Five year clinical outcomes and evaluation of the Oticon 4.5mm 45 2 4. Discussion The Birmingham Children’s Hospital is a tertiary referral centre in the UK which can account for the heterogeneous population with multiple medical comorbidities and the spread of ages seen in this current study group. This is reflective of the previous experiences reported in Birmingham. 4.1. Comparison with other studies To better understand the performance of the Oticon™ wide implant we can compare our current results to studies published from research undertaken on a similar patient demographic with the previous generations of BAHI at BCH. The largest comparable study was published in 2009 which included 174 children under the age of 16 years, who were implanted with the traditional Branemark flanged fixture. The outcomes were reported with a soft tissue complication rate of 17%, revision surgery 8% and 14% fixture loss [26], however at this time a split skin graft technique was used, and this fixture was of narrower diameter. Recent review of the Cochlear™ BIA300 BAHI (4.5 mm) at BCH in children aged between 3 and 16 years demonstrated a 5% fixture loss. Significant soft tissue complications were noted which required additional visits to nurse practitioner in 77% of implants, systemic antibiotics treatment in 35% and a revision rate of 35% due to skin overgrowth [27]. Therefore, soft tissue outcome of the Oticon wide implant system is a significant improvement over this previous generation of implant with revision surgery required in only 1.4% of implants and soft tissue reactions in 11.4%. However, it is important to consider that complication rates are influenced not only by the shape of BAHI but also the surgical technique used. A dermatome was applied in 57% of patients in the BAI300 study which I no longer the current practice at BCH and the length of follow up varies between these three studies makes comparison limited. Even with this considered soft tissue complication have improved with the adoption of a wider implanted fixture. Fixture failures of the Oticon wide implant is higher than that of the BAI300 at 10% and 5% respectively but this is likely due to the longer duration of follow up 5.4yrs vs a mean of 3.5yr and a smaller sample size in the previous study (n = 52). With a possible higher failure rate, the Oticon BAHI is still favourable due to the significant reduction is soft tissue compilation and implication this has on revision surgery and quality of life. Both studies provide evidence that a wider fixture improves on both survivability and soft tissue reaction in the population served by BCH. In addition, direct comparison of implant outcomes of the trisomy 21 subgroup data can be made to previous findings at this centre. 12 Trisomy 21 patients were included in this study
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