110 Chapter 4.1 The LAS doubled from 4.1 to 8.5 before and after the use of the adhesive retained BC aid. The responses from the HARQ indicated excellent levels of daily use of the adhesive retained BC system of up to 15 hours per day and there was little or no problems that discouraged the use of the device. Self-confidence in 18 of participants was increased following the use of the adhesive system. Following the closure of this study, all children requested to continue with the use of the adhesive retained BC system and to date none have returned to their previous bone conduction hearing aids. This is supported by recently published research in adult patients with CHL using the ABC system which reports high patient satisfaction levels and no skin irritation [29], and comparable audiological finding to softband use with regards to speech recognition and sound localization [30]. Many children are concerned with their appearance. The fact that no child in our study chose to cease using their new adhesive retained BC hearing system and return to previous bone conduction hearing aids was encouraging. The improved quality of life and improved learning most likely reflected the fact that the children were more accepting of the aesthetics of the adhesive adapter and were happy to wear their hearing system for longer periods in more situations than their previous softband, which could be uncomfortable and unsightly. Many children reported softband use only during the time at school. One concern regarding this transcutaneous adhesive hearing system is the loss of effective sound transmission through the intact skin and subcutaneous tissues. However, this did not appear to be the case in this study. The associated skin morbidities were minimal, whilst the aesthetic concerns were also negligible. The positioning of the adhesive adapter with the sound processor directly over the cochlear is advantageous and this is rarely possible with the softbands [33, 34]. Although we found the positioning with the adhesive adaptor to be stable, the replacement of these does incur additional costs as compared to a softband device. In addition, each patient’s requirement for the frequency of replacement is variable and influenced by the patient’s own skin, hairline and impacted if wearing eye glasses and head scarves. Some children require hair to be shaved in order for the adhesive adaptors to be optimally positioned. No child has the same requirement for the pads and therefore this additional cost cannot be simply calculated. On average during this study, we found that the adhesive adaptors were
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