Early Outcomes of a New Active Transcutaneous Bone Conduction Implant in Children with Microtia-Atresia

Abstract

Microtia-atresia comprises congenital malformations of the auricle and external auditory canal, causing conductive hearing loss and impacting speech, language, academic performance and quality of life, even in unilateral cases. Active transcutaneous bone conduction implants (atBCIs) offer reduced skin complications and enhanced high-frequency transmission compared with passive devices. The Osia® system, recently approved for implantation in children aged 5–12 years in Australia, is understudied in younger populations, with no prior systematic reviews or Australian data. This thesis evaluates the role of atBCIs in children with microtia-atresia, focusing on the Osia. It includes: (1) a systematic review of paediatric Osia outcomes, assessing safety, audiological benefit and patient-reported measures; and (2) the first Australian case series of children aged ≤12 years undergoing Osia implantation, including those receiving concurrent alloplastic auricular reconstruction.

The systematic review demonstrates that paediatric Osia implantation provides consistent audiological benefit and a favourable safety profile, though current evidence is limited by small, heterogeneous cohorts, variable follow-up and scarce functional outcome data. The Australian case series shows that Osia implantation is feasible and safe in carefully selected children. Parents’ Evaluation of Aural/Oral Performance of Children (PEACH) scores indicated better listening in quiet and noise. Parents also reported improved communication, reduced listening fatigue and greater device compliance. This thesis supports Osia as an effective hearing rehabilitation option in children with microtia-atresia and offers the first synthesis of global paediatric outcomes alongside the inaugural Australian cohort. Findings highlight early functional benefits and the potential value of timely implantation, while underscoring the need for larger prospective studies with standardised outcomes and long-term follow-up.