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Surgery

Photo: The audiologist should provide information on using and caring for the device

For children with microtia and atresia who may consider cosmetic surgery or prosthetic ears at a later date, it is important that you discuss with your surgeon the exact position of the BHCI abutment.

For further information about microtia and atresia see our factsheet for families: Children with microtia and atresia.

What it involves

The surgeon will decide which surgical procedure will be suitable for your child’s needs. The decision will be based upon your child’s age and the thickness and quality of the bone. The surgery will be carried out under general anaesthetic and will take between 40 minutes and an hour.

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.

Single stage surgery – this is usually for older children/young adults because sufficient bone thickness and quality is required. The implant and abutment are inserted in the same operation. A follow-up appointment will be made to remove the dressing and check the wound. The sound processor will be fitted around a month after the surgery.

Two stage surgery – this is for younger children. The first operation is used to put the implant in place. The second operation connects the abutment. This usually happens between three and six months after surgery. This is to allow for the new bone to form around the fixture and is known as ‘osseointegration’. Once the soft tissue has healed, the sound processor can be fitted.

Sleeper implant - There is a higher risk of the implant being knocked or damaged in children. This may cause it to become loose. 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.

The above timescales can vary depending on the type of device implanted and on how well the wound has healed.

 

After the surgery

In most cases, your child should be able to go home on the same day as their operation. If your child is having a second operation you will be given a date for this before leaving hospital. All team members, your child’s GP and local services will also be given information by the Hearing Implant Service.

The ENT liaison nurse should contact you within five days of the first surgery to answer any questions or concerns you may have. An appointment will also be given about seven to ten days after the second operation where you and your child will see the nurse who will check the wound site and remove the dressing and any stitches.

You will receive clear instructions on looking after the wound and the abutment. You or your child must maintain a daily routine to keep the implant site clean. This will prevent skin infections and reduce scarring. The nurse will give you a soft cleaning brush for the area and guidance on how to use it.

You will also be given:

  • a phone number to contact the nurse, audiologist, or coordinator in
    case of any problems
  • details of how to contact an audiological or ENT in case your child suffers any complications (such as an infection of the surgery site).
Follow-up

It’s really important that the abutment remains firmly held in the skull and doesn’t become loose. You will be given contact information in case the abutment needs tightening. If it does become loose, your child must be offered an appointment to see the Hearing Implant Service within 48 hours.

Your child will see the surgeon every six months during the first 12 months after surgery, and then once a year after that. Your child will also have regular follow-up tests and assessments by other members of the Hearing Implant Service. Copies of results should be sent to you, your GP and local services within three weeks of any tests or assessments.

Risks of surgery

Although there are risks associated with any surgery that requires a general anaesthetic, BCHI surgery is considered to be 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. There may be some numbness around the implant area but this should disappear after a while.

Fitting

Several months after the operation, the ENT surgeon, specialist nurse or audiologist
will check the surgery wound has healed and that new bone has formed around the
implant (osseointegration). This will usually take three to six months depending on the individual child. When the abutment is secure, the audiologist will then fit the sound processor and programme the device.

The audiologist should provide clear written instructions on:

  • how to fit and use the BCHI
  • how to keep the implant site clean
  • how to care for the equipment, and
  • how to maintain the system.
  • how to replace the batteries and get new ones

You should also receive a copy of the manufacturer’s user handbook, and safety guidelines.

If your local services haven’t already supported a child with a BCHI then the Hearing Implant Service will provide training and information to local professionals so they know how to look after your child and the equipment when necessary (for example, when your child is at school).

A record of how the sound processor is working will be measured in a specialist test box and compared to the manufacturer’s specifications. The result of this test will be used as a guide to measure how it is working in the future. This should be checked regularly (at least every three months). You may also be given a listening device – this will help you check your child’s sound processor at home.