Pediatric Aural Atresia Repair
What is Aural Atresia Repair?
Aural Atresia means the ear canal has failed to form and there is no opening from the outside ear to the hearing bones. In most cases, this congenital abnormality is present on one side only (>80%). It is usually found more often in males and the hearing organ is usually not affected. Repair of this condition starts with the repair of any outside ear abnormality present. This is known as MICROTIA and it takes several different forms. Please see Congenital Ear Abnormalities for more information.
Repair of the missing ear canal involves several steps. First, your child will be given a “grade” that will allow your doctor to tell you if your child is a candidate for surgery and the approximate chances for hearing return.
Generally, if your child is a surgical candidate, approximately 2/3 of the time, hearing can be improved to the 30-35dB range. Approximately 50% of the time, hearing can be improved to the 25dB range (just outside normal). Most children have a maximum conductive hearing loss to start meaning they hear = 50dB.
The “grade” your child gets is determined partly by a CT scan (X-ray study) of the ear. This scan is usually done about 4-5 years of age. It does not help to get scans earlier because, growth, to some extent, will affect the outcome.
Once the patient is found to be a candidate, your doctor will review the CT scan with you and go over the surgical repair in detail.
Surgery consists of making an incision behind the ear and creating an ear canal in the bone with a drill. The ear bones are uncovered and a new eardrum is made from tissue under the skin behind the ear. A skin graft (usually from the hip) is then used to make the new ear canal skin. Finally, an opening is made in the outside ear itself. This will look large at first because there is some expected shrinkage. This surgery takes about 4 hours. About 10 days after surgery, packing is removed from the ear.
You should be prepared that minor revision surgery is sometimes necessary for the first 6 months to a year due to scar formation or narrowing of the ear canal opening.
Patients usually stay overnight and are discharged the following morning. Regular follow-up is crucial to the success of the operation. Therefore, if you cannot commit to regular visits as directed by your doctor, it is best not to start the process initially.
The success of this operation is measured primarily by the hearing result and is outlined above.
Complications of this procedure include: bleeding, wound infection, loss of graft, infection or scaring at the graft site, failure to achieve expected hearing result, and hearing loss. Your doctor will discuss these possible complications with you before surgery.