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      Single-Stage BAHA and Mastoid Obliteration


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          A single-stage fitting of a bone-anchored hearing aid (BAHA) implant and abutment with mastoid obliteration both obviates the need for two separate procedures and utilises the BAHA soft tissue reduction in the mastoid obliteration. Such a procedure has good outcomes in terms of osseointegration and achieving a dry ear. We present a 6-patient case series report highlighting the technique of combined BAHA insertion and mastoid obliteration in six patients. All patients at twelve-month followup have a good degree of sound localisation and hearing thresholds with their BAHA and are free from the social stigma associated with a foul smelling discharging ear.

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          Bone-anchored hearing aids: current status in adults and children.

          The BAHA is the only cochlea stimulator in clinical use using bone conduction as the mode of stimulation. Sound transmitted through bone conduction is a natural way of hearing and the fundamentals of bone conduction are presented. The simple but important procedure has been refined and is presented in some detail. As the BAHA is approved by the Food and Drug Administration for children, aspects relevant for this age group will be addressed. The future includes semi-implantable BAHA, percutaneous electrical coupling, and a BAHA for tinnitus suppression.
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            Indications for and outcomes of mastoid obliteration in cochlear implantation.

            To review the indications, efficacy, and long-term outcomes of mastoid obliteration in cochlear implant surgery. Retrospective case review. Tertiary referral center. Seventeen patients who underwent a mastoid obliteration procedure to facilitate the insertion of a cochlear implant between 1978 and 2005. Mastoid obliteration procedure before cochlear implantation. Revision rate of the mastoid obliteration and cochlear implantation, postoperative audiometric scores (consonant-nucleus-consonant words/phonemes, Central Institute for the Deaf sentences, City University New York sentences in quiet and in noise), and incidence of complications. There were 17 patients with a median age of 60 years (range, 3-79 yr). Eight patients required mastoid obliteration for active chronic suppurative otitis media before cochlear implantation. Another 8 patients had existing mastoid cavities requiring obliteration (modified radical [n = 5] and fenestration cavities [n = 3]). A single patient with a sclerotic mastoid and an anterior sigmoid sinus underwent obliteration because of inadequate surgical access. The technique of obliteration was radical mastoidectomy with eustachian tube occlusion, blind sac closure of the external auditory canal, and cavity obliteration with either temporalis muscle flap (n = 15) or abdominal fat (n = 2). Cochlear implantation and mastoid obliteration were performed as a two-stage procedure in 10 patients and as a single-stage procedure in 7. Two patients required revision of the mastoid obliteration. At follow-up, all patients had stable obliterated cavities. Fifteen patients obtained significant improvement in speech discrimination scores, whereas 2 patients obtained some benefit from the cochlear implant through the perception of environmental sounds. For patients with chronic suppurative otitis media or existing mastoid cavities, the obliteration with temporalis muscle or abdominal fat is an effective technique to facilitate safe cochlear implantation.
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              Postauricular periosteal-pericranial flap for mastoid obliteration and canal wall down tympanomastoidectomy.

              To describe an effective technique for mastoid cavity obliteration in canal wall down tympanomastoidectomy for chronic otitis media and review its efficacy in producing a dry, low-maintenance, small mastoid cavity. : Retrospective clinical study of a consecutive series of procedures from 1995 to 2000. Tertiary referral center and institutional academic practice in otology and neurotology. Sixty consecutive procedures for active chronic otitis media with a minimum follow-up of 12 months (mean, 31 mo; range, 12-80 mo). All patients had canal wall down mastoidectomy with simultaneous tympanoplasty including split-thickness skin grafting. An inferiorly pedicled, periosteal-pericranial flap was used in conjunction with autologous bone pate to obliterate the mastoid cavity. The additional length provided by the pericranial extension of the flap permitted it to reach superior to the lateral canal and into the sinodural angle, with improved coverage of bone pate and better reduction of cavity size. The primary outcome measure was control of suppuration and creation of a dry, low-maintenance mastoid cavity, which was assessed using a previously developed semiquantitative scale. This scale includes a temporal dimension to assess control of infection. Secondary outcome measures included postoperative complications (i.e., hematoma, infection, flap necrosis, and meatal stenosis) and incidence of recurrent or residual cholesteatoma. Forty-nine ears (82%) maintained a small, dry, healthy mastoid cavity. Five ears (8%) had intermittent otorrhea easily controlled by topical treatment. Six ears (10%) had suboptimal control of otorrhea, of which four had meatal stenosis. There were no residual or recurrent cholesteatomas. Outcomes remained stable over progressively longer follow-up, up to 80 months. Obliteration of a canal wall down mastoid cavity by a postauricular periosteal-pericranial flap with autologous bone pate is a reliable and effective technique that results in a dry, trouble-free mastoid cavity in 90% of patients with active chronic otitis media.

                Author and article information

                Int J Otolaryngol
                Int J Otolaryngol
                International Journal of Otolaryngology
                Hindawi Publishing Corporation
                10 October 2012
                : 2012
                : 765271
                ENT Department, Queen Elizabeth Hospital, Birmingham, B15 2WB, UK
                Author notes

                Academic Editor: Leonard P. Rybak

                Copyright © 2012 Ajith George et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                : 21 July 2012
                : 17 September 2012
                Clinical Study



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