title: Bone-anchored hearing aid: a comparison of surgical techniques.
abstract: OBJECTIVE
  To determine which bone-anchored hearing aid (BAHA) implantation surgical technique is associated with the fewest major postoperative complications and shortest time between surgery and use of the BAHA. The techniques evaluated were 1) a free retroauricular "full-thickness" skin graft, 2) a pedicled parieto-occipital epidermal graft, 3) a dermatome-pedicled parieto-occipital dermal graft, and 4) two broad pedicled local epidermal skin envelopes/skin flaps.
  
  
  METHODS
  Retrospective case study.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  One hundred forty-three patients who received a BAHA at Maastricht University Medical Center between November 1996 and January 2007. Number and mean age of patients in each group: Technique 1 (n = 30; mean age, 55 yr), Technique 2 (n = 45; mean age, 54 yr), Technique 3 (n = 47; mean age, 55 yr), and Technique 4 (n = 21; mean age, 54 yr).
  
  
  METHODS
  Cumulative proportion of implants that remained free of major complications versus follow-up interval, time between surgery and use of BAHA.
  
  
  RESULTS
  Technique 4 (2 broad pedicled local epidermal envelopes/skin flaps) has a significantly higher proportion of implants that remained free of major complications during first year of follow-up (91%; p = 0.021). Pairwise comparisons revealed that Technique 4 also has a significantly shorter time until use (2 mo) than Techniques 1 (2.5 mo), 2, and 3 (both 2.3 mo).
  
  
  CONCLUSIONS
  Two broad pedicled, local epidermal envelopes/flaps are associated with significantly fewer major complications and have one of the shortest times between surgery and use of the BAHA. The use of a dermatome is not associated with fewer major complications. We recommend Technique 4 as the preferred standard in BAHA surgery to minimize complications, postoperative medication, discomfort, and cost.
authors.affiliation: Department of Otolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands. raymond.vande.berg@mumc.nl
authors.forename: Raymond
authors.initials: R
authors.lastname: van de Berg
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stokroos
authors.forename: Janny R
authors.initials: JR
authors.lastname: Hof
authors.forename: Michelene N
authors.initials: MN
authors.lastname: Chenault
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006310:Hearing Aids; D034381:Hearing Loss / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D018579:Patient Selection; D011183:Postoperative Complications; D019919:Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods*; D012044:Regression Analysis; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome