Sensorineural Hearing Loss In Children Research Articles

Sudden Sensorineural Hearing Loss in Children: A Report of 75 Cases.

Objective:To investigate the characteristics, treatment, and prognostic factors of sudden sensorineural hearing loss (SSNHL) in children.Methods:Seventy-five cases (78 ears) of SSNHL in children from February 2011 to June 2016 were retrospectively analyzed. We scrutinized the clinical manifestations, audiological assessments, and serologic examinations of these pediatric cases by univariate and multivariate logistic analysis methods. The patients were divided into four groups according to their audiometric curve type: ascending, descending, flat, and profound.Results:Of the 75 patients (78 ears), 25 patients were in the ascending group (32.00%), 9 patients were in the descending group (12.00%), 17 patients were in the flat group (22.67%), and 24 patients were in the profound group (32.32%). The overall recovery rates (complete + partial + slight) of the different groups were as follows: ascending group, 96.00%; flat group, 76.47%; profound group, 50.00%; and descending group, 44.44%. The overall recovery rate of all patients was 70.67%. The multivariate logistic analysis showed that the type of audiometric curve and the interval from onset to intervention were two independent risk factors that correlated with the prognosis of SSNHL in children. Some children had positive cytomegaoviyns, rubella virus, and herpes simplex virus immunoglobulin G antibodies. Twenty-one children were treated with additional intratympanic methylprednisolone as salvage therapy and 13 of these children showed improved (complete + partial + slight) recoveries. Three children had postauricular compound betamethasone injections, but none of them showed improvement. One of three children recovered slightly after treatment with intratympanic methylprednisolone combined with postauricular betamethasone injection.Conclusions:The prognosis of SSNHL in children is closely related to the type of audiometric curve and the onset of treatment. Intratympanic methylprednisolone and compound betamethasone injected postauricularly could be effective for SSNHL in children.

Cochlear implant performance in children deafened by congenital cytomegalovirus-A systematic review.

Congenital cytomegalovirus (cCMV) infection is a major cause of sensorineural hearing loss in children. The objective of this systematic review was to compare performance in paediatric cochlear implant users with SNHL caused by cCMV compared to non-cCMV implantees. Systematic review SEARCH STRATEGY: PubMed, EMBASE and the Cochrane databases were searched from inception up to 15 May 2017 for children, cochlear implant, performance and their synonyms. Titles, abstracts and full texts were screened for eligibility. Directness of evidence and risk of bias were assessed. From the included studies, study characteristics and outcome data (speech perception, speech production, receptive language and auditory performance of cCMV groups and non-cCMV groups) were extracted. A total of 5280 unique articles were screened of which 28 were eligible for critical appraisal. After critical appraisal, 12 studies remained for data extraction. Seven of 12 studies showed worse performance after cochlear implantation in cCMV children compared to non-cCMV children. Worse performance in cCMV children was attributed to cCMV-related comorbidities in six of these studies. Available data on asymptomatic cCMV children compared to non-cCMV children did not reveal an unfavourable effect on cochlear implant performance. The available evidence reveals that cCMV children often have worse cochlear implant performance compared to non-cCMV children, which can be attributed to cCMV related comorbidities. We urge physicians to take into account the cCMV related comorbidities in the counselling of paediatric CI users deafened by cCMV.

Sensorineural hearing loss in children with sickle cell anemia and its association with endothelial dysfunction

ABSTRACTObjectives: To investigate the prevalence of sensorineural hearing loss (SNHL) in children and adolescents with sickle cell anemia (SCA) and its association with endothelial dysfunction (ED).Methods: Fifty-two participants with stable SCA and 44 apparently healthy (AA genotype) participants aged 6–18 years were evaluated for pure tone audiometry and endothelial function using ultrasonographic imaging of the brachial artery to assess flow-mediated dilation (FMD). Laboratory analysis of the lipid profile and C-reactive protein levels was performed.Results: In the SCA group, 15 (28.8%) patients presented with SNHL. The FMD values were reduced in the SCA with SNHL group compared with the SCA without SNHL and healthy groups. Logistic regression analysis showed that FMD was associated with SNHL independent of the lipid profile and SCA characteristics (odds ratio [95% confidence interval] = 0.614 [0.440–0.858]; p = 0.004).Discussion: SNHL is a common complication in SCA; furthermore, this study identified a significant association between ED and SNHL. Damage to the vascular endothelium because of inflammation in SCA reduced blood flow in the inner ear. Thus, this circulatory disorder culminates in vaso-occlusive process and induces auditory disorders, such as SNHL.

