Comparison of Osseointegration Outcomes in Percutaneous Bone‐Anchored Hearing Implants: Linear Incision Versus Minimally Invasive Techniques

OBJECTIVE: To compare osseointegration outcomes between minimally invasive (MI) techniques and the linear incision (LI) technique for bone-anchored hearing implant placement. STUDY DESIGN: We conducted a retrospective, multicentre cohort study. SETTINGS: Eight tertiary referral centers. METHODS: Patients undergoing bone-anchored hearing implant placement with either MI or LI techniques were included. The primary endpoint was implant extrusion within 180 days post-placement, excluding trauma-related cases. Surgical technique was the main exposure variable. A Cox proportional hazards model was used to assess the risk of extrusion between techniques, adjusting for potential confounders. RESULTS: Eighty-eight patients were included in the LI group and 117 in the MI group. The 180-day non-traumatic extrusion rate was 16.24% (95% confidence interval [CI], 10-24) for the MI group and 1.14% (95% CI, 0.06-7.1) for the LI group. Multivariable analysis demonstrated a significantly higher extrusion risk with MI techniques (HR = 10.1; 95% CI, 1.34-76.7; P = .025). CONCLUSION: Our findings indicate a significantly increased extrusion risk with MI techniques compared with LI. Until higher-level evidence becomes available, LI should be preferred in patients at risk of compromised osseointegration.