Learning Objectives: Understand the approach in using bone conduction hearing aids in children with aural atresia and microtia.

Introduction: The prevalence of external ear abnormalities is around 1 % in Chinese children in Hong Kong. Coexisting hearing loss could be of outer ear, middle ear or inner ear in origin. Management of hearing losses depends on whether it is unilateral or bilateral, the severity and type as well as the plan of management of the external ear abnormalities.

Methods: A review of the management of Chinese patients underwent bone-conduction hearing aid with co-existing outer ear deformities is made from 1995 to 2015 in a single tertiary referral centre in Hong Kong.

Results: Early cases were managed with percutaneous Baha^TM until 2012. With the introduction of Bonebridge^TM and Baha Attract in 2013 and 2014 respectively in our centre, there is a change of management leaning towards these transcutaneous devices. Adults or older children were managed with either Bonebridge^TM or Baha^TM Attract system and children were managed with Baha^TM Attract.

Auricular reconstruction could be performed in the same procedure or as a separate procedure as long as a good surgical planning is made.

Two children and one adolescent (age 9, 13 and 19) with Nagata stage 1 auricular reconstruction and Baha^TM Attract at same setting were described as an illustration of our technique. Adults with Bonebridge^TM cum Nagata stage 1 were described in parallel for discussion.

Discussion and Conclusion: We describe the successful management of a series of congenital atretic and microtia patients with bone conduction hearing devices.

The transcutaneous system allows earlier switch on. The BahaTM Attract system is particularly suitable for some of these children with very thin skull. We see more patient/ parental acceptance with transcutaneous devices after their introduction into clinical practice.