title: Bone-anchored hearing aids for people with bilateral hearing impairment: a systematic review.
abstract: BACKGROUND
  Bone-anchored hearing aids (BAHAs) are indicated for people with conductive or mixed hearing loss who can benefit from amplification of sound. In resource limited health care systems, it is important that evidence regarding the benefit of BAHAs is critically appraised to aid decision-making.
  
  
  OBJECTIVE
  To assess the clinical effectiveness of BAHAs for people with bilateral hearing impairment.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  Nineteen electronic resources were searched from inception to November 2009. Additional studies were sought from reference lists, clinical experts and BAHA manufacturers.
  
  
  METHODS
  Inclusion criteria were applied by two reviewers independently. Data extraction and quality assessment of full papers were undertaken by one reviewer and checked by a second. Studies were synthesised through narrative review with tabulation of results.
  
  
  RESULTS
  Twelve studies were included. Studies suggested audiological benefits of BAHAs when compared with bone-conduction hearing aids or no aiding. A mixed pattern of results was seen when BAHAs were compared to air-conduction hearing aids. Improvements in quality of life with BAHAs were found by a hearing-specific instrument but not generic quality of life measures. Issues such as improvement of discharging ears and length of time the aid can be worn were not adequately addressed by the studies. Studies demonstrated some benefits of bilateral BAHAs. Adverse events data were limited. The quality of the studies was low.
  
  
  CONCLUSIONS
  The available evidence is weak. As such, caution is indicated in the interpretation of presently available data. However, based on the available evidence, BAHAs appear to be a reasonable treatment option for people with bilateral conductive or mixed hearing loss. Further research into the benefits of BAHAs, including quality of life, is required to reduce the uncertainty.
authors.affiliation: Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK. j.colquitt@soton.ac.uk
authors.forename: J L
authors.initials: JL
authors.lastname: Colquitt
authors.forename: E
authors.initials: E
authors.lastname: Loveman
authors.forename: D M
authors.initials: DM
authors.lastname: Baguley
authors.forename: T E
authors.initials: TE
authors.lastname: Mitchell
authors.forename: P Z
authors.initials: PZ
authors.lastname: Sheehan
authors.forename: P
authors.initials: P
authors.lastname: Harris
authors.forename: D W
authors.initials: DW
authors.lastname: Proops
authors.forename: J
authors.initials: J
authors.lastname: Jones
authors.forename: A J
authors.initials: AJ
authors.lastname: Clegg
authors.forename: K
authors.initials: K
authors.lastname: Welch
mesh_terms: D019317:Evidence-Based Medicine; D006310:Hearing Aids; D006314:Hearing Loss, Conductive / Q000534:rehabilitation*; D046089:Hearing Loss, Mixed Conductive-Sensorineural / Q000534:rehabilitation*; D006801:Humans; D053441:Suture Anchors