Evaluation and Management of Congenital Aural Atresia

Integrated microtia and aural atresia management

“…Alloplastic Porous Polyethylene (PPE) reconstruction (e.g., Medpor®, SuPor®): atresia reconstruction surgery is ideally done before or at the time of microtia reconstruction (concurrent surgery). Canal surgery after alloplastic porous polyethylene implant risks damage to the flap vascularity, exposure, and extrusion of the implant with or without infection, which is poorly tolerated by alloplastic implants ( 7 , 33 ).…”

“…Autologous costal cartilage reconstruction: atresia reconstruction surgery is ideally done after microtia reconstruction with cartilage to maintain the viability of the overlying local skin and subcutaneous tissue, which covers the cartilage construct in a tissue envelope ( 7 , 33 ). However, in cases of canal cholesteatoma, this may not be possible, requiring surgical management of the cholesteatoma and atresia repair prior to auricular reconstruction.…”

“…Careful patient selection, surgeon-specific training and skills, and meticulous technique at every operative step are required for successful ear canal reconstruction surgery ( 33 , 34 ). Aural atresia can be graded by severity, ranging from a Type A stenosis to Type C total bony atresia ( Table 3 ) ( 7 ).…”

“…Aural atresia can be graded by severity, ranging from a Type A stenosis to Type C total bony atresia ( Table 3 ) ( 7 ). The stenoses and partial atresias are at much higher risk for cholesteatoma due to the presence of skin inside the remnant canal ( 33 ). However, these allow for surgical approaches that do not require circumferential skin grafting of the reconstructed canal and thus may heal more reliably with better hearing outcomes ( 35 – 37 ).…”

“…There is concern for recurrent canal stenosis that occurs in up to one third of patients postoperatively ( 33 ). When the ear canal is lined with a skin graft, cerumen and debris typically do not migrate laterally, and therefore the patient requires ongoing and lifelong otologic care for aural hygiene.…”