Oberlies Nicholas R, Castaño Johnathan E, Freiser Monika E, McCoy Jennifer L, Shaffer Amber D, Jabbour Noel
University of Pittsburgh School of Medicine, S530 Scaife Hall, 3550 Terrace St., Pittsburgh, PA, 15261, USA.
Division of Pediatric Otolaryngology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave, Faculty Pavilion, 7th Floor, Pittsburgh, PA, 15224, USA.
Int J Pediatr Otorhinolaryngol. 2020 Aug;135:110125. doi: 10.1016/j.ijporl.2020.110125. Epub 2020 May 20.
Two of the most commonly employed bone-anchored hearing implant (BAHI) systems are the BAHA Connect and BAHA Attract. The BAHA Connect uses a skin-penetrating titanium abutment. The BAHA Attract uses an implanted magnet, leaving the overlying skin intact. Limited data is available on the difference in complication rates between the two systems. Our hypothesis was that there would be no difference in complications and audiologic data.
Retrospective chart review was performed of patients who had BAHA Connect vs. Attract at our tertiary care pediatric hospital from 2006 to 2018. Pre- and post-operative information, including demographics, related diagnoses, outcomes and complications were compared between the systems using Mann-Whitney U tests and Firth logistic regression for one year post-implant. Audiology data was analyzed with Wilcoxon rank-sum and Wilcoxon matched pairs signed rank tests.
Twenty-four Attract and 18 Connect BAHA surgeries were identified from 37 patients. Eleven Connect patients had the surgery completed in two stages. Connect patients followed up an average of 6.5 years post-implant and 15 months for Attract. A total of 58.8% of patients with Connect surgeries had complications within a year and 82.4% had a complication by their last follow-up. Aside from magnet strength related issues, there were no major complications with Attract surgery at any time point. Patients with Connect surgeries had significantly more skin overgrowths, cultured infections, times on antibiotics, nursing phone calls, and ENT visits within the first year and for all records, p < .05. The pure-tone average was significantly lower for both Connect [unaided-M(SD) = 61.7(9.8); aided-M(SD) = 26.4(5.5) and Attract (unaided-M(SD) = 66.0(22.5); aided-M(SD) = 25.6(6.1)] after implant, p < .001.
Implantation of both systems lead to improved hearing outcomes with profoundly different complication rates.
两种最常用的骨锚式听力植入（BAHI）系统是BAHA Connect和BAHA Attract。BAHA Connect使用穿透皮肤的钛基台。BAHA Attract使用植入式磁铁，使覆盖的皮肤保持完整。关于这两种系统并发症发生率差异的数据有限。我们的假设是，在并发症和听力学数据方面不会有差异。
对2006年至2018年在我们的三级护理儿科医院接受BAHA Connect与Attract治疗的患者进行回顾性病历审查。使用Mann-Whitney U检验和Firth逻辑回归对植入后一年的系统之间的术前和术后信息进行比较，包括人口统计学、相关诊断、结果和并发症。听力学数据采用Wilcoxon秩和检验和Wilcoxon配对符号秩检验进行分析。
从37例患者中确定了24例接受Attract和18例接受Connect的BAHA手术。11例Connect患者分两个阶段完成手术。Connect患者植入后平均随访6.5年，Attract患者平均随访15个月。接受Connect手术的患者中，共有58.8%在一年内出现并发症，82.4%在最后一次随访时出现并发症。除了与磁铁强度相关的问题外，Attract手术在任何时间点都没有重大并发症。接受Connect手术的患者在第一年以及所有记录中，皮肤过度生长、培养感染、使用抗生素的次数、护理电话和耳鼻喉科就诊次数明显更多，p < 0.05。植入后，Connect [未辅助-M（标准差）= 61.7（9.8）；辅助-M（标准差）= 26.4（5.5）]和Attract [未辅助-M（标准差）= 66.0（22.5）；辅助-M（标准差）= 25.6（6.1）]的纯音平均值均显著降低，p < 0.001。
两种系统的植入均能改善听力结果，但并发症发生率差异很大。
