BACKGROUND: Bone-anchored hearing aids (BAHAs) are indicated for people with conductive or mixed hearing loss who can benefit from amplification of sound. In resource limited health care systems, it is important that evidence regarding the benefit of BAHAs is critically appraised to aid decision-making. OBJECTIVE OF REVIEW: To assess the clinical effectiveness of BAHAs for people with bilateral hearing impairment. TYPE OF REVIEW: Systematic review. SEARCH STRATEGY: Nineteen electronic resources were searched from inception to November 2009. Additional studies were sought from reference lists, clinical experts and BAHA manufacturers. EVALUATION METHOD: Inclusion criteria were applied by two reviewers independently. Data extraction and quality assessment of full papers were undertaken by one reviewer and checked by a second. Studies were synthesised through narrative review with tabulation of results. RESULTS: Twelve studies were included. Studies suggested audiological benefits of BAHAs when compared with bone-conduction hearing aids or no aiding. A mixed pattern of results was seen when BAHAs were compared to air-conduction hearing aids. Improvements in quality of life with BAHAs were found by a hearing-specific instrument but not generic quality of life measures. Issues such as improvement of discharging ears and length of time the aid can be worn were not adequately addressed by the studies. Studies demonstrated some benefits of bilateral BAHAs. Adverse events data were limited. The quality of the studies was low. CONCLUSIONS: The available evidence is weak. As such, caution is indicated in the interpretation of presently available data. However, based on the available evidence, BAHAs appear to be a reasonable treatment option for people with bilateral conductive or mixed hearing loss. Further research into the benefits of BAHAs, including quality of life, is required to reduce the uncertainty.
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