Background:
Clinical practice of handling adverse reactions in BAHS patients includes untargeted treatment with local and oral antibiotics. Microbiological sampling is rarely performed in the diagnosis.

Methods:
We analysed 57 Staphylococcus spp. isolates (16 S aureus, 32 S. epidermidis, and 9 other coagulase-negative staphylococci) from 15 BAHS patients and three compartments (abutment, peri-abutment fluid and tissue). Whole-genome sequencing and microbiological analyses determined the virulence profile of all isolates, including their genetic lineage, biofilm production and antibiotic resistance. The results were evaluated in relation to clinical outcomes including Holgers and pain scores, and debris accumulation around the abutment.

Results:
In patients with elevated Holgers score, indicating skin inflammation, S. aureus the most prevalent species, whereas S. epidermidis was more frequently associated with pain. Biofilm slime production was linked to hygiene related issues, such as debris accumulation around the abutment. 56 % of the isolates exhibited both phenotypic and genotypic resistance to fusidic acid. Tetracycline resistance genes were detected in 11-34% of the isolates. Resistance levels increased under biofilm conditions, although rifampicin, oxacillin, and vancomycin retained the most antimicrobial activity. Importantly, both tetracycline and fusidic acid are both routinely used to treat adverse skin reactions in patients with percutaneous implant systems.

Conclusion:
The associations observed between bacterial virulence traits and clinical outcomes suggest that standard topical treatments may be inadequate, particularly in cases involving biofilm-forming and antibiotic-resistant strains. These findings highlight the need for biofilm-targeted diagnostics and therapies to more effectively manage adverse skin reactions and pain in patients with percutaneous implants.

Introduction:
The OSIA implant is an innovative bone conduction device using piezoelectric technology, with surgical techniques evolving to optimize outcomes. Postoperative wound healing and implant complications are key concerns influencing patient satisfaction and long-term success.
Objectives:
This systematic review aims to compare different surgical incisions for OSIA implantation, focusing on postoperative wound healing and complication rates. Secondary factors that will be compared is surgical time, intraoperative bleeding, and follow up duration.
Methods:
A comprehensive search will be conducted across PubMed, Cochrane, and Embase up to April 2025 for studies on primary OSIA implantation. Data on different surgical techniques and complications will be extracted independently from the included articles by two reviewers. A qualitative narrative synthesis will be performed, with study quality assessed via MINORS.

Results:
This study is still under process and data will be shared once completed.

Background:

Since the OSIA active transcutaneous bone-conduction implant was introduced in 2020, several innovations in surgical technique have been described. These include a minimally invasive horizontal incision approach for primary OSIA surgery as well as conversion of BAHA Connect and BAHA Attract devices to an OSIA.

The purpose of this study is to evaluate the results of adults and children at the University of Ottawa Auditory Implant Centres undergoing OSIA implantation utilizing these surgical innovations.

Methods:

An audit of adult and paediatric case records was performed. Outcomes of patients undergoing implantation with the minimally invasive approach for primary OSIA surgery and BAHA Connect / Attract conversion surgery were compared to the conventional surgical approach.


Results:

Between July 2021 and May 2025, 23 adults and 39 children underwent OSIA implantation. The minimally invasive incision approach was performed on 15 adults and 18 children.

The minimally invasive approach was preferred for patients with aural atresia particularly if subsequent auricular reconstruction was being contemplated. The conventional approach was preferred if the scalp thickness was greater than 9 mm or for BAHA Connect / Attract conversion surgery. BAHA conversion surgery could be successfully performed utilizing the previously situated 3- or 4-mm implant or a new 3-mm implant.

All patients were very satisfied with their functional auditory outcomes and continue to use their OSIA devices.

Conclusion:

These innovative surgical approaches were not associated with increased complications. Specific patient factors such as possible subsequent auricular reconstruction surgery, scalp flap thickness, or previous implant location may determine the optimal surgical approach.

