it. The rationale for this is that any surgery will result in some scar tissue that could be the focus of infection. The infections seen early during the development of the surgical procedure could perhaps be explained by the lack of seal between implant and abutment allowing bacteria to enter the space. A new helium tight seal may be advantageous and prevent biofilm formation. This will also allow the surgeon to use longer abutments should a need exist. Three to six weeks later or even earlier, the audiologist will fit and adjust the hearing processor according to the patient's hearing level. The fitting will be made using a special program in a computer. The original surgical procedure has been described in detail by Tjellström et al. 2001. Handling An area where skin is penetrated requires care and cleaning because of the risk of inflammation around the abutment. Daily cleaning is required. Small children Hearing is of importance for a normal speech development. The skull bone in children is often very thin and softer than in the adult. Surgery is thus often delayed until the age of four to five years. In the meantime, the child with bilateral atresia can be fitted with a band around the head with a coupling for a BAHA. This may be done at the age of one month. Infants at this age may tolerate this well. History Patients with chronic ear infection where the drum and/or the small bones in the middle ear are damaged often have hearing loss, but difficulties in using a hearing aid fitted in the ear canal. Direct bone conduction through a vibrator attached to a skin-penetrating implant addresses these disadvantages. In 1977, the first three patients were implanted with a bone-conduction hearing solution by Anders Tjellström at the Ear, Nose, and Throat Department at Sahlgrenska University Hospital in Gothenburg, Sweden. A 4-mm-long titanium screw with a diameter of 3.75 mm was inserted in the bone behind the ear, and a bone conduction hearing aid was attached. The term osseointegration was coined by Professor Brånemark. During animal studies, he found the bone tissue attached to the titanium implant without any soft tissue in between. He also showed an such an implant could take a heavy load. His definition of osseointegration was "direct contact between living bone and an implant that can take a load". The first clinical application of titanium was