Introduction 23 1 Baha® processor on these mounting options providing a direct comparison in audiological outcomes between the mounting systems and the processor used. It concluded that The Baha® 5 processor had better audiological results than its predecessor Baha® 4 when mounted on either the Baha® connect (31 vs 49) or Baha® Attract (22 vs 35) [91]. Overall, the best audiological results were seen in the percutaneous system with the processor with the highest maximal output [92]. With the recent release of the Osia® system by Cochlear, further comparison can be made between this active device and its passive Baha® Attract system. Both speech audiometry and free field were greater in the subcutaneous implanted device (42.8 dB SPL) compared to the Baha® Attract (38.8 dB SPL). In addition, superior quality of hearing was reported with the use of the Osia® system [93]. The potential benefits of this system combine the ease of implantation without the requirement of a bone well. A 4.5mm wide fixation screw with a good survival rate is likely to make this the preferred option for patients in the future. Audiological outcomes are comparable to available data for percutaneous options. To the author’s knowledge there is currently no available published data directly comparing this device to percutaneous options, and further research to establish this would be illuminating. The additional benefit of this system is the low skin complication rates which can often accompany skin penetrating abutments and ease of maintenance. Overall selecting the appropriate device for an individual patient is complex and is influenced by a combination of audiological, subjective and objective factors including patients choice [94] Application of BCHI in the paediatric population The positive impact of overcoming a conductive hearing loss on a child’s language acquisition and social development with the use of BAHI is well documented [95-102]. As hearing technology develops, breakthroughs have been made in both active and passive transcutaneous bone conduction systems with improving audiological outcomes [103-110]. In addition, there are many reports of improvement in quality of life as well as better speech and language acquisition [111,112,113]. The benefits of bilateral implant insertion, in particular with sound localisation and speech recognition, are now well appreciated [114,115,116]. However, complications associated with paediatric BAHIs continue: Lack of engagement from the child to accept such a hearing solution, peri-abutment soft tissue reactions and fixture
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