Postoperative Complications Related to Bone-Conduction Hearing Devices: A Comprehensive Evaluation at a Single Institution

Objectives: 1) To comprehensively report our experience with postoperative complications from bone-conduction hearing devices (BCHDs), and 2) to identify preoperative patient-related factors that differ among BCHD recipients. Study Design: Retrospective cohort. Setting: Tertiary referral center. Patients: One hundred eighty-seven patients Main Outcome Measures: Postoperative complications, operative time, demographics, and preoperative pure-tone average. Results: Between January 2018 and April 2024, 187 patients received BCHDs (Connect n = 36, Attract n = 26, Osia n = 64, Ponto n = 17, Bonebridge n = 44). Median age at implantation was lower for the Ponto (9 y, IQR, 7–67) and Osia (18 y, IQR, 12–47) compared with the Attract (33 y, IQR, 8–52), Connect (47 y, IQR, 15–60), and Bonebridge (49 y, IQR, 26–60). Gender, type of hearing loss, and preoperative air- and bone-conduction thresholds were equivalent among the devices ( P > 0.05). Postoperative infections were highest for the Connect (68%), followed by the Attract (45%), Osia (33%), Ponto (29%), and Bonebridge (8%) ( P < 0.001). Skin overgrowth was most prevalent with the Connect (25%) ( P = 0.002). Difficulties with magnet retention were more likely with the Bonebridge (12%) and Osia (8%) than the Attract (0%) ( P = 0.012). Patient complaints of pain, bleeding, and decreased hearing were similar among the BCHDs ( P > 0.05). Of 10 BCHDs that were revised, 6 converted from Connect or Attract to Bonebridge or Osia; 1 converted from Osia to Bonebridge; and 3 were replaced with the same device. Median operative time was similar between the Osia and Bonebridge ( P > 0.05). Conclusions: Despite issues with poor magnetization, active transcutaneous BCHDs had relatively lower rates of infection. Patients who underwent revision surgery were more likely to convert from a percutaneous to a transcutaneous device.