Safety of Autologous Human Umbilical Cord Blood for Sensorineural Hearing Loss in Children, A Phase I Trial

Background: Moderate to severe acquired sensorineural hearing loss (SNHL) in children is associated with substantial long term neurocognitive morbidity. The underlying cause of SNHL is loss of hair cells in the Organ of Corti. Currently, there are no successful neuro-reparative treatments for SNHL. Numerous pre-clinical studies suggest that cord blood derived mononuclear cells (hUCBC), cells derived from hUCBC, or similar cells derived from bone marrow allow at least partial restoration of SNHL by enabling …

Safety of Autologous Human Umbilical Cord Blood for Sensorineural Hearing Loss in Children, A Phase I Trial

Safety of Autologous Human Umbilical Cord Blood for Sensorineural Hearing Loss in Children, A Phase I Trial

MCMV triggers ROS/NLRP3-associated inflammasome activation in the inner ear of mice and cultured spiral ganglion neurons, contributing to sensorineural hearing loss.

Congenital cytomegalovirus (CMV) infection is the most common infectious cause of sensorineural hearing loss in children. While the importance of CMV-induced SNHL has been described, the mechanisms underlying its pathogenesis and the role of inflammatory responses remain elusive. The present study established an experimental model of hearing loss after systemic infection with murine CMV (MCMV) in newborn mice. Auditory brainstem responses were tested to evaluate hearing at 3 weeks, expression of inflammasome-associated factors was assessed by immunofluorescence, western blot analysis, reverse transcription-quantitative polymerase chain reaction and ELISA. MCMV sequentially induced inflammasome-associated factors. Furthermore, the inflammasome-associated factors were also increased in cultured spiral ganglion neurons infected with MCMV for 24 h. In addition, MCMV increased the content of reactive oxygen species (ROS). These results suggest that hearing loss caused by MCMV infection may be associated with ROS-induced inflammation.

Localization and Spatial Discrimination in Children and Adolescents with Moderate Sensorineural Hearing Loss Tested without Their Hearing Aids

The present study investigated two measures of spatial acoustic perception in children and adolescents with sensorineural hearing loss (SNHL) tested without their hearing aids and compared it to age-matched controls. Auditory localization was quantified by means of a sound source identification task and auditory spatial discrimination acuity by measuring minimum audible angles (MAA). Both low- and high-frequency noise bursts were employed in the tests to separately address spatial auditory processing based on interaural time and intensity differences. In SNHL children, localization (hit accuracy) was significantly reduced compared to normal-hearing children and intraindividual variability (dispersion) considerably increased. Given the respective impairments, the performance based on interaural time differences (low frequencies) was still better than that based on intensity differences (high frequencies). For MAA, age-matched comparisons yielded not only increased MAA values in SNHL children, but also no decrease with increasing age compared to normal-hearing children. Deficits in MAA were most apparent in the frontal azimuth. Thus, children with SNHL do not seem to benefit from frontal positions of the sound sources as do normal-hearing children. The results give an indication that the processing of spatial cues in SNHL children is restricted, which could also imply problems regarding speech understanding in challenging hearing situations.

Outcome of cochlear implantation in children with enlarged vestibular aqueduct (EVA) and mondini dysplasia (incomplete partition type II)

