Background:
External auditory canal atresia (EACA) is a rare condition, but in Chile, its prevalence is up to 8.7 times higher than the global average. Often associated with microtia and conductive hearing loss, it requires both functional and aesthetic management. From the start of the program, establishing interdisciplinary coordination and securing funding were priorities.
Methods:
A retrospective analysis was conducted to evaluate outcomes and key lessons after 10 years of the program at Hospital Dr. Luis Calvo Mackenna, Santiago, Chile, a tertiary pediatric hospital.
Results:
Active transcutaneous bone conduction implants (ATBCIs) were used exclusively, as they were considered the most appropriate choice for audiological rehabilitation in pediatric patients. A total of 87 patients have been implanted, 48 with a BCI-601, 27 with a BCI-602, and 12 with an Osia. The middle fossa was the preferred site for implantation. Audiological outcomes were satisfactory. No serious complications were observed except for one patient who developed a postoperative extradural hematoma and was later diagnosed with hemophilia. No other serious long-term complications were observed. Preoperative psychological evaluation played a key role in addressing myths and fears related to surgery. Multidimensional quality-of-life improvements were observed in both bilateral and unilateral EACA cases.
Conclusion:
ATBCIs are an excellent option for auditory rehabilitation in pediatric patients with microtia and EACA, as demonstrated by long-term outcomes in a Latin American tertiary pediatric hospital.

Background:
The bone conduction implant program in Chile began in 2013 at Hospital Dr. Luis Calvo Mackenna, alongside the market release of the Bonebridge® system. Initially, it targeted children with permanent conductive hearing loss associated with microtia and aural atresia attending public schools.

Methods:
This cross-sectional, observational, and descriptive study included 13 pediatric patients implanted between 2013 and 2015. Data were collected in the second half of 2025 using a structured questionnaire covering daily use, perceived performance, complications, device upgrades, and adherence. Auditory performance was assessed with the PEACH scale in quiet and noisy environments, free-field audiometry for functional gain, and a 5-point Likert satisfaction scale. Descriptive statistics (mean, range, SD) were applied.

Results:
All participants continued using their device, with a mean postoperative threshold (PTP) of 25.7 dB (range: 15–30 dB). Average free-field gain was 42 dB (±4.8 dB). PEACH scores averaged 95/100 in quiet (±5 SD) and 85/100 in noise (±8 SD). All users upgraded to SAMBA 2 after a mean of 8 years. The most common issue was processor detachment (69%), with no surgical failures or infections reported. Daily use averaged 11 hours (range: 9–18 h). 80% of users had completed high school and were pursuing higher education. Mean follow-up was one audiology visit per year. Satisfaction was high in 100% of cases.

Conclusion:
Bonebridge® has proven to be a long-term, safe, and effective auditory solution. Sustained functional hearing after ten years supports its high impact on quality of life, especially when combined with ongoing upgrades and clinical monitoring.

Introduction
Malformations of the outer and middle ear significantly impair sound transmission due to absent or abnormal ear structures. Bone conduction implants (BCIs), such as the Baha® and Osia® systems, have transformed auditory rehabilitation in this population. Despite their widespread use, direct comparisons between these devices remain limited.
Objective
To compare audiological outcomes and perceived benefit in patients with unilateral or bilateral microtia/atresia implanted with either Baha or Osia systems.
Methods
A national, multicenter, prospective repeated-measures study was conducted. Patients with alformations of the outer and middle ear scheduled for BCI implantation were included. Functional gain (FG), effective gain (EG), and subjective benefit (COSI questionnaire) were assessed. Patients were grouped according to implant type (Baha or Osia), and results were analyzed separately for conductive (CHL) and mixed hearing loss (MHL).
Results
A total of 678 cases were analyzed (565 Osia, 113 Baha [94% Baha Attract]). Preoperative thresholds were similar across groups. For CHL, average air conduction (AC) PTA4 was 60.5 dB (Baha) and 61.1 dB (Osia); bone conduction (BC) thresholds averaged 10.4 dB. For MHL, AC thresholds were 71.3 dB (Baha) and 73.2 dB (Osia), with BC thresholds of 27.8 dB and 25.5 dB, respectively. Osia showed higher FG (46 dB vs. 34 dB) and better EG (–2 dB vs. –15 dB) in MHL. COSI scores favored Osia in both CHL (4.5 vs. 3.9) and MHL (4.7 vs. 4.0).
Conclusion
Both systems provided significant auditory improvement; however, Osia yielded greater audiological gains and higher perceived benefit, particularly in mixed hearing loss cases.

