Since 1988, 309 patients have been referred to the Birmingham bone anchored hearing aid programme for assessment. One hundred and eighty-eight have been fitted with bone anchored hearing aids (BAHA). Of these 169 have been fitted with a BAHA alone and 20 with a BAHA and auricular prosthesis(es).

Only four (2.1 per cent) are not wearing their BAHAs. Three cases because the hearing had continued to deteriorate and in one case because of repeated failure to integrate. Nineteen patients (10.1 per cent) have lost fixtures but all but one of these have been successfully reimplanted. Of these 19 patients 10 (52.6 per cent) were syndromal and 10 (52.6 per cent) were under 16 years of age.

A surgical method has been evolved both to cope with predictable failure of integration and soft tissue control.

The Birmingham bone anchored hearing aid team is part of the Birmingham osseointegrated programme. In the first seven years of its existence it has received 309 referrals. Twenty-six per cent had suffered a congenital conductive hearing loss and 74 per cent had an acquired conductive hearing loss; the majority secondary to chronic suppurative otitis media.

This report is of 68 out of 106 adults wearing bone anchored hearing aids (BAHAs). Ninety-eight per cent showed audiological improvement with the congenital group demonstrating marginally the best freefield thresholds and speech discrimination. Questionnaire data as to the patient experience confirms the benefits especially hearing in noise, and comfort, and the vast majority were more satisfied with the bone anchored hearing aid than their previous aid.

Over a five-year period, 34 patients have been referred to the Birmingham bone anchored hearing aid programme, paediatric section, of whom 21 are now wearing the bone anchored hearing aid (BAHA) and four are awaiting surgery for fitting of the BAHA. Of the patients assessed, found to be suitable and who proceeded to surgery for the BAHA, 44 per cent had Treacher Collins syndrome, 28 per cent had bilateral atresia or microtia, 16 per cent had Goldenhaar's syndrome, four per cent (one patient) had branchio-oto-renal syndrome and eight per cent had chronic suppurative otitis media. This paper presents objective and subjective data collected from these patients. It is shown that the BAHA is a very effective hearing aid for children with congenital hearing loss.

The bone anchored hearing aid (BAHA) has mainly been used for the treatment of hearing loss in patients with congenital conductive problems or chronic suppurative otitis media.

In a five-year period, 32 otosclerotic patients have been referred to the Queen Elizabeth Hospital for consideration of a BAHA. Ten of these patients have been fitted and gained benefit compared to their previous hearing aid. The benefits are not necessarily those in hearing ability but in some cases relate to cosmetic or comfort improvements. This paper demonstrates that the BAHA offers a third treatment option for otosclerosis in patients who cannot or will not undergo stapedectomy and experience difficulty with conventional hearing aids.

Bone anchored hearing aids are gaining wide acceptability in the treatment of patients with congenital ear problems, chronic suppurative otitis media (CSOM) and in some cases otosclerosis. To date little information on the effect of the bone anchored hearing aid on the symptoms of chronic suppurative otitis is available. This retrospective study based on notes review and telephone interviews was to assess the outcome of bone anchored hearing aid surgery in patients with CSOM in terms of: ear discharge; surgical techniques and complications; the number of hours the aid is worn compared with the previous aid.

One hundred and forty-two patients were fitted with bone anchored hearing aids without additional prostheses in Birmingham between 1989 and 1995. Sixty-nine (48.5 per cent) of these were for chronic suppurative otitis media, 45 of these were female and 24 were male with a mean age of 58 years. Most (85 per cent) had undergone previous ear surgery with 65 per cent having mastoid surgery. Ninety-eight per cent of this patient group had undergone single stage surgery and 65 per cent under local anaesthetic as a day case. A variety of techniques for soft tissue reduction were employed.

The mean follow-up time for these patients was 24 months (range one month to seven years). No patients experienced worse discharge following their BAHA and 84 per cent had significantly reduced discharge, 16 per cent had no change. Complications included skin reactions, 15; failure to integrate, one; late loss of fixture, three. Seventy-three per cent wore their bone anchored hearing aid more than eight hours per day and 58 per cent were more satisfied with their bone anchored hearing aid than their previous aid.

Bone anchored hearing aids (BAHA) have been implanted in Birmingham since 1988. Since this time confidence has grown in the fitting and rehabilitation of BAHA wearers, with a corresponding increase in the implantation and rehabilitation of more difficult and borderline candidates.

This study analyses the results of 16 borderline BAHA candidates who have been assessed and fitted with a BAHA at Birmingham Children's Hospital and Queen Elizabeth Hospital, and who have had at least one post-fitting review. All of these subjects had mean bone conduction (BC) thresholds, in the better hearing ear, in excess of 45 dBHL in the frequency range 0.5–4 kHz, when initially assessed. The age range at the time of the study was 10–84 years, with a mean age of 60 years. The study demonstrates the benefits that these patients achieved with the BAHA compared to their previous aid, both audiologically and in terms of comfort and reduction in ear discharge.

Within the Birmingham osseointegrated implant programme there have been several patients with severe pre-lingual conductive hearing loss. The majority of these have been patients with Treacher Collins syndrome.

There are characteristic features of speech and voice in those with long-standing conductive hearing loss. In addition, the associated abnormalities of jaw, teeth and palate may amplify the problem. There may be spontaneous improvement in features such as voice pitch, quality and intensity following the fitting of a BAHA. However, in those with a pre-lingual hearing impairment, speech therapy may be necessary. Patients assessed as suitable for BAHA have a full assessment of communication skills including audio recording of speech and voice. Post-operative training improves auditory discrimination and perception and is followed by training in the production of the newly perceived speech sounds.