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Adapting the BAHA surgical technique for Children

Presenting Author: Iain Bruce

Published online by Cambridge University Press:  03 June 2016

Iain Bruce
Iain Bruce*
Affiliation:
Royal Manchester Children's Hospital
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Abstract

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Learning Objectives: 1. Percutaneous and transcutaneous BAHA are both important options in children 2. Adaptations to the skin and soft tissue technique used may be required in children 3. Special circumstances, such as microtia cases, require particularly careful planning and collaborative working with the reconstructive surgeon.

Introduction: The appropriateness and effectiveness of BAHA in selected children and young people is well established. Lower than expected uptake in children has contributed to recent technological advances, most notably percutaneous BAHA without soft tissue reduction and the development of transcutaneous BAHA (Cochlear™ Baha® Attract System), aimed at improving cosmesis and reducing skin problems. Adaptations in surgical technique and special considerations may be necessary when undertaking BAHA surgery in children.

Methods: A single surgeon's experience of BAHA surgery in children will be reviewed and illustrated, with emphasis upon adaptations in skin and soft tissue surgical technique and decision making regarding siting of the fixture in relation to the pinna.

Results: Five scenarios will be considered: 1. ‘No soft tissue reduction surgery’, 2. Adapting the recommended surgical technique for ATTRACT surgery, 3. Transitioning from percutaneous to transcutaneous BAHA, 4. Simultaneous BAHA and mastoid surgery, and 5. Microtia. Illustrative cases will be presented for each scenario. Most notably changing the position of the skin incision for ATTRACT surgery from anterior to posterosuperior to the implant magnet, offers potential cosmetic benefits and avoids disruption of the soft tissue planes in planned autogenous pinna reconstruction cases. Inappropriate choice of the implant site may also compromise future pinna reconstruction. Scar tissue over the implant magnet does not lead to problems with pressure induced skin necrosis, when transitioning from percutaneous to transcutaneous BAHA.

Conclusions: Traditionally, cosmesis and recurrent inflammation have limited uptake of BAHA in children. Advances in BAHA technologies have led directly to greater applications in children. The anticipated development of an active transcutaneous BAHA promises further improvement in cosmesis and acceptability to children and young people.