Bilateral Bone-anchored Hearing Aids Research Articles

Bilateral Bone Anchored Hearing aids: A Case Report on Right Side Percutaneous and Left Side Transcutaneous Implant.

Bilateral Bone Anchored Hearing Aids (BAHA) provide more subjective patient satisfaction and outcome than unilateral BAHA. Initially, percutaneous BAHAs were used for many decades. Transcutaneous BAHAs were started later to overcome problems associated with percutaneous ones. The present report gives the outcome of bilateral BAHA in a patient with percutaneous BAHA on one side and transcutaneousBAHA on the other.

Evidence for Early Loading of Osseointegrated Implants for Bone Conduction at 4 Weeks

The purpose of our study was to directly measure the stability of the abutment using resonance frequency analysis (RFA) and to report on the change in stability over time for implants loaded 4 weeks postoperatively. The principle behind RFA is to obtain a numerical value relating to stability. The Osstell RFA recording device measures the resonance in a magnetic field of a 1 cm commercially manufactured attachment (SmartPeg) that is screwed onto the bone conduction device abutment. RFA measurements were obtained at surgery, 1, 4, and 16 weeks after implant surgery. The degree of movement (vibration) is inversely proportional to the stability of the abutment, and a numerical figure, the implant stability quotient (ISQ), is derived. Patients were fitted with the new Cochlear Bone-Anchored Hearing Aid (BAHA) BI300 series implant using a 1-stage procedure and loaded 4 weeks postoperatively. Prospectively 68 consecutive patients were recruited with a male to female ratio of 23:45. Nineteen patients had bilateral BAHA devices fitted, giving a total of 88 implants. The average ISQ change (delta) for the cohort gives a value of 0 at time of surgery. The change in ISQ at 1 week was -0.10 (95% confidence interval [CI], 0.74), at 4 weeks was 1.21 (95% CI, 0.59), and at 16 weeks was 1.60 (95% CI, 0.77). Successful early loading of the BAHA sound processor has been achieved. RFA provides a reliable means of assessing stability for loading and measuring implant stability in the longer term. These data support the evidence for early loading at 4 weeks with good clinical safety.

Bilateral Bone‐Anchored Hearing Aids: A Systematic Review

Objective: To systematically review the outcomes of bilateral versus unilateral bone-anchored hearing aids (BAHA) for individuals with bilateral permanent conductive hearing loss (CHL) with the goal of 1) deriving clinically oriented insights into the advantages and disadvantages of bilateral fitting; and 2) identifying gaps in knowledge to stimulate future research. Method: Medline, EMBASE, and Cochrane databases were searched for studies of all languages published between 1977 and July 2011. Studies were included if subjects of any age had permanent bilateral CHL and bilateral implanted BAHAs. Outcome measures of interest included audiologic evaluation, quality of life indicators, and reports of adverse events. Results: A total of 628 abstracts were generated from the literature searches; 11 studies met the criteria for data extraction and analysis. All 11 studies were observational. In most studies, comparisons between unilateral and bilateral BAHA were intra-subject. Bilateral BAHA provided additional audiologic benefit compared to unilateral BAHA (improved thresholds for tones [2 studies], speech in quiet [5 studies] and in noise [3 studies], and improved localization [3 studies]), and patients perceived additional subjective benefit from bilateral BAHA [3 studies]. Disadvantages of bilateral BAHA included listening in noise in some conditions [3 studies], additional cost, and presumed increase in adverse event risk. Conclusion: Bilateral BAHA provided additional objective and subjective benefit compared to unilateral BAHA; however, there was a limited number of studies available with good quality evidence. Aspects of bilateral BAHA that would benefit from further investigation are described, and recommendations for bilateral BAHA candidacy criteria are provided.

