A 58-year-old with a stable canal-wall-down cavity has severe mixed hearing loss, recurrent otorrhoea with conventional aids and adequate cochlear reserve. The ear is dry after revision cavity surgery but the air–bone gap remains large. Which rehabilitation principle is best?
Implant selection is mechanism- and anatomy-led; formal aided assessment and imaging allow a defensible comparison rather than choosing by headline audiogram severity.
A. Repeat conventional air-conduction aid fitting only: Occlusion and recurrent otorrhoea have already made this route poorly tolerated.
B. Cochlear implantation solely because hearing is severe: Adequate cochlear reserve and a large conductive component require comparison with bone-conduction or active middle-ear options first.
C. No amplification can work after canal-wall-down surgery: Several implantable pathways can bypass the problematic ear canal.
D. Compare bone-conduction and active middle-ear implant options after aided testing and anatomical imaging: Choice depends on cochlear thresholds, speech benefit, cavity status, anatomy, skin/bone factors and patient goals.
E. Implant into an actively infected cavity: Implantation should not proceed through uncontrolled infection.
If bone-conduction thresholds had deteriorated beyond device limits with poor aided speech understanding, cochlear implantation might become the more appropriate pathway.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, or a substitute for local policy and specialist clinical judgement.
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