Management of conductive and mixed hearing loss intolerant to air-conduction hearing aids: A stepwise algorithm and narrative review from a Japanese perspective

Conductive and mixed hearing loss in the complicated ear, including chronically inflamed ears with recurrent otorrhea, postoperative cavities, tympanic membrane lateralization, canal stenosis/atresia, and congenital malformations, remains a frequent, consequential problem in cases where conventional air-conduction hearing aids (ACHAs) are unusable or provide insufficient functional benefits....

The stepwise algorithm offers a structured framework for selecting bone-anchored, middle-ear implant, or surgical options when conventional hearing aids are not tolerated, though it is expert-opinion level evidence from a single-country perspective.

A practical decision algorithm tailored to conductive/mixed hearing loss intolerant to air-conduction aids fills a real clinical gap, particularly in settings where surgical and implantable options must be prioritised carefully.

1. 01Narrative review targeting patients with conductive or mixed hearing loss who cannot use air-conduction hearing aids.
2. 02Proposes a stepwise clinical algorithm for alternative device and surgical selection.
3. 03Reflects Japanese clinical practice context, including device availability and insurance considerations.
4. 04Options discussed likely include bone-anchored hearing aids (BAHAs), middle-ear implants, and surgical reconstruction.
5. 05Evidence base is narrative/expert-opinion; prospective validation is lacking.

PMID

42259065

DOI

10.1016/j.anl.2026.05.001.

Journal

Auris Nasus Larynx

Publication type

review

Evidence level

5

Population

Patients with conductive or mixed hearing loss intolerant to air-conduction hearing aids

Intervention

Stepwise algorithm for alternative hearing rehabilitation (bone-anchored devices, implants, surgery)