When They Stop Coming: Key Factors in Pediatric BCHD Adherence in Microtia Patients

OBJECTIVE: To analyze the demographic and clinical factors associated with adherence to bone conduction hearing device follow-up care in pediatric patients with microtia and aural atresia. METHODS: Retrospective chart review of 127 patients in a tertiary care microtia database (2015-2025). Data collected included ethnicity, insurance type, current age, fitting age, unilateral versus bilateral hearing loss, time to first follow-up, annual visit frequency, and daily datalogging hours, each analyzed as components of a composite adherence score (1-9) and as independent variables. RESULTS: Unilateral hearing loss was the strongest predictor of decreased adherence on multivariate analysis (OR = 4.504, p = 0.034). Older age was independently associated with reduced adherence; patients aged ≥ 11 years had significantly higher odds of poor adherence versus those under 6 years (OR = 5.795, p = 0.001). While patients aged 7-10 had 4 times the odds of reduced adherence (OR = 4.391, p = 0.003). Public or no insurance was associated with decreased adherence versus private insurance (p = 0.009). Fitting age was not significant (p = 0.098). Independent analysis of daily datalogging hours confirmed a significant association with adherence tier (p < 0.001); patients logging fewer than 4 h per day had markedly higher odds of decreased adherence on multivariate analysis (OR = 33.39, p = 0.003). CONCLUSIONS: Unilateral hearing loss, public or no insurance, and older age are risk factors for poor long-term BCHD adherence in pediatric patients. Reduced daily device wear, as measured by datalogging, is a strong independent predictor and should be routinely monitored.