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Objectives  Providing hearing compensation to patients with aural atresia is considerably challenging. Hearing aid transducers vibrating the aural cartilage (cartilage conduction; CC) have been devised, and hearing aids utilizing them (CC hearing aids) have quickly become a beneficial option for aural atresia in clinical applications. However, it remains unclear which placement (on the aural cartilage or mastoid) is beneficial to signal transmission.    Methods  This study included 35 patients (53 ears with an abnormal ear canal and severe conductive hearing loss) who were using CC hearing aids. Thresholds were compared between the transducers on the aural cartilage and on the mastoid.    Results  In ears with bony aural atresia, thresholds were significantly improved when the transducer was placed on the aural cartilage compared to when it was placed on the mastoid for frequencies ≤ 500 Hz ( P  < .05). In aural atresia ears with a fibrotic tissue pathway, the aural cartilage stimulation improved the thresholds by approximately 20 dB for frequencies ≤ 1000 Hz ( P  < .05). In non‐atretic ears, the aural cartilage locations significantly worsened the threshold at 4000 Hz ( P  < .05).    Conclusion  Our findings demonstrated that placing the transducer at the aural cartilage improved the mid‐to‐low frequency thresholds compared to mastoid transduction in aural atretic ears. In contrast, no clear improvement to the signal transmission due to the transducer's placement on the aural cartilage was recognized in non‐atretic ears.    Level of Evidence  2

Effect of transducer placements on thresholds in ears with an abnormal ear canal and severe conductive hearing loss