132 Chapter 5 6 mm (23%), 9 mm (54%), 12 mm (8.6%) and 14 mm (2.9%). Of the 70 implants originally loaded with an abutment, there were seven fixture failures (10%). All occurring following implantation with the 3 mm fixture. Peri-abutment skin related complications were reported to affect eight implants (11.4%). Four peri-abutments skin problems were successfully treated with replacement with a longer abutment resulting in subsequent resolution of the skin issues. Two peri-abutment skin reactions required topical antibiotic treatment and one peri-abutment skin overgrowth required revision skin reduction surgery (1.4%). In patients below the age of five years, soft tissue complications, skin revision rates as well as traumatic and spontaneous fixture loss rates were higher [6]. 5 children in this very young age group were included in the study and interestingly, they showed favorable results although the sample size was small. It is concluded that the Oticon™ wide implant produces comparable results to previous studies with regards peri-abutment skin complications, revision surgery and, overall fixture loss. However, the results of this Birmingham paediatric BAHI series appears superior to previous implant systems used at Birmingham Women’s and Children’s Hospital (BWCH). Chapter 3 entitled “Clinical features of a novel laser ablated titanium Bone-Anchored Hearing implant” included two original published articles, one paper in a paediatric population and one paper specific to children with Down syndrome, including resonance frequency analyses. In chapter 3.1 a total of 115 consecutive paediatric patients aged 4 to 15 years were implanted with 176 laser ablated titanium bone anchored implants from January 2016 to January 2019. Clinical outcomes, implant failure rates and post implantation stability quotient (ISQ) scores were studied over the first 12-month period. A median 12-months survival of 96.6% was observed. Six implants (3.5%) were lost in total, one (0.6%) was lost due to trauma. Adverse skin reactions (Holger’s grade 2-4) were observed in 4.4% of all postoperative visits, occurring in 22 individuals (19.1%). The ISQ results, irrespective of abutment size, demonstrated an increasing trend from 49.1 to 57 over the 12 months review period. A statistically significant change was only demonstrated from the 3 months follow up assessment onwards. No relationship could be identified between the ISQ result and spontaneous fixture failures. It was concluded that the use of 4.5 mm wide ablated titanium bone anchored hearing implants resulted in superior survival rates and excellent clinical outcomes compared with previous
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