Learning Objectives:

Introduction: The use of bone conduction hearing implants (BCI) to management hearing loss in children with cholesteatoma/CSOM has not been well studied. In particular, can the use of a BCI alter the surgical approach to cholesteatoma and result in better disease management? Are BCI-related complications in patients with cholesteatoma different than patients without cholesteatoma?

Methods: Following IRB approval, a 12 year retrospective chart review of our BCI population at a tertiary academic children's hospital was performed.

Results: 45 subjects were identified with mean age at implantation of 8.2 years (range 1.7 to 19.1 years). All subjects had a device implanted with a percutaneous abutment. In 8 subjects, a BCI was placed in conjunction with surgery for cholesteatoma or chronic suppurative OM.

In total, 58 BCI-related complications occurred in 29 subjects. The majority of the complications were related to skin infection or overgrowth: 18 events required oral antibiotic and/or office-based cauterization and 17 events required revision surgery (43% percent of patients). In the subjects with cholesteatoma, the mean age at implantation was 9 years (range 5–19 years). All 8 subjects with cholesteatoma were also syndromic (Down and Crouzon Syndrome). There was no difference in the complication rate found in subjects with or without cholesteatoma. The use of a BCI permitted alteration of the ear procedure (EAC closure or thick cartilage grafting) that resulted in dry/stable ears in all 8 subjects.

Conclusions: Children with recurrent cholesteatoma/CSOM and unfavorable clinical factors (syndromic) can benefit use of a BCI which then permits use of surgical procedures to better control their underlying ear disease. No postoperative complications occurred related to their ear disease and the rate of BCI-related complications was no different then in children without cholesteatoma.