Active Versus Passive Transcutaneous Bone Conduction Hearing Devices: A Systematic Review and Meta-Analysis

Area of Science:

• Otolaryngology and Audiology
• Biomedical Engineering
• Medical Device Technology

Background:

• Percutaneous bone conduction hearing devices (BCHDs) are associated with complications.
• Transcutaneous bone conduction hearing devices (tBCHDs), both active and passive, have emerged as alternatives to mitigate these concerns.
• Direct comparative evidence on the efficacy and safety of active versus passive tBCHDs is limited.

Purpose of the Study:

• To systematically review and meta-analyze existing evidence comparing active and passive tBCHDs.
• To evaluate audiological outcomes, quality of life (QoL), and complication rates between active and passive tBCHDs.
• To synthesize current data to inform clinical practice and future research directions.

Main Methods:

• A systematic search of MEDLINE, EMBASE, CINAHL, and Cochrane CENTRAL databases was conducted.
• Included studies were observational or experimental, involving adults using active or passive tBCHDs.
• Meta-analysis using random-effects models was performed to pool data on audiological outcomes, QoL, and complications, adhering to PRISMA guidelines.

Main Results:

• Twenty-eight studies were included, with overall low quality. Pooled complication rate for active devices was 14.8%.
• Active devices showed significant improvement in functional hearing (31.8 dB) for mixed/conductive hearing loss.
• Active devices demonstrated superior high-frequency hearing gains compared to passive devices across multiple frequencies (2-6 kHz).

Conclusions:

• Both active and passive tBCHDs exhibit acceptable safety profiles and improve quality of life.
• Active tBCHDs may offer enhanced audiological benefits, particularly for high-frequency hearing.
• High-quality comparative studies are necessary to definitively establish the superiority of one device type over the other.