case, the contralateral sleeper fixture was not needed as a backup fixture, but was used in four patients (57 per cent) as the basis for a second-side bone-anchored hearing aid.

Conclusions:

In children with bilateral conductive hearing loss, in whom a bilateral bone-anchored hearing aid is being considered and the second side is to be operated upon at a later date, we recommend placing the sleeper fixture on the contralateral side at the time of primary first-side surgery. Our technique provides a sleeper fixture located in an optimal position, where it also offers the option of use for a second-side bone-anchored hearing aid and reduces the number of procedures needed.

Keywords

Implants and ProsthesesHearing AidsConductive DeafnessChildBone Anchored Hearing Aids
Type
Short Communications
Information
The Journal of Laryngology & Otology , Volume 123 , Issue 5 , May 2009 , pp. 555 - 557
Copyright
Copyright © JLO (1984) Limited 2008

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Footnotes

Presented at the Bone Conduction Hearing and Osseo-Integration Conference, 14 July 2007, Halifax, Nova Scotia, Canada, and at the Fourth BAHA Professionals Conference, 23 May 2008, Exeter, UK.

References

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