title: One-stage vs. two-stage BAHA implantation in a pediatric population.
abstract: OBJECTIVE
  BAHA implantation surgery in a pediatric population is usually done in two-stage surgeries. This study aims to evaluate the safety and possible superiority of the one-stage over the two-stage BAHA implantation and which one would be the best standard of care for our pediatric patients.
  
  
  METHODS
  A retrospective chart review of 55 patients operated in our tertiary care institutions between 2005 and 2010 was conducted. The actual tendency in our institutions, applied at the time of the study, is to perform a one-stage surgery for all operated patients (pediatric and adult), except for patients undergoing translabyrinthine surgeries for cerebellopontine tumor excision. These patients indeed had a two-stage insertion. 26 patients underwent one-stage surgery (group I) while 29 patients had a two-stage (group II) BAHA insertion. A period of 4 months was allowed for osseointegration before BAHA processor fitting. As for the safety assessment of the one-stage surgery, we compared both groups regarding the incidence and severity (minor, moderate and major) of encountered complications, as well as the operating time and follow-up. The operating time of the two-stage surgery includes the time of the first and of the second stage.
  
  
  RESULTS
  The mean age at surgery was 8.5 years old for the group I and 50 years old for the group II patients. There was no difference in the incidence of minor (p=0.12), moderate (p=0.41) nor severe (p=0.68) complications between groups I and II. Two cases of traumatic extrusion were noted in the group I. Furthermore, the one-stage BAHA implantation requests a significantly lower operating time (mean: 54 [32-100] min) than the two-stage surgery (mean: 79 [63-148] min) (p=0.012). All pediatric cases of BAHA insertion were performed in a one day surgery. The mean postoperative follow-up was 114 and 96 weeks for groups I and II respectively (p=0.058).
  
  
  CONCLUSIONS
  One-stage BAHA insertion surgery in the pediatric population is a reliable, safe and efficient therapeutic option that allows a good result in a significantly lower operating time compared to the two-stage insertion and is achieved in a one day surgery. It could therefore be considered as a standard of care for pediatric patients.
authors.affiliation: Division of Otorhinolaryngology Head & Neck Surgery, University of Montreal, Otology and Neurotology, Sainte-Justine University Hospital Center (CHU SJ), and University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada. issam.saliba@umontreal.ca
authors.forename: Issam
authors.initials: I
authors.lastname: Saliba
authors.forename: Patrick
authors.initials: P
authors.lastname: Froehlich
authors.forename: Sarah
authors.initials: S
authors.lastname: Bouhabel
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001844:Bone Conduction / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006310:Hearing Aids; D006314:Hearing Loss, Conductive / Q000151:congenital / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D016348:Osseointegration / Q000502:physiology; D010372:Pediatrics; D019919:Prosthesis Implantation / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D053441:Suture Anchors; D016896:Treatment Outcome; D055815:Young Adult