Lippmann E, et al. - Authors sought to review the demographic, audiological, and surgical outcomes of transcutaneous osseointegrated implant (TOI) placement in pediatric patients with aural atresia. They also ascertained a modification in incision technique in anticipation of later auricular reconstruction. Findings suggested a low complication rate of transcutaneous osseointegrated implantation among pediatric patients with atresia or microtia. It can provide excellent audiological results and should be included as a treatment option for this population of patients who meet audiological criteria.

Methods

• Experts conducted a retrospective case series review of 41 cases of TOI placement in pediatric patients between January 1, 2014, and September 30, 2016, at Lurie Children’s Microtia and Aural Atresia Clinic.
• At least 6 months of follow-up was given to the patients, all younger than 18 years and with atresia or microtia and they underwent testing before and after surgery.
• Patient age, indication for procedure, ear sidedness, case length, incision type, complications, and other postoperative events were the main outcomes and measures .
• They measured the audiological outcomes before and after implantation using pure-tone averages and the Hearing In Noise Test for Children, presented in variable signal to noise ratios.

Results

• Data suggested that in total, 46 TOIs were performed in 38 pediatric patients, but only 41 implantations in 34 patients were included in this study.
• Findings demonstrated that 13 (38%) out of the 34 patients were males and 21 (62%) were females, with a mean age of 8.9 (range, 5-17) years at the time of TOI placement.
• In 39 cases (95%), microtia on the implanted side was present.
• In 30 (73%) of 41 ears, a modified posterior-superior scalp incision technique was used, all in cases of microtia.
• Results suggested the occurrence of 1 perioperative surgical complication: a seroma requiring drainage.
• Minor skin irritation and erythema at the magnet site related to the overnight use of the processor was seen in 2 patients, which resolved when removed while sleeping.
• They noted that the mean (SD; range) score for the Speech In Noise test at 5 dB signal to noise ratio improved from 75.3% (14.4%; range, 50%-92%) correct in unaided/preoperative condition to 93.6% (6.95%; range, 80%-100%) correct in the aided/postoperative condition.
• As per data, the mean improvement in score was 18.3% (95% CI, 10.8%-25.9%), with an effect size of 1.62 (95% CI, 0.95-2.29).
• The mean pure-tone averages (SD; range) similarly improved from 63.7 (13.2; range, 25-11) dB to 9.6 (4.9; range, 5-15) dB.