Bilateral Bone‐Anchored Hearing Aids for Bilateral Permanent Conductive Hearing Loss

To systematically review the outcomes of bilateral versus unilateral bone-anchored hearing aids (BAHA) for individuals with bilateral permanent conductive hearing loss (CHL) with the goal of (1) deriving clinically oriented insights into the advantages and disadvantages of bilateral fitting and (2) identifying gaps in knowledge to stimulate future research. Medline, EMBASE, and Cochrane databases were searched for studies of all languages published between 1977 and July 2011. Studies were included if subjects of any age had permanent bilateral CHL and bilateral implanted BAHAs. Outcome measures of interest were any subjective or objective audiologic measures, quality of life indicators, or reports of adverse events. In all, 628 abstracts were generated from the literature searches; 11 studies met the criteria for data extraction and analysis. All 11 studies were observational. In most studies, comparisons between unilateral and bilateral BAHA were intra-subject. Bilateral BAHA provided audiologic benefit compared to unilateral BAHA (improved thresholds for tones [2 studies], speech in quiet [5 studies] and in noise [3 studies], and improved localization/lateralization [3 studies]) and patients' perceived subjective benefit from bilateral BAHA (3 studies). Disadvantages of bilateral BAHAs included listening in noise in some conditions (3 studies), presumed additional cost, and presumed increase in adverse event risk. Bilateral BAHA provided additional objective and subjective benefit compared to unilateral BAHA; however, there was a limited number of studies available with good quality evidence. Aspects of bilateral BAHA that would benefit from further investigation are described, and recommendations for bilateral BAHA candidacy criteria are provided.

Bone‐anchored hearing aids for people with bilateral hearing impairment: a systematic review

Bone-anchored hearing aids (BAHAs) are indicated for people with conductive or mixed hearing loss who can benefit from amplification of sound. In resource limited health care systems, it is important that evidence regarding the benefit of BAHAs is critically appraised to aid decision-making. To assess the clinical effectiveness of BAHAs for people with bilateral hearing impairment. Systematic review. Nineteen electronic resources were searched from inception to November 2009. Additional studies were sought from reference lists, clinical experts and BAHA manufacturers. Inclusion criteria were applied by two reviewers independently. Data extraction and quality assessment of full papers were undertaken by one reviewer and checked by a second. Studies were synthesised through narrative review with tabulation of results. Twelve studies were included. Studies suggested audiological benefits of BAHAs when compared with bone-conduction hearing aids or no aiding. A mixed pattern of results was seen when BAHAs were compared to air-conduction hearing aids. Improvements in quality of life with BAHAs were found by a hearing-specific instrument but not generic quality of life measures. Issues such as improvement of discharging ears and length of time the aid can be worn were not adequately addressed by the studies. Studies demonstrated some benefits of bilateral BAHAs. Adverse events data were limited. The quality of the studies was low. The available evidence is weak. As such, caution is indicated in the interpretation of presently available data. However, based on the available evidence, BAHAs appear to be a reasonable treatment option for people with bilateral conductive or mixed hearing loss. Further research into the benefits of BAHAs, including quality of life, is required to reduce the uncertainty.

Abstracts

The aim of this systematic review, using standard methodology,was to assess the clinical and cost-effectiveness of bone-anchored hearing aids (BAHAs) for people who are bilaterally deaf. Prospective studies comparing BAHAs versus conventional hearing aids [air conduction hearing aid (ACHA) or bone conduction hearing aid (BCHA)], unaided hearing or ear surgery; and unilateral versus bilateral BAHAs were eligible. Twelve clinical effectiveness studies were included. No eligible comparisons with ear surgery were identified. Overall quality was rated as weak for all included studies. There appeared to be some audiological benefi ts of BAHAs compared with BCHAs and improvements in speech understanding in noise compared with ACHAs, however ACHAs may produce better audiological results for other outcomes; the limited evidence reduces certainty. Hearing is improved with BAHAs compared with unaided hearing. Improvements in QoL with BAHAs were identifi ed by a hearing-specifi c instrument but not generic QoL measures. Studies comparing unilateral with bilateral BAHAs suggested benefi ts of bilateral BAHAs in many, but not all, situations. A decision analytic model was developed to estimate the costs and benefits of unilateral BAHAs over a ten year time horizon. The incremental cost per user receiving BAHA, compared with BCHA, was £16,344 for children and £13,281 for adults. In an exploratory analysis the incremental cost per QALY gained was between £118,898 and £55,424 for children and between £98,790 to £46,051 for adults for BAHAs compared with BCHA, depending on the assumed QoL gain and proportion of each modelled cohort using their hearing aid for eight or more hours per day. Deterministic sensitivity analysis suggested results were highly sensitive to the assumed proportion of people using BCHA for eight or more hours per day. Exploratory cost effectiveness analysis suggests that BAHAs are unlikely to be a cost effective option where the benefi ts are similar for BAHAs and their comparators. The greater the benefit from aided hearing and the greater the difference in the proportion of people using the hearing aid for eight hours or more per day, the more likely BAHAs are to be a cost effective option. The inclusion of other dimensions of QoL may also increase the likelihood of BAHAs being a cost effective option. A national audit of BAHAs is needed to provide clarity on the many areas of uncertainty surrounding BAHAs.

