Saliba Issam, Froehlich Patrick, Bouhabel Sarah
Division of Otorhinolaryngology Head & Neck Surgery, University of Montreal, Otology and Neurotology, Sainte-Justine University Hospital Center (CHU SJ), and University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada.
Int J Pediatr Otorhinolaryngol. 2012 Dec;76(12):1814-8. doi: 10.1016/j.ijporl.2012.09.007. Epub 2012 Sep 23.
BAHA implantation surgery in a pediatric population is usually done in two-stage surgeries. This study aims to evaluate the safety and possible superiority of the one-stage over the two-stage BAHA implantation and which one would be the best standard of care for our pediatric patients.
A retrospective chart review of 55 patients operated in our tertiary care institutions between 2005 and 2010 was conducted. The actual tendency in our institutions, applied at the time of the study, is to perform a one-stage surgery for all operated patients (pediatric and adult), except for patients undergoing translabyrinthine surgeries for cerebellopontine tumor excision. These patients indeed had a two-stage insertion. 26 patients underwent one-stage surgery (group I) while 29 patients had a two-stage (group II) BAHA insertion. A period of 4 months was allowed for osseointegration before BAHA processor fitting. As for the safety assessment of the one-stage surgery, we compared both groups regarding the incidence and severity (minor, moderate and major) of encountered complications, as well as the operating time and follow-up. The operating time of the two-stage surgery includes the time of the first and of the second stage.
The mean age at surgery was 8.5 years old for the group I and 50 years old for the group II patients. There was no difference in the incidence of minor (p=0.12), moderate (p=0.41) nor severe (p=0.68) complications between groups I and II. Two cases of traumatic extrusion were noted in the group I. Furthermore, the one-stage BAHA implantation requests a significantly lower operating time (mean: 54 [32-100] min) than the two-stage surgery (mean: 79 [63-148] min) (p=0.012). All pediatric cases of BAHA insertion were performed in a one day surgery. The mean postoperative follow-up was 114 and 96 weeks for groups I and II respectively (p=0.058).
One-stage BAHA insertion surgery in the pediatric population is a reliable, safe and efficient therapeutic option that allows a good result in a significantly lower operating time compared to the two-stage insertion and is achieved in a one day surgery. It could therefore be considered as a standard of care for pediatric patients.
儿科患者的骨锚式助听器（BAHA）植入手术通常分两期进行。本研究旨在评估一期BAHA植入相对于二期植入的安全性及可能存在的优势，以及哪一种是适合我们儿科患者的最佳治疗标准。
对2005年至2010年期间在我们三级医疗机构接受手术的55例患者进行回顾性病历审查。在研究时，我们机构的实际倾向是，除了接受经迷路手术切除桥小脑角肿瘤的患者外，对所有接受手术的患者（儿科和成人）进行一期手术。这些患者确实进行了两期植入。26例患者接受了一期手术（第一组），而29例患者进行了两期BAHA植入（第二组）。在安装BAHA处理器之前，允许4个月的骨整合期。至于一期手术的安全性评估，我们比较了两组在遇到的并发症的发生率和严重程度（轻微、中度和重度）、手术时间和随访情况。二期手术的手术时间包括第一期和第二期的时间。
第一组患者手术时的平均年龄为8.5岁，第二组患者为50岁。第一组和第二组之间在轻微（p = 0.12）、中度（p = 0.41）和重度（p = 0.68）并发症的发生率上没有差异。第一组记录到2例创伤性脱出。此外，一期BAHA植入所需的手术时间（平均：54 [32 - 100]分钟）明显低于二期手术（平均：79 [63 - 148]分钟）（p = 0.012）。所有儿科BAHA植入病例均在一日手术中完成。第一组和第二组的平均术后随访时间分别为114周和96周（p = 0.058）。
儿科患者的一期BAHA植入手术是一种可靠、安全且有效的治疗选择，与二期植入相比，能在显著更短的手术时间内取得良好效果，且在一日手术中即可完成。因此，它可被视为儿科患者的治疗标准。
