143 5 General Discussion The application of middle ear implantation in children is now well established and international consensus was published in 2010 [27]. It has been found to be a safe alternative, with stable improved audiological performance and significantly improved perception of speech in noisy situations with a high sound quality [28,29,30,31]. Further studies highlighted significant speech discrimination improvement from 28.9% (unaided) to 95.5% (Soundbridge-aided) in children between the age of 5-9 and 18.5% to 89% in children between 10-17 years. Interestingly they noted that older children 10-17 showed a faster adaptation to the VSB [32]. When assessing the impact of middle ear implants on quality of life in children using questionnaires, Leinung et al concluded that children with unilateral atresia benefited more from the VSB compared to bone conducting hearing devices. They felt this was a result of the reported increase in the daily usage time, better localisation and audiometry results [33] when compared to other BCHD. The VSB is proving to be a viable option for hearing rehabilitation in children. Impact of shrinking market Competition In April 2022, the Cochlear® Group and Demant announced the acquisition of the hearing implant division of Demant: Oticon Medical®. This acquisition underwent a Phase 2 investigation by the Competition and Market Authority (CMA) in the UK led by an independent inquiry group, In June 2023, the CMA published its final findings and prohibited the sale of the Bone-Anchored business of Oticon Medical. The merger was blocked as it may have led to a substantial lessening of competition in bone conduction solutions resulting from a single company holding a 90% market share. They suggested that this would have an direct impact on patients creating less choice, reduced quality, or less innovation, as well as the NHS potentially paying higher prices [34]. Subsequently, Demant and Cochlear announced an amended agreement in which Cochlear would acquire only the cochlear implant division of Oticon Medical®. The review process for this amendment via the CMA, the Australian Competition and Consumer Commission (ACCC) as well as others internationally is still ongoing and Demant / Cochlear expect to close this in the first half of 2024. It is hoped that the CMA’s decision to maintain healthy competition in the bone conductive hearing technology market, will fuel innovation, drive development and lead to innovation and breakthroughs in BAHD technology, delivering better yet unimagined products for the future.
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