Percutaneous titanium implants for bone conduction hearing aids. Experience with 283 cases

By virtue of direct bone conduction, percutaneous bone-anchored hearing implants offer a high level of wearing comfort, as well as audiologically superior signal transmission due to less dampening. Over the years, titanium implants have been optimized and the surgical technique developed into a minimally invasive intervention without soft tissue reduction. This study aims to investigate the success rates of the various percutaneous implant systems. This retrospective study includes 191 patients who received a total of 283 percutaneous titanium implants for bone conduction hearing systems during the period from 01.01.1989 until 31.12.2013. Patient age ranged from 2 to 81 years (mean 36 years). The mean follow-up duration was 5.2 years. The overall osseointegration success rate was 92.6 % and ranged from 90.5 to 100 % for the various implant systems (p = 0.6). For children and adolescents, the success rate was 86.8 %, compared to 95.2 % in adults (p = 0.023). Classical soft tissue reduction was received by 185 patients, mainly via the dermatome technique. The linear incision technique was used in 3.8 % of cases and the technique without soft tissue reduction in 3.7 % of cases. Revision surgery for soft tissue problems was performed in 4.2 % of cases. Success rates in adults were significantly higher than those in children and adolescents. Although success rates improved with the development of new systems, this did not reach statistical significance. Minimally invasive surgery without soft tissue reduction is considered state of the art.