title: Stability and survival of bone-anchored hearing aid implant systems in post-irradiated patients.
abstract: Bone-anchored hearing aids (BAHAs) are based on the principle of osseointegration, which is fundamental to implant stability and survival. Previous exposure to ionising radiation may compromise this, as evidenced in relation to dental and craniofacial implants. There is a dearth of data, however, regarding BAHA implant systems in patients with previously irradiated implant sites. We sought, therefore, to investigate implant stability and survival in such patients. Patients were identified retrospectively from our electronic BAHA database. Hospital records were reviewed for demographics; operative technique; complications; and details regarding previous irradiation. Implant stability was assessed by resonance frequency analysis (RFA), generating a numerical value-implant stability quotient (ISQ). Extrapolating from dental studies, successfully loaded implants typically have ISQs of ≥60. Readings were, therefore, interpreted with respect to this. Seven patients were identified for inclusion. Mean time between irradiation and implant insertion was 33 months (range 16-72 months), and mean time from implant insertion to RFA measurement was 41 months (range 3-96 months). Operatively, all patients underwent single-stage procedures under local anaesthesia. One patient suffered a Holger's grade 2 skin reaction, while two suffered significant skin flap failure, requiring revision procedures. The implant survival rate was 100 %. All ISQ values were >60, with a mean of 66.9 (95 % confidence interval 63.1-70.6). Our data support sufficient osseointegration of BAHA implant systems in post-irradiated patients, but highlight issues with wound healing. Contemporary soft tissue preservation operative techniques will likely overcome this, facilitating safe and efficacious BAHA insertion in this ever-increasing group of patients.
authors: Department of Otorhinolaryngology, Head and Neck Surgery, Countess of Chester Hospital, Chester, CH2 1UL, UK, mdwilkie@doctors.org.uk.
authors: Mark D
authors: MD
authors: Wilkie
authors: Kathryn A
authors: KA
authors: Lightbody
authors: Ali A
authors: AA
authors: Salamat
authors: Kalyan M
authors: KM
authors: Chakravarthy
authors: David A
authors: DA
authors: Luff
authors: Robert H
authors: RH
authors: Temple
mesh_terms: D000069343:Bone-Implant Interface / Q000503:physiopathology / Q000528:radiation effects; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy / Q000534:rehabilitation / Q000601:surgery; D006310:Hearing Aids; D006801:Humans; D008297:Male; D008875:Middle Aged; D016348:Osseointegration / Q000528:radiation effects*; D011475:Prosthesis Failure / Q000528:radiation effects*; D011878:Radiotherapy / Q000009:adverse effects*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing / Q000528:radiation effects