Background Congenital inner ear abnormality is a major cause of sensorineural hearing loss in children, about 20% of children with congenital sensorineural hearing loss (SNHL) have associated malformations of the temporal bone, and increased experience in cochlear implantation has led to more children with abnormal cochleo-vestibular anatomy submitted to this procedure. Aim To evaluate the outcome of cochlear implantation in cases with enlarged vestibular aqueduct (EVA) and Mondini deformity (incomplete partition type II) following cochlear implantation and comparing the results with cochlear implant cases without inner ear anomalies. Patients and methods 69 children all less than 6 years of age, CI surgeries underwent from April 2014 to December 2015 at the National Hearing & Speech institute (HSI) Giza-Egypt. Eight patients were congenital prelingual severe to profound hearing loss with enlarged vestibular aqueduct (EVA) and Mondini deformity (incomplete partition type II) Isolated EVA was detected in four cases, two cases with bilateral incomplete partition type II (Mondini deformity) and two cases with bilateral incomplete partition II (Mondini deformity) associated with dilated vestibule & vestibular aqueducts bilaterally with short lateral, SCC (semicircular canal), Beside those 8 cases, a random sample (16 control cases) . The ECAP thresholds determined with neural response telemetry (NRT) or Auditory response threshold (ART) software provide a good starting point for locating the behavioral T and C levels. Auditory skills were evaluated before start of rehabilitation and after 6 months of rehabilitation using LittlEARS Questionnaire and Auditory Checklists and compared to the auditory skills of other cochlear implantees with normal inner ear. Results: This study showed that the auditory skills and audiological performance of children with congenital ear anomalies developed over a period of 6 months after cochlear implantation, in a similar manner to those of young children with radiologically normal inner ears. Conclusion Cochlear implantation can be successfully performed in children with enlarged vestibular aqueduct (EVA) and Mondini dysplasia (incomplete partition type II) .These children and their parents can expect significant auditory benefits from this intervention.

Sudden sensorineural hearing loss in children: Our experiences in tertiary care teaching hospital of eastern India

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Swain S, Sahu M, Choudhury J. Sudden sensorineural hearing loss in children: Our experiences in tertiary care teaching hospital of eastern India. Pediatria Polska - Polish Journal of Paediatrics. 2018;93(2):127-131. doi:10.5114/polp.2018.74773. APA Swain, S., Sahu, M., & Choudhury, J. (2018). Sudden sensorineural hearing loss in children: Our experiences in tertiary care teaching hospital of eastern India. Pediatria Polska - Polish Journal of Paediatrics, 93(2), 127-131. https://doi.org/10.5114/polp.2018.74773 Chicago Swain, Santosh Kumar, Mahesh Chandra Sahu, and Jasashree Choudhury. 2018. "Sudden sensorineural hearing loss in children: Our experiences in tertiary care teaching hospital of eastern India". Pediatria Polska - Polish Journal of Paediatrics 93 (2): 127-131. doi:10.5114/polp.2018.74773. Harvard Swain, S., Sahu, M., and Choudhury, J. (2018). Sudden sensorineural hearing loss in children: Our experiences in tertiary care teaching hospital of eastern India. Pediatria Polska - Polish Journal of Paediatrics, 93(2), pp.127-131. https://doi.org/10.5114/polp.2018.74773 MLA Swain, Santosh Kumar et al. "Sudden sensorineural hearing loss in children: Our experiences in tertiary care teaching hospital of eastern India." Pediatria Polska - Polish Journal of Paediatrics, vol. 93, no. 2, 2018, pp. 127-131. doi:10.5114/polp.2018.74773. Vancouver Swain S, Sahu M, Choudhury J. Sudden sensorineural hearing loss in children: Our experiences in tertiary care teaching hospital of eastern India. Pediatria Polska - Polish Journal of Paediatrics. 2018;93(2):127-131. doi:10.5114/polp.2018.74773.

Tonal Perception Ability of Thai Children with Cochlear Implants and Hearing Aids

Background: Thai is one of several tonal languages. Accordingly, words spoken with different tones will change their meaning. Sensorineural hearing loss children have difficulty in perceiving tones which is directly related to a low level of speech understanding and intelligibility.Objectives: This study compared the tonal perception ability of severe-to-profound hearing loss children and profound hearing loss children who used hearing aids and cochlear implants respectively.Material and methods: Sixteen pre-lingual sensorineural hearing loss children from a preschoolaural rehabilitation program at Ramathibodi Hospital, Mahidol University, were selected. Subjects consisted of 8 bilateral hearing aid children and 8 unilateral cochlear implant children who were trained in the program for more than 3 years and able to produce speech recognition scores. All subjects demonstrated reasonable aided responses with their hearing devices. A Thai tone identification and discrimination test was used in this study. These tests were conducted by an experienced audiologist in a quiet room. The scores of the hearing aid group and the cochlear implant group were compared.Results: There were significant differences in tonal identification scores and tonal discrimination scores for the cochlear implant group when compared to the hearing aid group (p<0.05)Conclusion: Cochlear implantation provided better tonal perception of Thai lexical tone identification and discrimination of profound hearing loss children than severe-to-profound hearing loss children who used bilateral hearing aids.

Acquired sensorineural hearing loss in children: current research and therapeutic perspectives.

