European Archives of Oto-Rhino-Laryngology

, Volume 273, Issue 3, pp 559–565 | Cite as

A systematic review on skin complications of bone-anchored hearing aids in relation to surgical techniques

  • Shwan Mohamad
  • Imran Khan
  • S. Y. Hey
  • S. S. Musheer Hussain
Review Article


A systematic review to study the skin complications associated with the bone-anchored hearing aid in relation to surgical techniques. The following databases have been searched: MEDLINE, EMBASE, the Cochrane Library , Google scholar and the PubMed. The literature search date was from January 1977 until November 2013. Randomised controlled trials and retrospective studies were included. Initial search identified 420 publications. Thirty articles met the inclusion criteria of this review. The most common surgical techniques identified were full-thickness skin graft, Dermatome and linear incision techniques. The result shows that dermatome technique is associated with higher rate of skin complications when compared to linear incision and skin graft techniques. Based on the available literature, the use of a linear incision technique appears to be associated with lower skin complications; however, there is limited data available supporting this. Higher quality studies would allow a more reliable comparison between the surgical techniques.


Prosthesis and implants Hearing aids Complications 


Conflict of interest

There is no conflict of interest in this study. None of the authors have any financial and personal relationships with other people or organisations that could inappropriately influence (bias) their work.


  1. 1.
    Medical Advisory Secretariat Ministry of Health and Long-Term Care Ontario Health Technology Assessment Series (2002) Bone anchored hearing aid. Accessed 12 January 2012
  2. 2.
    Proops DW (1996) The Birmingham bone anchored hearing aid programme: surgical methods and complications. J Laryngol Otol Suppl 21:7–12PubMedGoogle Scholar
  3. 3.
    Tjellstrom A (1989) Osseointegration systems and their applications in the head and neck. Adv Otolaryngol Head Neck Surg 3:39–70Google Scholar
  4. 4.
    Holgers KM, Roupe G, Tjellstrom A, Bjursten LM (1992) Clinical, immunological and bacteriological evaluation of adverse reactions to skin-penetrating titanium implants in the head and neck region. Contact Dermatitis 27:1–7CrossRefPubMedGoogle Scholar
  5. 5.
    Holgers KM, Tjellström A, Bjursten LM, Erlandsson BE (1988) Soft tissue reactions around percutaneous implants: a clinical study of soft tissue conditions around skin-penetrating titanium implants for bone-anchored hearing aids. Am J Otol 9:56–59PubMedGoogle Scholar
  6. 6.
    Van Rompaey V, Claes G, Verstraeten N, van Dinther J, Zarowski A, Offeciers E et al (2011) Skin reactions following BAHA surgery using the skin flap dermatome technique. Eur Arch Otorhinolaryngol 268:373–376CrossRefPubMedGoogle Scholar
  7. 7.
    House John W, Kutz JW Jr (2007) Bone-anchored hearing aids: incidence and management of postoperative complication. Otol Neurotol 28:213–217CrossRefPubMedGoogle Scholar
  8. 8.
    Tania K, Colin B, Michel N, Fisher K (2011) Complications of bone-anchored hearing aids in pediatric patients. Int J Pediatr Otorhinolaryngol 75:749–753CrossRefGoogle Scholar
  9. 9.
    Tamarit Conejeros JM, Dalmau Galofre J, Murcia Puchades V, Pons Rocher F, Fernández Martínez S, Estrems Navas P (2009) Comparison of skin complications between dermatome and U-graft technique in BAHA surgery. Acta Otorrinolaringol Esp 60:422–427CrossRefPubMedGoogle Scholar
  10. 10.
    Shirazi MA, Marzo SJ, Leonetti JP (2006) Perioperative complications with the bone-anchored hearing aid. Otolaryngol Head Neck Surg 134:236–239CrossRefPubMedGoogle Scholar
  11. 11.
    Stalfors J, Tjellström A (2008) Skin reactions after BAHA surgery: a comparison between the U-graft technique and the BAHA dermatome. Otol Neurotol 29:1109–1114CrossRefPubMedGoogle Scholar
  12. 12.
    Van de Berg R, Stokroos RJ, Hof JR, Chenault MN (2009) Bone-anchored hearing aid: a comparison of surgical techniques. Otol Neurotol 31:129–135CrossRefGoogle Scholar
  13. 13.
    Wilkinson EP, Luxford WM, Slattery WH 3rd, De la Cruz A, House JW, Fayad JN (2009) Single vertical incision for Baha implant surgery: preliminary results. Otolaryngol Head Neck Surg 140:573–578CrossRefPubMedGoogle Scholar
  14. 14.
    De Wolf MJ, Hol MK, Mylanus EA, Cremers CW (2009) Bone-anchored hearing aid surgery in older adults: implant loss and skin reactions. Ann Otol Rhinol Laryngol 118:525–531CrossRefPubMedGoogle Scholar
  15. 15.
    Faber HT, de Wolf MJ, de Rooy JW, Hol MK, Cremers CW, Mylanus EA (2009) Bone-anchored hearing aid implant location in relation to skin reactions. Arch Otolaryngol Head Neck Surg 135:742–747CrossRefPubMedGoogle Scholar
  16. 16.
