Modified Surgical Technique for Combined Congenital External and Middle Ear Malformations

Abstract

Hypothesis: There is a positive correlation between type and intensity of combined congenital ear malformations and results of surgical reconstruction. Background: Combined congenital malformations of external and middle ear pose a lot of surgical problems and demand adequate skill and planned, fractioned therapy. The goals of these operations are: limited number of operations with minimal complications, well cosmetic result, hearing improvement and easier use of hearing aid, removal of congenital cholesteatoma, preservation of labyrinth and facial nerve. Methods: The aim of this work is to present the experience in treating patients with combined malformations of external and middle ear. In the period between 1992 and 2001 seventeen patients with this type of congenital malformations were operated. Classical dilemma who operates first, plastic surgeon or otosurgeon is solved here by complete otosurgical treatment with reduced number of operations. Results: Totally 36 operation was performed, two reoperations were made in four patients, and also three operations in three patients for the reconstruction of deformity of auricle. In seven patients costal rib cartilage was used for auricular framework. Reoperations were done during the course of auricular reconstruction (14 operations), or because of meatal restenosis (five operations), or cartilage graft necrosis (one case). Atresia was adequately solved in 14 patients, while in three cases connective tissue meatal restenosis was found. The results of reconstruction of auricular malformation were aesthetically good in 13 patients and sufficient in four patients. Conclusion: We found positive correlation between external ear and middle ear deformity, and the results of reconstruction, as well. Two thirds of patients have hearing threshold level under 30 dB, while the threshold in other patients is 30-40 dB. Residual airbone gap amounting about 20 dB was universally present.