Hostname: page-component-76fb5796d-25wd4 Total loading time: 0 Render date: 2024-04-26T14:37:58.362Z Has data issue: false hasContentIssue false
  • English
  • Français

Peri-operative cerebrospinal fluid leak during single-stage bone-anchored hearing aid implantation: case report

Published online by Cambridge University Press:  11 November 2014

G Dimbleby ,
A Mitchell-Innes  and
J Murphy
G Dimbleby*
Affiliation:
Department of Otolaryngology Head and Neck Surgery, Russells Hall Hospital, Dudley, UK
A Mitchell-Innes
Affiliation:
Department of Otolaryngology Head and Neck Surgery, Russells Hall Hospital, Dudley, UK
J Murphy
Affiliation:
Department of Otolaryngology Head and Neck Surgery, Russells Hall Hospital, Dudley, UK
*
Address for correspondence: Miss G Dimbleby, Department of Otolaryngology Head and Neck Surgery, Russells Hall Hospital, Dudley DY1 2HQ, UK E-mail: gdimbleby@doctors.org.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

A bone-anchored hearing aid uses the principle of bone conduction and osseointegration to transfer sound vibrations to a functioning inner ear. It consists of a permanent titanium implant, and removable abutment and sound processor. Informed consent requires discussion of the procedural benefits, alternatives and complications. The risks of bone-anchored hearing aid surgery include infection, soft tissue hypertrophy, skin graft or flap failure, osseointegration failure, and the need for further surgery.

Case report:

A case of cerebrospinal fluid leak in a patient undergoing bone-anchored hearing aid surgery is reported and discussed.

Conclusion:

Bone-anchored hearing aid surgery poses a risk of breaching the inner table of the temporal bone and dura, resulting in a cerebrospinal fluid leak; the risk of meningitis is rare but serious. The surgeon should discuss the possibility of cerebrospinal fluid leak when consenting patients. Pre-operative computerised tomography scanning should be considered in certain individuals to aid implant placement.

Keywords

Informed ConsentHearing AidTemporal BoneCerebrospinal Fluid
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 128 , Issue 12 , December 2014 , pp. 1111 - 1113
Copyright
Copyright © JLO (1984) Limited 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1ENT UK Indications for Bone Anchored Hearing Aid: Position Paper ENT UK 2010. In: https://www.entuk.org/sites/default/files/files/bone_anchored_hearing_aid.pdf [18 July 2014]Google Scholar
2Tjellstrom, A, Hakansson, B, Granstrom, G. Bone-anchored hearing aids: current status in adults and children. Otolaryngol Clin North Am 2001;34:337–64CrossRefGoogle ScholarPubMed
3Lloyd, S, Almeyda, J, Sirimanna, KS, Albert, DM, Bailey, CM. Updated surgical experience with bone-anchored hearing aids in children. J Laryngol Otol 2007;121:826–31Google Scholar
4Department of Health. Reference guide to consent for examination or treatment, second edition. In: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_103643 [18 July 2014]Google Scholar
5Parliament Publications and Records. Judgements - Chester (Respondent) v. Afshar (Appellant). In: http://www.publications.parliament.uk/pa/ld200304/ldjudgmt/jd041014/cheste-5.htm [18 July 2014]Google Scholar
6Chan, FM, Pantelides, H, Kim, AH. Cerebral spinal fluid leak associated with bone-anchored hearing aid screw removal. Otolaryngol Head Neck Surg 2013;148:1059–60CrossRefGoogle ScholarPubMed
7Scholz, M, Eufinger, H, Anders, A, Illerhaus, B, Konig, M, Schmieder, K. Intracerebral abscess after abutment change of a bone anchored hearing aid (BAHA). Otol Neurotol 2003;24:896–9CrossRefGoogle ScholarPubMed
8Deitmer, T, Krassort, M, Hartmann, S. Two rare complications in patients with bone-anchored hearing aids [in German]. Laryngorhinootologie 2003;82:162–5Google Scholar
9Mesfin, F, Perkins, NW, Brook, C, Foyt, D, German, JW. Epidural hematoma after tympanomastoidectomy and bone-anchored hearing aid (BAHA) placement: case report. Neurosurgery 2010;67:1451–3CrossRefGoogle ScholarPubMed
10GMC Consent guidance: patients and doctors making decisions together. In: http://www.gmc-uk.org/guidance/ethical_guidance/consent_guidance_discussing_side_effects_and_complications.asp [18 July 2014]Google Scholar
11Cochlear™ Baha® 3 surgery guide. In: http://www.cochlear.com/wps/wcm/connect/144a5c9b-e73c-49d8-8b83-49283d1b199a/BUN004+ISS1+SEP10+Baha+Surgery+Guide+Final.pdf?MOD=AJPERES&CACHEID=144a5c9b-e73c-49d8-8b83-49283d1b199a [10 September 2014]Google Scholar
12Ponto System – Surgical Manual. In: http://www.oticonmedical.com/~asset/cache.ashx?id=7171&type=14&format=web [10 September 2014]Google Scholar
13Moorthy, RK, Sarkar, H, Rajshekhar, V. Conservative antibiotic policy in patients undergoing non-trauma cranial surgery does not result in higher rates of postoperative meningitis: an audit of nine years of narrow-spectrum prophylaxis. Br J Neurosurg 2013;27:497–502CrossRefGoogle Scholar
14Novakovic, D, Meller, CJ, Makeham, JM, Brazier, DH, Forer, M, Patel, NP. Computed tomographic analysis of outer calvarial thickness for osseointegrated bone-anchored hearing system insertion. Otol Neurotol 2011;32:448–52CrossRefGoogle ScholarPubMed
15Cochlear™ Baha® Referral Guideline. In: http://professionals.cochlearamericas.com/sites/default/files/resources/FUN1020_ISS3_Dec1_Sell_Sheet.pdf [10 September 2014]Google Scholar
16Oticon Medical: Introduction to the Ponto Bone Anchored System. In: http://www.audiologyonline.com/articles/oticon-medical-introduction-to-ponto-6580 [10 September 2014]Google Scholar