Ethnic disparity in skin complications following bone-anchored hearing aid implantation.

OBJECTIVES: Sound processor loading after implantation of a bone-anchored hearing aid is often delayed by skin-site complications. This study examined the frequency of skin-site complications in various ethnic groups and determined factors that may lead to higher rates of skin-site complications resulting in delayed processor loading. METHODS: Adult, English-speaking patients who underwent implantation of a bone-anchored hearing aid between 2007 and 2010 were reviewed. Demographic data including ethnicity, tobacco use, diabetes mellitus, immunosuppression, and long-term steroid use were determined. Major and minor skin-site complications and the time to processor loading were recorded. RESULTS: The mean time to processor loading was 9.5 weeks, and the mean follow-up time was 23 months. There were no cases of osseointegration failure. African American patients had a significantly higher rate of major skin-site complications (p < 0.005) and a longer time to processor loading (mean, 17.6 weeks; p < 0.05) than the other ethnic groups. There was no significant difference in minor skin complication rates. There was no correlation between diabetes mellitus, long-term immunosuppression, or tobacco use and skin-site complications. CONCLUSIONS: Skin complications can delay processor loading following implantation of a bone-anchored hearing aid. There is a higher rate of major skin-site complications in African American patients, and these often delay processor loading. The risk of skin-site complications is not correlated with smoking, diabetes mellitus, or immunosuppression. An increased risk of skin-site complications is an important consideration for preoperative counseling.

Early loading after single-stage bone-anchored implantation in adults.

OBJECTIVE: Classically, processor loading after single-stage bone-anchored implantation (BAI) surgery follows a 3-month osseointegration period. The purpose of this study was to examine audiometric outcomes and postoperative complications in adult patients undergoing single-stage BAI with processor loading at less than 6 weeks postoperatively. STUDY DESIGN: Retrospective review. SETTING: Otology clinic in a tertiary care academic center. SUBJECTS AND METHODS: A retrospective review was performed of all adult patients (>18 years) undergoing BAI from 2007 to 2010. Sixty-four patients met inclusion criteria. Fifty-five patients had unilateral hearing loss, including single-sided deafness, conductive hearing loss, or mixed hearing loss. Nine patients had bilateral hearing loss. Patients were divided into groups based on time to processor loading (>12 weeks, <12 weeks, <6 weeks). All patients were loaded with the external processor at less than 6 weeks when possible. Preoperative and postoperative audiometric evaluations were performed. RESULTS: There were no cases of osseointegration failure. All groups showed significant improvement in audiometric testing using their BAI (P < .005), and there were no significant differences between patients loaded at less than 12 weeks and those loaded at less than 6 weeks (P > .05). Major skin complications were seen in 9% of subjects and minor complications in 30%. CONCLUSIONS: Single-stage BAI implantation with early processor loading is safe and effective in adults. All groups demonstrated significant audiometric benefit that was not affected in patients loaded early. Major and minor skin-site complications frequently delayed processor loading, but there were no cases of osseointegration failure in any group.