Introduction 25 1 magnet or a bone conduction floating mass transducer [122-126]. Magnetic retention is also a consideration in children whose activities and lifestyles may result in displacement or loss of a processor held in place by magnetic force alone. A comparative study comparing Baha® connect to Baha® Attract in paediatric patients found that 58% of patients with Baha® connect had complications in the first 12 months compared to no major complication (removing magnet strength issues) in the Baha® Attract group. These complications included high rates of skin overgrowth, infection, nursing phone calls and ENT visits with the Baha® connect group [127]. The latest studies into the application of the Osia® system in the paediatric population have demonstrated mean audiological benefit of 43.1 dB (+/- 10.2 dB), with a preference of this system over their previous percutaneous implants [128] and although morphometric studies show paediatric patients to have different anatomical skull dimensions to adults, this option is feasible and requires only a small alteration in positioning [129]. For those children with isolated microtia and canal atresia, the cosmetic considerations are extremely important. Care must be taken in choosing the placement of any implant system in such children to ensure that a sufficient post auricular skin envelope is maintained for potential future autologous reconstruction. Scaring in this region may compromise the option of reconstruction in later life as coverage of the neoauricle with local tissue might be insufficient [130,131,132]. Therefore, surgical options may be delayed until the child is older and non-surgical systems preferred and applied until this point. Non-surgical transcutaneous hearing systems provide a simple and effective solution in both unilateral and bilateral conductive hearing loss. Although audiologically effective, subjective patient feedback highlights poorer compliance with headbands due to concerns about the aesthetics. This can be a deterrent for many older children with self-perception issues and concerns about integrating with their peers. Additionally, the retention pressure by headbands may produce some complications and limitations in daily usage [133]. The transcutaneous adhesive bone conducting ADHEAR system demonstrated high levels of user satisfaction and no skin irritations [134], as well as comparable results to conventional softband devices with regards to speech understanding and sound localization [135] however is limited to conductive hearing losses of >25dB.
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