Chapter 2 46 with and of these 2 suffered with peri abutment skin issues (17%) and 1 fixture loss (8%). No revision surgery was required. Previous study in 2008 of 15 trisomy 21 patients demonstrated a 20% skin complication rate and a 0% fixture loss [28]. Therefore, the Oticon wide system does appear to also have favourable lower skin complication rates but a higher fixture failure rate in this subgroup. Comparison is again limited between these two studies as implant design and surgical techniques have changed over time. There is still some discussion regarding the minimum age for implantation [29]. Since the introduction of the softband in 2002 [30] and adhesive hearing aid systems in 2015 there are now non-surgical alternatives to allow hearing rehabilitation in the very young so relieving pressure to implant early. Although these two systems provide comparable audiological results [31], the output is lower than that found in percutaneous option even when powered processors are utilised. Percutaneous BAHI provides a higher quality audiological output, an important consideration with regards to hearing rehabilitation especially in regard to speech and language development in young children. In the under fives, there are reported soft tissue complication rate and revision rates of 42% and 25% respectively [32]. Our current review identified 5 children were under the age of five at implantation, one (20%) required revision, one (20%) required loading of sleeper following traumatic fixture loss and one (20%) reported skin complication. Spontaneous fixture loss was 0% in this group. In addition, concerns are raised regarding inadequate skull thickness in the very young which may prevent secure osseointegration. Thin calvarial thickness is also a common finding in children especially in those with a craniofacial abnormality such as Treacher-Collins syndrome and a minimum of 2.5-3 mm of skull thickness has been recommended as a minimum for a 3-4 mm fixture insertion to allow for osseointegration [33]. The results of this study are in keeping with the published literature regarding increased soft tissue complication rate in the paediatric population [26,27,28,29,33,34] and that BAHI implant losses do also appear to have a higher occurrence in the paediatric patients (p < 0.005) [29,35]. Other rare complications are reported in paediatric and adult patients which include subdural haematoma [36], intrusion injury [37,38] and intracerebral abscess [39], none of which were identified in our BCH cohort, but surgeons performing implantation should be aware of these occurring. Limitations The current study reports on long term outcomes of consecutively implanted children with the Oticon wide BAHI. The study includes surgeries performed between January 2014 and January 2016 and although retrospective in its data collection method the quality of information gathered was considered comprehensive as all patients’ records were identifiable
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