SUMMARYThe knowledge of mechanisms responsible for acquired sensorineural hearing loss in children, such as viral and bacterial infections, noise exposure, aminoglycoside and cisplatin ototoxicity, is increasing and progressively changing the clinical management of affected patients. Viral infections are by far the most relevant cause of acquired hearing loss, followed by aminoglycoside and platinum derivative ototoxicity; moreover, cochlear damage induced by noise overexposure, mainly in adolescents, is an emerging topic. Pharmacological approaches are still challenging to develop a truly effective cochlear protection; however, the use of steroids, antioxidants, antiviral drugs and other small molecules is encouraging for clinical practice. Most of evidence on the effectiveness of antioxidants is still limited to experimental models, while the use of corticosteroids and antiviral drugs has a wide correspondence in literature but with controversial safety. Future therapeutic perspectives include innovative strategies to transport drugs into the cochlea, such as molecules incorporated in nanoparticles that can be delivered to a specific target. Innovative approaches also include the gene therapy designed to compensate for abnormal genes or to make proteins by introducing genetic material into cells; finally, regenerative medicine (including stem cell approaches) may play a central role in the upcoming years in hearing preservation and restoration even if its role in the inner ear is still debated.

Detection of congenital cytomegalovirus in newborns using nucleic acid amplification techniques and its public health implications.

Human cytomegalovirus (HCMV), a herpesvirus, is an important human pathogen that causes asymptomatic infections in healthy or immunocompetent individuals but can lead to severe and potentially life-threatening complications in immune-immature individuals such as neonates or immune-compromised patients such as organ-transplant recipients and HIV-positive individuals. Congenital HCMV infection represents a significant public health issue and poses substantial healthcare and economic burden to society. This virus causes the most common viral congenital infection worldwide, and is the leading non-genetic cause of sensorineural hearing loss in children in developed countries. Congenital HCMV infection is believed to fulfill the criteria of the American College of Medical Genetics to be considered as a condition targeted for a newborn screening program. This is because congenital HCMV infection can be identified during a time (within 2 days after birth) at which it would not ordinarily be detected clinically, and there are demonstrated benefits of early detection, timely intervention, and efficacious treatment of the condition. Recent progresses in developing polymerase chain reaction-based approaches to detect HCMV in samples obtained from newborns have generated much excitement in the field. In this review, we highlight the recent progress in diagnostic techniques that could potentially be used for the detection of HCMV infection in neonates and its direct implications in public health settings for diagnosing congenital HCMV infection.

Sudden sensorineural hearing loss in children and adolescents: Clinical characteristics and age-related prognosis

ObjectiveAlthough many studies have investigated sudden sensorineural hearing loss (SSNHL) in adults, there were few studies on SSNHL in the pediatric population; especially research on treatment and prognosis of pediatric SSNHL was limited. The aim of this study was to evaluate clinical characteristics, treatment outcomes and prognostic factors in children and adolescents with SSNHL. MethodsA retrospective review of medical records of 67 pediatric patients (67 ears) who had diagnosed with SSNHL at our hospitals was performed to analyze patients’ clinical manifestations and audiograms. All patients were treated with high-dose systemic prednisolone (1mg/kg), and 17 of them underwent intratympanic steroid injection therapy. Audiological evaluation was carried out before and after treatment, and hearing recovery was defined as complete recovery and partial recovery according to Siegel’s criteria. Patients were divided into two groups: childhood group (ages between 4 and 12 years old) and adolescence group (age>12years), and clinical characteristics and treatment outcomes were investigated. In addition, patients were divided into two groups according to degree of hearing recovery, and evaluation was made regarding possible prognostic factors. ResultsThe recovery rate in total 67 patients was 55.2%. The recovery rate of the childhood group was significantly lower than that of the adolescence group (p=0.038). While the presence of vertigo did not significantly correlate with prognosis (p=0.219), the presence of tinnitus was significantly associated with hearing recovery (p=0.005). Audiological assessment revealed that a low initial hearing threshold, high speech discrimination score, and descending type of audiogram were positively associated with hearing recovery (p=0.002, p=0.003, and p=0.029, respectively). ConclusionThe childhood group had worse treatment outcomes than the adolescence group. High initial hearing threshold and absence of tinnitus were poor prognostic factors of hearing recovery. Active treatment is required for patients with these poor prognostic factors and childhood patients with SSNHL.

Prevalence of Severe and Profound Sensorineural Hearing Loss in School Children in West Bengal, India.