Bone-anchored hearing aids (BAHAs) for people who are bilaterally deaf: a systematic review and economic evaluation

A bone-anchored hearing aid (BAHA) consists of a permanent titanium fixture, which is surgically implanted into the skull bone behind the ear, and a small detachable sound processor that clips onto the fixture. BAHAs are suitable for people with conductive or mixed hearing loss who cannot benefit fully from conventional hearing aids. To assess the clinical effectiveness and cost-effectiveness of BAHAs for people who are bilaterally deaf. Nineteen electronic resources, including MEDLINE, EMBASE and The Cochrane Library (inception to November 2009). Additional studies were sought from reference lists and clinical experts. Inclusion criteria were applied by two reviewers independently. Data extraction and quality assessment were undertaken by one reviewer and checked by a second. Prospective studies of adults or children with bilateral hearing loss were eligible. Comparisons were BAHAs versus conventional hearing aids [air conduction hearing aid (ACHA) or bone conduction hearing aid (BCHA)], unaided hearing and ear surgery; and unilateral versus bilateral BAHAs. Outcomes included hearing measures, validated measures of quality of life (QoL), adverse events and measures of cost-effectiveness. For the review of cost-effectiveness, full economic evaluations were eligible. Twelve studies were included (seven cohort pre-post studies and five cross-sectional 'audiological comparison' studies). No prospective studies comparing BAHAs with ear surgery were identified. Overall quality was rated as weak for all included studies and meta-analysis was not possible due to differences in outcome measures and patient populations. There appeared to be some audiological benefits of BAHAs compared with BCHAs and improvements in speech understanding in noise compared with ACHAs; however, ACHAs may produce better audiological results for other outcomes. The limited evidence reduces certainty. Hearing is improved with BAHAs compared with unaided hearing. Improvements in QoL with BAHAs were identified by a hearing-specific instrument but not generic QoL measures. Studies comparing unilateral with bilateral BAHAs suggested benefits of bilateral BAHAs in many, but not all, situations. Prospective case series reported between 6.1% and 19.4% loss of implants. Most participants experienced no or minor skin reactions. A decision analytic model was developed. Costs and benefits of unilateral BAHAs were estimated over a 10-year time horizon, applying discount rates of 3.5%. The incremental cost per user receiving BAHA, compared with BCHA, was £ 16,409 for children and £ 13,449 for adults. In an exploratory analysis the incremental cost per quality-adjusted life-year (QALY) gained was between £ 55,642 and £ 119,367 for children and between £ 46,628 and £ 100,029 for adults for BAHAs compared with BCHA, depending on the assumed QoL gain and proportion of each modelled cohort using their hearing aid for ≥ 8 or more hours per day. Deterministic sensitivity analysis suggested that the results were highly sensitive to the assumed proportion of people using BCHA for ≥ 8 hours per day, with very high incremental cost-effectiveness ratio values (£ 500,000-1,200,000 per QALY gained) associated with a high proportion of people using BCHA. More acceptable values (£ 15,000-37,000 per QALY gained) were associated with a low proportion of people using BCHA for ≥ 8 hours per day (compared with BAHA). The economic evaluation presented in this report is severely limited by a lack of robust evidence on the outcome of hearing aid provision. This has lead to a more restricted analysis than was originally anticipated (limited to a comparison of BAHA and BCHA). In the absence of useable QoL data, the cost-effectiveness analysis is based on potential utility gains from hearing, that been inferred using a QoL instrument rather than measures reported by hearing aid users themselves. As a result the analysis is regarded as exploratory and the reported results should be interpreted with caution. Exploratory cost-effectiveness analysis suggests that BAHAs are unlikely to be a cost-effective option where the benefits (in terms of hearing gain and probability of using of alternative aids) are similar for BAHAs and their comparators. The greater the benefit from aided hearing and the greater the difference in the proportion of people using the hearing aid for ≥ 8 hours per day, the more likely BAHAs are to be a cost-effective option. The inclusion of other dimensions of QoL may also increase the likelihood of BAHAs being a cost-effective option. A national audit of BAHAs is needed to provide clarity on the many areas of uncertainty surrounding BAHAs. Further research into the non-audiological benefits of BAHAs, including QoL, is required.

