Simultaneous tympanoplasty and Osia®3 implantation in mixed hearing loss due to tympano-ossicular trauma

Tympano-ossicular damage, associated with tympanic membrane injury, may be a severe consequence of ear trauma. Several ossiculoplasty types have been employed as therapeutic options, usually with favourable hearing outcomes. However, in case of traumatic mixed hearing loss with a sensorineural component, ossiculoplasty might not be sufficient to restore serviceable hearing. In such cases, hearing rehabilitation with bone conduction implants might rationally be seen as a possible approach. However, to the best of our knowledge, there is no previous report of bone conduction implant placement during primary TM repair in this specific subset of patients. The aim of this report is to describe the first case of a simultaneous tympanoplasty and implantation of the bone conduction device Osia®3 (Cochlear Ltd., Lane Cove, NSW, Australia) for a traumatic tympano-ossicular damage, also providing details on surgical technique and outcomes. A 67-year-old man with traumatic tympano-ossicular damage was admitted to our unit, showing severe mixed hearing loss. A cone-beam CT scan showed a complex ossicular chain dislocation, involving the malleus head, incus, incudo-stapedial joint, and stapes footplate. Given such ossicular damage and the mixed hearing loss, an ossiculoplasty was unlikely to provide complete hearing restoration. Therefore, simultaneous tympanoplasty and Osia 3® implantation was performed. Two months after surgery, the neotympanum was stable and the unaided pure tone and speech recognition thresholds improved, due to TM reconstruction. The sound-field audiometry with the Osia® sound processor on demonstrated a mean functional gain of 20 dB, and the 100% speech discrimination score was achieved at 40 dB.