Therapeutic Effectiveness of Atresiaplasty Compared to Osseointegrated Bone Conduction Devices

OBJECTIVE: To compare total access to sound in congenital aural atresia patients who underwent atresiaplasty or placement of an osseointegrated bone conduction device (OBCD). METHODS: We conducted a retrospective cohort study at a single tertiary academic center of all pediatric patients with congenital aural atresia. The primary aim was to compare the therapeutic effectiveness of atresiaplasty and OBCD. Mean disease alleviation (MDA) of the air conduction pure tone average (AC PTA) was calculated based on post-operative change in air conduction thresholds with weighting of the hearing benefit based on device usage in the OBCD cohort. RESULTS: 169 pediatric patients (56.2% male, 83.4% complete) with congenital aural atresia were identified. 45 ears treated with atresiaplasty and 38 ears implanted with an OBCD were found to have complete pre- and post-operative audiometric data and were included in the analysis. The improvement in AC PTA after OBCD was higher compared to atresiaplasty (59.6% vs. 37.1%, p < 0.001). However, MDA of AC PTA was greater in the atresiaplasty cohort compared to OBCD (37.1% vs. 23.0%, p = 0.001). Multivariable regression accounting for clinical and sociodemographic co-variates demonstrated a higher MDA for atresiaplasty compared to OBCD (p = 0.01). CONCLUSIONS: Select patients with congenital aural atresia may obtain improved total access to sound, or auditory dosage, from an atresiaplasty in the hands of an experienced surgeon compared to an OBCD due to the fact that a canal reconstruction provides the same access to sound throughout the day while external device utilization can be variable. LEVEL OF EVIDENCE: Level 3.