Congenital aural atresia: Transmastoid approach; an old technique with good results (original) (raw)
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Congenital aural atresia surgery: Transmastoid approach, complications and outcomes
European Archives of Oto-Rhino-Laryngology, 2012
Repair of complete congenital aural atresia (CAA) could be a challenging procedure due to complications reported with CAA surgery such as facial nerve palsy, canal stenosis, graft lateralization, sensorineural hearing loss or the difficulty involved in the surgical technique. From 2006 to 2009, we used a one stage-modified transmastoid approach for surgical repair of 33 ears with complete CAA via a non-randomized controlled clinical trial. Some modifications in the technique of mastoidectomy, ossiculoplasty, fascia and skin grafting and meatoplasty have been described. Patients were followed up for 12 months to assess audiometric results and postoperative complications. Changes in air-bone gap and need for revision surgery or hearing aids were assessed at follow-up. There were no cases of facial weakness, dead ear or bony canal stenosis. Hearing success in 2 months follow-up was achieved in 72.7% of all patients. Success rate increased to 92.3% in patients with Jahrsdoefer's scores of 8 and above. Overall success rate decreased to 63.6% at 12 months follow-up. There were no significant difference in Jahrsdoerfer score of patients with successful first surgical attempt and those who needed revision surgery (P value [0.056). Also patients of lower age (less than 5-years-old) did not have more need for revision surgery when compared with older patients (P value [0.36).
Management of congenital atresia of the external auditory canal
Otolaryngology - Head and Neck Surgery, 1997
The management of a unilateral congenital atresia of the external auditory canal is nonuniform and debated. Various surgical approaches, timing, coordination with microtia repair, and variable hearing improvements all contribute to the debate regarding management of this entity. This paper outlines our craniofacial team approach to the congenital unilateral atresia and microtia in children. Selection criteria, timing of repair, coordination with microtia repair, surgical results, and pitfalls will be discussed. The results of surgery in 16 patients with unilateral congenital atresia of the external auditory canal and 2 children with bilateral atresia will be presented. Repair of the atresia was undertaken in children 5 years or older who had pneumatized mastoids and middle ears. Replacement of the malleus/incus complex with a partial ossicular reconstruction prosthesis improved closure of the air-bone gap. Drawbacks included meatal stenosis and deepithelization of the split thickness skin graft lining the external auditory canal. Repair of the unilateral congenital atresia is a demanding and challenging problem but one in which excellent results are achievable.
Congenital external auditory canal atresia and methods of rehabilitation
2015
Congenital external auditory canal atresia is a disorder with a prevalence of one in 10 000-20 000 live births and is bilateral in one third of the patients. With a conductive hearing loss of 60 dB, even unilateral atresia restricts hearing related social skills. The degree of middle ear deformity may make reconstruction surgery impossible or too hazardous, thus bone-conduction hearing aids have become the first-line therapy. Children with unilateral cartilaginous and bony external auditory canal atresia were enrolled. High-resolution computed tomography with three dimensional reconstructions were made. Reconstruction surgery from retroauricular approach comprised maximal enlargement of the tympanic and mastoid cavities and their closure with adapted conchal cartilage. Hearing improvement reached the level above the social threshold. The auditory canal remained stable and widely patent and facial nerve function was unremarkable. The authors highlight that surgical reconstruction of ...
Congenital auditory meatal atresia: a numerical review
European Archives of Oto-Rhino-Laryngology, 2009
Congenital auditory meatal atresia (CAMA) is an uncommonly encountered disorder. Though a rare condition, CAMA poses multiple problems for aVected children. Recent management of CAMA in developed countries rests on osseo-integrated prostheses and boneanchored hearing aids. The situation is diVerent in developing countries where aesthetic and otologic surgeries are the available lines of management. Surgical management of CAMA has been staged into reconstructive surgery for auricular deformity followed by external and middle ear reconstruction either via anterior or transmastoid approaches. Multiple case series describing the outcomes and complications of both approaches have been published, but no authors have attempted to compare either. We have attempted to compare the outcomes and complications of both approaches by analyzing published medical articles concerning surgical management of CAMA identiWed by searching the Medline database using "congenital aural atresia" and "external auditory canal atresia" as keywords. A total of 923 ears were reported by 13 articles included in this study. The transmastoid approach is shown, by multiple linear regression, to have better postoperative hearing gain and less likely restenosis.
