SynthesisEuropean archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery2026
Surgical Approaches and Complications in OSIA: a Systematic Review.
Synthesis in European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
backgroundThe Osseointegrated Steady-State Implant (OSIA) is an active transcutaneous bone conduction system offering effective hearing rehabilitation via a piezoelectric actuator and osseointegrated anchor, while preserving skin integrity. Despite the growing adoption of OSIA, the literature on optimal surgical approaches and complication patterns remains fragmented.
objectiveThis is the first systematic review aimed at evaluating intraoperative and postoperative complications associated with OSIA implantation, with a specific focus on incision orientation, patient age, and prior surgical history.
methodsA systematic review was registered with PROSPERO and conducted per PRISMA guidelines. PubMed, Embase, and CENTRAL were searched for studies published from January 2016 to April 2025. Fifteen eligible studies were included, encompassing 784 OSIA implants across prospective and retrospective cohorts.
resultsOSIA implantation was associated with a low pooled intraoperative complication rate of 0.77% and a postoperative complication rate of 5.25%. Most complications were mild and manageable, with no cases requiring permanent device removal. Incisions placed across the device had a significantly higher complication rate (14.4%) compared to incisions placed around the device (4.6%). Pediatric-predominant cohorts experienced more complications (10.2%) than adult-predominant cohorts (4.3%). Patients with prior mastoidectomy had a complication rate of 12.0%.
conclusionOSIA is a generally safe hearing solution, but surgical planning should consider patient-specific factors and incision orientation. Incisions placed across the device are linked to higher complication rates. These findings support evidence-based risk stratification and preoperative counseling.
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