Results of Surgical Treatment of Patients with Congenital Auditory Canal Atresia and Microtia

Abstract

Purpose: Creation and implementation effective methods of complex anatomical, functional and aesthetic rehabilitation for different categories of patients with atresia of the external auditory canal (AEAC) and microtia. Methods: Fourty seven patients (n = 47) with congenital atresia of external auditory canal and microtia of different grade underwent surgery on the base of ear diseases department of Federal Scientific and Clinical Center of Otorhinolaryngology (FSCCO) of Federal Medico-Biological Agency of Russian Federation. All patients were divided into three groups. The first group included patients with EACA and 1 grade microtia. The second group included patients with EACA and 2-3 grade microtia. The third group included patients with AECA and 2-3 grade microtia who underwent different types of surgeries previously, had unsufficient development of local tissue, history of trauma, radiation or auricular cancer. To all of them one of three surgical approaches was performed due to individual features and indications: formation of an EAC, tympanoplasty with ossicular chain reconstruction (n = 23) to the 1 st group of patient; formation of an EAC, tympanolasty with ossicular chain reconstruction and concomitant reconstruction of an auricle by use of MEDPORto the 2 nd group of patients (n = 9) or fixation of cranial osseointegrated implants (COI) to the 3 rd group of patients (n = 15). Results: During the observation period which covered on average 3.2 years ( + / -9 months) achieved stable anatomical result. The air-bone gap was on the average 17,0±3.2 dB. Medpor reconstruction provided reliable aesthetic results. The removable auricural prosthesis completely covered up a congenital defect and was a reflection of a healthy ear. Conclusion:The application of the method of lining the formed bone walls of the external auditory canal with a skin pedicled flap and free skin grafts makes it possible to achieve stable anatomical result. Ossiculoplasty with titanium prostheses and tympanoplasty with auto-fascia graft provide a significant hearing improvement in patients with congenital atresia of the external auditory canal. Simultaneous surgical interventions with atresia repair; tympanoplasty and Medpor implantation or setting of ectoprosthetic on COI can be successfully used to improve hearing, replace abnormal ear in different categories of patients according to indications and return them to the social life.