Implantable hearing aids in otosclerosis: indications, surgical applications, and cost-effectiveness

Since the 1980s, implantable hearing devices have revolutionised otologic surgery, providing new options for patients with otosclerosis. This article discusses two primary types of devices that are beneficial to patients with otosclerosis: bone anchored hearing devices (BAHDs) and active middle ear implants (AMEIs). BAHDs include percutaneous, passive, and active transcutaneous devices, offering an alternative for patients where stapes surgery or conventional hearing aids are not feasible. Although BAHDs improve audiological outcomes, they are generally considered a third-line treatment due to their limited cost-effectiveness ratio in otosclerosis. AMEIs, such as the Vibrant Soundbridge, are another option, offering superior speech recognition without the occlusion effects of traditional hearing aids. While implantable hearing devices show promising results, they are typically reserved for patients at high surgical risk or who do not benefit from conventional hearing aids. Further cost-benefit analysis is needed, as implantable devices are less economically favourable compared to stapes surgery.