(1016) Does Device Selection or Age Impact Complication Rates for Bone-Anchored Hearing Systems?

Introduction: There are several bone-anchored hearing implants (BAHI) available including the BAHA Connect, Attract, and OSIA systems. While the percutaneous devices have a high rate of skin issues at the site of the device, limited data is available comparing complication rates between the transcutaneous BAHA Attract and OSIA. The objective of this study is to compare rates of postoperative complications between these systems. Because OSIA placement is only FDA approved for children 12 years and older, subgroup analysis was performed to determine the rate of complications between off label OSIA placement in children less than 12 years old compared to FDA approved patients 12 years and older.

Methods: A retrospective chart review of pediatric patients implanted with BAHIs from our institution between 2018-2023 was performed. Subgroup analysis was subsequently performed to compare complication rates between patients ≥12 years old and those ages 0-11.

Results: In total, 65 patients with 86 devices were included. The mean age was 11.8 years old. Of the total, 33 patients were under 12, while 32 patients were 12 years old or older. BAHA Connect was implanted in 12 ears, 28 with BAHA Attract, 36 with OSIA, and 9 with other devices. The most common complication was chronic wound irritation (6.2%), followed by persistent pain at the implant site (4.6%). The BAHA Connect was associated with the highest overall complication rate (33%), most commonly skin irritation at the abutment site. The transcutaneous devices had a lower overall complication rate, (21% for BAHA Attract, 9% for OSIA), most commonly persistent discomfort at the site. Overall complication rates between the younger and older groups were similar (16% in under 12 years old and 17% in 12 and older).

Conclusions: Fully implanted BAHI devices avoid the local skin complications associated with the percutaneous devices but are associated with a risk of long term discomfort at the surgical site which can impact patient use. No significant difference was identified between younger patients undergoing early OSIA placement compared to those 12 years and older.