111 4.1 First paediatric experience with ADHEAR changed every second day, (three to four times a week) however some individuals require this more frequently. The ADHEAR user kit including processor and attachment costs £2078 (incl. VAT) and the adhesive adaptors cost £35.75 (15pcs) adding £371 -495 a year in additional costs; approximately £2511 (incl. VAT) for the first year. However, pricing is not uniform across Europe so there is fluctuation in these figures. In the Netherlands for example the user kit cost €3531 and the adaptors are €41.65 (15pcs). The impact of this incremental cost is therefore dependant on the frequency of changing the adhesive adaptor and this should be taken into consideration. In comparison a Oticon soft band mount costs £48.60 and the price of the processor in the UK fluctuates from NHS trust to trust. This ranges between £2097 to £2895 depending on the producer and model used therefore total maximal cost for year 1 £2145- 2944. In the Netherland these costs are equivocal. For children with long standing acquired conductive hearing loss such as those children with Down syndrome [35], Primary Ciliary dyskinesia (PCD) [36] and those with a cleft palate [37], the NICE guidelines do not recommend ventilation tubes. The authors of this paper feel that the adhesive hearing system could be an appropriate treatment alternative in these high-risk groups of children. For those children with microtia, the adhesive retained BC system provides a simple noninvasive option especially if they wish to consider autologous ear reconstruction in the future. The skin envelope on the microtia side is thus preserved and remains unscarred [38]. A further advantage of this system is that it avoids the process of estimating the surface area of healthy skin needed for an autologous reconstruction in the future when placing a surgical Bone conducting hearing implant (BAHI). This estimation is difficult for the BAHI surgeon, since often the surgical BAHI is placed at a young age well before the age of cosmetic considerations and the possibility of future autologous ear reconstruction. As the child grows, the distance measured between microtia remnant and BAHI may still not be sufficient to allow for a framework to match the unaffected side. This adhesive retained BC hearing system is a very valuable hearing option for such children providing excellent “cosmetic” hearing until such time as the child and carers decide on their aesthetic pathway.
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