Practice guidelines for bone-anchored hearing aids in children.

After more than 20 years of clinical experience in children, bone-anchored hearing aids, essentially BAHA(®), have become the standard treatment for conductive or mixed hearing loss. Based on a general review of the literature and the authors' own experience, this article reviews the use of bone-anchored hearing aids in children. The main indications for bone-anchored hearing aids are a minimum age of 5 years at the time of implantation and/or cortical bone thickness ≥ 3 mm. Fixture loss is observed in 40% of children under the age of 5 years versus 8% for children aged 5 to 10 years and 1% for children over the age of 10 years, i.e. identical to the rate observed in adults. Skin complications are similar to those observed in adults and must be prevented by parental education and regular follow-up. Surgery is generally performed in two stages or as a one-stage procedure for fixtures ≥ 4 mm. The functional success rate, correlated with medium- and long-term use of BAHA(®) is about 96%. BAHA(®) may be indicated in children with profound unilateral hearing loss following a trial period wearing a BAHA(®) headband for several weeks with the child's active participation. Sequential bilateral implantation requires complementary investigations and appears to provide improved perception in noise. This type of hearing aid provides an improvement of the quality of life of children with bilateral conductive and/or mixed hearing loss which should be further improved as a result of recent technical developments.