Percutaneous bone-anchored hearing aids at a pediatric institution.

OBJECTIVES: The goals were to evaluate hearing, complications, and patient satisfaction with the percutaneous bone-anchored hearing aid (BAHA) and to monitor long-term successful use achieved by careful patient selection. METHODS: This prospective longitudinal study included participants with inoperable congenital bilateral aural atresia, pure-tone average (PTA) bone conduction less than 45 dB HL, prior use of a conventional bone-conduction hearing aid (CBCA), and adequate intelligence, integration, and personal hygiene. Surgery for BAHA implantation was performed in two stages. Evaluation consisted of skin reactions, audiologic results with CBCA and BAHA, and patient satisfaction. Follow-up was at least 24 months. RESULTS: In 11 participants aged 5 to 17 years, the PTA free-field air conduction improved 37%, and free-field speech discrimination improved 23%. Successful integration and implant use were achieved in 10 cases but were lost in 1 case as a result of head trauma. All patients preferred the BAHA as opposed to the CBCA. CONCLUSIONS: The BAHA is a valuable device that can improve hearing and provide significant parent and patient satisfaction. Careful selection appears to correlate with successful long-term use.

Pediatric vocal fold paralysis: a long-term retrospective study.

OBJECTIVE: To review our experience of pediatric vocal fold paralysis (VFP), with particular emphasis on etiological factors, associated airway pathologic conditions, and treatment and prognostic outcomes. DESIGN: Retrospective case review of a cohort of patients presenting with VFP. SETTING: Tertiary referral center. PATIENTS: A consecutive sample of 102 patients presenting with VFP to Great Ormond Street Hospital for Children, London, England, over a 14-year period from 1980 to 1994. RESULTS: There was an almost equal distribution of unilateral (52% [n = 53]) and bilateral (48% [n = 49]) VFP. Iatrogenic causes (43% [n = 44]) formed the largest group, followed by idiopathic VFP (35% [n = 36]), neurological causes (16% [n = 16]), and finally birth trauma (5% [n = 5]). Associated upper airway pathologic conditions were noted in 66% (n = 23) of patients who underwent tracheotomy. Tracheotomy was necessary in only 57% (n = 28) of children with bilateral VFP. Prognosis was variable depending upon the cause, with neurological VFP having the highest rate of recovery (71% [5/7]) and iatrogenic VFP the lowest rate (46% [12/26]). CONCLUSION: Recovery after an interval of up to 11 years was seen in idiopathic bilateral VFP; this has significant implications when considering lateralization procedures in these patients.