Bone-anchored hearing aid quality of life assessed by Glasgow Benefit Inventory

Comparison of Quality of Life Outcomes for Percutaneous Versus Transcutaneous Implantable Hearing Devices: A Systematic Review and Meta-analysis

OBJECTIVE

To compare quality of life (QOL) outcomes of percutaneous and transcutaneous bone conduction devices (pBCD and tBCD, respectively).

DATABASES REVIEWED

Pubmed, Scopus, CINAHL.

METHODS

A systematic review was performed searching for English language articles from inception to March 15, 2023. Studies reporting QOL outcomes measured using a validated tool following implantation of either pBCDs or tBCDs were considered for inclusion. QOL outcomes included scores for Glasgow Benefit Inventory, Glasgow Children's Benefit Inventory, Abbreviated Profile of Hearing Aid Benefit, and the Speech, Spatial, and Qualities of Hearing Scale. A meta-analysis of continuous measures was performed.

RESULTS

A total of 52 articles with 1,469 patients were included. Six hundred eighty-nine patients were implanted with pBCDs, and the remaining 780 were implanted with tBCDs. Average Glasgow Benefit Inventory scores for the tBCD group (33.0, 95% confidence interval [22.7-43.3]) were significantly higher than the pBCD group (30.9 [25.2-36.6]) (Δ2.1 [1.4-2.8], p < 0.0001). Mean Glasgow Children's Benefit Inventory scores (Δ3.9 [2.0-5.8], p = 0.0001) and mean gain in Abbreviated Profile of Hearing Aid Benefit scores (Δ5.6 [4.8-6.4], p < 0.0001) were significantly higher among patients implanted with tBCDs than those implanted with pBCDs. Patients implanted with tBCDs also had significantly higher gains on the Speech (Δ1.1 [0.9-1.3], p < 0.0001), Spatial (Δ0.8 [0.7-0.9], p < 0.0001), and Qualities of Hearing (Δ1.2 [1.1-1.3], p < 0.0001) portions of the Speech, Spatial, and Qualities of Hearing Scale than those implanted with pBCDs.

CONCLUSIONS

Patients implanted with transcutaneous devices had better QOL outcomes than those implanted with percutaneous devices.

Long-Term Results of the Linear Incision Technique With Tissue Reduction Versus Tissue Preservation for Inserting Bone-Anchored Hearing Implants: The Ongoing Optimization in Bone Implant Surgery

OBJECTIVE

To compare the long-term outcomes of the linear incision technique with tissue reduction (LIT-TR) and the linear incision technique with tissue preservation (LIT-TP) for inserting bone-anchored hearing implants (BAHIs).

STUDY DESIGN

Single-center retrospective cohort study.

SETTING

Large general teaching hospital.

PATIENTS

A total of 231 adult patients were included between August 2005 and October 2020, with a minimum follow-up time of 6 months.

INTERVENTION

The test group received a BAHI using the LIT-TP (N = 147). The control group underwent surgery using the LIT-TR (N = 84).

MAIN OUTCOME MEASURES

Soft tissue reactions, skin thickening, postoperative complications (e.g., wound dehiscence), and implant loss were compared between the test and control group. Furthermore, Cochlear Bone Anchored Solutions AB (Mölnlycke, Sweden) and Oticon Medical AB (Askim, Sweden) implants/abutments within the LIT-TP cohort were compared. Validated questionnaires were used to quantify patients' health-related quality of life (HRQoL).

RESULTS

Significantly more cases with wound dehiscence and adverse soft tissue reactions (Holgers ≥2) were observed in the LIT-TR cohort (p < 0.001). However, the LIT-TP cohort showed significantly more cases with skin thickening (requiring treatment) within the first 2 years after implantation. There were no differences in implant loss rates, overall soft tissue reactions (Holgers >1), and overall HRQoL between the two patient groups. Significant improvement in the patients' HRQoL after implementation of a BAHI was found in both techniques. The Ponto Wide implant/abutment showed less frequent skin thickening (requiring treatment) and fewer soft tissue reactions compared with the BIA400 implant/abutment.

CONCLUSION

This large-scale study demonstrates that the LIT-TP shows excellent long-term outcomes, including a low incidence of implant failure.

Transcutaneous versus percutaneous bone-anchored hearing aids: A quality of life comparison

PURPOSE

To determine whether patients have improved quality of life outcomes with percutaneous bone conduction implant (p-BCI) versus transcutaneous bone conduction implant (t-BCI).

MATERIALS & METHODS

Retrospective chart review of patients who have undergone placement of a BCI in the Ascension St John Providence Health System from 2013 to 2018. Patient satisfaction of t-BCI and p-BCI was measured using a questionnaire that incorporated the Glasgow Benefit Inventory (GBI) and BAHA, aesthetic, hygiene & use (BAHU) survey. Key outcome variables were separated into 2 categories: (1) evaluation of wound healing and implant-associated complications, and (2) quality of life improvements.

RESULTS

Comparative analysis of the 27 p-BCI patients and 10 t-BCI patients showed overall positive benefit with no statistically significant difference on quality of life improvement between the two groups. Total complication rates for p-BCI (48.1 %) vs t-BCI (10 %) was marginally significant (p = 0.056). Rate of revision for p-BCI versus t-BCI was 14.8 % vs 0 %, respectively.

CONCLUSION

This study provides a much-needed comparative insight in patient's experience with these two devices. Understanding which device is preferable in the patient's view will offer helpful information for guiding proper implant selection.

Bone-Anchored Hearing Implants: Surgical and Audiological Comparison of Different Surgical Techniques

Introduction The bone-anchored hearing implant system (BAHS) is an effective amplification system that transmits the sounds received by an external operating system to the inner ear by bypassing the middle ear placed in the temporal bone.

Objective This study compares the results of patients who underwent bone-anchored hearing implant system (BAHS) surgery using two different surgical methods in terms of preoperative and postoperative complications, surgical time, audiological findings, and patient satisfaction.

Methods The results of 22 patients who underwent BAHS were evaluated retrospectively from video records and audiological results, The Turkish Version of the Glasgow Benefit Inventory (GBI) questionnaire were evaluated. Two different surgical approaches were used for implantation: the linear incision technique (n = 9) and the punch technique (n = 13).

Results Mean surgical durations were 9.67 ± 2.85 and 47.65 ± 6.13 minutes for Groups A and B, respectively, and these were significantly different (p < 0.001). There were no significant differences between the groups' speech recognition scores for a signal-to-noise ratio (SNR) of +5 (p = 0.173), SNR of 0 (p = 0.315), or SNR of -5 (p = 0.360) and results of the GBI scores.

