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Evaluating Hearing Outcomes in Microtia Reconstruction: A Comparison Meta-Analysis Study Using Bone Anchored Hearing Aids (BAHA) versus Canaloplasty with Middle Ear Ossicular Reconstruction
Vikas S. Kotha MD, Alison Jin BA, Edward H. Davidson, MD, Alejandro Rivas MD, Anand R. Kumar MD
Case Western Reserve University
2021-02-15
Presenter: Vikas S. Kotha MD
Affidavit:
100% of this project represents the original work of the resident
Director Name: Edward Davidson
Author Category: Other Specialty Resident
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
BACKGROUND: Binaural hearing restoration after external ear reconstruction in patients with microtia continues to be sought by patients and families. The optimal surgical method for hearing restoration using either bone anchored hearing aids (BAHA) or canaloplasty with middle ear ossicular reconstruction (MEOR) remains understudied. The aim of this study is to evaluate and compare hearing outcomes using either intervention after microtia reconstruction.
METHODS: A retrospective metanalysis evaluating hearing outcomes after BAHA implantation or Canaloplasty (MEOR) was performed following PRISMA guidelines (79 studies). Primary predictor variables were auricular reconstruction method and type/timing of hearing intervention. Primary outcomes were hearing outcomes, and postoperative complications. Hearing success was defined as postintervention pure tone average (PTA), air-bone gap (ABG) <30 dB, hearing gain >30 dB. Standard statistical analysis was performed with SPSS27 software.
RESULTS: Twelve studies (n=847 hearing procedures) met inclusion criteria. Auricle reconstruction was performed using an alloplastic framework in 0.7% of cases (n=6) and autologous costal cartilage in 99.3% of cases (n=841). Median age was 12.5 yrs. for alloplastic auriculoplasty vs. 12 with autologous auriculoplasty (p=0.48). Of the eight hundred & four (n=804) procedures reporting comparable hearing outcomes, BAHA implantation was associated with two times greater odds of obtaining a successful hearing outcome than canaloplasty (OR 2.07, 95% CI, 1.69-2.53).
CONCLUSION: BAHA implantation after microtia reconstruction was associated with superior hearing outcomes and lower complications than canaloplasty in a large retrospective meta-analysis cohort study. Future studies will be needed to identify clinically useful primary predictor variable to direct optimal hearing restoration procedures.
