European Archives of Oto-Rhino-Laryngology

, Volume 276, Issue 11, pp 3067–3072 | Cite as

Long-term soft tissue outcomes for hydroxyapatite-coated bone-anchored hearing implant surgery

  • Todd KanzaraEmail author
  • Hussein Walijee
  • Rashid Badar Sheikh
  • Andrew Lau
  • Robert Temple



To investigate skin-related postoperative outcomes following a tissue preservation technique in percutaneous hydroxyapatite-coated bone-anchored hearing aid (BAHA) abutment implantation.


A retrospective medical records review of adult patients, who underwent single-stage BAHA implantation between July 2013 and November 2017 at a tertiary centre was conducted. Surgical procedures were performed by a single surgeon using a linear incision soft tissue preservation technique. Patients were reviewed at 1 week, 4 weeks, 3 months, 6 months, and annually postoperatively and soft tissue reactions were graded using Holger’s score


There were 102 patients included with a slight female preponderance (female:male 56:46). There were 586 follow-up episodes during the study period. From the recorded follow-up episodes, Holger’s scores were documented as follows: Holger score 0 (89%); 1 (7%); 2 (2%); 3 (1.9%). Three patients (3%) required peri-abutment soft tissue excision (Holger 3) and insertion of longer abutments. One patient (1%) reported atraumatic implant loss. The BAHA was re-implanted in two patients (2%) due to traumatic dislodgement. There was a statistically significant association (p = 0.009) when the mean time to minor skin complications was compared with mean time to a significant skin reaction.


Tissue preservation technique is the procedure of choice for BAHA abutment implant surgery. It confers excellent soft tissue outcomes and an excellent implant survival rate.


BAHA Osseointegrated device Abutment Linear incision soft tissue preservation techniques Minimally invasive surgery 


Compliance with ethical standards

Conflict of interest

The authors declare that there are no conflicts of interests.

Ethical approval

For this type of study formal consent is not required. We deemed this study to be service evaluation and therefore we did not seek research ethics committee approval.

Informed consent

This was a retrospective records review and as such informed consent was not sought from all the patients whose records we reviewed. Furthermore, the data used in our work is anonymised and there is no patient identifiable information. Written consent for the use of clinical photographs was sought and granted by the patients whose photographs are used in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.ENT DepartmentCountess of Chester HospitalChesterUK

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