Conclusion The punch technique has a significant advantage due to a shorter surgery duration without increased surgical complications. Additionally, the punch technique showed no significant difference in hearing performance or satisfaction compared with linear incision.

Hearing-Related Quality of Life in 75 Patients With a Percutaneous Bone Conduction Device

OBJECTIVE

To evaluate long-term hearing-related quality of life (HRQoL) and device use in bone conduction (BCD) users. Furthermore, to assess differences between indications and changes in HRQoL over time.

STUDY DESIGN

Prospective questionnaire survey.

SETTING

Tertiary referral center.

PATIENTS

Seventy-five patients with a percutaneous BCD.

MAIN OUTCOME MEASURES

Glasgow Benefit Inventory (GBI) at 3 and 12 months postoperatively, Glasgow Health Status Inventory (GHSI) preoperatively, and 6 and 36 months postoperatively, device use at 6, 12, and 36 months. Changes over time were assessed and outcomes were compared between indications.

RESULTS

After implantation, 97% of all patients reported a positive benefit on the GBI total. The GHSI total had improved with median 15 points (Interquartile range [IQR] 12). At 36 months, median device use was 15 hours/day (IQR 10) and one nonuser was reported. Patients with bilateral hearing loss (BHL) showed greater improvement on the GHSI total (median 18 vs 14, p < 0.0001) and used their devices more frequently (median 16 vs 8 h/day, p < 0.0001) than patients with unilateral HL (UHL). Postoperative GHSI and GBI scores were consistent over time, in the entire patient population and for every indication. Between 6 and 36 months, device use was stable over time, except for patients with single-sided deafness (SSD; median -6.4 h/day, p = 0.009).

CONCLUSION

The BCD improves HRQoL in patients with BHL, in patients with unilateral conductive/mixed hearing loss and in patients with SSD. Patients with BHL experienced a greater improvement in hearing status compared to patients with UHL. Although use decreased over time in SSD patients, device use was high for every indication.

Do patients report quality of life improvements after fitting of their unilateral bone conducting hearing implant?

OBJECTIVE

The audiological benefits of a bone conducting hearing implant are well documented; however, there is a paucity of literature comparing pre- and post-operative quality of life benefits. This study assessed the quality of life status before and after the device is implanted.

METHODS

A prospective study was conducted of all adult bone conducting hearing implants inserted in a teaching hospital between 2012 and 2017. All patients completed the Glasgow Health Status Inventory, a validated quality of life questionnaire, before and three to six months after implantation.

RESULTS

Sixty-two patients received a unilateral bone conducting hearing implant. All scores except the social score improved post-operatively. The paired t-test showed that the differences in the means for the Glasgow Health Status Inventory total, general and physical scores were statistically significant at the 5 per cent level (p < 0.0001).

CONCLUSION

This study, one of the few to assess quality of life pre- and post-implantation, showed a vast improvement in patients' perceived quality of life from the pre- to the post-operative phase.

Surgical and functional outcomes of two types of transcutaneous bone conduction implants

OBJECTIVE

This study aimed to evaluate surgical and functional outcomes, in a tertiary referral centre, of two different types of semi-implantable transcutaneous bone conduction devices.

METHOD

This study involved prospective data collection and review of patients implanted between November 2014 and December 2016. Glasgow Hearing Aid Inventory (Glasgow Hearing Aid Benefit Profile or Glasgow Hearing Aid Difference Profile) and Client Oriented Scale of Improvement were completed where appropriate. Surgical and audiological outcomes were recorded in the surgical notes.

RESULTS

Glasgow Hearing Aid Difference Profile and Glasgow Hearing Aid Benefit Profile showed similar mean score in the active and the passive transcutaneous bone conduction devices. Client Oriented Scale of Improvement showed improvements in listening situations. Post-operative speech reception threshold showed better mean threshold in the active transcutaneous bone conduction devices group when compared with the passive transcutaneous bone conduction devices group. No device failures or surgical complications existed in either group, with the surgical time being less in the passive transcutaneous bone conduction devices group.

CONCLUSION

Both devices are reliable semi-implantable transcutaneous bone conduction devices with excellent surgical and functional outcomes and patient satisfaction. Overall surgical time was much less in the passive transcutaneous bone conduction devices group with no necessity for pre-planning. This is much easier to remove with the possibility of conversion to other devices in the manufacturer's portfolio and wide-ranging wireless accessories. Further studies are needed to assess the longer-term results in a bigger population.

Comparing costs of microsurgical resection and stereotactic radiosurgery for vestibular schwannoma

OBJECTIVE

Given rising scrutiny of healthcare expenditures, understanding intervention costs is increasingly important. This study aimed to compare and characterize costs for vestibular schwannoma (VS) management with microsurgery and radiosurgery to inform practice decisions and appraise cost reduction strategies.

METHODS

In conjunction with medical records, internal hospital financial data were used to evaluate costs. Total cost was divided into index costs (costs from arrival through discharge for initial intervention) and follow-up costs (through 36 months) for 317 patients with unilateral VSs undergoing initial management between June 2011 and December 2015. A retrospective matched cohort based on tumor size with 176 patients (88 undergoing each intervention) was created to objectively compare costs between microsurgery and radiosurgery. The full sample of 203 patients treated with resection and 114 patients who underwent radiosurgery was used to evaluate a broad range of outcomes and identify cost contributors within each intervention group.

RESULTS

Within the matched cohort, average index costs were significantly higher for microsurgery (100% by definition, because costs are presented as a percentage of the average index cost for the matched microsurgery group; 95% CI 93-107) compared to radiosurgery (38%, 95% CI 38-39). Microsurgery had higher average follow-up costs (1.6% per month, 95% CI 0.8%-2.4%) compared to radiosurgery (0.5% per month, 95% CI 0.4%-0.7%), largely due to costs incurred in the initial months after resection. A major contributor to total cost and cost variability for both resection and radiosurgery was the need for additional interventions in the follow-up period, which were necessary due to complications or persistent functional deficits. Although tumor size was not associated with increased total costs for radiosurgery, linear regression analysis demonstrated that, for patients who underwent microsurgery, each centimeter increase in tumor maximum diameter resulted in an estimated increase in total cost of 50.2% of the average index cost of microsurgery (95% CI 34.6%-65.7%) (p < 0.001, R2 = 0.17). There were no cost differences associated with the proportion of inpatient days in the ICU or with specific surgical approach for patients who underwent resection.

