Aetiology-specific modification of incision design in OSIA® implantation; a cohort of 46 implants in a tertiary paediatric centre

OBJECTIVES: Active transcutaneous bone conduction devices have expanded rehabilitation options for children with conductive, mixed, and single-sided deafness (SSD). The Cochlear™ OSIA® system improves hearing while preserving intact skin. We hypothesised that postoperative outcomes vary by operative context and that incision design may influence complication risk. METHODS: A prospectively maintained database of paediatric patients implanted between September 2021 and April 2026 was retrospectively analysed. Patients were grouped by operative context: (1) microtia/craniofacial anomalies, (2) surgically altered tissues (chronic ear disease/post-mastoidectomy or conversion from percutaneous devices), and (3) normal anatomy (SSD). The primary outcome was soft tissue complications. Secondary outcomes included audiological improvement and subjective benefit (SAC-A). RESULTS: Thirty-four children underwent 46 OSIA® implants (22 unilateral, 12 bilateral); they were aged between 7-19 years and 56% were female. Seventeen had microtia/craniofacial syndromes, twelve had chronic ear disease (including four conversions), and five had SSD. No perioperative complications occurred. Postoperative soft tissue complications occurred in 4/46 implants (8.7%), exclusively in the microtia/craniofacial and surgically altered tissue groups. One explantation was required for late infection; the remainder were managed conservatively or with revision surgery. Significant improvements were seen at 2 kHz (P = 0.009), 4 kHz (P < 0.001), and in speech recognition (86% to 95%, P = 0.004). SAC-A scores improved significantly (36 to 24; P = 0.002), with 94.1% reporting satisfactory usability. CONCLUSIONS: Paediatric OSIA® implantation provides substantial audiological benefit with low complication rates. Complications clustered in anatomically or surgically altered tissues, supporting context-specific counselling and surgical planning.