Audiometric thresholds measured with single and dual BAHA transducers: The effect of phase inversion

The bone-anchored-hearing-aid (BAHA) transduces airborne sound into skull vibration. Current bilateral BAHA configurations, for sounds directly facing listeners, will apply forces that are in-phase with each other and directed roughly towards the center of the head. Below approximately 1000 Hz the two cochleae respond in approximately the same direction and with approximately the same phase to each BAHA, thus it may be preferable to drive bilateral BAHAs such that when one pushes, the other pulls. This can be achieved by adjusting the relative phase offset of the BAHAs, and doing so results in greater vibration and improved hearing threshold. In this paper we compare performance of bilateral BAHAs driven in this configuration to the standard configuration. In twelve normal participants we show significant improvements in low-frequency (≤750 Hz) hearing thresholds using out-of-phase BAHAs. The threshold measurements are further supported by velocimetric measurements taken at the cochlear promontory in a cadaveric head. Comparing vibration arising from each configuration confirms that out-of-phase driving results in greater vibration. Neither dataset shows either improved or reduced threshold at high frequencies.SumarioLos auxiliares auditivos osteo-integrados (BAHA), convierten el sonido del aire, en vibración en el cráneo. Las configuraciones bilaterales actuales del BAHA, para sonidos que están directamente frente a los oyentes, aplican fuerzas que están en fase entre si y dirigidas alrededor del centro de la cabeza. Aproximadamente por debajo de 1000 Hz, las cócleas responden aproximadamente en la misma dirección y la misma fase en cada BAHA, por lo que es preferible el manejo de BAHAs bilaterales para que cuando uno empuja, el otro arrastre. Esto puede lograrse ajustando los controles de fase relativa de los BAHAs, que así resultan en mayor vibración y mejoría de umbrales auditivos. En este trabajo comparamos el desempeño de BAHAs bilaterales con esta configuración frente a la configuración estándar. En doce participantes normales mostramos mejorías significativas en umbrales auditivos de frecuencia baja (≤750 Hz) usando BAHAS fuera de fase. Las mediciones de umbrales son además apoyadas por mediciones velocimétricas tomadas en el promontorio coclear de la cabeza de un cadáver. Al comparar la vibración que surge de cada configuración, se confirma que los resultados obtenidos fuera de fase, resultan en una mayor vibración. Ninguno de los datos muestra mejoría o reducción de umbrales en las frecuencias agudas.

Bilateral Bone-Anchored Hearing Aid Application in Children

This study presents clinical data and quality of life questionnaire outcomes in children and young adults with bilateral Bone-Anchored Hearing Aids (BAHAs). Retrospective review. Tertiary care referral center. Eligible study subjects comprised 27 patients with bilateral conductive hearing loss fitted with bilateral BAHAs in childhood or as young adults at the Radboud University Nijmegen Medical Centre between June 1996 and October 2008. Questionnaires comprised the "Daily use of bilateral BAHAs" questionnaire, the Glasgow Children's Benefit Inventory, and the Speech Spatial and Qualities of Hearing scale modified for children. A total of 23 children were selected to fill out the postal questionnaires; 21 (91%) of them responded. In 90%, both BAHAs were being used 7 days a week. One child was using 1 BAHA but not the other, and one child was only using both BAHAs at school. Nine children reported that they switched off both BAHAs when the background became too noisy. Bilateral BAHAs provided better hearing quality according to 70%. The Glasgow Children's Benefit Inventory demonstrated subjective overall benefit of +38 (n = 20). The spatial domain of the Speech, Spatial and Qualities of Hearing scale showed a trend toward better spatial hearing with decreasing age at bilateral application. Bilateral percutaneous BAHAs can be applied simultaneously from the age of 4 years, after a successful trial period with the BAHA Softband or other equivalent hearing aids. Bilateral BAHAs showed clear benefit in the vast majority. Outcomes of bilateral audiologic testing are needed in the near future.