CONCLUSIONS

This study is the largest assessment to date based on internal cost data comparing VS management with microsurgery and radiosurgery. Both index and follow-up costs are significantly higher when tumors were managed with resection compared to radiosurgery. Larger tumors were associated with increased resection costs, highlighting the incremental costs associated with observation as the initial management.

Surgical Explantation of Bone-Anchored Hearing Devices: A 10-year Single Institution Review

Objective

To identify clinical variables associated with the decision to surgically discontinue bone-anchored hearing device function.

Study Design

Retrospective chart review.

Setting

Tertiary neurotology referral center.

Subjects and Methods

This study examines surgical interventions performed on existing bone-anchored hearing devices at a single institution from 2008 to 2018. Patient characteristics, indications for implantation, and complications prompting surgical intervention were assessed.

Results

Seventy-seven cases were included in this study. Among patients in the younger cohort (<37 years old), 100% (13 of 13) of those discontinuing their device had a contralateral normal-hearing ear. Conversely, 0% (0 of 14) of the younger patients with bilateral hearing loss surgically discontinued their devices. Within the older cohort (≥37 years old), female patients ( P = .002) and those with an increased body mass index ( P = .035) were more likely to surgically discontinue their devices. Multivariate analysis revealed that a contralateral normal-hearing ear ( P = .001) and infection without soft tissue overgrowth of the abutment ( P = .026) were the strongest predictors of device discontinuation, after adjusting for potential confounders.

Conclusion

Surgical discontinuation is associated with several clinical variables. Targeted interventions that are viable alternatives to removal, such as device relocation, should be presented to younger patients with a contralateral normal-hearing ear who experience persistent complications. Patients with persistent infection in the absence of soft tissue overgrowth would especially benefit from enhanced counseling on proper hygiene.

Stapes Surgery for Profound Hearing Loss Secondary to Otosclerosis

The objective of this study is to evaluate stapes surgery in patients with otosclerosis and "profound" hearing loss. This means they meet hearing threshold criteria for cochlear implantation (CI). We performed a retrospective study and patient questionnaire. The results from 33 patients (35 ears) were recorded (mean age: 63.6, range: 40-85). The primary outcome measure was hearing thresholds recorded before and after surgery at 0.5, 1, 2, 3, and 4 kHz. Hearing thresholds at 2 and 4 kHz were also analyzed. Glasgow Benefit Inventory (GBI) was used in 21 patients to assess life quality changes. Hearing thresholds improved in 80% of ears (mean improvement, 26.3 dB), were unchanged in 11.4%, and worsened in 8.6%. Mean GBI score was +20.7. Hearing aid use decreased in 23.8% and ceased in 28.6%. One patient subsequently underwent CI. For patients with profound otosclerosis, stapes surgery provides a quantitative improvement in hearing thresholds and improvement in quality of life, with reduced reliance on hearing aids. This avoids CI, auditory rehabilitation, and a change in quality and tonality of sound.

The impact of rehabilitation on quality of life after hearing loss: a systematic review

Purpose

Hearing loss is a major health problem and is associated with several negative outcomes such as difficulties in communicating and poor quality of life. The aim of this study was to conduct a systematic literature review to evaluate the impact of different types of hearing rehabilitation after hearing loss and their impact on quality of life.

Methods

A systematic literature search was conducted on Pubmed which retrieved 549 articles. Of these, 29 articles regarding cochlear implants, bone anchored hearing devices and traditional amplification hearing aids have been systematically reviewed. The search was limited to articles published from 1960/01/01 to 2017/05/22, included human participants and available in English.

Results

The main finding was that hearing rehabilitation is beneficial in all types of hearing loss and treatment regarding quality of life. However, bone-anchored hearing devices and cochlear implants were shown to produce greater improvements in terms of quality of life than conventional hearing aids.

Conclusion

From these findings, we concluded that hearing rehabilitation does have a positive impact on quality of life after hearing loss.

Passive Transcutaneous Bone Conduction Hearing Implants: A Systematic Review

OBJECTIVE

To systematically review the literature on currently available passive transcutaneous bone conduction hearing implants (pTCBI) with regard to complications, audiological outcomes, and quality-of-life scores.

DATA SOURCES

MEDLINE, EMBASE, Scopus, and Cochrane Library.

STUDY SELECTION

All identified English-language articles reporting on the implantation of currently available pTCBI's and their complications. Both pediatric and adult patients were included. No limitation was placed on study design or level of evidence.

DATA EXTRACTION

Complications, audiological outcomes including mean pure-tone average gain and mean speech reception threshold gain, and quality-of-life outcomes.

DATA SYNTHESIS

Twenty-six articles were included in the review. Four hundred eighty-two pTCBIs have been reported in the literature. Major complications including skin breakdown, wound dehiscence, hematoma, seroma, and inability to use the device occurred in 5.2% of patients. Minor complications including pain and self-resolving erythema at the implant site occurred in 13.1% of the patients. The weighted mean pure-tone average gain of the two included devices was 28.4 ± 2.1 dB and the mean speech reception threshold gain was 32.9 ± 3.9 dB. Favorable quality-of-life scores have been demonstrated with pTCBIs.

CONCLUSION

pTCBIs are a viable alternative to percutaneous devices in a carefully selected group of patients. These devices have demonstrated good audiological outcomes, low morbidity, and high patient satisfaction.

Patient satisfaction after auditory implant surgery: ten-year experience from a single implanting unit center

CONCLUSIONS

The satisfaction rate of the subjects with an auditory implant appears strictly related to the resulting auditory improvement, and the surgical variables would play a prevailing role in respect to the esthetic factors.

OBJECTIVES

To assess the rate of satisfaction in subjects who underwent the surgical application of an auditory device at a single Implanting Center Unit.

METHOD

A series of validated questionnaires has been administered to subjects who underwent the surgical application of different auditory devices. The Glasgow Benefit Inventory (GBI), the Visual Analog Scale (VAS), and the Abbreviated Profile of Hearing Aid Benefit (APHAB) have been used to compare the implanted situation with the hearing-aided one; a percutaneous bone conductive implant (pBCI) with an active middle ear implant (AMEI) on the round window in mixed hearing loss; and an invisible, fully-implantable device with a frankly and bulky semi-implantable device.

RESULTS

The mean GBI scores were higher in Vibrant Soundbridge (VSB)^® and Bonebridge^® subjects, without significant differences among the various devices. The mean VAS score increased for all the devices in comparison with the conventional hearing aid. The mean APHAB score was similarly better in the implanted condition as total and partial scores.

Consensus Statements on the BAHA System: Where Do We Stand at Present?

