Introduction
Active transcutaneous bone conduction implant systems are useful for patients with conductive and mixed hearing loss but can also be used in single-sided deafness. In young children lesser bone thickness and thin skin pose challenges to successful implantation of these devices. Thus, young children, especially children 4 years or younger, were previously mainly treated with a percutaneous osseointegrated bone-anchored hearing aid (BAHA) or an active middle-ear implant. Both of these systems have risks of complications like dislocation or infection potentially necessitating revision surgery. These complications can be omitted with active transcutaneous bone conduction implant systems. In this study we applied the second generation of the Bonebridge (BCI 602) which features a decreased thickness of the implant with reduced drilling depth and can thus be implanted in younger children.

Material and Methods
Children four years or younger with single-sided deafness due to aural atresia were implanted with the BCI 602. Computed tomography was performed to measure bone thickness and to determine the consistency of the temporal bone and the Otoplan software was used in order to find the optimal position for the implant.

Results
All patients were successfully implanted, did not suffer from severe adverse effects, and showed a good postoperative hearing performance.

Discussion
With adequate preoperative workup and planning, active transcutaneous bone conduction implants can safely be implanted in young children.

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