Brazilian Society of Otology Task Force - bone-anchored hearing system - recommendations based on strength of...

To provide evidence-based recommendations for the indication of bone anchored hearing system in adults and children.

Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions.

The topics were divided into four parts: 1) Non-implantable hearing devices; 2) Percutaneous systems; 3) Passive transcutaneous systems; 4) Active transcutaneous systems.

All types of BAHSs provide significant and sustained benefits, and device selection should be individualized according to the patient's audiological profile, anatomic considerations, and personal preferences. Active transcutaneous devices are more cost-effective for health care systems and demonstrate superior long-term safety and quality-of-life outcomes compared with percutaneous devices, but with no statistically significant difference in quality of life when compared to each other.