Chapter 1 26 Thesis Prelude The paediatric BCHD was introduced to Birmingham Children’s Hospital in 1988 and over the last 36 years has produced one of the largest cohorts of implanted paediatric patients in the United Kingdom. Previous research from this Institution has resulted in 6 preceding PhD theses in association with Radboud University, Nijmegen. This thesis focuses on the clinical impact of the introduction of the Oticon wide diameter fixation screws and the clinical outcome in the paediatric population. This is compared to previously utilised narrow implants at the same centre. It then examines the impact of laser ablation on the surface of the implanted fixture with regards to clinical outcome and examines the relationship between survival rates and Resonance Frequency Analysis (RFA) in both the general paediatric population and patients with trisomy 21. Due to the availability of comparable data sets published previously from the same centre this thesis provides compelling evidence of how developments in implant design have directly impacted clinical outcomes in the paediatric population. In addition, it cross examines the usefulness of RFA in predicting fixture failures in the paediatric population and its feasibility in real-world application. Finally, this thesis investigates the audiological outcomes and impact on quality of life of the novel adhesive retained bone conduction hearing system (ADHEAR) at its introduction in 2015 and again in 2019. This longitudinal review allows for analysis of paediatric patient compliance, conversion rates to alternative systems, skin complications and limitations with regards to its application in the paediatric setting.
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