Congenital Aural Atresia-Our Experience with Three Distinct Cases
2015
Congenital aural atresia, a rare entity, may be accompanied with variations in course of facial nerve and congenital cholesteatoma. In the present study, we describe three distinct cases of aural atresia, with successful management, according to the extent of atresia. Management of atresia is essentially a team work, comprising of otologist, plastic surgeon, radiologist and paediatrician, thus making this rare anomaly a special case.
Middle Ear Dimensions in Congenital Aural Atresia and Hearing Outcomes After Atresiaplasty
Otology & Neurotology, 2010
To determine if middle ear dimensions in congenital aural atresia (CAA) patients can predict early postoperative audiometric outcomes in order to establish specific parameters that facilitate stratification of surgical candidates. Study Design: Retrospective case review. Setting: Tertiary referral center. Patients: Twenty-five patients with CAA (28 atretic ears and 22 nonatretic ears) and 12 controls (24 ears). Intervention: Primary repair of congenital aural atresia. Main Outcome Measures: Measure and compare middle ear dimensions in controls, atretic ears, and nonatretic ears in unilateral CAA. Determine correlations between the dimensions and best speech reception threshold during the first postoperative year (SRT-1). Results: The epitympanic depth, medial canal diameter, and the mesotympanic height, area, and estimated volume measurements in atretic ears differ significantly with those in control ears. The mesotympanic length, area, and estimated volume measurements each correlate significantly with SRT-1. Atretic ears with a mesotympanic volume estimate measurement greater than or equal to 42 mm 3 are 24 times more likely to have an SRT-1 of 25 dB or better than those measuring less than 42 mm 3 (odds ratio = 24.5; 95% confidence interval, 2.826Y212.4; Fisher's exact test, p = 0.0022). Conclusion: Middle ear measurements in appropriately selected patients may help predict successful early hearing outcomes after atresiaplasty, thus offering a valuable tool for the surgical decision-making process.
Surgical Treatment of Acquired Atresia of the External Auditory Ear Canal
International Archives of Otorhinolaryngology, 2017
Introduction Acquired atresia of the external auditory canal is characterized by the formation of fibrous tissue in the medial part. The causes include chronic otitis externa, perforated chronic otitis media, postoperative or idiopathic healing problems. Acquired atresia presents with hearing loss and can be associated with otorrhea. Objective We analyzed the results of surgery after six months and two years by checking (1) pre- and postoperative hearing thresholds; (2) presence of otorrhea; and (3) whether a dry and patent ear canal is achieved. Methods We conducted this retrospective study at a tertiary referral center. In total, 27 ears underwent treatment with resection of the fibrotic plug followed by transplantation of a split-thickness skin graft covering the bare bone and tympanic membrane. When necessary, we combined this with a myringoplasty and a (meato-) canalplasty. Results Otorrhea was present in 59.3% of the patients initially and in 14.8% at six months and 11% at two...
Congenital malformations of the ear
The Indian Journal of Pediatrics, 1992
Tile external ear develops from I and II branchial arches commencing on 38th day of fetal life. The middle ear is formed from the ends of Ist pharyngeal puch and the surrounding mesenchyme, which also is part of the I and II branchial arches. The congenital defects of the external and middle ear usually occurs in combination, and many times with congenital defects of other systems. The cochlear functions i.e. bone conduction is normal in 50% of these cases, thus rehabilitation of these patients with congenital anomalies of external and middle ear is possible. The coexistence of congenital aural atresia with varying degrees of malformation of inner ear may be more frequent than generally assumed. Moderate and severe forms of congenital aural atresia area encountered in about 1 in 10,000 to 20,000 individualJ Tile more severe forms of congenital auricular malformation are always associated with meatal atresia, whereas meatal atresia may, in a few cases be seen in patients with a normal pinna. Atresia of the meatus may be membranous or osseus, membranous atresia is much less common and is characterised by rudimentary cartilagenous canal sep~ated from the middle ear by a dense structure of con
Audiology and Neurotology
Objective: A review of published data regarding binaural hearing after treatment of congenital unilateral conductive hearing loss (UCHL) due to aural atresia. Treatment options concern atresia surgery (reconstructive surgery), application of a bone conduction device (BCD), or application of a middle ear implant (MEI). Data Sources: Database PubMed was searched for articles published in English and German between January 1, 1994, and January 1, 2019. Study Selection: The initial search identified 52 studies, of which 9 met the inclusion criteria. