The use of a bone-anchored hearing aid (Baha) in children with severe behavioural problems--the Birmingham Baha programme experience.

Objective: A trial of a bone conductor is traditionally used to determine whether a bone-anchored hearing aid (Baha) will be beneficial to a child. However there is a subgroup of children where a Baha assessment is not possible due to severe behavioural/mental/sensory disorders. We describe our experience in a small series of such children.

Method: Retrospective case series review of four children at the severe end of the spectrum of behavioural difficulties who underwent Baha implantation where no formal preoperative hearing aid assessment was possible. The Glasgow Children's Benefit Inventory and a visual analogue scale assessing health status were used to determine the benefit of Baha implantation in this group.

Results: There was no surgical morbidity in this group although a more intensive postoperative follow up was required. All four children wore their hearing aids at least 8h a day. Parents reported a positive impact of the Baha on the behaviour and mood of their children. The Baha showed a positive benefit when assessed using the Glasgow Children's Benefit Inventory and showed a positive change in health status.

Conclusions: We feel that our early experience with Baha in children with severe behavioural difficulties has been positive to date. Multidisciplinary teams should not dismiss these children even if a trial of a bone conductor is not possible. We feel that the bone-anchored hearing aid has been successful in our cases because the children do not physically feel the presence of the hearing aid.