What is the most appropriate option for hearing rehabilitation in a patient with a 3cm x 3cm basal cell carcinoma (BCC) to the concha bowl, status post excision with a 6mm margin and reconstruction?

Hearing Rehabilitation After Concha Bowl BCC Excision

For a patient with concha bowl basal cell carcinoma excision and reconstruction, the most appropriate hearing rehabilitation option is BTE (behind-the-ear) hearing aids if hearing loss is present, or no hearing device if hearing is preserved, as the concha bowl anatomy can typically be reconstructed to accommodate conventional amplification. 1

Clinical Context and Anatomical Considerations

The concha bowl is part of the external ear structure that can be reconstructed after tumor excision, and this reconstruction typically preserves or restores the anatomical framework needed for conventional hearing aid fitting. 2 The 6mm surgical margin for a 3cm x 3cm BCC is appropriate for complete excision, with clean margins associated with better outcomes. 2

Hearing Rehabilitation Algorithm

Step 1: Assess Post-Reconstruction Anatomy and Hearing Status

• If the ear canal remains patent and hearing is preserved: No hearing device is needed initially. 1
• If conductive hearing loss develops due to canal stenosis or reconstruction: Consider conventional hearing aids first. 1
• If mixed or sensorineural hearing loss is present: Audiometric testing should guide device selection. 1

Step 2: Device Selection Based on Anatomical Integrity

Conventional BTE or in-the-ear canal hearing aids (options c and d) are preferred when:

• The external auditory canal remains patent after reconstruction 1
• The concha bowl anatomy can support device placement 3
• Bone conduction thresholds are worse than 60 dB, making bone-anchored devices less effective 4

BAHA (option a) is indicated only when:

• Chronic ear drainage or infection prevents conventional hearing aid use 3, 4
• External auditory canal stenosis or atresia exists 4
• Bone conduction pure tone average is 60 dB or less at 0.5,1,2, and 4 kHz 4
• The patient cannot tolerate conventional hearing aids 3

CROS (option b) is indicated only when:

• Severe to profound sensorineural hearing loss exists in the affected ear with normal hearing in the contralateral ear 1
• Word recognition scores are severely compromised despite amplification 1

Why BTE is Most Appropriate for This Case

BTE hearing aids are the optimal choice because:

• The concha bowl reconstruction after BCC excision typically preserves sufficient anatomy for conventional hearing aid placement 1
• Modern BTE devices provide excellent amplification with digital noise reduction and can be adjusted as hearing changes 1
• They avoid the surgical risks and costs associated with BAHA implantation 3, 4
• CROS devices are unnecessary unless profound unilateral hearing loss develops 1

Common Pitfalls to Avoid

• Do not automatically recommend BAHA simply because ear surgery was performed—BAHA is reserved for chronic drainage, canal atresia, or inability to use conventional aids 3, 4
• Do not select CROS unless severe unilateral hearing loss with good contralateral hearing is documented 1
• Assess hearing function post-reconstruction before recommending any device, as many patients retain serviceable hearing 1

Post-Reconstruction Monitoring

• Audiometric testing should be performed 6 months post-reconstruction to assess for any hearing changes, as function may not stabilize immediately 1
• If conductive hearing loss develops due to canal compromise, conventional hearing aids remain first-line before considering bone-anchored options 1, 3

Answer: d. BTE (behind-the-ear hearing aids) is the most appropriate option, assuming the reconstruction preserves adequate ear canal anatomy and the patient develops hearing loss requiring amplification.