Surgery for bone conduction implants

You may also want to see our page on what to consider when making a decision about bone conduction implants.

Preparing for surgery

Once you and the implant team have decided to go ahead with surgery, they will arrange a pre-operative appointment with an ENT (ear, nose and throat) consultant. In this appointment, the ENT consultant will explain the surgery and discuss any risks.

About 1 or 2 weeks before surgery, you and your child will attend a pre-assessment appointment at the hospital. The medical team will check your child and make sure they’re fit for both the anaesthesia and operation. You’ll also be asked to complete a consent form. It’s important to read this carefully to make sure you fully understand the procedure. If you have any questions or concerns, ask the surgeon or anaesthetist.

You can learn more about the surgery experience by connecting with other families or reviewing helpful resources provided by implant manufacturers and hospitals.

Support from other parents

Many parents who have been through the bone conduction implant process can offer valuable advice on practical matters involved with surgery. Your implant team can help connect you with support groups and services.

There are various support groups available on social media. See a list of some Facebook groups run by parents and families (Oticon Medical).

Support from your hospital

Ask your hospital if they have resources to help prepare your child for surgery and their hospital stay. Many hospitals have play specialists or liaison nurses who will help guide your child through the experience.

"It was important to me that Charlie was fully informed on what would happen. We had an appointment a couple of weeks before the operation, and they helped explain things in a very child-friendly way. They used a teddy to show how they would send him to sleep, where they would make the cut, and they explained that they’d need to shave some hair off.” 

Tina, mum to Charlie, who got bone conduction implants when he was 8. 

Read Charlie's story.

Types of surgery

Bone conduction implant surgery may be done in one or two stages. 

• Single-stage surgery: The implant and abutment, or implant and magnet, are inserted in the same operation. A follow-up appointment will be made to remove the dressing and check the wound. The sound processor can be fitted around a month after the surgery.
• Two-stage surgery: Younger children who are having an implant and abutment arrangement may need two-stage surgery. The first operation puts the implant in place. The second operation connects the abutment and usually happens between 3 and 6 months after the first surgery. This is to allow for new bone to form around the fixture and is known as ‘osseointegration’. Once the soft tissue has healed, the sound processor can be fitted.

The surgeon will decide which surgical procedure will be suitable depending on the device chosen, your child’s age and the thickness and quality of the bone.

What happens during surgery

Depending on the age of your child, surgery for bone conduction implants can be done under either:

• Local anaesthesia: the area around the surgery is numbed, but your child will still be awake. Local anaesthesia may be offered to older teenagers and occasionally for children who have very complex needs when general anaesthetic might be considered riskier for them.
• General anaesthesia: your child will be given medicines to send them to sleep during the procedure.

Your consultant will discuss which type of anaesthesia is most appropriate for your child.

The surgery usually takes between 40 minutes and an hour, but timings can vary depending on the type of device implanted and whether one or both ears are being done. The surgeon will make a small incision (cut) behind the ear and fix the implant in position. Different devices have different methods of fixing into position: 

• Abutment with titanium screw: A small titanium screw is implanted into the skull bone behind the ear. The bone naturally grows into the fixture, holding it securely in place. An abutment is then connected to the fixture through the skin. Once the wound has healed, the only visible part of the implant is the abutment. The sound processor is attached to the abutment and is easy to take off, for example, when your child is going to bed.
• Magnetic implant under skin: A magnet is inserted under the skin behind the ear. Different devices fix the magnet in different ways, for example it may be attached to a screw implanted in the bone, or the magnet may be attached to the bone using tiny screws. Once the wound is healed, the internal part of the implant is not visible and the sound processor is held in place using magnetic attraction.

When your child goes into hospital for the surgery, the ENT liaison nurse will be there to support you. If you or your child have any concerns or questions about the surgery or the effects of the anaesthetic then you should speak to them beforehand.

Risks of surgery

Although there are risks associated with any surgery that requires a general anaesthetic, bone conduction implant surgery is a simple and relatively safe and effective procedure.

As with all operations, there are a few complications that can happen. Your child’s ENT surgeon will discuss these with you before the operation. The most common complications are skin overgrowths along the abutment and infections. Antibiotics may be given to treat infections, and if needed, your doctor will discuss the need for a short procedure to remove the skin. 

Device failure and sleeper implants

For children who have abutments implanted, there is risk that knocking the processor can cause loss or damage of the implant. It might be recommended to put in a “sleeper” implant which can be used later on if the original implant is no longer viable. 

A sleeper implant is a second screw implanted near the first one at the same time, it’s covered by skin and can’t be seen. A simple operation to uncover the sleeper can be done if needed. Having a sleeper implant reduces the time between losing an implant and having a new abutment fitted.

Recovery

After surgery, you will be able to see your child in the recovery area. A dressing may be placed around their head, which will likely be removed the day after surgery.

In most cases, your child should be able to go home the same day as their operation. 

There may be some numbness around the implant area, but this should disappear within 2 to 3 months.

If your child is having two-stage surgery, you will be given a date for the second operation before you leave the hospital. The implant centre will also send information to your child’s GP and local healthcare providers to ensure continuity of care.

Around a week after the operation, you’ll have an appointment to check the wound, remove the dressing, and take out any stitches if needed.

Before leaving the hospital, you should be given:

• clear instructions on how to care for the wound and abutment (if your child has one). Keeping the wound site clean is essential to prevent infection and reduce scarring. If your child has an abutment, you will be provided with a soft cleaning brush and shown you how to use it as part of your child’s daily care routine.
• a contact number for the nurse, audiologist, or coordinator in case of any problems
• contact details contact for an audiologist or ENT specialist in case of complications (such as signs of infection)

Fitting

Once the wound has healed, the sound processor can be fitted and programmed for your child. 

For those children who have been fitted with an abutment, the sound processor cannot be fitted until new bone has formed around the screw and is holding it firmly. This may take 3 to 6 months. Your ENT surgeon and audiologist will check the abutments stability and in the meantime your child can continue to wear their bone conduction hearing device worn on a soft headband. 

More about the fitting process.