Spectrum of Hearing Disorders and Their Management in Children With CHARGE Syndrome

The CHARGE syndrome is associated with ear anomalies and deafness in addition to other malformations. Deformations of the ossicles or aplasia of the semicircular canals, cochlear hypoplasia, hypoplasia or aplasia of the VIIIth cranial nerve and abnormal routing of the VIIth cranial nerve, sigmoid sinus, and emissaries are typical findings. The aim of this study is to explore the feasibility and procedure of cochlear implantation in patients with CHARGE syndrome and to assess the outcome. Retrospective case review. Tertiary referral center; cochlear implant program. Ten patients with CHARGE syndrome and 3 patients with CHARGE-like syndrome treated in our center due to hearing impairment. Eleven patients were congenitally deaf, 1 patient had progressive hearing loss, and 1 patient had mixed hearing loss. Computed tomography of temporal bones and magnetic resonance imaging of the brain; bone-anchored hearing aid surgery, cochlear implantation, rehabilitation results. Surgical suitability and hearing rehabilitation. We illustrate the management of preoperative diagnostics, surgical planning, and hearing rehabilitation. One patient with mixed hearing loss underwent bilateral bone-anchored hearing aid surgery. Because 2 patients had bilateral aplasia of the auditory nerves, we recommended an auditory brainstem implant. The unilateral cochlear implantation was performed in 9 patients and bilateral in 1 patient. In selected cases, it was helpful to plan the operation using a simulator for temporal bone surgery. Complex malformations, such as in CHARGE syndrome, with an increased intraoperative risk for complications should be facilitated by using intraoperative digital volume tomography-assisted navigation and intraoperative digital volume tomography control of electrode position. The results after CI surgery vary due to the differing extent of additional disabilities such as developmental delay, intellectual delay, and visual impairment. Nine of our patients showed improved responsiveness with the cochlear implant. Open speech comprehension could not be observed in 8 patients, whereas the follow-up period was less than 1 year in 4 patients. The relatively high age of our patients at implantation might be an important factor. Careful planning of the treatment of CHARGE syndrome patients with sensorineural hearing loss can, to a limited extent, lead to auditory benefit without increasing surgical complications. Cochlear implantation is therefore indicated after critical assessment.

Bilateral Bone-Anchored Hearing Aid

To investigate whether the fitting of bilateral Bone-anchored Hearing Aid (BAHA) would result in any additional improvement in patients' quality of life (QOL) over and above what we would experience from the fitting of a single-sided BAHA. Retrospective, anonymized, cross-sectional postal survey using the Glasgow Benefit Inventory (GBI). Tertiary referral center. All 93 adult patients who had been using bilateral BAHA for more than 6 months. Hearing rehabilitation using bilateral BAHA. These include the GBI benefit scores across the following domains: "overall benefit," "general health benefit," "physical health benefit," and "social benefit." Comparison of GBI scores against other otological interventions including single-sided BAHA. Response rate was 76%. Ninety-two percent of patients reported improvement in QOL. Positive QOL improvement scores were reported across all domains. Overall GBI benefit score was +ve 38. This is higher than the benefit scores reported by patients with single-sided BAHA, although this may not be statistically significant. After fitting the second BAHA, patients may report additional improvement in their QOL (of a smaller magnitude) over and above the initial improvement in their QOL after fitting of their first BAHA. In fact, the overall benefit score for bilateral BAHA seem to be close to that for cochlear implantation.