Background: Compared to bone-anchored hearing systems, semi-implantable Bone conduction devices (BCDs) provide greater flexibility in terms of placement. Experimental research using laser Doppler vibrometry (LDV) on human cadaver models has shown that positioning the implanted transducer closer to the cochlea results in higher output at the cochlear promontory, which correlates with improved auditory perception. This study is the first to explore how output varies with transducer distance in patients implanted with the Bonebridge system.
Methods: Postoperative CT scans from 28 patients with Bonebridge implants were reviewed to determine the spatial relationship between the bone conduction (BC) transducer and the ipsilateral cochlea. A novel method was used to calculate the maximum output (MO) for each patient, relying solely on audiological data. Correlation analyses were performed to assess the relationship between the transducer-to-cochlea distance and MO across different frequencies.
Results: The measured distances from the center of the BC transducer to the ipsilateral cochlea ranged from 30 to 50 mm, covering a span of about 20 mm. Average MOs across frequencies from 0.5 to 6 kHz ranged between 53 and 71 dB HL. Pearson correlation analysis with linear regression (R²=0.41; p<0.05) indicated that shorter distances between the transducer and the cochlea were linked to higher MOs at low frequencies (0.5–2 kHz).
Conclusion: Clinical data from BCI patients demonstrate that the placement of the implant significantly affects audiological outcomes, with closer proximity to the ipsilateral cochlea yielding greater benefits. These results underscore the importance of optimal implant positioning to maximize hearing performance.

BACKGROUND

Rapid technical advancements have made bone-anchored hearing devices more accessible and efficacious for patients. In addition to the percutaneous type, the emergence of transcutaneous devices has increased in popularity and acceptance. The study examines implantation trends at a tertiary neurotology practice.

METHODS

A retrospective cohort study was performed on patients who received a bone-anchored hearing device at a high-volume tertiary neurotology practice between 2008 and 2023.

RESULTS

Five hundred thirty-five patients who had undergone implantation with a bone-anchored hearing device were identified. The median age was 50.7 (range, 5-88) years, and most were female (60.7%). Common reasons for implantation were attributed to chronic ear disease (37.6%), sudden hearing loss (18.6%), and single-sided deafness from vestibular schwannoma resection (17.5%). During primary implantation, patients received the percutaneous Cochlear BAHA (72.2%) and Oticon Medical Ponto (25.6%) as well as transcutaneous implants (BoneBridge, BAHA Attract, and Osia; 2.2%). Patients with chronic ear disease and sudden hearing loss had the most significant increase in implantation rates (12.89%/year, p < 0.01) and (5.1%/year, p = 0.012), respectively. Twenty-seven patients (5.0%) underwent device replacement. Within that cohort, 10 individuals received a cochlear implant (37.0%), 12 (44.4%) were switched from a percutaneous to a transcutaneous device, and five (18.5%) remained with a transcutaneous implant.

CONCLUSION

Transcutaneous devices are increasingly utilized in primary implantation and conversion from percutaneous implants in a tertiary neurotologic practice. Local infection rates tended to be greater in Cochlear BAHA devices compared to Oticon Medical Ponto and less in transcutaneous devices than percutaneous devices.

Background: This study evaluates cumulative survival rates and device failure incidences among Bonebridge users at two Latin American implantation centers. It highlights the importance of device survival and failure risk in clinical decision-making for patients with conductive, mixed hearing loss, or single-sided deafness.
Methods: A survival analysis of Bonebridge implantation at two centers evaluated device failure, defined as explantation requiring revision surgery. Kaplan-Meier survival curves and Cox regression estimated failure risk, stratified by age and device model. Log-rank tests compared survival across subgroups, assessing interactions between age and device type in cumulative survival outcomes.
Results: A total of 186 cases (172 patients) were included, with 14 undergoing bilateral surgery. The mean implantation age was 33.87±18.29 years, with 18.02% pediatric cases. Most patients had conductive hearing loss, with Microtia (44.1%) and COM sequelae (37.1%) as leading etiologies. BB601 was the most used device (68.8%), primarily placed in the mastoid area (51.1%). The study observed three device failures, four extrusions, and eight lost follow-ups, with no significant survival differences between age groups or device types (Kaplan-Meier, Log-Rank Test, p=0.791). Cox regression found no significant interactions between age and device type (p>0.05)
Conclusions: Bonebridge implantation demonstrated high cumulative survival rates (96–98.4%) over a 10-year period, with no significant differences between age groups or device models (BB601 vs. BB602). Device failures occurred within the first 43.2 months. Cox regression showed no significant interactions between age and device type as covariates for survival.

