The concept of osseointegrated implants (OI) used for extraoral purposes was originally developed in adult patients but has with time been used in the younger age group 2-l5 years of age. The main indication for a BAHA has been in patients with bilateral ear canal atresia who are wearing conventional bone conduction transducers pressed against the skin over the mastoid. The present investigation was undertaken to study the outcome of the BAHA in the age-group below 15 years. All children that were supplied with OI for a BAHA between 1983 and 1997 were studied. Pre- and postoperative audiograms taken and roentgenograms were investigated. Indication for OI, number of inserted implants, the bone thickness and specific surgical problems at the site of implantation was studied. Other types of reconstructive surgery was catalogued, and hearing results obtained were evaluated. Skin reactions around the implants were studied. Altogether 40 children below 15 years of age were included in the study. Mean age at the time of surgery for BAHA was 8,7 years. The most common reason for giving the patient a BAHA was bilateral ear canal atresia. Fourteen of the patients had a syndrome belonging, of which the Treacher Collins syndrome was most common (7) followed by Crouzon's syndrome (3). The others had an isolated ear canal atresia without anomalies in other parts of the body. Audiograms revealed a good inner ear function but maximum conductive hearing losses. Sixteen of the patients had earlier middle-ear surgery to reconstruct hearing with poor results. It was in all instances possible to find bone enough for inserting a 3 mm OI. OI surgery was combined with semipermeable membrane placement in 10 cases. The sigmoid sinus and dura of the middle cranial fossa was exposed in 22 per cent of the implant sites. No case of facial nerve damage occurred. Hearing results were determined to be good by the patient and its parents, and none returned to use the conventional bone-conduction device. It is concluded that the BAHA is an excellent alternative to conventional bone-conduction hearing aids in cases of bilateral ear canal atresia. The BAHA is also a good alternative to reconstructive middle ear surgery in the syndromic patients with bilateral ear canal atresia. This study was supported by grants from the Magnus Bergvall foundation, Stiftelsen Fonden for Forskning rörande Hörselskador och orsaken till Dövhet, Stiftelsen Samariten, Sven Jerrings Minnesfond and by the Ahlen-stiftelsen.