Background:
Children with congenital conductive hearing loss have limited solutions for hearing intervention before age 5. Research has consistently shown that earlier auditory access can support critical periods of speech, language, and cognitive development, as well as improved long-term device use and acceptance. The aim of this study was to evaluate the safety and effectiveness of the MED-EL active transcutaneous bone conduction implant in children ages 3 – 11 years of age.

Methods:
Eleven pediatric patients (3–11 years) with conductive hearing loss were prospectively enrolled. All participants had prior experience with a softband bone conduction system. Outcome measures included aided soundfield thresholds (500–4000 Hz) and Consonant-Nucleus-Consonant (CNC) word recognition scores in English. Additional qualitative metrics include Glasgow Children’s Benefit Inventory and device wear time.

Results:
All participants demonstrated significantly improved auditory performance. At 6 months post-activation, mean soundfield thresholds improved from 65.25 dB HL in the unaided condition to 26.25 dB HL in the aided condition across 500-4000 Hz. CNC word recognition improved from 0% at baseline to a mean score 73%. Device use revealed an average use of 9.88 hours/day. Qualitative assessments revealed improved retention, cosmetic acceptance, device adherence, and quality of life compared to pre-surgical softband systems.

Conclusion:
Early results support Bonebridge implantation to be a safe and effective intervention option for children as young as three years with conductive hearing loss. Early audiologic outcomes and user satisfaction support expanded pediatric indications and underscore the implant’s practical advantages over non-surgical bone conduction solutions.

Background: Bone conduction devices are hearing assistive devices that are used in many children who have conductive hearing loss (CHL), mixed hearing loss or single sided deafness (SSD). The aim of this study is to assess long-term outcomes of children who underwent piezoelectric Active transcutaneous bone conductive device (pABCD) implantation.

Method:  A prospective cohort of children who underwent pABCD implantation between January 2021 and December 2022. The main Outcome measures were; Long-term complications, hearing thresholds, speech discrimination, sound localization and quality of life.

Results: 25 children were implanted with 27 devices. The median surgical time 39 minutes. 6 children had SSD, 21 ears had CHL due to microtia/canal atresia (20 ears) or chronic ear disease (1 ear). None of the patients had any major adverse events.  In children with conductive hearing loss, the median threshold of improvement was 37.5 dB. All patients reported significant improvement of their auditory function. Aided thresholds were best at 1 kHz (median 20 dB HL). Recorded gains were measured up 8000 Hz reflecting good auditory performance even at high frequencies. Speech Discrimination when using the pABCD was 89% and self-reported hearing and quality of life by participants improved in all domains assessed.

Conclusion: pABCD is a safe and effective solution to restore hearing without any major long term complications. It provides auditory benefits that covers a wide range of frequencies. Children had significant improvement in their ability to sound localize as well as QoL. pABCD implantation can be performed in a routine day surgery setting safely in children.

Background: This study evaluated the impact of early access to bone conduction devices (BCDs) on children’s quality of life (QoL) and academic performance, comparing results between those who received BCDs and those who did not.

Methods: Prospective cohort study involving children aged <12 years with congenital conductive hearing loss caused by external auditory canal atresia. The participants were categorized into three groups: those without BCDs, those using nonsurgical BCDs, and those implanted with active transcutaneous BCDs. School performance was evaluated based on annual academic performance and extracurricular activities. QoL was assessed using HEAR-QL-AR.

Results: A total of 57 children participated in the study. At enrolment, the median HEAR-QL-AR scores were significantly higher in both BCD groups (80 and 81 in the nonsurgical and implanted groups, respectively) than in the non-BCD group (66, p = 0.013). After 6 months, the implanted group achieved the highest median HEAR-QL-AR score (90), followed by the nonsurgical group (76) and the non-BCD group (64, IQR = 16; p < 0.001). Academic performance was better in the BCD groups, with a median grade of “A” compared to “B” in the non-BCD group (p = 0.004). Participation in extracurricular activities was also higher in the implant group (median = 1.5) than in the nonsurgical (median = 1) and non-BCD groups (median = 0; p < 0.001). No surgical complications occurred, and the median surgical duration was 38 minutes.

Conclusion: The early implantation of active transcutaneous BCDs significantly improves QoL, academic performance, and social participation in children with conductive hearing loss.