There is pressing need for reliable information about prevalence of sensorineural hearing loss in children in India. Without this basic information it is difficult to plan services on a rational basis. In this stratified cross sectional study, we aimed to determine the prevalence of severe and profound sensorineural hearing loss in school children in West Bengal, India. We hypothesized that all children with severe or profound hearing loss in elementary schools (age 6-14years) would be among those identified as 'children with special need' because of their marked problems with hearing, speech or communication. First stratum of our study included all 6-14years old mainstream elementary school 'children with special need', with known or suspected hearing problem. Second stratum covered all 6-14years old hearing impaired children attending special schools. Comprehensive audiological assessment of 10,763 'children with special need' in mainstream elementary schools identified 3984 children showing severe or profound SNHL (≥71dB). A further 1022 children were identified with similar loss in special schools, giving a total of 5006 children with severe or profound sensorineural loss among a school population of 8,654,057, with estimated prevalence of 0.58 (CI 0.57-0.59) per 1000 children. This is the first large scale study of the epidemiology of severe and profound sensorineural hearing loss in school children in India. Although further studies are needed from other parts of India, in the interim, findings of this study can form the basis for planning resource allocation, service provision, investigation into etiology and prevention of sensorineural deafness in children in India.

Hearing impairment in children with congenital cytomegalovirus (CMV) infection based on distortion product otoacoustic emissions (DPOAE) and brain evoked response audiometry stimulus click (BERA Click) examinations

Congenital cytomegalovirus (congenital CMV) infection is a leading factor of nongenetic sensorineural hearing loss in children. Hearing loss caused by CMV infection does not have a pathognomonic configuration hence further research is needed. The development of knowledge on hearing loss caused by congenital CMV infection is progressing in many countries. Due to a lack of research in the context of Indonesia, this study assesses hearing impairment in children with congenital CMV infection in Indonesia, more specifically in the Cipto Mangunkusumo Hospital. Our objective was to profile hearing impairment in children 0-5 years of age with congenital CMV infection using Distortion Product Otoacoustic Emissions (DPOAE) and Brain Evoked Response Audiometry Stimulus Click (BERA Click) examinations. This cross-sectional study was conducted in the Cipto Mangunkusum Hospital from November, 2015 to May 2016 with 27 children 0-5 years of age with congenital CMV infection. Of individual ears studied, 58.0% exhibited sensorineural hearing loss. There was a significant relationship between developmental delay and incidence of sensorineural hearing loss. Subjects with a developmental delay were 6.57 times more likely (CI 95%; 1.88-22.87) to experience sensorineural hearing loss. Congenital CMV infection has an important role in causing sensorineural hearing loss in children.

Analysis of archived newborn dried blood spots (DBS) identifies congenital cytomegalovirus as a major cause of unexplained pediatric sensorineural hearing loss

PurposeCongenital cytomegalovirus (cCMV) infection is the most common non-genetic cause of sensorineural hearing loss (SNHL). However, accurate diagnosis of cCMV as the etiology of SNHL is problematic beyond the neonatal period. This study therefore examined whether cCMV infection could be identified retrospectively in children presenting with unexplained SNHL to a multidisciplinary diagnostic outpatient otolaryngology clinic at an academic medical center in Minnesota. MethodsOver a 4-year period, 57 patients with an age range of 3months to 10years with unexplained SNHL were recruited to participate in this study. Informed consent was obtained to test the archived dried blood spots (DBS) of these patients for cCMV infection by real-time PCR, targeting a highly conserved region of the CMV UL83 gene. Results were normalized to recovery of an NRAS gene control. Chart review was conducted to identify subjects who underwent genetic testing and/or neurodiagnostic imaging to investigate possible genetic, syndromic, or anatomical causes of SNHL. ResultsIn total, 15 of the 57 children with unexplained SNHL tested positive for CMV DNA in their DBS (26%). A mean viral load of 8.3×104 (±4.1×104) [range, 1×103–6×105] copies/μg DNA was observed in subjects retrospectively diagnosed with cCMV. No statistically significant correlation was found between viral load and SNHL severity. ConclusionsA retrospective DBS analysis demonstrated that 26% of patients presenting with unexplained SNHL in childhood had cCMV. DBS testing is useful in the retrospective diagnosis of cCMV, and may provide definitive diagnostic information about the etiology of SNHL.

