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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, Anthony DeLeonibus MD, Alison Jin BA, Francis Papay MD, Bahar Bassiri Gharb MD PhD, Antonio Rampazzo MD PhD
Cleveland Clinic Foundation
2023-02-10
Presenter: Vikas Kotha, MD
Affidavit:
Certify this is the author's own work and has not been published or presented before.
Director Name: Steven Bernard, MD
Author Category: Resident Plastic Surgery
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.
METHODS: A retrospective metanalysis evaluating hearing outcomes after BAHA implantation or MEOR was performed using PUBMED, EMBASE and MEDLINE following PRISMA guidelines (79 studies). Primary predictor variables were auricular reconstruction method (alloplastic vs. autologous) 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) with a mean MINORS score of 12.67 (10-16) met inclusion criteria. 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). Of the 60 cases with comparable complication outcome data, the median number of complications was 1 for canaloplasty cases (n=17) vs. 0 for BAHA cases (n=43) (p=0.001). In subset analysis, mean hearing gain after BAHA implantation (n=17) was 37.4 dB (95% CI, 32.9- 41.9) vs. 24.9 dB (95% CI, 18.3- 31.5) for canaloplasty cases (n=17) (p=.002).
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. Subset analysis also identified superior hearing improvement and overall improved hearing using BAHA
