Investigation of the long-term performance and safety of Bonebridge in children and adolescents with congenital bilateral conductive hearing loss (BCHL) over 3 years post-implantation.20 children and adolescents diagnosed with congenital BCHL underwent Bonebridge implantation over 36 months were enrolled. Preoperative and final follow-up pure-tone average (PTA) results were recorded, and whether postoperative complications occurred. All patients tested under two listening conditions: (1) unaided, (2) Bonebridge aided. The speech reception thresholds (SRTs), speech discrimination scores (SDSs) and sound field hearing thresholds (SFHTs) were measured. The mean absolute error (MAE) of sound source localization was calculated to assess the sound localization accuracy.The median age of 20 patients underwent Bonebridge implantation was 9 years old, and follow-up time was 55 months. There were no difference in PTA air conduction and bone conduction between preoperative with postoperative. The performance in SRTs, SDSs and SFHTs were significantly higher in the Bonebridge aided condition than that in the unaided. Concerning sound source localization, the accuracy of localization exhibited a sharp decline when using a single side Bonebridge. However, their sound localization abilities on the Bonebridge implantation same side remained unaffected. One patient had implant exposure, and completed the experiment with the exposed Bonebridge, then underwent a revision surgery. All other complications were resolved by conservative treatment.The performance and safety of Bonebridge were established in children and adolescents with congenital BCHL over 3 years post-implantation.Copyright © 2025. Published by Elsevier B.V.