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      Evaluation of surgery and surgical results of Baha® Attract system implantations – single centre experience of hundred twenty five cases Translated title: Avaliação da cirurgia e resultados cirúrgicos dos implantes do sistema Baha® Attract – experiência de um único centro com cento e vinte e cinco casos

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          Abstract

          Introduction

          Bone-anchored hearing aids are currently well-established solutions for treatment of hearing-impaired patients.

          Objective

          To evaluate the surgery of the Baha® Attract system, healing process and soft tissue condition after the processor activation.

          Methods

          125 patients implanted with the Baha® Attract system during a 3 year period in a single ENT department were analysed. Evaluated parameters comprised: details of surgery, healing process and soft tissue condition at the time of the processor activation and on subsequent follow-up visits.

          Results

          The implantation was conducted under local anaesthesia in 96% of patients. The mean surgery time was 42 min. Soft tissue reduction was performed in 43.2% of cases; bone polishing in 23.2% and bipolar coagulation in all the cases. Healing was uneventful in 92.8%. 10 days after the surgery, pain was reported in 48% of cases. On subsequent follow-up visits, 1 month and 3 months after the surgery, pain was present in 18.4% and 2.4% of cases respectively. Similarly, numbness and paresthesia, initially reported in 84% and 15.2%, were present in 60% and 11.2% after a month, and in 17.6% and 1.6% after three months. After the processor attachment, no serious problems were observed in the analysed group during follow-up visits. However, mild redness and/or mild pain over the magnet were observed in 9.6% of patients.

          Conclusion

          Implantation of the Baha® Attract system is an easy and safe procedure. It can be performed under local anaesthesia in adults. There are no major surgical problems or complications, and the healing process proceeds efficiently in most patients. Postoperative pain is usually mild and gradually decreases in the following months. Numbness in the operated area is frequent, but as reinnervation occurs in time, the numb patch decreases in size and finally completely disappears in most cases.

          Resumo

          Introdução

          Os processadores de implantes auditivos de ancoragem óssea são atualmente soluções bem estabelecidas para o tratamento de pacientes com deficiência auditiva.

          Objetivo

          Avaliar a cirurgia de implante do sistema Baha® Attract, o processo de cicatrização e a condição dos tecidos moles após a ativação do processador.

          Método

          Foram analisados 125 pacientes implantados com o sistema Baha® Attract durante um período de 3 anos em um único departamento de otorrinolaringologia. Os parâmetros avaliados compreenderam: detalhes da cirurgia, processo de cicatrização e condição dos tecidos moles no momento da ativação do processador e nas consultas de seguimento subsequentes.

          Resultados

          O implante foi realizado sob anestesia local em 96% dos pacientes. O tempo médio de cirurgia foi de 42 minutos. A redução de tecido mole foi realizada em 43,2% dos casos; polimento ósseo em 23,2% e coagulação bipolar em todos os casos. A cicatrização transcorreu sem complicações em 92,8%. Dez dias após a cirurgia, dor foi relatada em 48% dos casos. Nas consultas de seguimento subsequentes, 1 mês e 3 meses após a cirurgia, a dor esteve presente em 18,4% e 2,4% dos casos, respectivamente. Da mesma forma, dormência e parestesia, inicialmente relatados em 84% e 15,2%, estavam presentes em 60% e 11,2% dos casos após um mês, e em 17,6% e 1,6% após três meses. Após a fixação do processador, nenhum problema grave foi observado no grupo analisado durante as consultas de seguimento. No entanto, vermelhidão leve e/ou dor leve sobre o ímã foram observados em 9,6% dos pacientes.

          Conclusão

          O implante do sistema Baha® Attract é um procedimento fácil e seguro. Ele pode ser realizado sob anestesia local em adultos. Não há grandes problemas ou complicações cirúrgicas, e o processo de cicatrização é contínuo e eficaz na maioria dos pacientes. No pós-operatório, a dor é geralmente leve e diminui gradualmente nos meses seguintes. A dormência na área operada é freqüente, mas como a reinervação ocorre com o tempo, a área dormente diminui de tamanho e finalmente desaparece por completo na maioria dos casos.

