1. A different way to look at bone anchored devices for small children Lori Van Riper University of Michigan Mott Children’s Hospital

2. Z 14 months old Ongoing otitis media and chronic MEE w/ear drainage Fluctuating mild to moderate conductive hearing loss Delayed speech-language skills

3. Z Fit Cochlear Baha on softband in clinic Sent loaner device home with child Returns after using it daily for 4 months Mother reports child suddenly doesn’t want to wear it anymore Hearing is WNL!

4. J Newborn with Down syndrome Diagnosed moderate conductive hearing loss bilaterally Miniscule ear canals Fit with loaner Oticon Ponto on softband

5. J Age 7 months, PE tubes placed bilaterally Ears big enough for earmolds Fit with BTEs – Doesn’t appear to hear as well – Pulls them off repeatedly – Parents go back to Ponto

6. J Age 14 months, PE tubes replaced Parents report J won’t wear Ponto anymore They feel his hearing is much better Testing reveals borderline normal hearing 17 months old, hearing WNL

7. K 7 year old with Down syndrome Passes NBHS Age 7 months behavioral testing suggests severe hearing loss Ears too small for PE tube placement Age 11 months ABR suggests bilateral moderate mixed hearing loss

8. K PE tubes placed at 15 months Moderate mixed hearing loss identified through behavioral testing Fit with Cochlear Baha on softband at 18 months Worn intermittently

9. K Age 6 years, arrives for appointment to consider implanting Baha Testing suggests mild conductive hearing loss Goes to OR for EUA/cerumen (impacted) removal Repeat testing a few weeks later reveals hearing WNL bilaterally for speech frequencies.

10. E Newborn with stenotic EACs Moderate conductive hearing loss bilaterally Could not fabricate earmolds Fit with Oticon Ponto on softband

11. E Age 16 months, EACs large enough for earmolds Fit with loaner BTEs 18 months, fit with own BTEs