134 Chapter 5 and 13 had congenital causes for the CHL. The commonest aetiologies included microtia (n=8), isolated ear canal atresia (n=3) and ossicular fixation (n=2). The age distribution in both groups were similar (5-14 years), however as expected, the acquired group had more older children: 5 (62%) children were over the age of 10 in the acquired group compared to 4 (30%) in the congenital. The ADHEAR adhesive system demonstrated a statistically significant improvement in thresholds of 5.6 dB HL (p=0.0001) over and above those found with conventional Ponto softband devices. Following 4 weeks of acclimatisation with the device, the hearing advantage had increased to 7.3 dB HL. Mean thresholds were improved by 19 dB HL with Ponto softband and 26.3 dB HL with the use of the ADHEAR system as compared to the unaided situation. This improvement was demonstrated across all frequencies above 500Hz. Mean PTA4 during Ponto softband and ADHEAR system use was found to be 30 dB HL ± 6- and 26-dB HL ± 3 respectively. A quality-of-life review revealed 86% of children had improved self-confidence with the use of the ADHEAR system as compared to their previous transcutaneous device. GCBI response scores increased at the 4-week review by 33 ± 25 although overall GCBI demonstrated negative scores in 3 participants. The LAS score increased by 4.5 after fitting with ADHEAR system. This initial review of ADHEAR’s application provided evidence that this was a comparable alternative to the Ponto softband device and was very well-liked and accepted by the children. Its application in the paediatric population was limited by health and safety concerns surrounding the ease of access to the battery and the risks this posed to young children. There was also variability in quality and longevity of the adhesive. The patient’s skin and the manufacture batches of product varied. At the time of this study the lack of suitable locking mechanism for the battery door prevented the fitting of children under the age of 5 therefore this was the minimum inclusion age. The latest model of the adhesive ADHEAR system now has a lockable battery door. As central auditory maturation is age dependent and limited by hearing input from only one ear, the impact of both the aetiology and time of onset of conductive hearing loss is not yet fully understood. It is becoming more apparent that hearing in noisy circumstances and lateralisation is improved by bilateral hearing input and therefore the provision of bilateral hearing solutions at an earlier age has the greatest impact [7,8,9]. Although the age at which this effect is most important for central maturation is yet unclear. There may indeed be a difference in those with bilateral losses as compared to unilateral.
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