Background

Cranial orthosis is a widely accepted treatment approach for moderate to severe deformational plagiocephaly. Custom-fit helmets molded tightly to the head are worn for 23 hours a day for several months2. This poses a challenge for children with concurrent conductive hearing loss who benefit from hearing devices, specifically bone anchored hearing aids (baha), that are intended to contact the skull directly1. We theorized the bone conducted signals could be transferred through the helmet to the baha device given its tight fit to the cranium.

Methods

This is a pilot study in which we present a case report of three patients in whom baha with headbands were used over their helmet therapy. Feedback management settings were adjusted to account for this. Given the age and development of the children, aided testing was performed.

Results

Good aided benefit was seen with using baha placement over the helmet. Optimal results were achieved with placement of the processor on the flat section of the helmet near the ear pinna. One patient, however, did not tolerate stimulus well and the baha was discontinued. For the other two patients, the baha over the helmet was utilized until they completed helmet therapy. Baha program settings were re-measured/adjusted when the device was used without the helmet. Parents reported positive responses when their child was wearing the baha compared to without.

Conclusion

Placement of the baha with headband over a molding helmet is an important alternative method for patients with concurrent deformational plagiocephaly and conductive hearing loss. This modification allows for earlier baha implementation to facilitate auditory and language development, and minimize communication delays, while permitting optimal head reshaping without compromising speech development or head shape.

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Bone Anchored Hearing Aid With Headband Over Cranial Orthosis: A Pilot Study