Optimization of surgical interventions in auditory rehabilitation for chronic otitis media: comparative between passive middle ear implants, bone conduction implants, and active middle ear systems.

Introduction: In otology consultations, patients with chronic otitis media (COM) often present as candidates for various hearing rehabilitation options. Selecting the most suitable approach requires careful consideration of patient preferences and expectations, the risk of disease progression, and the integrity of the bone conduction pathway. This study aims to evaluate and compare postoperative hearing outcomes in COM patients undergoing tympanoplasty (with or without passive middle ear implants), bone conduction systems (BCI), or active middle ear implants (AMEI). The objective is to assess the effectiveness of each surgical approach in hearing rehabilitation, considering the type and severity of hearing loss as well as the duration of the disease.

Methods: Retrospective data analysis in a tertiary referral center studying average PTA across six different frequencies, speech perception at 65 dB, influence of Eustachian tube dysfunction, reintervention rate and adverse effects, and the influence of disease duration on functional outcomes via linear regression analysis.

Results: 116 patients underwent surgery due to COM between 1998 and 2024. With a slight female predominance (54.31%). AMEIs and bone conduction devices provided the highest amplification in terms of PTA and speech discrimination, with a lower reintervention rate when comparing both groups with passive middle ear implants, OR in BCI group of 0.30 (0.10; 0.89, p = 0.030), OR in VSB group of 0.15 (0.04; 0.56, p = 0.005). It was also observed that a longer evolution time could be associated with greater auditory gain, with a p-value = 0.033.

Conclusions: The selection of each treatment option primarily depends on bone conduction thresholds, along with surgical risk, patient preferences, and MRI compatibility. In our study, AMEIs demonstrated the highest functional gain in terms of speech discrimination and frequency-specific amplification, followed by BCI. These findings support the use of implantable hearing solutions as effective alternatives for auditory rehabilitation in COM patients.