138 Chapter 5 Within the paediatric setting there are many challenges in the assessment. Firstly, there are issues with cognitive understanding in many of our patient groups. This is often due to a young age but many of the children have additional educational, emotional, and physical disabilities. Secondly, there is a lack of sufficient patient maturity and autonomy to make independent decisions in the majority of cases. Peer pressure at school, self-perception and self-esteem add another layer of complexity as children reach puberty and their teenage years. A multi-disciplinary assessment is essential for all children which includes specialist paediatric audiological assessments. A trial period of a BAHD on a softband, or ADHEAR, without commitment to surgical intervention, provides invaluable insight for patients, care givers and clinicians. It is this trial period that is the most important in predicting the benefits from providing such an implant retained bone anchored aid device in a child. These same factors also create additional barriers when attempting to undertake objective audiological assessments and obtain completed feedback questionnaires. It is experience of BCWH, that the patient reported outcome measures hold far more gravitas when considering the benefit of hearing rehabilitation options than a purely audiological assessment. Assessment of Quality-of-life impact is achieved through the application of validated questionnaires, real world usage time and patient reported concerns. We would consider that the reported use of a hearing device of greater than 8 hours a day 7 days a week with associated improvement in a child’s psychosocial development, as a success, irrespective of any audiological benefit that may have been demonstrated during objective tests. This approach is not without its limitations. In practice, caregivers and parental guardians provide this information as a proxy for their children and so results are affected by engagement with the studies, willingness to respond to questionnaires and attendance for follow-up appointments. Despite following formal research study protocol where caregivers / child sign research agreements to attend pre-set follow up appointments and complete feedback, it has been noted that there has been a pattern of poor response rates because of social and cultural factors as well as the increase burden of research and attendance. In the UK, school attendance is carefully monitored and there is a reluctance to miss school for follow up visits if the child is well. Furthermore, many of our patients have multiple comorbidities and additional learning needs which require additional attendance at hospital for other medical reviews. Attending the hospital when the carers perceive their child has no concerns regarding their hearing, maybe not be seen as a priority by their caregiver and adds to the burden of care. Indeed, the additional time away from the educational environment in these circumstances may also be seen as a negative impact. Interestingly recent study from Texas Children’s hospital concluded that a missed initial ABR appointment was the greatest
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