title: Ethnic disparity in skin complications following bone-anchored hearing aid implantation.
abstract: OBJECTIVE
  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.
authors.affiliation: University of Miami Ear Institute, Department of Otolaryngology, Miami, Florida, USA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Zeitler
authors.forename: Bjorn S
authors.initials: BS
authors.lastname: Herman
authors.forename: Hillary A
authors.initials: HA
authors.lastname: Snapp
authors.forename: Fred F
authors.initials: FF
authors.lastname: Telischi
authors.forename: Simon I
authors.initials: SI
authors.lastname: Angeli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001844:Bone Conduction; D017439:Cicatrix, Hypertrophic / Q000209:etiology*; D019929:Cochlear Implantation / Q000009:adverse effects; D003054:Cochlear Implants / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007627:Keloid / Q000209:etiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016348:Osseointegration; D044469:Racial Groups; D012189:Retrospective Studies; D012871:Skin Diseases / Q000209:etiology* / Q000628:therapy; D014945:Wound Healing; D055815:Young Adult