Background: The latest generation of the Bonebridge, the BCI 602 is intended to treat individuals with either conductive or mixed hearing loss (C/MHL) or single sided deafness (SSD). Here we present a study which main objective is to provide prospective and retrospective data on safety and performance results with the active transcutaneous bone conduction BCI 602 in children.
Methods: A total of 22 paediatric patients (≤17 years) with an average age of 11 years were analysed. 20 with (C/MHL) and 2 with SSD. This group encompassed 13 female and 9 male. The pure tone average (PTA4= 0.5, 1, 2,4 kHz) air bone gap measured ≥15 dB. Performance data were collected during 3 months after the first fitting and was evaluated by sound field thresholds (SF) and word recognition scores (WRS) in quiet and noise. Quality of life was assessed with the Speech, Spatial, and Qualities of Hearing (SSQ12/P) and Audio Processor Satisfaction Questionnaire (APSQ). Safety was demonstrated by stable pure-tone measurements and adverse events reported.
Results: The Bonebridge improved SF thresholds (+31.9 dB) in C/MHL group, and 11.3 dB HL in the SSD patients. The mean improvement for the speech intelligibility (WRS) in quiet was +83%, and in noise, signal to noise ratio +5 (SNR5) was +50%. AC and BC thresholds remained stable over time. The mean total scores were 5.5 ±1.8 on the SSQ12/P and 8.87 ±0.93 on the APSQ questionnaires. No complications were reported.
Conclusions: The Bonebridge proved to be an effective and safe treatment in children.

Introduction: This study reviews the usage and outcomes of active osseointegrated bone conduction devices a pediatric population with diverse clinical characteristics.
Methods: A retrospective review was conducted at a tertiary academic hospital. From May 2018 to October 2024, 132 children received 145 devices. Analysis focused on 122 children with unilateral implantation.
Results: Mean age at the time of implantation was 10.8 years (SD=4, 4.6-18). Over half had unilateral hearing loss, either conductive (n=61/122; 50%) or single-sided deafness (n=9/122; 7%), while 42% (51/122) had bilateral conductive hearing loss. Most had used of a prior bone conduction device (104/122, 83%). Data logging was available for 80 (66%), including 46 with unilateral and 32 bilateral hearing loss. Children with bilateral loss used their devices significantly more (mean 10 hours/day) than those with unilateral loss (mean 4.8 hours/day; p<0.001). Non-use (< 4 hours/day) occurred in 28% of those with bilateral loss versus 57% with unilateral loss. Prior device use was associated with were better adherence. Audiometric results showed OSIA thresholds outperformed air conduction in all groups (p<0.0001). Mean aided speech perception scores exceeded 75% in quiet, with significantly better performance in quiet compared to noise (p<0.0001).
Conclusions:
Patterns of use among children are mainly influenced by hearing loss type. Children with unilateral loss are at higher risk of non-use. Advancements in data logging could improve patient counselling and decision-making on implantation as well as device outcomes. OSIA devices provided satisfactory hearing outcomes across all frequencies.

Introduction:
Children with syndromic conditions such as Down’s syndrome are particularly prone to bilateral conductive hearing loss due to recurrent otitis media, Eustachian tube dysfunction, and ossicular anomalies. These hearing deficits can significantly delay speech, language, and cognitive development. When compounded by comorbidities like recurrent respiratory infections and feeding difficulties, surgical intervention may be contraindicated.
Background:
A 3-year-old child with Down’s syndrome presented with bilateral conductive hearing loss resulting from recurrent otitis media and ossicular chain fixation. The child also had a history of recurrent respiratory tract infections, aspiration pneumonia, and was PEG-tube dependent. Due to high surgical risk, and unfit to be taken under Anaesthesia standard otologic procedures were deferred.
Method:
The ADHEAR bone conduction system (MED-EL) was considered to provide auditory input without surgical implantation. The child was fitted with the device and monitored and regular programming was done.
Result:
Significant improvement in auditory awareness and speech-related behaviors. The caregivers reported enhanced responsiveness to environmental sounds, increased vocalization, and improved social interaction. No adverse skin reactions occurred.
Conclusion:
The ADHEAR system proved to be a safe, effective, and well-tolerated non-surgical hearing solution in patients with syndromic conductive hearing loss. It provided crucial early auditory access in a medically complex case where surgical intervention was not possible.
Keywords:
Down’s syndrome, conductive hearing loss, ADHEAR, bone conduction, non-surgical intervention, ossicular fixation, pediatric audiology

Background.
Conductive hearing loss in pediatric age can interfere with language development and speech auditory perception, significantly affecting their biopsychosocial development. The Bonebridge system is an effective option for auditory rehabilitation in these patients.
Objective.
To evaluate the impact of the Bonebridge system on auditory perception and quality of life in pediatric patients with conductive hearing loss due to unilateral or bilateral microtia atresia.
Methods.
Seven pediatric patients with unilateral or bilateral conductive hearing loss were evaluated, using the Bonebridge BCI 602 system with Samba processor (Med-el), from the Federico Gómez Children's Hospital in Mexico. Detection and discrimination tests of the six Ling sounds were applied, and the ABEL questionnaire to the parents to assess the patient's auditory behavior in daily life.
Results.
100% showed a significant improvement in auditory thresholds with the use of Bonebridge, with a PTA equal to or less than 20dBHL. The detection and discrimination of Ling sounds was 100%. The ABEL questionnaire showed overall improvement in daily functional auditory performance, in family and school contexts.
Conclusion.
The Bonebridge system in pediatric patients with unilateral or bilateral conductive hearing loss is a valuable tool for early intervention that promotes functional auditory perception and communicative development in their biopsychosocial environment.