After more than 25 years of clinical experience, the BAHA (bone-anchored hearing aid) system is a well-established treatment for hearing-impaired patients with conductive or mixed hearing loss. Owing to its success, the use of the BAHA system has spread and the indications for application have gradually become broader. New indications, as well as clinical applications, were discussed during scientific roundtable meetings in 2004 by experts in the field, and the outcomes of these discussions are presented in the form of statements. The issues that were discussed concerned BAHA surgery, the fitting range of the BAHA system, the BAHA system compared to conventional devices, bilateral application, the BAHA system in children, the BAHA system in patients with single-sided deafness, and, finally, the BAHA system in patients with unilateral conductive hearing loss.

Bone anchored hearing implants without skin thinning: the Gruppo Otologico surgical and audiological experience

To investigate the surgical and audiological outcomes of an installation of a bone-anchored hearing system (BAHS) procedure without tissue reduction using Ponto implants and abutments. Retrospective consecutive case series. Forty-nine patients, 18 years or older and eligible for treatment with a bone-anchored hearing system with tissue preservation surgery, were included in the study. Following a systematic scheme for medical outcomes, we collected the data regarding surgical intervention, quality of life (GBI), skin and soft tissue reactions (Holgers grading system), pain and numbness (VAS). Hearing performance (aided thresholds and speech recognition in noise) was recorded in 20 patients. No implants were lost, skin, and soft tissue reactions were mild in 96 % of the all visits. Quality of life (GBI) generally improved in the aided condition compared to prior to implantation. Audiologically, 100 % of the 20 patients examined showed improvement of speech reception and sound field thresholds comparing aided to unaided. An average improvement of 33 dB on PTA was recorded. The study, presenting data on a large population, treated with tissue preservation and modern titanium implants, shows that this treatment is a viable solution that results in fewer complications, high degree of predictability and good audiological results.

The Glasgow Benefit Inventory: a systematic review of the use and value of an otorhinolaryngological generic patient-recorded outcome measure

BACKGROUND

The Glasgow Benefit Inventory (GBI) is a validated, generic patient-recorded outcome measure widely used in otolaryngology to report change in quality of life post-intervention.

OBJECTIVES OF REVIEW

To date, no systematic review has made (i) a quality assessment of reporting of Glasgow Benefit Inventory outcomes; (ii) a comparison between Glasgow Benefit Inventory outcomes for different interventions and objectives; (iii) an evaluation of subscales in describing the area of benefit; (iv) commented on its value in clinical practice and research.

TYPE OF REVIEW

Systematic review.

SEARCH STRATEGY

'Glasgow Benefit Inventory' and 'GBI' were used as keywords to search for published, unpublished and ongoing trials in PubMed, EMBASE, CINAHL and Google in addition to an ISI citation search for the original validating Glasgow Benefit Inventory paper between 1996 and January 2015.

EVALUATION METHOD

Papers were assessed for study type and quality graded by a predesigned scale, by two authors independently. Papers with sufficient quality Glasgow Benefit Inventory data were identified for statistical comparisons. Papers with <50% follow-up were excluded.

RESULTS

A total of 118 eligible papers were identified for inclusion. A national audit paper (n = 4325) showed that the Glasgow Benefit Inventory gave a range of scores across the specialty, being greater for surgical intervention than medical intervention or 'reassurance'. Fourteen papers compared one form of surgery versus another form of surgery. In all but one study, there was no difference between the Glasgow Benefit Inventory scores (or of any other outcome). The most likely reason was lack of power. Two papers took an epidemiological approach and used the Glasgow Benefit Inventory scores to predict benefit. One was for tonsillectomy where duration of sore throat episodes and days with fever were identified on multivariate analysis to predict benefit albeit the precision was low. However, the traditional factor of number of episodes of sore throat was not predictive. The other was surgery for chronic rhinosinusitis where those with polyps on univariate analysis had greater benefit than those without. Forty-three papers had a response rate of >50% and gave sufficient Glasgow Benefit Inventory total and subscales for meta-analysis. For five of the 11 operation categories (vestibular schwannoma, tonsillectomy, cochlear implant, middle ear implant and stapes surgery) that were most likely to have a single clear clinical objective, score data had low-to-moderate heterogeneity. The value in the Glasgow Benefit Inventory having both positive and negative scores was shown by an overall negative score for the management of vestibular schwannoma. The other six operations gave considerable heterogeneity with rhinoplasty and septoplasty giving the greatest percentages (98% and 99%) most likely because of the considerable variations in patient selection. The data from these operations should not be used for comparative purposes. Five papers also reported the number of patients that had no or negative benefit, a potentially a more clinically useful outcome to report. Glasgow Benefit Inventory subscores for tonsillectomy were significantly different from ear surgery suggesting different areas of benefit

CONCLUSIONS

The Glasgow Benefit Inventory has been shown to differentiate the benefit between surgical and medical otolaryngology interventions as well as 'reassurance'. Reporting benefit as percentages with negative, no and positive benefit would enable better comparisons between different interventions with varying objectives and pathology. This could also allow easier evaluation of factors that predict benefit. Meta-analysis data are now available for comparison purposes for vestibular schwannoma, tonsillectomy, cochlear implant, middle ear implant and stapes surgery. Fuller report of the Glasgow Benefit Inventory outcomes for non-surgical otolaryngology interventions is encouraged.

Quality of life benefit after endoscopic frontal sinus surgery

BACKGROUND

There is a lack of reports on the quality of life (QOL) assessment after frontal sinus surgery. This study aimed to assess the QOL of patients after one of three frontal sinus procedures, using the Glasgow Benefit Inventory (GBI) and the 22-item Sino-Nasal Outcome Test (SNOT-22).

METHODS

We designed an observational study with two arms. The first arm was a cross-sectional retrospective study recruiting all patients (with rhinosinusitis or mucocele) who had balloon sinuplasty, frontal recess clearance, or endoscopic modified Lothrop procedure in our tertiary referral unit at Newcastle upon Tyne Hospitals, between April 2010 and April 2012. The second arm was a prospective cohort study recruiting all patients having frontal sinus procedures between April 2012 and September 2012. The QOL was measured primarily by the GBI and SNOT-22 questionnaires. A total of 45 patients were recruited. Retrospectively, we identified 27 patients, of whom 19 (70%) returned the questionnaires. Eighteen patients were recruited in the prospective cohort and 14 (77.7%) of them completed the questionnaires 3 months postoperatively.

