**1. Introduction**

Congenital aural atresia (CAA) is a congenital malformation of the ear that causes both esthetic and functional impairments. The malformation presents different severities of impairment; CAA may be the only malformation in the body or be associated with other malformation as observed in syndromic patients.

CAA is a failure in the ear development that happens in the first gestation' weeks; the failure may be complete by affecting the external and the middle ear or partial, as, for example, a stenotic external canal with normal middle ear structures.

In all cases, the hearing function is impaired, despite having different hearing threshold.

Our group showed that independently from the severity of the hearing impairment, children with hearing loss present a reduction of the memory function and scholar abilities [1], so the restoration of hearing function should be considered

the first goal in CAA followed, eventually, before the adolescent age by an esthetic reconstruction of the external ear [2]. In 1992 Jahrsdoerfer et al. [3] proposed a CT grading system for CAA that was shown to correlate with postoperative hearing outcomes, as a supporting method during the decisional process of treatment of CCA malformation; the suggestion of the author was to treat the high score of malformation with external canal bone reconstruction and eventually ossiculoplasty, while in the case of lower scores, the bone-anchored hearing implants (BAHIs) were the most appropriate treatment.

Other more recent scoring systems as the Lübeck score have been proposed; this system is based on strong analyses conducted on high-resolution CT scan. The proposed method used a 16-score grading for addressing to the best ear implant [4] that has the same efficacy as the Jahrsdoerfer et al. classification [3].

In this chapter we discuss the CCA management with BAHIs by illustrating the different implants available on the market and the implantation method and finally reporting the results that we obtained in more than 10 years of experience with these systems.
