Learning Objectives: to popularise the middle fossa approach to placement of the receiver stimulator and vibrating mass transducer of the bone bridge implant instead of the mastoid cavity

Introduction: The Bone Bridge is a new bone conduction device that works on the principle of transcutaneous sound transmission and a vibrating mass transducer placed with titanium screws on to the mastoid bone to deliver sound to the cochlea in conductive and mixed hearing losses. Since we use this technique mostly in children and adults with microtia, the placement of the device in the mastoid can compromise future otoplasty surgery for pinna reconstruction. We demostrate a technique of middle fossa placement of the device that is easier to perform, quicker and leaves the post aural skin free for later reconstruction.

Methods: The bone bridge has a large vibrating mass transducer that needs a well fitting circular cavity so that the titanium screws are placed properly. We chose the area above the mastoid, above the transverse sinus for placement where a small incision can place the implant easily and firml

Results: Of the cases performed in two centers, London health sciences center has done 19 and Calicut MESIARC 6. All these are middle fossa placements. The age of the patients vary from 4 years to 58. Placement timing was between 30–40 minutes for one side. No post operative immediate or delayed complications were noted. Hearing results were excellent.

Conclusions: The middle fossa technique of bone bridge vibrating mass transducer is a safe, easy and quick technique even in very young children with minimum morbidity

Learning Objectives: It is expected that this technique is more widely followed than the conventional sinodural angle placement method