RESULTS

The total benefit of frontal sinus surgery was found to be +31 for the retrospective group and +25.59 for the prospective arm. The three domains of GBI showed a positive impact after surgery. The general domain scored +37.5 in the retrospective study and +29.76 for the prospective one. The social domain scored +18.81 retrospectively and +21.42 prospectively. The physical domain scores were +17.71 retrospectively and +13 prospectively. The SNOT-22 preoperative score was +59.8 and this significantly improved to +35.2 (p = 0.017).

CONCLUSION

Our study is the first report of QOL benefit after all three frontal sinus procedures using the validated GBI, showing benefit in all aspects of health domains. The physical symptoms and QOL assessed by SNOT-22 significantly improved after all three procedures.

Quality of life of Nepali patients with ear disease before and after corrective surgery

OBJECTIVES

Hearing impairment is a significant burden in the developing world. However, no suitable quality of life (QoL) measures exist for use in Nepal. We aimed to amend and translate the Glasgow Health Status Inventory (GHSI), assessing QoL at any given time, and the Glasgow Benefit Inventory (GBI), assessing change in QoL following intervention, into Nepali and to assess the impact of ear disease and effect of surgery on QoL.

METHODS

The GHSI and GBI were translated into Nepali and independently verified. The GHSI was administered by interview to patients before surgery, and the GBI was administered 6 months after surgery. The Mann-Whitney U-test was used for hypothesis testing.

RESULTS

The GHSI was administered to 242 patients. In total, 205 had chronic suppurative otitis media (CSOM) without cholesteatoma and 37 had cholesteatoma. The mean GHSI score was 47.9. There was no significant difference in GHSI scores between patients with CSOM without cholesteatoma and those with cholesteatoma. The GBI was administered to 161 patients, 73 of whom had also been in the GHSI group. In total, 130 had CSOM without cholesteatoma, 31 had cholesteatoma. The mean GBI score was +38.4 with no significant difference between disease groups.

CONCLUSIONS

Ear disease in Nepal is associated with reduced QoL, and surgical intervention is associated with improved QoL. There is no difference in QoL or benefit following surgery for CSOM between patients with or without cholesteatoma. There are few QoL measures suitable for the developing world. It is essential to invest in these measures to guide health interventions.

Osseointegrated hearing implant surgery using a novel hydroxyapatite-coated concave abutment design

OBJECTIVE

Recently, a novel hydroxyapatite-coated concave bone-anchored hearing device abutment was introduced, the first designed specifically to improve outcomes in soft-tissue preservation osseointegrated hearing implant surgery. We sought to evaluate our early experience with this abutment.

STUDY DESIGN

A single-center case series with planned data collection including patient-reported outcomes.

SETTING

Tertiary referral center.

SUBJECTS AND METHODS

The first 30 consecutive patients undergoing osseointegrated hearing implant surgery using the Cochlear DermaLock (BA400) abutment at our institution (February-September 2013) were studied. Follow-up was for a minimum of 6 months. The following data were collected: operative duration; wound healing; postoperative complications, chiefly soft-tissue reactions graded by Holger's classification; and postintervention patient-perceived health-related quality of life, as assessed by the Glasgow Benefit Inventory (GBI).

RESULTS

The mean operating time was 16 minutes (range, 9-22 minutes). Favorable and rapid wound healing was observed in all cases. Three patients (10%) reported transient periabutment paraesthesia. Four patients (13.3%) suffered adverse soft-tissue reactions, all of which were successfully managed conservatively and graded as follows: Holger's grade 1 (n = 2), 2 (n = 1), and 3 (n = 1). Respective overall general health, social support, and physical health GBI mean scores were +38 (95% confidence interval [CI], 31 to 45), +51 (95% CI, 42 to 60), +19 (95% CI, 8 to 30), and +8 (95% CI, -1 to 17).

CONCLUSION

Our preliminary clinical and patient-reported outcomes support soft-tissue preservation surgery and indicate that the technology on which the Cochlear DermaLock (BA400) abutment is based may enhance soft-tissue outcomes in this context. We recommend further appraisal of this approach on a larger scale with more extensive follow-up.

Initial experience of a rapid-insertion bone-anchored hearing system: series of 20 consecutive implants

Objective: The loading of bone-anchored hearing system sound processors usually occurs two to three months after surgical implant. This study examined a new bone-anchored hearing system coupling mechanism that permits loading at two weeks post-implantation without compromising osseointegration. Methods: Twenty implants were implanted into 15 patients. The interval between operation and time of processor loading was recorded, along with the cause of any delay and any late complications. Results: Two patients were fitted with implants at seven and nine weeks. The delay was a result of administrative errors; the patients reported no skin problems. Of the remaining 17 implants, 8 processors were fitted at 2 weeks, 1 at 3 weeks, 4 at 4 weeks, 3 at 7 weeks and 1 at 8 weeks. For those nine implants fitted later than two weeks, the delay was because of incomplete skin healing. Conclusion: The Oticon Medical Xpress system allowed processor loading at two weeks post-operatively, providing skin healing was adequate. Early loading occurred in approximately half of the patients. All patients were fitted within the two to three months traditionally allowed. Prolonged skin healing time was the main reason for the delayed fitting of sound processors.

Can audiometric results predict qualitative hearing improvements in bone-anchored hearing aid recipients?

Introduction:

Patients receiving a bone-anchored hearing aid have well-documented improvements in their quality of life and audiometric performance. However, the relationship between audiometric measurements and subjective improvement is not well understood.

Methods:

Adult patients enrolled in the Nova Scotia bone-anchored hearing aid programme were identified. The pure tone average for fitting the sound-field threshold, as well as the better and worse hearing ear bone conduction and air conduction levels, were collected pre-operatively. Recipients were asked to complete the Speech, Spatial and Qualities of Hearing questionnaire; their partners were asked to complete a pre- and post-bone anchored hearing aid fitting Hearing Handicap Inventory for Adults questionnaire.

Results:

Forty-eight patients who completed and returned the Speech, Spatial and Qualities of Hearing questionnaire had partners who completed the Hearing Handicap Inventory for Adults questionnaire. The results from the Speech, Spatial and Qualities of Hearing questionnaire correlated with the sound-field hearing threshold post-bone-anchored hearing aid fitting and the pure tone average of the better hearing ear bone conduction (total Speech, Spatial and Qualities of Hearing Scale to the pre-operative better hearing ear air curve (r = 0.3); worse hearing ear air curve (r = 0.27); post-operative, bone-anchored hearing aid-aided sound-field thresholds (r = 0.35)). An improvement in sound-field threshold correlated only with spatial abilities. In the Hearing Handicap Inventory for Adults questionnaire, there was no correlation between the subjective evaluation of each patient and their partner.