    Van der Pouw CT, Mylanus EA, Cremers CW (1999) Percutaneous implants in the temporal bone for securing a bone conductor: surgical methods and results. Ann Otol Rhinol Laryngol 108:532–536CrossRefPubMedGoogle Scholar
  17. 17.
    De Wolf MJ, Hol MK, Huygen PL, Mylanus EA, Cremers CW (2008) Nijmegen results with application of a bone-anchored hearing aid in children: simplified surgical technique. Ann Otol Rhinol Laryngol 117:805–814CrossRefPubMedGoogle Scholar
  18. 18.
    Lekakis GK, Najuko A, Gluckman PG (2005) Wound related complications following full thickness skin graft versus split thickness skin graft on patients with bone anchored hearing aids. Clin Otolaryngol 30:324–327CrossRefPubMedGoogle Scholar
  19. 19.
    Woolford TJ, Morris DP, Saeed SR, Rothera MP (1999) The implant-site split-skin graft technique for the bone-anchored hearing aid. Clin Otolaryngol Allied Sci 24:177–180CrossRefPubMedGoogle Scholar
  20. 20.
    Wazen JJ, Young DL, Farrugia MC, Chandrasekhar SS, Ghossaini SN, Borik J et al (2008) Successes and complications of the Baha system. Otol Neurotol 29:1115–1119CrossRefPubMedGoogle Scholar
  21. 21.
    Lloyd S, Almeyda J, Sirimanna KS, Albert DM, Bailey CM (2007) Updated surgical experience with bone-anchored hearing aids in children. J Laryngol Otol 121:826–831PubMedGoogle Scholar
  22. 22.
    Gillett D, Fairley JW, Chandrashaker TS, Bean A, Gonzalez J (2006) Bone-anchored hearing aids: results of the first eight years of a programme in a district general hospital, assessed by the Glasgow benefit inventory. J Laryngol Otol 120:537–542CrossRefPubMedGoogle Scholar
  23. 23.
    Reyes RA, Tjellstrom A, Granstrom G (2000) Evaluation of implant losses and skin reactions around extraoral bone-anchored implants: a 0- to 8-year follow-up. Otolaryngol Head Neck Surg 122:272–276CrossRefPubMedGoogle Scholar
  24. 24.
    Papsin BC, Sirimanna TK, Albert DM, Bailey CM (1997) Surgical experience with bone-anchored hearing aids in children. Laryngoscope 107:801–806CrossRefPubMedGoogle Scholar
  25. 25.
    Kiringoda R, Lustig LR (2013) A meta-analysis of the complications associated with osseointegrated hearing aids. Otol Neurotol 34:790–794CrossRefPubMedGoogle Scholar
  26. 26.
    D’Eredita R, Cenzi M (2010) TriVerse versus molecular resonance-harvested grafts in single-stage Baha surgery. Otolaryngol Head Neck Surg 142:560–564CrossRefPubMedGoogle Scholar
  27. 27.
    Ray J, Addams-Williams J, Baldwin A (2012) Minimal access surgery for implantable bone conduction systems: early experience with the “Sheffield” incision. Otol Neurotol 33:1232–1234CrossRefPubMedGoogle Scholar
  28. 28.
    Gluth MB, Eager KM, Eikelboom RH, Atlas MD (2010) Long-term benefit perception, complications, and device malfunction rate of bone-anchored hearing aid implantation for profound unilateral sensorineural hearing loss. Otol Neurotol 31:1427–1434PubMedGoogle Scholar
  29. 29.
    Hobson JC, Roper AJ, Andrew R, Rothera MP, Hill P, Green KM (2010) Complications of bone-anchored hearing aid implantation. J Laryngol Otol 124:132–136CrossRefPubMedGoogle Scholar
  30. 30.
    McDermott AL, Williams J, Kuo M, Reid A, Proops D (2009) The Birmingham pediatric bone-anchored hearing aid program: a 15-year experience. Otol Neurotol 30:178–183CrossRefPubMedGoogle Scholar
  31. 31.
    Badran K, Arya AK, Bunstone D, Mackinnon N (2009) Long-term complications of bone-anchored hearing aids: a 14-year experience. J Laryngol Otol 123:170–176CrossRefPubMedGoogle Scholar
  32. 32.
    De Wolf MJ, Hol MK, Huygen PL, Mylanus EA, Cremers CW (2008) Clinical outcome of the simplified surgical technique for BAHA implantation. Otol Neurotol 29:1100–1108CrossRefPubMedGoogle Scholar
  33. 33.
    Persaud RA, Papadimitriou N, Siva T, Kothari P, Quinn JS (2006) How we do it: a novel approach to the skin–abutment interface of the bone-anchored hearing aid: use of local skin flaps. Clin Otolaryngol 31:540–542CrossRefPubMedGoogle Scholar
  34. 34.
    Zeitoun H, De R, Thompson SD, Proops DW (2002) Osseointegrated implants in the management of childhood ear abnormalities: with particular emphasis on complications. J Laryngol Otol 116:87–91CrossRefPubMedGoogle Scholar
  35. 35.
    Tjellstrom A, Granstrom G (1995) One-stage procedure to establish osseointegration: a zero to five years follow-up report. J Laryngol Otol 109:593–598CrossRefPubMedGoogle Scholar
  36. 36.
    Mylanus EA, Cremers CW (1994) A one-stage surgical procedure for placement of percutaneous implants for the bone-anchored hearing aid. J Laryngol Otol 108:1031–1035CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Shwan Mohamad
    • 1
  • Imran Khan
    • 1
  • S. Y. Hey
    • 2
  • S. S. Musheer Hussain
    • 3
  1. 1.Otolaryngology DepartmentSouthern General HospitalGlasgowUK
  2. 2.Glasgow Royal Infirmary HospitalGlasgowUK
  3. 3.Departments of OtolaryngologyNinewells Hospital and Medical School DundeeDundeeUK

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