Assessment of more than 1,000 implanted percutaneous bone conduction devices: skin reactions and implant survival

Otol Neurotol. 2012 Feb;33(2):192-8. doi: 10.1097/MAO.0b013e318241c0bf.


Objective: This study assesses soft tissue reactions and implant stability of 1,132 percutaneous titanium implants (970 patients) for bone conduction devices (BCDs). In addition, it examines BCD usage and comparisons between different patient groups.

Study design: Retrospective survey. Mean follow-up time of 4.6 years.

Setting: Tertiary care referral center.

Patients: The surveyed cohort was divided into 3 different age groups (children, adults, and the elderly). In addition, 4 groups with variable loading times (i.e., the time between placement of the implant and loading the BCD sound processor) were identified as well as a subgroup of patients with mental retardation.

Main outcome measures: Soft tissue reactions around the percutaneous implants as classified by the Holgers grading system, implant failure, and revision surgery rates.

Results: In 95.5% of the 7,415 observations of 1,132 implants, there were no adverse soft tissue reactions. Implant loss was 8.3%. Significantly more soft tissue reactions and implant failures were observed in children compared with adults and the elderly (p < 0.05). Implant survival was lower in patients with mental retardation compared with patients without mental retardation (p = 0.001). The loading time did not influence the occurrence of soft tissue reactions and implant survival rates.

Conclusion: Children and patients with mental retardation are the most vulnerable to soft tissue reactions and implant losses. Additional and more frequent care needs to be given during outpatient consultations. Because loading as early as 3 to 5 weeks did not negatively affect skin reactions or implant survival, full BCD installation can occur earlier without risk.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Biocompatible Materials
  • Bone Conduction / physiology*
  • Child
  • Child, Preschool
  • Cochlear Implants / adverse effects*
  • Cohort Studies
  • Data Interpretation, Statistical
  • Equipment Failure
  • Female
  • Follow-Up Studies
  • Humans
  • Intellectual Disability / complications
  • Male
  • Middle Aged
  • Osseointegration
  • Reoperation
  • Retrospective Studies
  • Skin Diseases / etiology*
  • Skin Diseases / pathology
  • Skin Transplantation
  • Survival Analysis
  • Titanium
  • Treatment Outcome
  • Young Adult


  • Biocompatible Materials
  • Titanium