In the last decades, novel bone transmission devices have been developed, such as active-transcutaneous devices, which maintain the integrity of the skin and direct vibratory stimulation of the bone. There is no consensus regarding the minimum age to carry out the surgery and it is a topic for continued debate. We present a case of a male patient, 3years of age, diagnosed with hemifacial microsomia and bilateral atresia of the external auditory canal, among other malformations. Despite making multiple adjustments to the bone conduction hearing aid, limited gain of function and auditory perception were observed in the patient. Implantation of an active bone conduction hearing aid, MED-EL brand, BonebridgeTM model, was thus proposed to improve auditory perception. We present the results of treatment and follow-up.

Background: Bone conduction implants have emerged as a viable solution for patients with conductive or mixed hearing loss who are unable to use conventional hearing aids due to anatomical abnormalities. Individuals with rare genetic syndromes, such as Treacher-Collins, Goldenhar, Klippel-Feil, Charge syndromes, often experience significant hearing impairments due to external and middle ear malformations. This study evaluates the effectiveness and safety of bone-conduction implants in this patient population.
Methods: A retrospective cohort study was conducted at a tertiary referral center, including 6 patients diagnosed with the aforementioned syndromes. All patients exhibited conductive or mixed hearing loss and were not candidates for conventional hearing aids. Bone-conduction implants were surgically placed, and hearing improvement was assessed through pure-tone audiometry and speech audiometry. Additionally, subjective satisfaction was measured using the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire.
Results: The results demonstrated significant hearing improvements following implantation. Audiometric assessments showed enhanced hearing thresholds and speech recognition in both quiet and noisy environments. Patients reported high satisfaction levels, noting improved daily communication abilities. The surgical procedures were performed safely, with a low incidence of minor complications.
Conclusions: These findings highlight the importance of bone-conduction implants as an effective intervention for managing hearing loss in patients with rare genetic syndromes associated with ear malformations. Early implantation supports auditory rehabilitation, facilitates speech development, and enhances overall quality of life. Further research and clinical application of this technology may improve outcomes for this unique patient population.

Background: Percutaneous bone-conduction implants (BCHDs), whilst long established over 40years, are associated with soft tissue complications in some recipients due to skin penetration. Newer transcutaneous options are helping to widen the choice and overcome some of these issues.

Methods: We report on 25 consecutive implant conversions from 21(84%) percutaneous and 4(16%) passive transcutaneous BCHDs to the newer Osia® Systems. The percutaneous abutment was removed in clinic 4 weeks before the new implantation to allow scalp healing. Transcutaneous implants were replaced during the surgery.

Results: 25 Osia® devices replaced pre-existing BCHDs in 22 patients (3 bilateral). Mean age was 50.2 years (range 27 - 78 years) and Male (6) :Female (16). Indications were skin related (irritation, granulation, overgrowth), pain and fixture loss. Mean duration of surgery was 43min (range 35 - 65min). Sheffield ‘S’ incision was commonly used (72%) with ‘C’ and linear in others. The previous fixture was re-used in 5(20%). Bone polishing was needed in 7(28%) and a scalp pocket in 3(12%). No device-related issues were reported but 4 experienced some pain over the implant site. The average gain in conductive and mixed loss remained unchanged.

Conclusion: The new Osia® System provides a stable, predictable and wider alternative for those experiencing problems with previous versions of BCHDs. The surgery is straightforward. Careful planning is required with consideration to the time interval before conversion surgery, incision, new device placement, condition of the scalp and underlying bone, patient choice and preference.

Background:
Revision tympanoplasty (Re-TPL) after previous surgeries often yields variable hearing outcomes, strongly influenced by middle ear conditions. In complex cases, satisfactory results are not always achieved. The OSIA implant, a novel bone conduction system, bypasses the middle ear and directly stimulates the inner ear, offering a potential alternative for patients with mixed or conductive hearing loss.
Methods:
This retrospective study included 25 patients with persistent conductive hearing loss who received an OSIA implant after two or more tympanoplasties. Outcomes were compared to a audiologically matched group treated with Re-TPL. Measures included audiometric data, hearing gain, and patient-reported outcomes using standardized questionnaires (IOI-HA, GBI-5F). In the OSIA group, preoperative simulation with the SoundArc device was performed to estimate expected benefit and assist in decision-making.
Results:
The OSIA group demonstrated better objective hearing outcomes than the Re-TPL group, which showed high variability. OSIA results were more consistent and reliable. Patients with OSIA also reported higher satisfaction, reflected in GBI-5F- and IOI-HA-scores. The SoundArc simulation correlated well with postoperative results and proved valuable for patient counselling.
Conclusion:
This is the first study comparing outcomes of OSIA vs. Re-TPL patients in audiologically matched groups. The OSIA implant represents a promising alternative to revision tympanoplasty, particularly for patients with challenging middle ear conditions or prior surgical failure. It provided more consistent and objectively superior hearing outcomes, along with greater subjective benefit. Preoperative SoundArc simulation supports treatment planning and shared decision-making. Further studies are warranted to assess long-term outcomes and validate the predictive value of simulation tools.

