BAHA SURGERY COMPLICATIONS - Alexorl

1 baha SURGERY baha SURGERY COMPLICATIONSCOMPLICATIONS27thAlexandria International Combined ORL CongressAlexandria, Egypt April 9, 2009 Antonio De la Cruz, MDH E I tit t L Al C lifiHouse Ear Institute Los Angeles, CaliforniaAntonio De la Cruz, MD27th Alexandria International Combined ORL CongressgAlexandria, Egypt April 8, 2009 baha baha Direct Bone ConductionW k i dd tl f l d Works independently of ear canal and middle ear Direct transmission gives clear sound Preoperative testing possible Preoperative testing possible High wearing comfort Safe and simple surgeryBAHA baha 1977 (Tjellstrom et al., 1981) bbG teborg, SueciaG teborg, SueciaBAHA Clinical Indications-Conductive hearing loss-Mixed hearing loss In patients who are unable to use standard air-conduction aid and cannot or decline to be helped by reconstructivebe helped by reconstructive ear surgeryUnilateral sensorineuralUnilateral sensorineuralhearing loss as a CROS Hearing AidgBAHA Cli i l I diiBAHA Clinical Indications Acoustic neuroma Unilateral sudden hearing loss Inoperable atresias EAC Inoperable atresias EAC Chronic external otitis Tumors EAC and middle earBAHA Clinical Indications Recurrent stenosis EAC Ibl dti HL Inoperable conductive HL Conductive HL in only hearing earyg Large mastoidectomy cavities->feedbackSURGERYS urgical ProcedureSurgical ProcedureSurgical ProcedureSurgical ProcedureBAHA in ChildrenBAHA in Children Minimum Minimum 5 of boneof bone33fi tfi t 33--mm fixturemm fixture Second fixture (sleeper)Second fixture (sleeper)

2 3 3 to to 6 6 months waiting period between stages months waiting period between stages (range up to (range up to 15 15 mo in </mo in </55y)y)(gp(gpy)y) Fitting Fitting 6 6 to to 8 8 weeks after stage weeks after stage 22 DELAYED HEALINGDELAYED HEALING Hair lossHair loss Bone exposureBone exposure Without infecciWithout infecciononWithout infecciWithout infecciononBAHABAHA: baha :COMPLICATIONSCO MPLICATIONSBAHA SURGICAL COMPLICATIONSBAHA: SURGICAL COMPLICATIONS IntraoperativeIntraoperativeSigmoid Sin s Pe fo atioSigmoid Sin s Pe fo ationn Sigmoid Sinus PerforatioSigmoid Sinus Perforationn Insufficient thicknes of Insufficient thicknes of temporal squamatemporal squama CSF leakCSF leakPiPi PostoperatoriasPostoperatorias-- Soft tissue infectionsSoft tissue infections-- Flap NecrosisFlap Necrosis-- Oseointegration failure Oseointegration failureMeningitis IC abcessMeningitis IC abcess--Meningitis, IC abcessMeningitis, IC abcessComplications in 150 patientsimplanted with a BAHAN umber (%)Complicationsimplanted with a BAHAN umber (%)Complications11 ( )Skin overgrowing abutmentabutment5 ( )Implant extrusion2 ( )Wound infection1( )Flap necrosis1 ( )Flap necrosisHouse J, Kutz W, Otol Neurotol 2007 ComplicationsSkin overgrowing the abutment 11 patients ( ) 3 to 24 months after SURGERY (mean = 12 months)months)

3 Possible inciting Possible inciting factors Low placement Low placement Not wearing speech processor Allergy to titanium?House J, Kutz W, Otol Neurotol 2007 Implant ComplicationsImplant ComplicationsImplant ComplicationsImplant COMPLICATIONS (6(6--15%)15%)(()) Regular hygieneRegular hygiene Delayed healingDelayed healing Skin infection/overSkin infection/over--growthgrowth Tamovate Ung. % TID Post Post--op use of healing capop use of healing cap Osteointegration failureOsteointegration failure Traumatic fixture lossTraumatic fixture lossAntonio De la Cruz, MD27th Alexandria International Combined ORL CongressgAlexandria, Egypt April 9, 2009 baha SURGERY baha SURGERY COMPLICATIONSCOMPLICATIONS27thAlexandria International Combined ORL CongressAlexandria, Egypt April 9, 2009 Antonio De la Cruz, MDH E I tit t L Al C lifiHouse Ear Institute Los Angeles, California