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Steroid Cream Reduces Skin and Scar Overgrowth on Hearing-Aid Abutments: Presented at AAO-HSN

By Jacquelyn Beals

WASHINGTON, DC -- September 20, 2007 -- Topical application of clobetasol effectively reduces overgrowth of abutments for bone-anchored hearing aids (BAHAs), researchers at Vanderbilt University reported here in a poster paper displayed this week at the Annual Meeting of the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) Foundation. Clobetasol, a steroid cream used to treat psoriasis, resolved overgrowth at abutment sites after an average treatment course of 7 weeks.

Study author Michael T. Falcone, MD, Resident, Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States, described the physical setting of a BAHA: "The hearing aid is mounted to a titanium implant abutment placed behind the ear … [it] may be removed from the abutment in a similar manner in which a traditional hearing aid is removed from the ear."

The titanium post is surgically embedded in the skull. Before BAHA use, the implant must bond fully with the bone -- a process that takes 3 to 6 months. A removable processor attached to the abutment transmits vibrations to the embedded abutment, surrounding bone, and the inner ear.

When skin or scar tissue grow across the abutment, proper attachment of the BAHA becomes difficult. The resulting poor attachment may also reduce the effective transmission of vibrations to the cochlea. In the past, surgery has been used to excise scar tissue and remedy the situation.

The current study reviewed the records of 88 patients with BAHAs. Patients had a median age of 42.5 years. Over periods ranging from 2 weeks to 19 months, skin or scar-tissue overgrowth occurred at 20 abutment sites. Thirteen sites were treated with 0.05% clobetasol and 7 with skin excision. The overgrowth was reduced at 11 of the abutment 13 sites (85%) after 3 weeks to 3 months of treatment. The report notes: "Of the seven sites treated with excision, four required multiple revision procedures."

To increase the advantages of clobetasol treatment, the authors suggest: "Patient education regarding skin overgrowth can lead to early detection and treatment and minimise delay of BAHA use." The authors conclude that clobetasol not only enables patients to return to BAHA use, but "may improve vibration conduction to the cochlea and obviate the need for scar revision."

BAHAs are more effective than the common in-the-ear or behind-the-ear aids for certain types of hearing loss "including fixed conductive loss and unilateral sensorineural hearing loss," noted the researchers.

[Presentation title: Bone-Anchored Hearing Aid Abutment Skin Overgrowth Reduction.]

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