136 Chapter 5 The conclusion of these two presented studies is that the adhesive ADHEAR system provides an excellent alternative to non-surgical bone conduction hearing devices. It should be one of the first-choice options for children with microtia since it avoids the need for any implant surgery prior to any decision on autologous reconstruction. In addition, it can be utilised as an appropriate steppingstone to moving forward to an implantable device once a child reaches the age where they can also be involved in decision making discussions. The ADHEAR system is limited by the variability in the longevity of the adhesive mount and associated reported skin sensitivity. The addition of a locking door for the battery compartment will improve its application and availability to younger children. Further review and study of this age group is recommended as is long term follow up for ADHEAR users. As an early adopter of this technology, BWCH has gained a great deal of experience over the last three decades, engaging with regular and rigorous reflection, review, and assessment of developing technological innovations and their applications in the paediatric setting. This foundation of high-quality research created a valuable comparison of new technologies as they were introduced, and from this evaluation many lessons were learnt. A series of 6 core principles have been established because of these 35 years of clinical and patient experience. Core Principle 1 – In children with bilateral conductive hearing loss: – One sound processor is good, Two sound processors are excellent. Bone conducting hearing device application is now well established for unilateral rehabilitation of both conductive and mixed hearing loss. Bilateral application is still debated in the literature: This is more established in adult patient groups [9] with improvement in speech perception in noise and sound localisation demonstrated [10]. Bilateral application in children is still controversial but has been demonstrated to be superior to single sided implantation in achieving educational goals over the long-term, as well as having improved sustained quality of life measures. In addition, BCHDs are established for the management of hearing losses picked up at younger ages due to the effectiveness of screening programs and are widely used in audiological rehabilitation programs such as that at BWCH. It is well known that bilateral hearing losses have a direct effect on speech and language development, behaviour and education and therefore early rehabilitation improves outcomes in all these aspects. In 2013 improvements in spatial recognition were demonstrated in bilaterally aided children, with a reduction in the minimum audible angle to 13 degrees from 57 degrees in monaural aiding [7]. More recently, bilateral application in children with congenital conductive hearing losses has demonstrated improved lateralisation and sound localisation and it was concluded
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