Emory’University’Departments’of’Otolaryngology … · 2014. 1. 6. · • This "sinodural...
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SITE FOR BONE ANCHORED HEARING SYSTEM FOR CHILDREN YOUNGER THAN FIVE YEARS CeIsha Ukatu; Nilesh K. Desai, MD 1 ; N. Wendell Todd, MD, MPH 2 Emory University Departments of Otolaryngology 2 and Radiology 1 INTRODUCTION RESULTS METHODS ABSTRACT REFERENCES CONTACT Objective: To describe, in children younger than the present FDA-approved five year of age, the thickest part of the temporal bone available for placement of a bone anchored hearing system (BAHS). Technique: With IRB approval, from the radiology records of a large children's hospital, for the years 2002-2012, thirty-eight patients less than age 6 years with congenital aural atresia had temporal CTs useable for this study. Bone thickness perpendicular to the surface of the bone was measured in the topmost axial CT slice that included any adjacent petrous ridge (i.e., at the sinodural angle). Conclusion: Based on this small case series, bone thickness at the sinodural angle is sufficient for many children suffering from aural atresia to have bone anchored hearing systems implanted younger than the present FDA-approved age of five years. • Participants were patients, aged birth to 18 years of age, who underwent CT of the temporal bones for bony congenital aural atresia • Patients were identified through the database of radiology reports for ten years (2002- 2012) • On the top-most axial CT image that included any contiguously adjacent petrous ridge, bone thickness was measured perpendicular to the cortical surface • This "sinodural site" was posterior-superior to the external auditory canal, and above the level of the sigmoid plate, with the sinodural angle in full view • A second site for measurement of bone thickness was taken 5 mm posterior to the first measurement, the "cortical site" 1) Jensen DR, Grames LM, Lieu JEC. Effects of aural atresia on speech development and learning: Retrospective analysis From a multidisciplinary craniofacial clinic. JAMA Otolaryngol Head Neck Surg. [Epub ahead of print] 2) Lieu JEC, Tye-Murray N, Fu Q. Longitudinal study of children with unilateral hearing loss. Laryngoscope 2012;122:2088–95. 3) Semenov YR, Yeh ST, Seshamani M, Wang NY, Tobey EA, Eisenberg LS, Quittner AL, Frick KD, Niparko JK; the CDaCI Investigative Team. Age-dependent cost- utility of pediatric cochlear implantation. Ear Hear 2013;34:402-12. 4) Novakovic D, Meller CJ, Makeham JM, Brazier DH, Forer M, Patel NP. Computed tomographic analysis of outer calvarial thickness for osseointegrated bone- anchored hearing system insertion. Otol Neurotol 2011;32:448-52. 5) BAHA Surgery Guide. Cochlear Americas. 2010. 6) Ponto System – Surgical Manual. Oticon Medical. M50324/09.09. 7) Sophono Alpha (S) & Alpha (M) - Bone Conduction Hearing Systems - Physician Manual. REV A S0460-00 01/2013. CeIsha Ukatu Emory University Dept of Otolaryngology Email: [email protected] Website: hmp://otolaryngology.emory.edu • Patients with unilateral hearing impairment, as with congenital unilateral aural atresia, suffer lifelong consequences attributable to infantile auditory deprivation. 1,2 • Surgical options to improve hearing in children with aural atresia are not generally available until age five years, well beyond the age for auditory input to have a purposeful effect on the infant- dominant plasticity of the auditory system. 3 • Bone anchored hearing systems are not FDA- approved until age five years in the United States; the concern is adequate cortical bone thickness. 4 • The objective of this study is to describe bone thickness at the most lateral extent of the sinodural trough, i.e. the thicker mastoid bone in children 5 for placement of a BAHS • Bone thickness at the "sinodural site" was, on average, more than 4 mm • Bone thickness at the "cortical site" was nearly as thick • No significant difference in bone thickness at the two sites was observed between the atretic and the non-atretic ears • The concordance correlation coefficients checking inter- observer agreement were excellent o For the sinodural sites 0.76 (95%CI 0.64-0.85) for the atretic side and 0.81 (95%CI 0.69 to 0.88) for the non-atretic side o For the cortical sites, both were 0.85 (95%CI 0.75-1.00) • The mean distances from the "sinodural site" to nearest pinna attachment of the microtic pinna at 10 mm from the skin ranged from 12.8 to 23.5 mm • Sufficient distance exists from the center of the implant to the nearest pinna, for the child to wear the present 10 mm radius external device, plus the needed 7 mm distance to avoid acoustic feedback • Measured the distance from 5 mm lateral from the skin at the "sinodural site" to the nearest portion of the microtic pinna attached to the overlying scalp • This measurement was repeated at 10 mm lateral from the skin at the "sinodural site" • Thickness at the "sinodural site" in children younger than age five years is usually sufficiently thick for the safe placement of a screw extending 3 mm into the bone • Use of the "sinodural site" would require a magnetic BAHS, which could be repositioned posteriorly at age five years when pinna construction endeavors typically begin • We endorse a prospective randomized study of children less than age five years to address both (1) safety and stability of the installing BAHS at the "sinodural site" (2) evidence that quality auditory input truly benefits the children of unilateral hearing loss CONCLUSION
Transcript of Emory’University’Departments’of’Otolaryngology … · 2014. 1. 6. · • This "sinodural...
