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Practice guidelines for bone-anchored hearing aids in children
S Roman1, R Nicollas, J-M Triglia
1Service ORL pédiatrique, CHU de la Timone, université de la Méditerranée, 264, rue St-Pierre, 13385 Marseille cedex 05, France. sroman@ap-hm.fr
Insights
Bone-anchored hearing aids (BAHA) are a standard treatment for children with conductive or mixed hearing loss. Successful outcomes are high (96%), with risks decreasing significantly after age 5.
Area of Science:
- Otolaryngology
- Pediatric Audiology
- Biomedical Engineering
Background:
- Bone-anchored hearing aids (BAHA) have over 20 years of clinical use in children.
- They are a standard treatment for conductive or mixed hearing loss.
- This review synthesizes literature and clinical experience regarding BAHA in pediatric populations.
Purpose of the Study:
- To review the established use of bone-anchored hearing aids (BAHA) in children.
- To outline indications, surgical considerations, and outcomes.
- To discuss BAHA application in unilateral and bilateral hearing loss.
Main Methods:
- Literature review.
- Analysis of authors' clinical experience.
- Evaluation of patient data regarding age, bone thickness, fixture loss, and complications.
Main Results:
- Key indications include age ≥ 5 years and bone thickness ≥ 3 mm.
- Fixture loss rates are significantly lower in children ≥ 5 years (8-1%) compared to <5 years (40%).
- Functional success rate is approximately 96%, with comparable skin complication rates to adults.
Conclusions:
- BAHA is a safe and effective treatment for pediatric conductive/mixed hearing loss, with improved outcomes in older children.
- BAHA offers significant quality of life improvements for children, especially with recent technological advancements.
- Careful patient selection, parental education, and regular follow-up are crucial for minimizing complications and maximizing success.
Abstract:
After more than 20 years of clinical experience in children, bone-anchored hearing aids, essentially BAHA(®), have become the standard treatment for conductive or mixed hearing loss. Based on a general review of the literature and the authors' own experience, this article reviews the use of bone-anchored hearing aids in children. The main indications for bone-anchored hearing aids are a minimum age of 5 years at the time of implantation and/or cortical bone thickness ≥ 3 mm. Fixture loss is observed in 40% of children under the age of 5 years versus 8% for children aged 5 to 10 years and 1% for children over the age of 10 years, i.e. identical to the rate observed in adults. Skin complications are similar to those observed in adults and must be prevented by parental education and regular follow-up. Surgery is generally performed in two stages or as a one-stage procedure for fixtures ≥ 4 mm. The functional success rate, correlated with medium- and long-term use of BAHA(®) is about 96%. BAHA(®) may be indicated in children with profound unilateral hearing loss following a trial period wearing a BAHA(®) headband for several weeks with the child's active participation. Sequential bilateral implantation requires complementary investigations and appears to provide improved perception in noise. This type of hearing aid provides an improvement of the quality of life of children with bilateral conductive and/or mixed hearing loss which should be further improved as a result of recent technical developments.
