Outcomes, Complications and Management of the Congenital Aural Atresia Surgery

Oğuz Kuşcu,Önder Günaydın,Umut Akyol,Ömer Faruk Ünal,Emel Tahir

doi:10.4236/ijohns.2014.34031

Abstract

Congenital aural atresia is characterized by aplasia of the external auditory canal (EAC), often associated with abnormalities of the auricula (microtia), the middle ear, and, occasionally, the inner ear structures. The aim of this study is to evaluate the surgical challenges, complications and long term results of congenital aural atresia(CAA) surgery. Records of 103 patients who underwent surgery because of congenital aural atresia were reviewed between 1992 and 2012 in a tertiary referral center. Audiological and surgical events were observed. Surgical technique, incision type, graft material and long term results were noted. Postoperative visit records and audiograms were investigated. Many types of ossicular chain abnormalities such as absence of an ossicle, deformity of an ossicle or ossicular block were observed. Facial canal dehiscence or abnormal location of the facial nerve was seen in 33.9% of patients. Closure of the air-bone gap (ABG) to 30 dB or less at short-term follow-up occurred in 63.1% of patients. Major complications were as follows: restenosis of the external ear canal, hearing loss, facial paralysis, iatrogenic cholesteatoma and perforation of the graft. The air-bone gap cannot be totally closed in all aural atresias, and there is also the chance of sensorineural type hearing loss. Success of the surgery depends on accompanying abnormalities like unexpected route or dehiscence of facial nerve, status of the ossicular chain and middle ear cleft and surgical techniques. Long term results of congenital aural atresia surgery are encouraging and promising.

Highlights

Congenital aural atresia is characterized by aplasia of the external auditory canal (EAC), often associated with abnormalities of the auricula, the middle ear, and, occasionally, the inner ear structures
EAC atresia is more commonly osseous than membranous, and osseous atresia usually coexists with malformation of the middle ear
More severe microtia indicates a more severe middle ear abnormality, some atresias are associated with normal pinnae [1]

Summary

Introduction

Congenital aural atresia is characterized by aplasia of the external auditory canal (EAC), often associated with abnormalities of the auricula (microtia), the middle ear, and, occasionally, the inner ear structures. Techniques of canalplasty, meatoplasty, tympanoplasty, and ossiculoplasty have improved considerably, but surgical correction of congenital aural atresia is still one of the most difficult and challenging procedures performed on the ear What makes this a challenging surgery is the lack of landmarks, altered anatomy of the facial nerve and middle ear, limited space for middle ear reconstruction, and delayed healing process. These factors make it more difficult to achieve the primary goals of surgery, such as restoring hearing and the maintenance of a patent, reconstructed EAC that is free of infection. The complexity of this surgery requires a good knowledge of the surgical anatomy of the facial nerve, oval window, and inner ear, and their congenital variations [3]

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