Systematic Review of QoL in BAHI: Conductive Versus Unilateral Sensorineural Hearing Loss

CLINICAL QUESTION

Do disease-specific quality-of-life (QoL) outcomes following bone-anchored hearing implant (BAHI) use differ between patients with conductive/mixed hearing loss (CHL) and those with unilateral sensorineural hearing loss (U-SNHL)?

BOTTOM LINE

Both CHL and U-SNHL patients demonstrate significant disease-specific QoL improvement after BAHI implantation; however, patients with CHL experience greater improvements across multiple QoL domains compared with those with U-SNHL, particularly in measures of communication, sound quality, and overall health benefit, including psychosocial status.

BACKGROUND: Bone-anchored hearing implants are an established rehabilitation option for CHL, mixed hearing loss, and U-SNHL. While audiologic benefits are well documented, patient-reported QoL outcomes may vary by hearing loss etiology and are not reliably predicted by audiometric thresholds alone. Understanding these differences is essential for realistic patient counseling and shared decision making.

STUDY DESIGN: Systematic review and meta-analysis conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard. Databases were searched from inception through October 2022, with updated searches performed in November 2023 and July 2024. Eligible studies included patients who were implanted with BAHI administered a validated, disease-specific QoL measure. Risk of bias was assessed using the RoBANS tool, and random-effects meta-analyses were performed when sufficient data were available.

SETTING: International literature, including studies from 19 countries across tertiary referral and outpatient otology practices.

SYNOPSIS: A total of 56 articles, including 1,919 patients, met the inclusion criteria: 1,408 with CHL/mixed hearing loss and 511 with U-SNHL. Seven disease-specific QoL instruments were used, with meta-analysis possible for the Abbreviated Profile of Hearing Aid Benefit (APHAB), Glasgow Benefit Inventory (GBI), and Speech, Spatial, and Qualities of Hearing Scale (SSQ) questionnaires. Both patient groups demonstrated statistically significant improvements following BAHI use. However, pooled analyses consistently favored CHL patients. Conductive/mixed hearing loss users showed significantly greater improvement in APHAB global scores and key subdomains, as well as GBI global and general health domains. On the SSQ, CHL patients experienced larger gains in speech understanding, spatial hearing, and sound quality. Patients with U-SNHL also benefited from BAHIs, but improvements were smaller and less consistent across domains. The authors suggest this difference may reflect persistent head-shadow effects and reliance on the normal contralateral ear in U-SNHL patients. Sensitivity analyses attenuated statistical significance for some GBI subdomains but did not alter the overall pattern favoring CHL. Limitations of this study included substantial clinical and methodological heterogeneity, predominance of nonrandomized studies, variable reporting of hearing loss severity, and inconsistent differentiation between conductive and mixed losses. Despite these limitations, the authors conclude that hearing loss etiology significantly influences patient-reported QoL outcomes after BAHI implantation.

CITATION: Théorêt K, et al. Systematic review of quality of life in bone anchored hearing: conductive vs. unilateral sensorineural hearing loss. Laryngoscope. 2025;135:3472-3484. doi:10.1002/lary.32229.

COMMENT: This is a systematic review that evaluated the differences in disease-specific quality of life benefits experienced by BAHI users between those with U-SNHL and CHL. The article finds that while both groups of patients experience clinically meaningful benefit from BAHI, patients with CHL report greater benefits from BAHI than those with U-SNHL, with higher scores on domains relating to communication ease, clarity of sounds, and their overall health and psychosocial status.

The article guides clinicians on the expected improvements that patients with different types of hearing loss can expect following BAHI. Patients with CHL are excellent candidates for BAHI. Patients with U-SNHL can also expect benefit from BAHI, but to a lesser extent than those with CHL. This provides credence to careful consideration of other options, including cochlear implantation and CROS (contralateral routing of signal) hearing aids in those with U-SNHL before moving forward with BAHI.—Robert Hong, MD, PhD