Background
The Sentio System is a new active transcutaneous bone conduction system for patients with conductive or mixed hearing losses, or for those with single-sided deafness. To date, experience of the Sentio System is limited to the adult population while this clinical study investigates safety and performance of use in a pediatric population, aged 3–11 years. The objective is to share the very first surgical experiences of Sentio implantation in young children.
Methods
A prospective, multicentre clinical investigation including a total of 50 children, 3–11 years old, is being performed at eight university hospitals across Europe (UK, Spain and the Netherlands) to evaluate safety and performance of the Sentio system in the paediatric population (clinicaltrials.gov identifier: NCT06976086). Study objectives include clinical and audiological outcomes, subjective assessments of quality of life, listening fatigue and satisfaction. The study participants will be followed for 12 months after implantation.
Results
The first study participants, two SSD patients aged 4- and 9 years old, were implanted in May 2025. Both underwent day-case surgery under general anesthesia. Recesses of 3mm were made for housing of the implant transducer with successful fixation using the shorter fixation band (39mm) and the antenna/magnet secured in a periosteal pocket. Overall, the surgeries went smoothly and took around 1 hour.
Conclusions
The first 3 month results will be available in time for Osseo. The small size of the implant and the flexibility of the fixation to bone are beneficial factors for successful implantation of the Sentio in young children.

Introduction:
Optimal placement of bone-anchored hearing implants (BAHI) is critical for long-term device stability, and avoidance of complications such as dural or vascular injury. Conventional surgical planning relies on anatomical landmarks and imaging, but these methods fail to work accurately inside the surgical field. This study presents our initial experience using patient-specific 3D-printed surgical indicators, designed based on 3D skull reconstruction, to guide precise BAHI placement in safe and structurally robust regions of the temporal bone.

Methods:
Patients scheduled for BAHI surgery underwent preoperative CT scans, which were processed to generate 3D skull models. Critical structures, including major vessels (sigmoid sinus, emissary veins), were segmented. A surgical indicator was designed to fit the patient's skull contour, incorporating a guiding sleeve for optimal drill trajectory targeting areas of maximal bone thickness while avoiding critical anatomy. The indicators were fabricated using biocompatible, sterilizable 3D-printing materials. Intraoperatively, the indicators were used to guide pilot drilling and abutment placement. Operative time, intraoperative complications, and implant stability were recorded.
Results:
4 patients were included. The use of the 3D-printed indicators facilitated accurate implant positioning, with no intraoperative vascular injuries or dural exposures. Average bone thickness at the implant site was 4.3 mm. The mean operative time was reduced by 20% compared to standard procedures. Follow-up demonstrated stable osseointegration and satisfactory audiological outcomes.

Conclusion:
Patient-specific 3D-printed surgical indicators offer a promising approach for enhancing safety and precision in BAHI placement. Preoperatively mapping skull thickness and vascular anatomy allows surgeons to confidently target robust bone while minimizing risks.

Background:
The Cochlear OSIA® 2 System is an active transcutaneous bone anchored hearing device. The manufacturer recommends an extended post-auricular incision with a minimum of 1cm distance from the edge of the implant, to prevent the risk of device exposure. The aversity of families to a larger incision, our concern that scarring might interfere with future auricular reconstruction in microtia patients, and the risk of post-operative pain with extended dissection led us to evolve our approach to a minimally invasive technique.

Methodology
We describe our novel approach and present a pilot study of 24 children with aural atresia who underwent a minimally invasive OSIA implant surgery (MOSIA). Outcomes reported were postoperative pain, numbness, surgical site infection, wound dehiscence, device exposure, patient satisfaction, and complications.

Results
The approach consists of a small horizontal incision with endoscopic guidance to minimize dissection, postoperative pain, scarring, and post-operative numbness (a complaint we have encountered with the traditional approach). The bi-plane dissection, subcutaneous and a higher muscular/periosteal plane, reduces the risk of device exposure. An angled endoscope allows the visualisation and alignment of the fixation screw into the osseo-integrated implant through the small incision. A total of 24 children with aural atresia received MOSIA. Only one patient had sigmoid bleeding; controlled using bone wax and changing the implant site. All wounds healed nicely with no device exposure.

Conclusion
The MOSIA is a novel endoscopic-assisted, minimally invasive technique ideal for microtia patients, as it reduces postoperative morbidity, enhances aesthetic outcomes, minimizes dissection, and preserves the auricular reconstruction site.