title: Hearing outcomes of atresia surgery versus osseointegrated bone conduction device in patients with congenital aural atresia: a systematic review.
abstract: OBJECTIVE
  To perform a systematic review, comparing hearing outcomes of atresiaplasty versus osseointegrated bone conduction device (OBCD) in congenital aural atresia (CAA) patients.
  
  
  METHODS
  Approximately 107 studies, published from 1975 to 2012, evaluating hearing outcomes after atresiaplasty and/or OBCD in CAA patients were identified through a PubMed search.
  
  
  METHODS
  Articles that evaluated external auditory canal stenosis alone, did not report speech reception threshold (SRT), pure tone average (PTA), hearing gain, or air-bone gap (ABG) or had less than 5 patients were excluded. For authors or institutions with multiple reports, the largest or most recent study was included. Forty-one articles satisfied our inclusion and exclusion criteria.
  
  
  METHODS
  The number and percentage of ears with a postoperative SRT, PTA, ABG less than 30 dB, and/or average hearing gain were extracted. The total number of ears and the timing of the postoperative audiogram were also noted.
  
  
  RESULTS
  Of the atresiaplasty ears, 73.8% (95% CI, 62.2%-85.4%), had a SRT less than 30 dB (338 ears), 60.3% (95% CI, 45.8%-74.8%) had a PTA less than 30 dB (390 ears), and 68.9% (95% CI, 59.4%-78.3%) had an ABG less than 30 dB (852 ears). The average hearing gain was 24.1 dB (95% CI, 21.62-26.51) for 516 ears. Hearing outcomes deteriorated with time. Of OBCD patients, 95.9% (95% CI, 91.5%-100.0%) had a PTA less than 30 dB (77 ears), and 98.2% (95% CI, 94.5%-100.0%) had an ABG less than 30 dB (47 ears); the average hearing gain was 38.0 dB (95% CI, 33.14-45.22) in 100 ears.
  
  
  CONCLUSIONS
  The OBCD has better hearing outcomes compared with atresiaplasty in patients with CAA.
authors.affiliation: *Department of Otolaryngology-Head and Neck Surgery, Stanford School of Medicine, Stanford, California; †Division of Otolaryngology, Department of Surgery, and ‡Division of Public Health, Study Design and Biostatistics Center, University of Utah, Salt Lake City, Utah, U.S.A.
authors.forename: Garani S
authors.initials: GS
authors.lastname: Nadaraja
authors.forename: Richard K
authors.initials: RK
authors.lastname: Gurgel
authors.forename: Jaewhan
authors.initials: J
authors.lastname: Kim
authors.forename: Kay W
authors.initials: KW
authors.lastname: Chang
mesh_terms: D001844:Bone Conduction; D000013:Congenital Abnormalities / Q000601:surgery*; D004423:Ear / Q000002:abnormalities* / Q000601:surgery*; D006310:Hearing Aids; D006320:Hearing Tests; D006801:Humans; D019651:Plastic Surgery Procedures; D013067:Speech Perception; D016896:Treatment Outcome