To POP or Not: Ossiculoplasty in Congenital Aural Atresia Surgery

Abstract

Patients reconstructed with their own intact native chain during aural atresia surgery have better audiometric outcomes than those undergoing OP and are less likely to undergo revision surgery.

The “Boomerang” Malleus-Incus Complex in Congenital Aural Atresia

“…2 However, hearing results in the current study are comparable with those of other reports, with the postoperative pure tone average in the mild hearing loss range and speech reception thresholds in the borderline normal range. 2,[4][5][6][7][8] In addition, the PORP reconstruction in which the prosthesis is placed on the mobile stapes crural arch appears to be more stable and reliable than the PORP reconstruction in which the prosthesis is placed through the obturator foramen down onto the stapes footplate. 5 Other studies have reported comparable results between intact native ossicular chain reconstruction and ossicular replacement prostheses.…”

“…6 The method of reconstruction is dictated by the anatomy at surgery, but if the stapes suprastructure is intact and mobile, the author has found superior results from placing the prosthesis on the suprastructure. 2 One limitation of this study is the lack of long-term data (mean follow-up hearing data are 28 months after surgery; range, 1-58 months). Patients come to the University of Virginia for surgery from around the country.…”

“…Depending on the timing of the arrest in development, the ear canal can be completely absent or mildly stenotic, with a wide range of ossicular malformations most commonly involving the malleus and incus. 2 While patients with CAA have a wide variety of ossicular malformations and configurations seen on high-resolution CT (HRCT), we present a series of 12 patients with a characteristic, consistent "boomerang"-shaped fusion abnormality of the malleus and incus on axial sections through the epitympanum. In this anomaly, the malleus is hypoplastic, with an absent neck, manubrium, and umbo.…”

Prospective blinded study of computed tomography in congenital aural atresia

“…Facial nerve injury is a known complication of aural atresia repair. It has been reported to occur in 0-7% of cases [14][15][16][17][18][19][20][21]. In one study of 99 patients a 6% incidence of transient postoperative facial palsy was noted with a mean total recovery time of 16 weeks [14].…”

“…The appropriate ossiculoplasty or stapes surgery may then be performed. Dobratz et al [15], and Lambert [17] compared hearing outcomes for aural atresiaplasty using the native ossicular chain versus ossiculoplasty. Better hearing outcomes and a lower rate of revision surgery were found when the native ossicular chain was preserved versus when ossiculoplasty was performed.…”