Case selection and technique for surgical repair of aural atresia

Abstract

The potential for severe distortion of the normal anatomy makes the repair of aural atresia technically difficult and risky. However, there is a good success rate and low rate of complications in selected patients. The ideal candidate for surgical repair has an isolated atresia with a well-developed atresia plate, a well-developed middle ear, ossicles, facial nerve, and mastoid, and no other severe head and neck malformations. More severe malformations may still be repairable in selected cases. Surgery is genrally delayed until approximately age 5 years to allow full development of the tympanic ring. In general, the atresia is suitable for surgical repair when the expected results can average 25 dB or less hearing level, a patent external canal, and adequate closure of the air-bone gap. The Jahrsdoerfer grading scale may be used to determine the prognosis for good hearing results. Severe microtia/anotia, hemifacial microsomia, and retrodisplacement of the mandible often correspond to low scores on the Jahrsdoerfer scale. In cases where severe malformations carry a poor prognosis for surgical repair, boneanchored hearing-assistive devices are an alternative to surgery.