Conclusion:

The subjective impressions of hearing aid recipients with regards to speech reception and the spatial qualities of hearing correlate well with pre-operative audiometric results. However, the overall magnitude of sound-field improvement predicts an improvement of spatial perception, but not other aspects of hearing, resulting in hearing aid recipients having strongly disparate subjective impressions when compared to those of their partners.

Mastoidectomy and mastoid obliteration with autologous bone graft: a quality of life study

BACKGROUND

A mastoid cavity resulting from a canal wall down mastoidectomy can result in major morbidity for patients due to chronic otorrhea and infection, difficulty with hearing aids and vertigo with temperature changes. Mastoid obliteration with reconstruction of the bony external ear canal recreates the normal anatomy to avoid such morbidity. Few have the studied the quality of life benefit that this procedure confers.

METHODS

This retrospective observational study was conducted to determine if mastoid obliteration with autologous cranial bone graft following mastoidectomy improves quality of life (QOL). Patients with cholesteatoma who had mastoidectomy with primary or secondary mastoid obliteration by a tertiary otologist were surveyed using the validated Glasgow Benefit Inventory (GBI), our primary outcome measure.

RESULTS

Fifty-eight patients were interviewed. Forty-six were primary obliteration after canal wall down mastoidectomy of a primary cholesteatoma. Twelve were secondary obliteration of an existing canal wall down mastoid cavity. Overall GBI scores were improved, with average scores of 22. Average general subscale scores were 23, physical health scores were 25, and social health scores were 22. The primary obliteration group had average scores of 19, general subscale scores of 20, physical health scores of 21, and social health scores of 22. Those with secondary obliteration scored higher, with average scores of 31, general subscale scores of 34, physical health scores of 39, and social health scores of 25.

CONCLUSION

This study shows that mastoidectomy with obliteration using autologous cranial bone graft offers a significant QOL benefit. The GBI scores compare favourably with other otorhinolaryngology procedures. Secondary obliterations after revision mastoidectomy scored much higher than primary obliterations. This is currently the only QOL study comparing these two patient groups.

Benefit of Baha in the elderly with single-sided deafness

The objective of this study is to determine the benefits of bone-anchored hearing aid (Baha) contralateral routing of signal (CROS) in the older adult population with single-sided deafness. Five questionnaires [general usage questionnaire, Glasgow benefit inventory (GBI), Abbreviated profile of hearing aid benefit (APHAB), Nijmegen cochlear implant questionnaire and the hearing handicap inventory for the elderly-screening version (HHIE-S)] were used to evaluate Baha use. Consecutive patients over 60 years of age with SSD fitted with a Baha CROS between April 1990 and April 2007 not using a conventional hearing aid in the better-hearing ear were identified. Nine out of 11 patients (82 %) were still using their Baha CROS, and 7 of the 11 patients (64 %) were still satisfied. The patients experienced no to little problems with handling and cleaning of the device. The GBI scores show good benefit in domains total (14 ± 11) and general (19 ± 17). The APHAB shows that, overall, 3 out of the 11 patients (27 %) experienced significant benefit, while all others experienced no significant benefit and no drawbacks. The HHIE-S shows that the patients experienced severe (18 %), mild to moderate (46 %) or no handicap (36 %) when using the Baha CROS. In conclusion, the benefit of a Baha CROS for elderly patients with SSD is evident in the majority of patients.

Quality of life improvement for bone-anchored hearing aid users and their partners

OBJECTIVES

Bone-anchored hearing aid recipients experience well documented improvements in their audiometric performance and quality of life. While hearing aid recipients may understate their functional improvement, their partners may be more aware of such improvement. We sought to investigate patients' partners' perceptions of functional improvement following bone-anchored hearing aid fitting.

METHODS

Surveys were sent to 153 patients who had received a bone-anchored hearing aid through the Nova Scotia bone-anchored hearing aid programme. The validated survey asked patients' partners to give their subjective impression of the bone-anchored hearing aid recipient's functional status.

RESULTS AND CONCLUSIONS

Surveys were completed by 90 patients (58.8 per cent), of whom 72 reported having a partner. Partners reported a significant improvement in hearing (p ≤ 0.0001). Partners reported improvement in 87.0 per cent of functional scenarios, no change in 12.6 per cent, and a decline in 0.4 per cent. These findings demonstrate a significant improvement in the emotional and social effects of hearing impairment, as perceived by bone-anchored hearing aid recipients' partners.

The bone-anchored hearing aid in the rehabilitation of single-sided deafness: experience with 58 patients

OBJECTIVES

To assess the efficacy of the bone-anchored hearing aid (BAHA) in the rehabilitation of single-sided deafness (SSD).

STUDY DESIGN

Retrospective case-control series review.

SETTING

Tertiary referral unit.

PATIENTS

Fifty-eight consecutive patients that had a bone-anchored hearing aid for single-sided deafness completed outcome questionnaires, building upon earlier audiological assessment of 19 patients. Single-sided deafness controls (n = 49) were mainly acoustic neuroma patients.

MAIN OUTCOME MEASUREMENTS

speech discrimination testing in directional noise, speech and spatial qualities of hearing questionnaire and the Glasgow Benefit Inventory (GBI).

RESULTS

The mean follow-up time was 28.4 months. Five (13%) of the bone-anchored hearing aid patients were non-users because of lack of benefit. The audiometric testing confirmed that when noise was on the bone-anchored hearing aid side speech perception was reduced but benefited when noise was on the side of the hearing ear. There was no difference between the Speech and Spatial Qualities of Hearing Scores in bone-anchored hearing aid users and controls. In particular there was no difference in the spatial subscores. In the bone-anchored hearing aid users the median Glasgow Benefit Inventory score was 11. If the non-users are included then 13 (22%) patients had no or detrimental (negative) Benefit scores. No or negative benefit scores were more frequent in those deaf for <10 years. In open-field questions, patients felt the bone-anchored hearing aid was most useful in small groups or in 'one-to-one' conversation.

CONCLUSIONS

Bone-anchored hearing aid rehabilitation for single-sided deafness is less successful than for other indications, reflected here by relatively low median Glasgow Benefit Inventory scores. There was also no significant difference between controls and bone-anchored hearing aid users in the Speech and Spatial Qualities of Hearing Questionnaire. Patients with a longer duration of deafness report greater subjective benefit than those more recently deafened, perhaps due to differing expectations.

Benefit and quality of life in older bone-anchored hearing aid users

OBJECTIVE

Benefit and quality-of-life analysis in the older adult bone-anchored hearing aid (BAHA) users.