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SITE FOR BONE ANCHORED HEARING SYSTEM FOR CHILDREN YOUNGER THAN FIVE YEARS
CeIsha Ukatu; Nilesh K. Desai, MD1; N. Wendell Todd, MD, MPH2 Emory University Departments of Otolaryngology2 and Radiology1
INTRODUCTION RESULTS
METHODS
ABSTRACT
REFERENCES
CONTACT
Objective: To describe, in children younger than the present FDA-approved five year of age, the thickest part of the temporal bone available for placement of a bone anchored hearing system (BAHS). Technique: With IRB approval, from the radiology records of a large children's hospital, for the years 2002-2012, thirty-eight patients less than age 6 years with congenital aural atresia had temporal CTs useable for this study. Bone thickness perpendicular to the surface of the bone was measured in the topmost axial CT slice that included any adjacent petrous ridge (i.e., at the sinodural angle). Conclusion: Based on this small case series, bone thickness at the sinodural angle is sufficient for many children suffering from aural atresia to have bone anchored hearing systems implanted younger than the present FDA-approved age of five years.
• Participants were patients, aged birth to 18 years of age, who underwent CT of the temporal bones for bony congenital aural atresia
• Patients were identified through the database of radiology reports for ten years (2002- 2012)
• On the top-most axial CT image that included any contiguously adjacent petrous ridge, bone thickness was measured perpendicular to the cortical surface
• This "sinodural site" was posterior-superior to the external auditory canal, and above the level of the sigmoid plate, with the sinodural angle in full view
• A second site for measurement of bone thickness was taken 5 mm posterior to the first measurement, the "cortical site"
1) Jensen DR, Grames LM, Lieu JEC. Effects of aural atresia on speech development and learning: Retrospective analysis From a multidisciplinary craniofacial clinic. JAMA Otolaryngol Head Neck Surg. [Epub ahead of print]
2) Lieu JEC, Tye-Murray N, Fu Q. Longitudinal study of
children with unilateral hearing loss. Laryngoscope 2012;122:2088–95.
3) Semenov YR, Yeh ST, Seshamani M, Wang NY, Tobey
EA, Eisenberg LS, Quittner AL, Frick KD, Niparko JK; the CDaCI Investigative Team. Age-dependent cost-utility of pediatric cochlear implantation. Ear Hear 2013;34:402-12.
4) Novakovic D, Meller CJ, Makeham JM, Brazier DH,
Forer M, Patel NP. Computed tomographic analysis of outer calvarial thickness for osseointegrated bone-anchored hearing system insertion. Otol Neurotol 2011;32:448-52.
5) BAHA Surgery Guide. Cochlear Americas. 2010. 6) Ponto System – Surgical Manual. Oticon Medical.
M50324/09.09. 7) Sophono Alpha (S) & Alpha (M) - Bone Conduction
Hearing Systems - Physician Manual. REV A S0460-00 01/2013.
CeIsha Ukatu Emory University Dept of Otolaryngology Email: [email protected] Website: hmp://otolaryngology.emory.edu
• Patients with unilateral hearing impairment, as with congenital unilateral aural atresia, suffer lifelong consequences attributable to infantile auditory deprivation.1,2
• Surgical options to improve hearing in children with aural atresia are not generally available until age five years, well beyond the age for auditory input to have a purposeful effect on the infant-dominant plasticity of the auditory system.3
• Bone anchored hearing systems are not FDA-approved until age five years in the United States; the concern is adequate cortical bone thickness.4
• The objective of this study is to describe bone thickness at the most lateral extent of the sinodural trough, i.e. the thicker mastoid bone in children5 for placement of a BAHS
• Bone thickness at the "sinodural site" was, on average, more than 4 mm
• Bone thickness at the "cortical site" was nearly as thick
• No significant difference in bone thickness at the two sites was observed between the atretic and the non-atretic ears
• The concordance correlation coefficients checking inter-observer agreement were excellent o For the sinodural sites 0.76
(95%CI 0.64-0.85) for the atretic side and 0.81 (95%CI 0.69 to 0.88) for the non-atretic side
o For the cortical sites, both were 0.85 (95%CI 0.75-1.00)
• The mean distances from the "sinodural site" to nearest pinna attachment of the microtic pinna at 10 mm from the skin ranged from 12.8 to 23.5 mm
• Sufficient distance exists from the center of the implant to the nearest pinna, for the child to wear the present 10 mm radius external device, plus the needed 7 mm distance to avoid acoustic feedback
• Measured the distance from 5 mm lateral from the skin at the "sinodural site" to the nearest portion of the microtic pinna attached to the overlying scalp
• This measurement was repeated at 10 mm lateral from the skin at the "sinodural site"
• Thickness at the "sinodural site" in children younger than age five years is usually sufficiently thick for the safe placement of a screw extending 3 mm into the bone
• Use of the "sinodural site" would require a magnetic BAHS, which could be repositioned posteriorly at age five years when pinna construction endeavors typically begin
• We endorse a prospective randomized study of children less than age five years to address both (1) safety and stability of the installing BAHS at the "sinodural site" (2) evidence that quality auditory input truly benefits the children of unilateral hearing loss
CONCLUSION
