Author(s)
Benjamin D. Lovin, MD
Mike Hernandez, MS
Paul W. Gidley, MD
Karine Al Feghali, MD
Jack Phan, MD, PhD
Catherine Wang, MD
Dianna Roberts, PhD
Marc-Elie Nader, MD
Affiliation(s)
MD Anderson Cancer Center; Baylor College of Medicine;
Abstract:
Objective:
To evaluate the impact of radiotherapy on osseointegrated hearing aids (OIHA) outcomes and complications.
Study Design:
Retrospective cohort
Setting:
Tertiary referral academic practice
Patients:
All percutaneous OIHA performed from 2006 to 2021
Interventions:
Evaluation of implant and abutment-related OIHA outcomes and complications stratified by receipt of radiation and dosage. Radiation dosages were calculated at both bone and soft tissue level.
Main Outcome Measures:
Abutment, implant, and major complications assessed using the modified Holgers and IPS grading scales.
Results:
Total of 190 OIHA were included of which 124 (65%) were placed in irradiated temporal bones. Radiation cohort was older (p=0.002) and more often prior/current smokers (p=0.003). Total of 84 (44%) OIHA experienced at least one complication at mean follow-up of 43.3 months. Radiation cohort had greater rates of having any complication (p=0.032), major complication (p=0.014), implant complication (p=0.007), and abutment complication (p=0.032). When comparing scales, IPS score distribution was significantly different between groups (p=0.011); a similar trend, yet not significant, was found with Holgers classification (p=0.075). Logistic regression identified radiation (p=0.029) and abutment size (p=0.048) as significantly associated with any complication. Notably, every 1mm increase in abutment size decreased the risk of any complication by 11%. There was a trend towards more implant and abutment complications with higher radiation doses (p=0.208 and 0.186, respectively). Cumulative incidence plots demonstrate a greater discrepancy in complication rates between groups as time increases.
Conclusions:
Radiation significantly increases the risk of both abutment and implant-related OIHA complications, particularly in the long-term. The IPS grading scale may be more sensitive to detecting differences in complication rates. Increasing the abutment size and decreasing radiation dosages may decrease the risk of complication.
Professional Practice Gap & Educational Need: There is a paucity of literature on long-term evaluation of OIHA complications, particularly after radiation. This data may prove helpful in patient counseling before percutaneous OIHA or when considering alternatives, such as non-operative bone conduction technology or transcutaneous devices. There has also not been prior comparison of OIHA complication grading scales.
Learning Objective: The rate of OIHA complications is significant in long-term follow up and appears potentiated by radiation. IPS grading scale may be more helpful in identifying these complications. Using a longer abutment or decreasing radiation dosage may reduce risk of complications.
Desired Result: Thoughtful implantation and follow up of patients with OIHA and a history of temporal bone irradiation.
Level of Evidence - III
Indicate IRB or IACUC: MD Anderson Cancer Center, PA19-0106