title: Clobetasol's Influence on the Management and Cost of Skin Overgrowth Associated with the Bone-Anchored Hearing Aid.
abstract: BACKGROUND
  Management of the skin/abutment interface in patients with bone-anchored hearing aids (BAHAs) can occasionally be a challenge. Even with the most compliant patients and the most intensive home/office treatment regimens, painful triamcinolone injections and revision surgery can become necessary. Such treatments can be associated with an inordinate cost burden. To our knowledge this research provides the first objective comparison of cost and patient outcomes after the introduction of topical 0.05% clobetasol cream for the care of the skin/abutment interface in patients with BAHAs.
  
  
  METHODS
  Thirty-three patients were managed with the traditional algorithm (local wound care, triamcinolone injection, and revision surgery). Nineteen patients were managed with the contemporary algorithm in which 0.05% topical clobetasol cream was added to the traditional treatment regimen.
  
  
  RESULTS
  Common postoperative skin reactions were comparable in the traditional vs contemporary treatment groups: granulation tissue (53.8% vs 56.3%), soft-tissue overgrowth (30.8% vs 18.8%), and both granulation tissue and soft-tissue overgrowth (15.4% vs 25.0%). The addition of clobetasol cream was associated with a marked decrease in the invasive treatment endpoints in the contemporary vs traditional treatment groups: triamcinolone injections (0.0% vs 12.1%) and surgical revision (0.0% vs 9.1%). The difference in cost for managing soft-tissue overgrowth at the abutment site was substantial, with the traditional treatment group averaging $2,773.25 per patient and the contemporary treatment group averaging $47.94 per patient (P<0.021) according to 2013 estimates and values.
  
  
  CONCLUSIONS
  Clobetasol use during early postoperative care of a BAHA implant dramatically decreases cost and improves treatment outcomes by reducing the need for invasive postoperative procedures to treat common postoperative skin reactions.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Tulane University School of Medicine, New Orleans, LA.
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Hildrew
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Tulane University School of Medicine, New Orleans, LA.
authors.forename: Jesse A
authors.initials: JA
authors.lastname: Guittard
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Tulane University School of Medicine, New Orleans, LA.
authors.forename: John M
authors.initials: JM
authors.lastname: Carter
authors.affiliation: Department of Otolaryngology, Ochsner Clinic Foundation, New Orleans, LA ; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Molony
keywords: Clobetasol; health care costs; hearing aids; hearing loss; postoperative complications; prostheses and implants