title: Three year experience with the cochlear BAHA attract implant: a systematic review of the literature.
abstract: BACKGROUND
  Bone conduction devices are widely used and indicated in cases of conductive, mixed or single sided deafness where conventional hearing aids are not indicated or tolerated. Percutaneous bone-conduction devices gave satisfactory hearing outcomes but were frequently complicated by soft tissue reactions. Transcutaneous bone conduction devices were developed in order to address some of the issues related to the skin-penetrating abutment. The aim of this article is to present a systematic review of the indications, surgical technique and audiological, clinical and functional outcomes of the BAHA Attract device reported so far.
  
  
  METHODS
  A systematic computer-based literature search was performed on the PubMed database as well as Scopus, Cochrane and Google Scholar. Out of 497 articles, 10 studies and 89 reported cases were finally included in our review.
  
  
  RESULTS
  The vast majority of implanted patients were satisfied with the aesthetics of the device scoring highly at the Abbreviated Profile of Hearing Aid Benefit, Glasgow Benefit Inventory and Client Oriented Scale of Improvement. Overall, hearing outcomes, tested by various means including speech in noise, free field hearing testing and word discrimination scores showed a significant improvement. Complications included seroma or haematoma formation, numbness around the area of the flap, swelling and detachment of the sound processor from the external magnet.
  
  
  CONCLUSIONS
  The functional and audiological results presented so far in the literature have been satisfactory and the complication rate is low compared to the skin penetrating Bone Conduction Devices. Further robust trials will be needed to study the long-term outcomes and any adverse effects.
authors.affiliation: Department of Otolaryngology, Sheffield Teaching Hospitals, Sheffield, UK.
authors.forename: Panagiotis A
authors.initials: PA
authors.lastname: Dimitriadis
authors.affiliation: Department of Otolaryngology, Sheffield Teaching Hospitals, Sheffield, UK.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Farr
authors.affiliation: Department of Otolaryngology, Sheffield Teaching Hospitals, Sheffield, UK ; Department of Otolaryngology, Mansoura University Hospitals, Mansoura, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Allam
authors.affiliation: Department of Otolaryngology, Sheffield Teaching Hospitals, Sheffield, UK.
authors.forename: Jaydip
authors.initials: J
authors.lastname: Ray
keywords: BAHA Attract; Hearing loss; Transcutaneous bone conduction device