131 5 General Discussion General Discussion In the 45 years since the initial conception of the bone conduction hearing device (BCHD) there has been significant technological evolutions in both non-surgical and surgical applications. This innovation has created greater choice and can now be tailored to the patients’ audiological needs. These options have been evaluated in the wider literature over the past four decades proving that BCHDs are both safe, effective, and very well accepted by patients, both young and old alike. Chapter 2 The Oticon™ wide implant system was launched in 2009 and used at Birmingham Children’s Hospital from 2014. This chapter demonstrates the clinical outcomes of the Oticon™ wide implant (Oticon Medical), with a focus on skin complication rates and fixture loss over a 5-year period in a cohort of complex children, typical of those undergoing treatment in a Tertiary paediatric hospital. Innovations in Bone Anchored Hearing Implant (BAHI) systems have resulted in more stable implants since their commercial introduction and in 2009 a new implant was introduced. The new implant had a diameter of 4.5mm, from the previous 3.75mm width and the abutment structure had been altered from the previous cone shape to a bell shape. The larger implant diameter provided a larger bone-implant contact surface and was designed to improve osseointegration and the overall stability of the implant. The shape of the abutment aimed to reduce soft tissue complications and skin overgrowth. A systematic review published in 2020 by Kruyt et al [1] supported the finding that wider implants provided a greater stability and a reduction in spontaneous fixture loss in children. It demonstrated a 17.1% loss in smalldiameter implants compared to a 5.9% for wide diameter implants irrespective of any other design variation. This increasing evidence for better stability allowed at this same time, a shift towards utilizing longer abutments at the primary placement [2]. This provided superior soft tissue tolerability, [3,4,5]. Both Cochlear and Oticon increased the range of available abutments lengths which could be attached to their implant. Cochlear provided 6, 9 and 12 mm abutments and Oticon provided 6, 9, 12 and 14 mm abutments respectively. Chapter 2 presents the review of 47 children who underwent BAHI implantation with the wide Oticon™ implant between January 2014 and December 2015 with a total of 70 implants: 24 (51%) unilateral and 23 (49%) bilateral implantations. The mean age was 9 years 6 months. All were performed with two staged procedures. Of those 70 implants, 49 (56%) had a 3 mm length and 21 (30%) 4 mm length. The length of the applied abutments at second stage surgery was
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