Auditory rehabilitation in mixed hearing loss due to chronic otitis media sequelae: passive versus active transcutaneous bone conduction implant

PURPOSE: To compare audiological outcomes and self‑perceived benefits in patients with sequelae of chronic otitis media (COM) and mixed hearing loss (MHL) undergoing rehabilitation with either a passive transcutaneous bone conduction implant (PT-BCI) or an active transcutaneous bone conduction implant (AT-BCI). METHODS: A multicenter, prospective and observational analytical study in Colombia included patients receiving PT‑BCI or AT‑BCI. Main outcomes were pure‑tone average (PTA=0.5-4Khz), high‑frequency PTA (HF‑PTA=4-8 kHz), and Client Oriented Scale of Improvement (COSI). Comparative analyses used two‑way repeated‑measures ANOVA (complete‑case) followed by linear mixed‑effects models for repeated measures (LMMs‑RM) to address group imbalance and missing postoperative data, thereby optimizing statistical power. RESULTS: A total of 211 AT‑BCI and 50 PT‑BCI patients were included. Baseline characteristics were comparable, except for soft‑tissue thickness. Both devices achieved significant improvements in PTA and HF‑PTA at 3 and 12 months (p<0.010). LMMs‑RM confirming significant effects of device type (superior with AT‑BCI) and time for both outcomes: for PTA (Device type: F(1,321)=5.317, p=0.022; Time: F(2,321)=201.179, p<0.001) and for HF‑PTA (Device type: F(1,320)=5.665, p=0.018; Time: F(2, 320)=116.934, p<0.001). 82 patients (88.2%) reported that their performance with the device was "Better"/"Much better" on the COSI scale, no statistically significant differences observed between the AT‑BCI and PT‑BCI groups (p=0.283). CONCLUSIONS: The findings of the present study suggest that AT‑BCI provides a greater and clinically meaningful auditory gain for HF‑PTA in patients with MHL secondary to COM. In ATBCI group a stable audiological performance was achieved as early as the 3‑month follow‑up and is maintained over time.