Quality of Life in Children Fitted With a Bone-Anchored Hearing Aid

To evaluate the self-rated quality of life and benefits associated with the use of a Bone-Anchored Hearing Aid (BAHA). To assess any change in health status after a BAHA. This was a retrospective postal questionnaire study. The Glasgow Children's Benefit Inventory was the validated tool used.Children with a BAHA on the Birmingham pediatric Bone-Anchored Hearing Aid Programme from February 1992 to February 2007 were included. One hundred fifteen children were sent a postal questionnaire. Eighty-four were returned, giving a response rate of 73%. All children had worn their BAHA for more than 6 months. Children with an implant-retained auricular prosthesis were excluded from the study, as were children who were older than 16 years at the time of the questionnaire. Patients with bilateral BAHA were advised to answer the questionnaire with reference to their first BAHA. The BAHA was a success in the pediatric population. All 84 children reported a positive benefit with their BAHA. The median benefit score was +54. No child demonstrated deterioration in health status after their BAHA. The use of a BAHA significantly enhanced general well-being, improved patient state of health (quality of life), and finally, was considered a success by patients and their families. This study demonstrates a significant benefit from BAHA as measured by the Glasgow Children's Benefit Inventory.

Knochenverankerte Hörgeräte (BAHA)

Bone anchored hearing aids (BAHA) achieve optimal acoustic coupling by means of direct bone conduction via an osseointegrated percutaneous titanium implant. Currently this system has a record of over 30 years of clinical application and reliability. Patients with bilateral hearing loss with air-bone gaps will benefit from bilateral BAHA fitting. Likewise, unilateral conductive hearing loss with normal hearing on the other side can be treated with a BAHA. New developments in this field include the BAHA Intenso and also novel implant systems, such as the Epiplating system by Medicon, the alpha system by Otomag and the OBC system by Otorix. Due to the advantages of the BAHA system (possibility of preoperative testing, simple surgery without the risk of inner ear damage, MRI compatibility, etc.), the BAHA will keep its important role in hearing rehabilitation even in the era of other partially and totally implantable hearing devices.

Bone-anchored hearing aid abutment skin overgrowth reduction with clobetasol

The bone-anchored hearing aid (BAHA) osseointegrated cochlear stimulator can treat hearing loss in a variety of clinical situations. Occasionally skin/scar overgrowth may cover the abutment. This overgrowth interferes with affixing the BAHA to the abutment. Surgical scar revision/excision has been used to treat this problem. Clobetasol (0.05%), a steroid gel, can reduce skin overgrowth. Experience with skin overgrowth and the efficacy of clobetasol to treat this problem was reviewed. The authors conducted a retrospective analysis of patients who underwent BAHA abutment implantation from January 2003 through December 2006. Eighty-eight patients (2 patients received bilateral BAHAs) were reviewed. Twenty (22%) of 90 sites developed overgrowth. Thirteen of 20 sites were treated with clobetasol. The overgrowth resolved in 11 (85%) of 13 sites after treatment. Patients with incomplete skin graft survival were significantly more likely to develop skin overgrowth (P = 0.0017). Clobetasol is an effective treatment for abutment skin/scar overgrowth. Clobetasol allows patients to resume BAHA use and obviates the need for scar revision.

An approach to bilateral bone-anchored hearing aid surgery in children: contralateral placement of sleeper fixture

