99 4.1 First paediatric experience with ADHEAR 1. Introduction The positive impact of overcoming conductive hearing loss (CHL) on a child’s language acquisition and social development with the use of bone-anchored hearing implants (BAHI) is well documented [1-8]. As hearing technology develops, breakthroughs have been made in both active and passive transcutaneous bone conduction systems with improving audiological outcomes [9-16]. Transcutaneous implant systems reduce potential for skin complications traditionally associated with percutaneous implants. Such implant systems produce excellent audiological outcomes but still require the surgical implantation of either an osseointegrated fixture and/or magnet or a bone conduction floating mass transducer [17-21]. For those children with isolated microtia and canal atresia, the cosmetic considerations are extremely important. Care must be taken in choosing the placementof any implant system in children with pinna deformity to ensure that a skin envelope is maintained over the mastoid 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 [22-24]. Nonsurgical transcutaneous hearing systems provide a simple and effective solution for both a unilateral and bilateral CHL. 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 [25]. Eye glass mounted options can be limited due to the weight of the processor. This is problematic for patients withmicrotia. many of whom may not have sufficient external pinna to hold their eye glasses level with the additional weight. Furthermore, microtia is often asymmetrical making the uses of spectacles impractical [26,27]. With the headband options, migration of the sound processor from its optimal position reduces its efficacy [28]. It also increases artifacts by movement over the patient’s own hair. Often the position of the processor can “slip” and be far from the mastoid process and therefore the cochlea. This becomes more pronounced for those children requiring glasses or those with an unusual shaped skull. The transcutaneous adhesive bone conducting (BC) system used in this study was designed for pressure-free sound transmission, prevention of sound processor migration and removes
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