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          Most cited references18

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          Speech Understanding with a New Implant Technology: A Comparative Study with a New Nonskin Penetrating Baha System

          Objective. To compare hearing and speech understanding between a new, nonskin penetrating Baha system (Baha Attract) to the current Baha system using a skin-penetrating abutment. Methods. Hearing and speech understanding were measured in 16 experienced Baha users. The transmission path via the abutment was compared to a simulated Baha Attract transmission path by attaching the implantable magnet to the abutment and then by adding a sample of artificial skin and the external parts of the Baha Attract system. Four different measurements were performed: bone conduction thresholds directly through the sound processor (BC Direct), aided sound field thresholds, aided speech understanding in quiet, and aided speech understanding in noise. Results. The simulated Baha Attract transmission path introduced an attenuation starting from approximately 5 dB at 1000 Hz, increasing to 20–25 dB above 6000 Hz. However, aided sound field threshold shows smaller differences and aided speech understanding in quiet and in noise does not differ significantly between the two transmission paths. Conclusion. The Baha Attract system transmission path introduces predominately high frequency attenuation. This attenuation can be partially compensated by adequate fitting of the speech processor. No significant decrease in speech understanding in either quiet or in noise was found.
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            Long-term follow-up with the bone-anchored hearing aid: a review of the first 100 patients between 1977 and 1985.

            Skin-penetrating implants have been used since 1977 for retention of Bone Anchored Hearing Aids, or BAHA. This paper analyzes the stability of the implants and the frequency of skin reactions in the first one hundred consecutive patients operated upon at Sahlgrens Hospital, Göteborg. The follow-up time varied between 8 and 16 years. Ninety percent of the implants were found to be stable. Five percent were explanted due to direct trauma. Another five percent lost integration but often after many years in use. Adverse skin reactions were seen, but 79% of the patients had no or one single episode of soft tissue reaction. A percutaneous coupling in the mastoid process will give rise to only minor clinical problems and could be considered as a simple, predictable and safe device.
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              Surgical, functional and audiological evaluation of new Baha® Attract system implantations

              Bone-anchored hearing aids are well-established solutions for treatment of hearing-impaired patients. However, classical systems with percutaneous abutments have disadvantages concerning aesthetics, hygiene and adverse soft tissue reactions. The study aimed to evaluate surgical, functional and audiological results of a new Baha® Attract system, in which the sound processor is attached by magnetic force. Twenty patients implanted with a Baha® Attract system were divided into two groups: A—bilateral mixed and conductive hearing loss, B—single-sided deafness, and evaluated during a 6-month follow-up. Parameters analysed comprised: (1) surgery and wound healing, (2) postoperative functional results (GBI, APHAB and BAHU questionnaires), (3) audiological results (free field speech in noise audiometry in two situations: with signal from implant side and from contralateral side). Obtained results revealed: mean time of surgery—44 min, soft tissue reduction—30 %, bone polishing—20 %, haematoma—10 %. Functional results showed: GBI total score—29.6 points, APHAB global score mean gain—23.5 %, BAHU ‘good or very good’ score for: aesthetic—85 %, hygiene—100 %, ease of placing the processor—100 %, stability of attraction—75 %. Audiological results—mean gain for the two analysed situations: 32.9 % (group A—36.5 %, group B—27.5 %). To conclude, the data obtained prove the safety and effectiveness of the Baha® Attract system in patients with conductive and mixed hearing loss as well as in patients with single-sided deafness. Cosmetic aspects are highly acceptable and the idea of Attract itself is important for patients with limited manual dexterity.
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                Author and article information

                Contributors
                Journal
                Braz J Otorhinolaryngol
                Braz J Otorhinolaryngol
                Brazilian Journal of Otorhinolaryngology
                Elsevier
                1808-8694
                1808-8686
                31 May 2018
                Sep-Oct 2019
                31 May 2018
                : 85
                : 5
                : 597-602
                Affiliations
                [0005]Poznań University of Medical Sciences, Department of Otolaryngology and Laryngological Oncology, Poznań, Poland
                Author notes
                [* ]Corresponding author. wojgaw@ 123456interia.pl
                Article
                S1808-8694(18)30286-6
                10.1016/j.bjorl.2018.04.011
                9443060
                30098889
                23a61a0d-5e72-40b7-84a9-368af64011f8
                © 2018 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda.

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                : 28 February 2018
                : 25 April 2018
                Categories
                Original Article

                bone conduction,hearing aids,hearing loss,condução óssea,aparelhos auditivos,perda auditiva

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