Comparative Efficacy of Prostheses in Hearing Restoration: A Systematic Review and Network Meta-Analysis

Chronic otitis media (COM) often leads to ossicular chain damage, necessitating ossiculoplasty for hearing restoration. Various prosthetic materials are available, including autologous grafts and synthetic materials like titanium, hydroxyapatite, and teflon. However, the comparative efficacy of these materials in ossiculoplasty remains unclear. This study aims to evaluate and compare the efficacy of different prosthetic materials used in ossiculoplasty. A systematic review and network meta-analysis were conducted, adhering to PRISMA guidelines. Studies comparing at least two different prosthetic materials in ossiculoplasty were included. Postoperative hearing outcomes were the primary focus measured at long-term follow-up (6-12 months). A Bayesian framework was used for the statistical analysis, incorporating both direct and indirect comparisons through a random-effects model. Seventeen studies with a total of 1,273 patients were included. Titanium and hydroxyapatite prostheses showed similar air-bone gap (ABG) outcomes, with mean effects of 16.00 dB but varying confidence intervals. Autologous and teflon showed the best air conduction (AC) outcomes with 31.00 and 32.00 dB respectively. In terms of bone conduction (BC) autologous and hydroxyapatite demonstrated similar results (18.00 dB). This network meta-analysis provides the first comprehensive comparison of prosthetic materials used in ossiculoplasty, demonstrating that autologous offers superior outcomes in AC and BC, while hydroxyapatite and titanium perform similarly in ABG closure. Despite these findings, no single prosthesis emerged as definitively superior across all outcomes, emphasizing the need for individualized prosthesis selection based on patient-specific factors. Further research with head-to-head trials and long-term follow-up is needed to optimize ossiculoplasty outcomes.