Bone-anchored hearing aid surgery in younger children is a two-stage procedure, with a titanium fixture being allowed to osseointegrate for several months before an abutment is fitted through a skin graft. In the first procedure, it has been usual to place a reserve or sleeper fixture approximately 5 mm from the primary fixture as a backup in case the primary fixture fails to osseointegrate. This ipsilateral sleeper fixture is expensive, is often not used, and is placed in thinner calvarial bone where it is less likely to osseointegrate successfully. The authors have implanted the sleeper fixture on the contralateral side, with the additional objective of reducing the number of procedures for bilateral bone-anchored hearing aid implantation, providing a cost-effective use for the sleeper. The authors implanted the bone-anchored hearing aid sleeper fixture in the contralateral temporal bone instead of on the ipsilateral side in seven successive paediatric cases with bilateral conductive hearing loss requiring two-stage bone-anchored hearing aids, treated at the Royal Manchester Children's Hospital, UK. The seven patients ranged in age from five to 15 years, with a mean age of 10 years; in addition, a 20-year-old with learning disability was also treated. In each case, the contralateral sleeper fixture was not needed as a backup fixture, but was used in four patients (57 per cent) as the basis for a second-side bone-anchored hearing aid. In children with bilateral conductive hearing loss, in whom a bilateral bone-anchored hearing aid is being considered and the second side is to be operated upon at a later date, we recommend placing the sleeper fixture on the contralateral side at the time of primary first-side surgery. Our technique provides a sleeper fixture located in an optimal position, where it also offers the option of use for a second-side bone-anchored hearing aid and reduces the number of procedures needed.

The role of bone anchored hearing aids in children with Down syndrome

To evaluate complication rates and outcomes of children with Down syndrome fitted with a Bone Anchored Hearing Aid (Baha). To evaluate whether the Bone Anchored Hearing Aid is a successful form of aural rehabilitation in children with Down syndrome from a patients' perspective. Retrospective case analysis and postal questionnaire study. The Birmingham Children's Hospital, UK. A total of 15 children were fitted with a Baha between February 1992 and February 2007. The age range was 2-15 years. A postal questionnaire was sent to each family. The Glasgow Children's Benefit Inventory (GCBI) was used in this study. Implantation results, skin reactions and other complications were recorded. Quality of life after receiving a Baha was assessed with the GCBI. All 15 patients are using their Baha 7 days a week for more than 8h a day after a follow-up of 14 months with continuing audiological benefit. No fixtures were lost, and skin problems were encountered in 3 (20%). Regarding quality of life, all 15 patients had improved social and physical functioning as a result of better hearing. Baha has an important role in the overall management of individuals with Down syndrome after conventional hearing aids and/or ventilation tubes have been considered or already failed. This study has shown a 20% rate of soft tissue reaction and there were no fixture losses in this group. No significant increase in complication rates was identified in children with Down syndrome. Finally, there was a significantly improved quality of life in children with Down syndrome after receiving their Baha. There was a high patient/carer satisfaction with Baha. Two of our series had bilateral two stage fixture procedures without any complications. More consideration should be given to bilateral bone anchored hearing aids in this group.

P131: Bone-Anchored Hearing Aid Abutment Skin Overgrowth Reduction

P131: Bone-Anchored Hearing Aid Abutment Skin Overgrowth Reduction

Unilateral versus bilateral bone-anchored hearing aids (BAHAs)

Unilateral versus bilateral bone-anchored hearing aids (BAHAs)

Unilateral versus bilateral bone-anchored hearing aids (BAHAs)

Unilateral versus bilateral bone-anchored hearing aids (BAHAs)

Miniseminar: Bone-anchored hearing AIDS (BAHA) in children

BAHA is today a well-accepted treatment modality in adults and it has received FDA approval for use in children above the age of 5 years. The educational objectives of this miniseminar are to present the current status of the use of BAHA in children. The panel will discuss:(1) indications and contraindications; (2) selection of patients; (3) surgical procedure; (4) handling of complications; and (5) postop treatment. In the panel there are surgeons with extensive experience in the treatment of children with external ear canal atresia. Topic to be discussed include when an ear canal reconstruction should be recommended and when a BAHA may be a better alternative. The recommendation of timing between BAHA vs external ear reconstruction/implant retained auricular prosthesis will be covered. The use of BAHA in single-sided conductive loss and experience with bilateral BAHA in children will also be discussed together with the special surgical considerations in children. The panelists will present their view on how to handle the soft and thin bone in the mastoid of the child and how to proceed if the dura of the middle cranial fossa is exposed; the wall of the sigmoid sinus is damaged; or if the air-cells of the mastoid process are entered. Additionally, how to increase bone volume with the use of membrane technique will be described. The importance of soft tissue handling during surgery and pointers and pitfalls will be discussed. The seminar will also cover postop and follow-up routines.