A case of microtia with bilateral conductive hearing loss with unusual findings

Abstract

Microtia refers to a group of congenital auricle malformations that range in severity from minor partial structural abnormalities to full auricle absence (anotia). A 17-year-old female, who was also a known case of left ear microtia presented to OPD with chief complaint of reduced hearing from both ears since 4 years. Examination showed Left ear microtia with narrow canal with retracted tympanic membrane while right ear had a normal pinna and canal with grade 3 retraction present in the tympanic membrane. In pure-tone audiometry (PTA) a conductive hearing loss of 57 dB in the right ear and 52 dB in the left ear, and impedance audiometry showed a curve of "Ad" and bilaterally ipsilateral reflexes were found to be absent. During exploratory tympanotomy, intraoperatively facial nerve was found to be low lying over the promontory, showing an abnormal course. A piece of cartilage was placed over the posterosuperior region. Temporalis fascia graft was placed over it. Any such case that has a congenital anomaly like microtia should not be planned for any kind of surgical intervention as they might have abnormal findings like an aberrant course of the facial nerve, and any kind of intraoperative manipulation with the ear might further increase the complications of the patient like facial nerve paresis. These patients should be properly assessed and counselled to directly go for a hearing aid rather than undergo any kind of surgical risk or complication.