Congenital cytomegalovirus – who, when, what-with and why to treat?

Congenital cytomegalovirus (CMV) is the commonest cause of congenital infection worldwide and the leading non-genetic cause of sensorineural hearing loss in children. Appropriate investigations and timely decision on treatment is required as studies have shown that treatment with antiviral therapy leads to improved hearing and neurodevelopmental outcomes in the long term when started in the first month of life. This paper outlines the epidemiology, investigations in the diagnosis of congenital CMV infection and current evidence surrounding treatment.

Cyclosporine causes no hearing defect in paediatric patients with nephrotic syndrome

Objective: We aimed to evaluate the ototoxicity of cyclosporine A (CsA) in children with nephrotic syndrome (NS).Design: Data of paediatric patients with NS followed in paediatric nephrology department were evaluated retrospectively, and hearing functions were evaluated by pure tone audiometry (PTA) and transient evoked otoacoustic emissions (TEOAEs). Age, gender, type of NS, duration and cumulative doses of immunosuppressives were noted.Study sample: The patients who had received CsA (n: 16) and immunosuppressives other than CsA (n: 13) for at least 6 months formed two patient groups and healthy cases formed a control group (n: 20). Children with known previous hearing defect, inner ear trauma or surgery, recurrent otitis media and those using hearing aid were excluded.Results: Gender, age at first clinical presentation, laboratory tests and number of relapses were similar between the groups. No hearing loss was defined in PTA at frequencies of 250, 500, 1000, 2000, 4000 and 8000 Hz. The results of TEOAEs were similar between the groups and compatible with normal hearing.Conclusions: CsA is not responsible for permanent sensorineural hearing loss in children with NS, and there is no sufficient evidence to consider routine hearing assessment in children with NS treated with CsA.

Complications and parent satisfaction in pediatric osseointegrated bone‐conduction hearing implants

To assess long-term complication rate and parental satisfaction of osseointegrated bone conduction hearing implants (OBCHIs). Retrospective chart review of children undergoing OBCHIs. A retrospective chart review of children undergoing OBCHIs for the treatment of conductive, mixed, and single-sided sensorineural hearing loss in children. Forty-five subjects were identified with 0.3 to 10.4 years of follow-up. The mean/median age and age range at implant were 9.0/7.8 and 1.7 to 19.1 years. The underlying hearing loss for the cohort included conductive (N = 30), sensorineural (N = 7), and mixed (N = 8) hearing loss. Conductive hearing loss, caused by aural atresia (62.9), was the most common indication for implantation. Fifty-eight complications occurred in 29 subjects, most related to skin infection or overgrowth. Seventeen events required revision surgery, and 18 required oral antibiotics and/or office-based cauterization. Children under the age of 5 years were more likely to have failure of osseointegration or require revision surgery. Parents of 33 subjects underwent a phone interview; 76% rated the overall satisfaction as satisfied or very satisfied. A large percentage of children undergoing OBCHI develop postoperative complications, and up to 44% require revision surgery-a figure higher than generally reported and higher than in adults. No factors were found to adequately explain the higher complication rates in children compared to adults. Despite the occurrence of complications, parents viewed this device as satisfactory from many perspectives. 4. Laryngoscope, 127:2165-2170, 2017.

Pediatric unilateral sensorineural hearing loss: implications and management.

The purpose of this review is to summarize current studies detailing the impact of unilateral sensorineural hearing loss in children and the most current modalities of treatment used in its management. Current studies corroborate historic views on the impact of unilateral sensorineural hearing loss on patient wellbeing and academic success and stress the use of additional surveillance and studies to diagnose those patients that may pass standard screening practices and suffer from lack of prompt and proper care. With respect to management, notable findings include the continuous development of improved conventional and contralateral routing of signal amplification devices that may act to provide alternatives to percutaneous bone-anchored hearing aid implantation. These include improvements in more conventional hearing aid technology, so as to bridge the performance gap with the classical bone-anchored hearing aid implant, and the development of partially implanted transcutaneous bone conduction hearing devices. Due to dissatisfaction with sound localization, a new and significant development is the burgeoning accumulation of research on cochlear implantation for the treatment of unilateral sensorineural hearing loss in children. With advances in technology in historic modalities of treatment, and the advent of new modalities such as cochlear implantation, the clinician has a wide armamentarium by which to provide treatment to patients based on clinical circumstances and patient desires.