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Congenital aural atresia: bone-anchored hearing aid vs. external auditory canal reconstruction
Sarah Bouhabel1, Pierre Arcand, Issam Saliba
1Sainte-Justine University Hospital Center (CHU SJ), University of Montreal, 3175, Côte Sainte-Catherine, Service ORL, Montreal H3T 1C5, Quebec, Canada.
Insights
Bone-anchored hearing aid (BAHA) implantation offers superior hearing gain compared to external auditory canal reconstruction (EACR) alone in pediatric congenital aural atresia. However, EACR combined with conventional hearing aids provides comparable outcomes to BAHA.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Audiology
Background:
- Congenital aural atresia (CAA) presents unique challenges in pediatric hearing rehabilitation.
- Surgical options include external auditory canal reconstruction (EACR) and bone-anchored hearing aid (BAHA) implantation.
Purpose of the Study:
- To compare the audiologic outcomes and feasibility of BAHA versus EACR in pediatric patients with CAA.
- To evaluate hearing gain, operative time, and complications associated with each surgical approach.
Main Methods:
- Retrospective chart review of 40 pediatric patients (20 EACR, 20 BAHA) between 2002-2010.
- Comparison of air conduction, bone conduction, pure tone average, and speech discrimination scores pre- and post-operatively.
- Documentation of operative time, complications, and microtia presence.
Main Results:
- BAHA demonstrated significantly superior hearing gain compared to unaided EACR at 6 months and 1 year post-surgery.
- Aided EACR outcomes were comparable to BAHA outcomes.
- Operative time was significantly shorter for BAHA implantation than for EACR.
- Complication rates were similar between groups, with one transient facial paralysis in the EACR group.
Conclusions:
- Unaided EACR alone yields suboptimal results for pediatric CAA.
- Combined EACR with conventional hearing aids can achieve audiologic outcomes comparable to BAHA.
- BAHA implantation is a safe, effective, and reliable option for significantly improving hearing in pediatric CAA patients.
Objective:
To compare the audiologic outcome and feasibility of bone-anchored hearing aid (BAHA) and external auditory canal reconstruction (EACR) surgeries in pediatric patients presenting a congenital aural atresia (CAA).
Methods:
A retrospective chart review of 40 patients operated in our tertiary pediatric care center between 2002 and 2010 was performed. 20 patients underwent EACR, whereas another 20 patients were implanted with a BAHA device. Air conduction (AC), bone conduction (BC), pure tone average (PTA) and speech discrimination score (SDS) were compared preoperatively, and hearing gain (HG) postoperatively at 6 and at 12 months at frequencies of 500, 1000, 2000 and 4000 Hz. Operative time, complications and associated microtia were documented as well. EACR patients were graded retrospectively upon Jahrsdoerfer's classification.
Results:
Preoperative AC were significantly different between groups, at 500, 1000 and 2000 Hz but not at 4000 Hz. BAHA group compared postoperatively to EACR group showed significantly a superior HG of 46.9 ± 7.0 dB (p<0.001) and of 39.8(7) ± 7.2(6.9)dB (p<0.001) at 6 months and at 1 year, respectively. Moreover, aided air thresholds from the EACR group revealed an audiologic status similar to those of the BAHA group patients, at 6 months and one year postoperatively. Both groups had a similar evolution of their BC, as well as of the incidence of complications. We report one case of transient facial paralysis in the EACR group. Total operative time is significantly lower (p<0.001) for a BAHA implantation (56 ± 21 min) than for EACR surgery (216 ± 174 min). No preoperative or postoperative correlation (Pearson correlation test; p>0.05) was found between patient's Jahrsdoerfer's score and their audiologic outcome. HG does not seem to be influenced by the presence of microtia.
Conclusion:
EACR, although constituting an attractive option, does not give acceptable results alone. It can however, when combined to conventional air conduction hearing aids, provide excellent audiologic outcomes comparable to BAHA. BAHA implantation is a reliable, safe and efficient therapeutic option that allows a significantly better audiologic outcome when compared to unaided EACR for patients with CAA.
