Comparison of Complication Rates Between Percutaneous and Transcutaneous Bone Conduction Devices

Introduction: Bone conduction devices (BCDs) are commonly used for conductive, mixed, or single-sided deafness and include percutaneous (pBCD) and transcutaneous (tBCD) types. While pBCDs have historically had higher complication rates, this study compares complication rates between pBCDs and tBCDs, passive and active tBCDs, and evaluates brand-specific complication rates.

Methods: A retrospective cohort study was conducted from 2009 to 2023 at a tertiary care academic center. The study included 90 subjects who underwent BCD placement. Complications following surgery were the primary outcome, and the independent variables included the brand and type of BCD. Analysis was performed using chi-square tests, odds ratios, and descriptive statistics.

Results: A total of 91 BCDs were placed during the study period, with a mean patient age of 47 years (range: 15–75, 43.9% male, 91% white). Thirty devices (33%) were percutaneous and 61 (67%) were transcutaneous. Complications occurred in 60% of pBCDs and 21% of tBCDs, with pBCDs showing a significantly higher likelihood of complications (OR: 5.54, 95% CI: 2.13–14.37, p< 0.001). Among pBCDs, Cochlear Connect had a 74% complication rate, compared to 36% for Oticon Ponto (OR: 3.12, 95% CI: 0.65–15.03, p=0.16). The most common complications for pBCDs were infection (n=9), soft tissue irritation (n=5), and skin overgrowth (n=3). For tBCDs, the complication rates were 20% for Cochlear Attract, 18% for Cochlear Osia, 20% for Bonebridge, and 50% for Sophono Attract. The most common complications for tBCDs were pain (n=5) and soft tissue irritation (n=3). There was a significant difference in complication rates between active tBCD and pBCDs (χ² = 7.16, p = 0.007), but no significant difference between active and passive tBCDs. Overall, complications in 4 pBCDs (13%) and 5 tBCDs (8%) led to explantation or revision.

Conclusions: Our study found that pBCDs had a significantly higher complication rate than tBCDs. Comparing active and passive tBCDs, complication rates were similar. While most complications were minor, a small percentage required explantation or revision due to more severe issues.