Smoking as a risk factor for spontaneous bone anchored hearing implant extrusion: A case report and review of literature

Objectives: To report a case of two BAHI extrusions occurring in a heavy smoker and to review the literature to investigate the underlying biomechanisms leading to implant losses in smokers. Methods: Case report and literature review. Results: A 35-year-old man experienced delayed healing and increased pain around the abutment site despite an uneventful BAHI surgery. The implant extruded 2 days after sound processor coupling. A second implant was placed and extruded 1 week after post-operatively. The literature review identified 2 other cases of implant loss in heavy smokers; one undergoing 6 surgeries. Smoking is thought to adversely affect hormones and enzymes involved in bone regulation, and to have an inhibitory effect on osteogenesis and on angiogenesis. At the cellular level, nicotine reduces the proliferation of red blood cells, macrophages, and fibroblasts and increases micro clot formation in blood vessels through increased platelet adhesiveness. Conclusion: We highlight possible risks associated with bone anchored hearing implant loss and smoking. These risks should be discussed with patients who are BAHI candidates and heavy smokers. Keywords: Bone anchored hearing implant, BAHA, Smoking, Implant loss, Extrusion, Osseointegration