Background:
Bone conduction hearing implants play a crucial role in treating conductive and mixed hearing loss, as well as single-sided deafness (SSD). The Bonebridge BCI 602, a second-generation active transcutaneous implant, addresses anatomical challenges seen with earlier devices. Successful implantation depends on anatomical compatibility, including mastoid bone size, pneumatization, and the position of nearby structures such as the sigmoid sinus and dura mater. In some cases, insufficient bone may require surgical modification. Preoperative imaging is therefore essential. While many studies have been done in European populations, there is limited data on anatomical suitability for the BCI 602 in Middle Eastern populations. Given potential ethnic and geographic variations in skull morphology, it is important to assess anatomical compatibility within specific populations. Currently, no normative data exist for Saudi individuals regarding mastoid bone characteristics relevant to this implant.

Methods:
This open-label, retrospective, single-center study evaluates high-resolution temporal bone CT scans of Saudi patients. Image processing software is used to generate 3D models of the mastoid region to simulate Bonebridge BCI 602 placement virtually.

Result:
The study is currently in progress. Data collection and simulation analysis are ongoing. Final results will be presented at the upcoming congress.

Conclusion:
This study will aid in classifying each case as either: (1) feasible for BCI 602 implantation without modification, (2) feasible with modification, or (3) not feasible. These findings will contribute to safer surgical planning and expand our understanding of anatomical variability in the Saudi population.

Background
With the advent of cochlear implants, tactile aids for the profoundly deaf became obsolete decades ago. Nevertheless, they might still be useful in rare cases. We report the case of a 25-year-old woman with Bosley–Salih–Alorainy Syndrome and bilateral cochlear aplasia.

Methods
After it was determined that cochlear or brainstem implants were not an option and tactile aids were not available anymore, a bone conduction device (BCD) on a softband was tried as a tactile aid. The usual retroauricular position and a second position close to the wrist, preferred by the patient, were compared. Sound detection thresholds were measured with and without the aid. Additionally, 3 bilaterally deaf adult cochlear implant (CI) users were tested under the same conditions.

Results
At 250–1000 Hz, sounds were perceived as vibrations above approximately 45–60 dB with the device at the wrist. Thresholds were approximately 10 dB poorer when placed retroauricularly. Differentiation between different sounds seemed difficult. Nevertheless, the patient uses the device and can perceive loud sounds. The perception thresholds of the 3 CI users were comparable.

Conclusions
Cases where the use of tactile aids may make sense are probably very rare. The use of BCD, placed, e.g., at the wrist, may be useful, but sound perception is limited to low frequencies and relatively loud levels.

Introduction
Conductive hearing loss in children poses a significant barrier to language development and academic performance, requiring early and effective intervention. Active bone conduction devices (ABCDs) bypass the external and middle ear by transmitting vibrations directly to the cochlea, offering an effective alternative for children with anatomical anomalies or other contraindications to conventional hearing aids.

Objective
To describe the clinical, surgical, audiological, and subjective outcomes in children under 12 years implanted with ABCDs.

Methods
This retrospective, multicenter study included 325 children with conductive or mixed hearing loss implanted between 2020 and 2024. Data collected included age, etiology, skin thickness, implant type, preoperative PTA4 (air and bone conduction), effective gain (EG) at 3 and 12 months, and self-reported benefit using the COSI questionnaire.

Results
Of the 325 children, 90% had conductive and 10% mixed hearing loss. The most frequent etiology was outer and middle ear malformations (85.7% and 78.1%, respectively). The mean age was 8.0 years in the conductive group and 8.9 years in the mixed group. The 3 mm implant was most commonly used. At 12 months, EG averaged -13.8 dB (conductive) and 2.4 dB (mixed). The most frequently selected goals were “Speech in Noise” and “Social Settings,” with average improvements of 4.6/5 and 4.7/5, respectively.

Conclusion
ABCDs are a safe and effective intervention in pediatric patients, yielding both audiological improvements and high user satisfaction, particularly in challenging listening environments.

Background: Most centres limit the access of active transcutaneous bone conduction devices to older children due to safety and performance concerns.This study examines safety and auditory outcomes in young children implanted with piezoelectric ABCD.

Methods: Prospective cohort study in a single tertiary referral academic center. Enrolled patients were aged 5 years and younger with congenital conductive hearing loss or single sided deafness. Demographics, surgical techniques, duration of surgery, hospital stay, auditory outcomes, postoperative complications, and device use were collected. Following active piezoelectric bone conduction implantation surgery, patients were followed up for 1 week post-surgery, with devices switched on at 3 weeks postoperatively. Surgery and audiology follow-up occurred at 1, 3, 6 months, then every 6 months thereafter.

Results: Fourteen children received eighteen implants (four patients received bilateral simultaneous implants). The median age of children in this study was 4.2 years (IQR = 3.1–5 years). The indication for implantation was conductive hearing loss (CHL) due to external auditory canal atresia in 15/18 ears, and congenital single-sided deafness in 3/18 ears. No patients experienced serious intraoperative or postoperative complications. None of the patients had cutaneous complications during the follow up period. For patients with CHL, there was a significant postoperative improvement in hearing, marked by a median pure-tone average gain of 45 dB. All 14 patients regularly used their sound processors, with a median utility time of 10.6 h/day.

Conclusions: Piezoelectric ABCD are a safe option for young children and provided significant and stable improvements in auditory function.