BAHA can improve hearing levels in congenital microtia What is BAHA? BAHA stands for Bone anchored hearing aid, a hearing device that uses the principle of bone fusion to improve hearing by transmitting sound signals directly to the inner ear through the bone conduction pathway. The BAHA consists of three main components: a titanium implant, an external connecting base, and an external speech processor. The titanium screw is implanted in the temporal bone behind the ear. After the titanium screw is implanted in the skull, it can be integrated with the skull after a period of time. The vibrations are transmitted through the bone vibrations to the inner ear, causing fluctuations in the endolymphatic fluid, which stimulates the sensory hair cells to produce hearing. Why don’t we do external auditory canal and tympanoplasty? Because the anatomical structure of the middle ear and facial nerve in children with congenital external auditory canal atresia is highly variable, the risk of surgical damage to the facial nerve is high due to the lack of normal signs during surgery, and postoperative reattachment of the external auditory canal is likely to occur. At the same time, after the reconstruction of the external auditory canal, it is easy to crust, the cavity is easily infected, the drainage is poor, and the effect of wearing hearing aids is not good. BAHA is a simple procedure that does not involve the middle or inner ear and does not involve the risk of additional hearing damage or facial paralysis. What are the indications for surgery? BAHA implantation can be considered directly for congenital external middle ear deformity combined with conductive deafness, regardless of unilateral or bilateral, to improve hearing, especially for bilateral small ear deformity with external canal atresia. When the air-bone conduction difference is >30 dB, BAHA implantation is far more effective than wearing a conventional air-conduction hearing aid. Titanium implants are generally considered to be feasible only when the bone cortex thickness is >2.5m, and therefore can currently only be used in children over 5 years of age. Of course, for children with mild deformities, BAHA can be a safe and effective alternative to traditional hearing reconstruction surgery, while for patients with severe external middle ear deformities, BAHA is almost the only way to improve their hearing. What are the advantages and disadvantages of BAHA for small ear deformities? The most important feature of BAHA is that it is not necessary to consider the structural and functional status of the external and middle ear, and only requires that the patient’s cochlea function is normal or close to normal, and the patient’s air-bone conduction difference has no effect on the hearing improvement effect. Compared with traditional bone-conduction hearing aids, the advantages are high sound transmission efficiency, better sound quality, less power consumption, and safe wearing; compared with traditional air-conduction hearing aids, it reduces symptoms such as ear canal infection and wearing pain. It can be performed at the same time as stage II surgery for small ear deformities. The disadvantage is that the hearing aid is more exposed and large, and some children do not accept it. There is also a tendency for children to develop infections during surgery and recovery. What is the procedure? The BAHA procedure is relatively simple and is performed on children under general anesthesia. The flap is drilled in the skull below the center of the flap with a special electric drill, with a diameter of 4 mm and a depth of 3-4 mm. Two months after the surgery, the protective cover is then removed and the speech processor is connected and can be turned on.