Background:
The incidence of auricular malformation, including aural atresia, is approximately 1:10,000 to 1:20,000 newborns. The Vibrant Soundbridge (VSB) offers a physiological hearing rehabilitation by selectively stimulating the affected side. Successful application of the VSB depends on the optimal coupling of the Floating Mass Transducer (FMT). The "VSB BERA" measurement via the AcoustiAP system (MedEl) enables objective evaluation of this coupling intraoperatively and postoperatively.
Method:
A specialized surgical approach preserves the option for Bonebridge implantation if VSB coupling is no possible in good quality. In a subset of cases, intraoperative coupling was evaluated using the AcoustiAP system (MedEl). Postoperative assessments of coupling quality were also carried out during follow-up care in previously implanted patients.
Results:
From 2008 to 2024, a total of 81 patients received VSB implants, 26 of whom had aural atresia, including 13 adults (aged 19–43 years) and 13 children (aged 1.5–17 years). Intraoperatively, coupling quality was measured using the AcoustiAP system. Initial results of intraoperative objective coupling measurements show a strong correlation with bone conduction thresholds, supporting the method as a potentially reliable indicator of coupling quality. In adults, postoperative monosyllable recognition at 65 dB ranged between 75% and 90%.
Conclusion:
This study highlights the effectiveness of the VSB system in children with aural atresia, particularly when intraoperative coupling is guided by VSB BERA (AcoustiAP). The described surgical approach not only facilitates successful FMT placement but also preserves the option for Bonebridge implantation if needed, offering a flexible and individualized rehabilitation strategy for pediatric patients with complex middle ear anatomy.

Background
2/3 of children with UAA will have communication problems. PEACH is a validated hearing questionnaire which may aid decision making about the benefit of a bone conduction (BC) hearing aid or implant.
Methods
Prospective PEACH questionnaires were collected in the unaided and trial BC aid situations for UAA and BAA children and compared with their eventual outcomes.
Results
11 BAA and 26 UAA children were assessed. BAA assessed unaided: 3 abnormal vs. 0 normal. BAA assessed during BC trial: 6 abnormal vs. 8 normal. Of the 6 abnormal: 1 had a BAHA and the others continued with aiding. Of the 8 that were normal 1 had surgery for cholesteatoma, 3 had Bonebridges, 1 had Osia and 3 continued with aiding.
UAA assessed unaided: 7 abnormal vs. 6 normal. Of the 7 abnormal: 3 continued with aiding, 1 stopped-no benefit, 1 stopped-discomfort, 1 had VSB and 1 had Bonebridge. Of the 6 normal: 1 continued with aiding. UAA assessed during BC trial: 3 abnormal vs. 9 normal. Of the 3 abnormal: 2 continued with aiding and 1 had VSB. Of the 9 normal: 7 continued with aiding, 1 had Bonebridge and 1 had VSB.
Conclusion
Only 71% of UAA children with abnormal unaided PEACH score will go onto use a BC aid. 17% with a normal score will still want one. 100% continued with aid or proceeded to implantation irrespective of score when trialling a BC aid. PEACH may be useful in combination with other factors in determining who will benefit from hearing implantation.

Background:
Active transcutaneous bone conduction implants have emerged as a preferred method for consistent auditory outcomes for patients with microtia and ear canal atresia. The Sentio was recently approved by FDA for use in the United States in July 2024. We summarize our auditory and surgical outcomes in patients presenting to the Stanford Microtia and Atresia Center who received the Sentio implant.

Methods:
Children from 5 to 19 years old with microtia and canal atresia who received the Sentio implant were enrolled in this study. Hearing outcomes and surgical outcomes were recorded.

Results:
There were 9 patients in this case series. 4 patients underwent Sentio implantation in conjunction with 2nd stage microtia surgery. 4 patients had early implantation prior to microtia reconstruction. 1 patient was implanted following microtia reconstruction. Excellent hearing outcomes were achieved in all patients. Some modifications to surgical technique were made to optimize results with the microtia reconstruction.

Conclusion:
The Sentio implant provides consistent and excellent results in microtia and atresia patients.

Background
Since 2012 we have had a protocol for the management of UAA based on a trial of BC aid. We present our protocol and outcomes.
Methods
Prospective national database figures are presented for UAA patients born between 1998-2021, number with another reason for hearing loss (e.g. learning difficulties), number that had a BC trial, age it started and outcome. Of those implanted we present implant used and datalogged usage post-op.
Results
Of the 136 with UAA 13 had additional causes of hearing impairment: Permanent hearing loss in the other ear (4), developmental delay (3), Severe Autism (3), CHARGE and autism (1), Ebsteins (1), Townes Brock (1). Of the 123 remaining patients there was a complete dataset for 95. Of those 14 declined BC trials, 27 found no benefit, 5 abandoned as uncomfortable, 2 abandoned due to appearance, 17 still wearing, 6 still wearing as having auricular reconstruction first, 23 had implants and 1 is on the waiting list. Average age at start of trial 6.8 years (range 0.3-13.9). 9 VSB, 8 Attract, 3 Bonebridge and 3 BAHA’s were implanted. Post op datalogging at 1 year demonstrated a range of use from 0.6-12 hours a day.
Conclusion
15% of children/carers don’t perceive a hearing problem great enough to merit BC trial. Of those that do 43% abandon because of lack of benefit, discomfort or appearance. 8 % delay implantation for auricular reconstruction. Only 24% of UAA proceeded to hearing implantation but most of those use the implant all day.