STUDY DESIGN

Retrospective evaluation.

METHODS

Four questionnaires (Glasgow Benefit Inventory, Abbreviated Profile of Hearing Aid Benefit [APHAB], Nijmegen Cochlear Implant Questionnaire [NCIQ], and the Hearing Handicap Inventory for the Elderly screening version [HHIE-S]) were used.

RESULTS

The response rate was 80%, mean age was 75 years (range, 62-93 yr), and mean pure-tone average at frequencies of 500, 1,000, 2,000, and 4,000 Hz for bone conduction was 42 +/- 13 dBHL. More than 80% of the patients were using their BAHA for more than 8 hours a day. To obtain a "snapshot" of current BAHA use, the NCIQ, HHIE-S, and the APHAB were used. The NCIQ showed good disability and handicap results (score range, 49-64). The HHIE-S showed that 60% of the patients had a mild to moderate handicap. The APHAB aided scores ranged from 39 to 58%. Mean benefit scores of the Glasgow Benefit Inventory were positive in 112 of the 134 patients (84%). The APHAB showed clinically significantly more benefit with the BAHA than with the previous aided or unaided situation. A trend could be seen-the higher the pure-tone average at frequencies of 500, 1,000, 2,000, and 4,000 Hz for bone conduction, the smaller the mean benefit scores on the questionnaires.

CONCLUSION

Bone-anchored hearing aid users aged 60 years or older were able to place and handle the device very adequately and clean the skin around the implant. Most patients reported comparable or increased general benefit and good quality of life with the BAHA.

Bone-anchored hearing aids in children and young adults: the Freeman Hospital experience

OBJECTIVE

To investigate the utilisation of bone-anchored hearing aids and Softband, as well as the effects on quality of life, amongst the paediatric and young adult population of Freeman Hospital, Newcastle Upon Tyne, UK.

METHOD

Retrospective, anonymised, cross-sectional survey using the Glasgow Benefit Inventory and Listening Situation Questionnaire (parent version), administered at least three months following the start of bone-anchored hearing aid or Softband use.

RESULTS

One hundred and nine patients were included, of whom syndromic children made up a significant proportion (22 of 109). Patients using bone-anchored hearing aids obtained significant educational and social benefit from their aids. The mean Listening Situation Questionnaire difficulty score was 17 (15 patients), which is below the trigger score of 22+ at which further reassessment and rehabilitation is required. 87% (of 15 patients) did not require further intervention. The overall mean GBI score for the 22 patients (syndromic and non-syndromic) was +29.

CONCLUSION

The use of bone-anchored hearing aids and Softband results in significant improvements in quality of life for children and young adults with hearing impairment. There is significant under-utilisation of bone-anchored hearing aids in children with skull and congenital abnormalities, and we would advocate bone-anchored hearing aid implantation for these patients.

Bilateral Bone-anchored Hearing Aid: impact on quality of life measured with the Glasgow Benefit Inventory

OBJECTIVE

To investigate whether the fitting of bilateral Bone-anchored Hearing Aid (BAHA) would result in any additional improvement in patients' quality of life (QOL) over and above what we would experience from the fitting of a single-sided BAHA.

STUDY DESIGN

Retrospective, anonymized, cross-sectional postal survey using the Glasgow Benefit Inventory (GBI).

SETTING

Tertiary referral center.

PATIENTS

All 93 adult patients who had been using bilateral BAHA for more than 6 months.

INTERVENTION(S)

Hearing rehabilitation using bilateral BAHA.

MAIN OUTCOME MEASURE(S)

These include the GBI benefit scores across the following domains: "overall benefit," "general health benefit," "physical health benefit," and "social benefit." Comparison of GBI scores against other otological interventions including single-sided BAHA.

RESULTS

Response rate was 76%. Ninety-two percent of patients reported improvement in QOL. Positive QOL improvement scores were reported across all domains. Overall GBI benefit score was +ve 38. This is higher than the benefit scores reported by patients with single-sided BAHA, although this may not be statistically significant.

CONCLUSION

After fitting the second BAHA, patients may report additional improvement in their QOL (of a smaller magnitude) over and above the initial improvement in their QOL after fitting of their first BAHA. In fact, the overall benefit score for bilateral BAHA seem to be close to that for cochlear implantation.

The Baha system in patients with single-sided deafness and contralateral hearing loss

OBJECTIVE

To evaluate the effectiveness of the Baha system in cases of single-sided deafness (SSD) and mild to moderate hearing loss in the better-hearing ear.

STUDY DESIGN

Prospective trial.

SETTING

Tertiary otologic referral center.

SUBJECTS AND METHODS

Twenty-one patients with SSD and mild to moderate hearing loss in the contralateral ear implanted with the Baha system between June 2006 and March 2008 were evaluated following Baha implantation and fitting with the Divino and Intenso processors. Pure-tone air and bone conduction thresholds, sound-field testing (aided and unaided in quiet and noise) of consonant nucleus consonant words (Northwestern University Auditory Test No. 6 words), and Hearing in Noise Test sentences were obtained. Patient satisfaction questionnaires were administered pre- and post-intervention for either device.

RESULTS

Patients with SSD and mild to moderate hearing loss in the contralateral ear showed a statistically significant improvement in all measures with the use of the Divino or Intenso processors compared with the unaided situation. Change in hearing, as measured in noise testing word recognition scores, revealed a statistically significant difference between the two aided conditions favoring the Intenso (P < 0.05). The Glasgow Benefit Inventory revealed that 91 percent of the patients reported improvement in their quality of life and would recommend the procedure to others.

CONCLUSION

The Baha system is effective in the rehabilitation of patients with SSD and mild to moderate hearing loss in the only hearing ear. Results of the current study suggest that either the Divino or Intenso processor was successful in reestablishing hearing from the deafened side.

Patient quality of life with bone-anchored hearing aid: 10-year experience in Glasgow, Scotland

OBJECTIVES

This study aimed to ascertain the usefulness of the bone-anchored hearing aid and its impact on the quality of life of patients fitted in Glasgow between 1996 and 2006.

METHOD

The Entific Medical Systems questionnaire and the Glasgow Benefit Inventory were posted to patients in order to assess their satisfaction and quality of life changes.

RESULTS

Sixty adult patients were identified, with a questionnaire response rate of 63 per cent. Thirty-two respondents (85 per cent) reported using their bone-anchored hearing aid for more than eight hours per day. Twenty-nine respondents (75 per cent) found their bone-anchored hearing aid to be generally better than their previous, conventional aid. Twenty-seven respondents (71 per cent) reported that their bone-anchored hearing aid improved their quality of life. The median total Glasgow Benefit Inventory score was +33.3.

