title: Experience of bone-anchored hearing aid implantation in children younger than 5 years of age.
abstract: OBJECTIVE
  To assess the practicality and benefit of Bone-anchored hearing aid (BAHA(®)) implantation in children younger than 5 years of age. FDA approval for use of BAHA(®) only exists for children 5 years of age and older. Their use in Australia is also rare, however their use for younger children is approved by the European Union. We wish to share our experience of implantation in an antipodean setting in this age group.
  
  
  METHODS
  Institutional board approval was obtained for this study. All children undergoing BAHA(®) implantation under 5 years old were included from our prospective database. We examined the variety of surgical techniques, (including skin grafting, limited soft tissue reduction and no soft tissue reduction), BAHA(®) implants and abutments used, and use of the new series 400 hydroxyapatite coatings. Demographic data obtained included age at surgery, follow up duration, gender, ethnicity and indication for surgery. Anonymous benefit questionnaires (Glasgow children's benefit inventory (GCBI) and parents' evaluation of aural performance of children (PEACH)) were completed online as well as a questionnaire on device use. Complications recorded included soft tissue reactions, implant loss/removal, abutment replacement/removal. We also assessed whether patient weight, ethnicity or socioeconomic status were risk factors for these complications.
  
  
  RESULTS
  24 Children (26 ears/26 implants) under five years were identified from the database and included in the study. There was a 14:10 male to female ratio. Patient caregivers reported subjective benefit and improved quality of life (QOL) despite setbacks and complications related to BAHA(®) usage. 10/24 (42%) of children required treatment for significant peri-implant skin reactions whilst 25% required replacement of their abutments and/or implants. An increased risk of major complication was associated with socioeconomic deprived backgrounds and in patients of New Zealand Maori and Pacific Island ethnicity but not in patients with increased weight centiles.
  
  
  CONCLUSIONS
  The BAHA(®) implant and hearing aid system is of value to children under age 5 years. Parents tolerate the skin reactions and complications because of the perceived benefit in hearing and quality of life. Careful counselling of parents of potential young BAHA(®) implant candidates is necessary in light of this.
authors: Starship Children's Hospital, Park Road, Grafton, Auckland 1024, New Zealand.
authors: Kwamena
authors: K
authors: Amonoo-Kuofi
authors: Starship Children's Hospital, Green Lane Hospital, Auckland, New Zealand.
authors: Andrea
authors: A
authors: Kelly
authors: Starship Children's Hospital, Park Road, Grafton, Auckland 1024, New Zealand.
authors: Michel
authors: M
authors: Neeff
authors: Starship Children's Hospital, Park Road, Grafton, Auckland 1024, New Zealand. Electronic address: colin@adhb.govt.nz.
authors: Colin R S
authors: CR
authors: Brown
mesh_terms: D001315:Australia; D002675:Child, Preschool; D005062:European Union; D005260:Female; D006310:Hearing Aids; D006314:Hearing Loss, Conductive / Q000523:psychology / Q000534:rehabilitation*; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000379:methods*; D011788:Quality of Life / Q000523:psychology; D011795:Surveys and Questionnaires; D053441:Suture Anchors
keywords: BAHA(®) complications; Bone hypertrophy; Bone-anchored hearing aids; Osseo-integration; Pediatric; Soft tissue hypertrophy