Amonoo-Kuofi Kwamena, Kelly Andrea, Neeff Michel, Brown Colin R S
Starship Children's Hospital, Park Road, Grafton, Auckland 1024, New Zealand.
Starship Children's Hospital, Green Lane Hospital, Auckland, New Zealand.
Int J Pediatr Otorhinolaryngol. 2015 Apr;79(4):474-80. doi: 10.1016/j.ijporl.2014.12.033. Epub 2015 Jan 3.
To assess the practicality and benefit of Bone-anchored hearing aid (BAHA(®)) implantation in children younger than 5 years of age. FDA approval for use of BAHA(®) only exists for children 5 years of age and older. Their use in Australia is also rare, however their use for younger children is approved by the European Union. We wish to share our experience of implantation in an antipodean setting in this age group.
Institutional board approval was obtained for this study. All children undergoing BAHA(®) implantation under 5 years old were included from our prospective database. We examined the variety of surgical techniques, (including skin grafting, limited soft tissue reduction and no soft tissue reduction), BAHA(®) implants and abutments used, and use of the new series 400 hydroxyapatite coatings. Demographic data obtained included age at surgery, follow up duration, gender, ethnicity and indication for surgery. Anonymous benefit questionnaires (Glasgow children's benefit inventory (GCBI) and parents' evaluation of aural performance of children (PEACH)) were completed online as well as a questionnaire on device use. Complications recorded included soft tissue reactions, implant loss/removal, abutment replacement/removal. We also assessed whether patient weight, ethnicity or socioeconomic status were risk factors for these complications.
24 Children (26 ears/26 implants) under five years were identified from the database and included in the study. There was a 14:10 male to female ratio. Patient caregivers reported subjective benefit and improved quality of life (QOL) despite setbacks and complications related to BAHA(®) usage. 10/24 (42%) of children required treatment for significant peri-implant skin reactions whilst 25% required replacement of their abutments and/or implants. An increased risk of major complication was associated with socioeconomic deprived backgrounds and in patients of New Zealand Maori and Pacific Island ethnicity but not in patients with increased weight centiles.
The BAHA(®) implant and hearing aid system is of value to children under age 5 years. Parents tolerate the skin reactions and complications because of the perceived benefit in hearing and quality of life. Careful counselling of parents of potential young BAHA(®) implant candidates is necessary in light of this.
评估骨锚式助听器（BAHA(®)）植入5岁以下儿童的实用性和益处。美国食品药品监督管理局（FDA）仅批准5岁及以上儿童使用BAHA(®)。在澳大利亚，其使用也很少见，不过欧盟批准将其用于年幼儿童。我们希望分享在这个年龄组的 antipodean 环境中进行植入的经验。
本研究获得了机构委员会的批准。我们前瞻性数据库中纳入了所有5岁以下接受BAHA(®)植入的儿童。我们检查了各种手术技术（包括植皮、有限的软组织复位和无软组织复位）、使用的BAHA(®)植入体和基台，以及新系列400羟基磷灰石涂层的使用情况。获得的人口统计学数据包括手术年龄、随访时间、性别、种族和手术指征。在线完成了匿名益处问卷（格拉斯哥儿童益处量表（GCBI）和家长对儿童听力表现的评估（PEACH））以及关于设备使用的问卷。记录的并发症包括软组织反应、植入体丢失/取出、基台更换/取出。我们还评估了患者体重、种族或社会经济地位是否为这些并发症的危险因素。
从数据库中确定了24名5岁以下儿童（26耳/26个植入体）并纳入研究。男女比例为14:10。尽管BAHA(®)使用存在挫折和并发症，但患者护理人员报告了主观益处和生活质量（QOL）的改善。10/24（42%）的儿童因严重的植入体周围皮肤反应需要治疗，而25%的儿童需要更换基台和/或植入体。社会经济贫困背景以及新西兰毛利人和太平洋岛民种族的患者发生重大并发症的风险增加，但体重百分位数增加的患者未出现这种情况。
BAHA(®)植入体和助听器系统对5岁以下儿童有价值。由于在听力和生活质量方面的明显益处，家长能够容忍皮肤反应和并发症。鉴于此，有必要对潜在的BAHA(®)植入候选幼儿的家长进行仔细的咨询。