CONCLUSIONS

Bone-anchored hearing aid usage rates and satisfaction levels were high amongst patients in Glasgow. Glasgow Benefit Inventory indices were comparable to published findings from other centres. Despite this, bone-anchored hearing aid funding is still not universally available within the National Health Service in Scotland.

Bone anchored hearing aids: a preliminary assessment of the impact on outpatients and cost when rehabilitating hearing in chronic suppurative otitis media

OBJECTIVES

To compare the difference in ENT and Audiology visits, treatments dispensed and potential savings pre- and post-bone anchored hearing aid (BAHA) insertion in patients with chronic suppurative otitis media exacerbated by behind the ear hearing aids.

DESIGN

A retrospective pilot study.

SETTING

District General Hospital.

PARTICIPANTS

All patients who had BAHA inserted from January 2001 to January 2006.

PARAMETERS

Age, gender, number of visits per month, treatments per month dispensed from the ENT and Audiology Departments and direct and limited indirect medical costs pre- and post-BAHA insertion.

RESULTS

Twelve of 26 (46%) adult patients had BAHA inserted over the 5-year period for CSOM. The male to female ratio was 1 : 3 with a median age of 61 (range 29-81). The number of visits and treatments dispensed per month in the ENT Department fell from a mean of 0.42-0.33 (P < 0.08) and 0.22-0.14 (P < 0.02) respectfully. When the difference in medical cost was taken into account BAHA offered a potential saving of pound 627.80 per patient.

CONCLUSION

Although the initial acquisition of surgical equipment and BAHA sound processors is expensive, there is a reduction in the number of treatments and visits required for patients with chronic suppurative otitis media after BAHA is inserted leading to a reduction in average costs.

Clinical outcome of the simplified surgical technique for BAHA implantation

OBJECTIVE

To evaluate the clinical outcome of a simplified surgical technique for BAHA implantation, in terms of implant failure and its causes.

DESIGN

Retrospective analysis.

METHODS

Analysis of a consecutive cohort of 142 patients (150 loaded implants) fitted with the BAHA implant between January 1, 1997, and December 31, 1999. The simplified surgical Nijmegen technique comprises a longitudinal postauricular incision, extensive subcutaneous tissue reduction, and removal of the periosteum. Clinical outcomes were the rate of implant failures, its causes for this, and skin reactions around the percutaneous implants classified according to Holgers. Clinical results were compared with other BAHA series.

RESULTS

Mean follow-up was 5.6 +/- 2.7 years (range, 0-10.5 yr). Holgers grade 2 or more severe skin reactions were seen in 6.5% of the 1,038 follow-up visits. Extrusion of the implants occurred as a result of failed osseointegration (n = 3), trauma (n = 5), infection (n = 1), and (other) medical reasons (n = 5 explanations). Total extrusion rate was 9.3%. Only 3% (1 and 3) were due to failed osseointegration or infection around the percutaneous implant.

CONCLUSION

The modified Nijmegen surgical technique is a simple straightforward surgical procedure without the use of a pedicled skin flap. Surgery takes approximately 20 minutes. Meticulous performance of the procedure is considered important to achieve optimal results in the long-term. Particularly the soft tissue reduction has to be done with great care. In terms of the low rates of implant failure and adverse tissue reactions, the Nijmegen surgical technique proved to be a good alternative to other techniques.

Nijmegen results with application of a bone-anchored hearing aid in children: simplified surgical technique

OBJECTIVES

A retrospective analysis was performed to evaluate the clinical outcome of percutaneous bone-anchored hearing aid (BAHA) application in children with the outcome measures of fixture loss and skin reactions.

METHODS

An analysis was done of 93 of the 101 children 16 years of age or younger who underwent the simplified Nijmegen surgical technique between January 1994 and July 2007.

RESULTS

Twenty-one of 129 fixtures (16.3%) were lost or removed. In 12 cases, osseointegration failed. The majority of the fixture losses (86%) occurred within 1 year after surgery. No differences were found between 3 age groups or between fixture lengths (seven 3-mm implants versus fourteen 4-mm implants). The BAHA fixtures were less stable in children than in adults. In 8 cases, Holgers grade 4 skin reactions were noted at an average (+/-SD) of 5.5 +/- 4.7 months after surgery, ie, significantly sooner than the milder reactions (p = 0.001). In 28 cases (22%), skin reactions of Holgers grades 2 to 4 were observed. Revision surgery to reduce subcutaneous scar tissue was necessary in 22 implants (17%).

CONCLUSIONS

Fixture loss was more frequent in children than in adults. The age of the child and the length of the fixture did not appear to influence fixture stability. Children should undergo frequent checkups at the outpatient clinic.

Histologic and morphologic evaluation of explanted bone anchors from bone-anchored hearing aids

Bone-anchored hearing aids are a standard option in rehabilitation of patients with conductive or mixed hearing loss, and also CROS fitting. However, the skin-penetrating bone anchor repeatedly gives reason for discussion about the risk of infection of surrounding tissues as a major cause of malfunction. In the present study, explanted bone anchors with surrounding bone and soft tissue were examined and compared with the morphology of lost implants. The anchors originated from five patients. Two needed explantation due to deafness with the need of cochlea implantation. A third patient underwent explantation due to meningeal irritation by the bone anchor. Another patient lost the implant due to mechanical stress shortly after implantation. The last implant was lost in a child without apparent reason. All implants were clinically free of infection and had been stable for a median implantation period of 12 months. During the explantation procedure, the fixtures were recovered together with the attached soft tissue and bone. The specimens were examined by light microscopy or scanning electron microscopy (SEM). Sectioning for light microscopy was performed with a diamond-coated saw microtome. Histopathologic examination of the surrounding skin and subcutaneous soft tissue showed slight inflammation in one case only. The bone was regularly vital, presenting no signs of inflammation. The threads of the fixtures were filled with bone, with particularly strong attachment to the flank of traction. The SEM investigation exposed the ultrastructural interaction of bone with the implant surface. Filiform- and podocyte-like processes of osteocytes attach to the implant; lost implants did not reflect these features. Implant integration involves both osseointegration as well as soft tissue integration. Titanium oxide as the active implant surface promotes this integration even in unstable implants. The morphologic analysis exposed structural areas of the implant with weak bone-to-metal contact. Optimized implant design with modified surface and threads may additionally improve osseointegration of hearing aid bone anchors.