Congenital aural atresia

TLDR

Success in bilateral atresia surgery is defined by eliminating the need for a hearing aid, while unilateral surgery aims to mitigate unilateral hearing loss, with a hearing threshold of 20 dB or better considered satisfactory. Over 25 years, 69 ears with congenital aural atresia were treated using meatoplasty (7 ears), canaloplasty (22 ears), canaloplasty with stent (8 ears), or mastoidectomy with stapediopexy (26 ears). Among 62 ears with partial or total atresia, 8% had hidden cholesteatomas, 10% experienced complications such as temporary facial palsy or abandoned surgery, and only 30% of canaloplasty and 8% of mastoidectomy with stapediopexy met the 20 dB hearing threshold criterion.

Abstract

This report is based on 25 years' experience in the surgical management of 69 ears with congenital aural atresia. There were 7 ears with meatal atresia, 11 with partial atresia, 50 with total atresia, and 1 with hypopneumatic total atresia. Meatoplasty was performed in 7 ears, canaloplasty was performed in 22 ears, canaloplasties with strust in 8 ears, and mastoidectomy with stapediopexy was performed in 26 ears. Of the 62 ears that had partial or total atresia, five (8%) had hidden cholesteatomas that were destined to create future complications by expansion and erosion had they not been removed. In five of the 62 ears, temporary facial palsy resulted from exposing the facial nerve in the atresia plate, and in another five ears, attempts to improve hearing were abandoned intraoperatively because of surgically insurmountable anomalies. A reasonable criterion for success in an operation for bilateral atresia is that the need for a hearing aid is obviated; whereas, for unilateral atresia, a successful procedure should largely eliminate the disadvantages of unilateral hearing loss. These criteria seem to be satisfied if the threshold of hearing can be brought to a level of 20 dB or better. This criterion was met in 30% of the group that underwent canaloplasty and in 8% of the group that underwent mastoidectomy with stapediopexy.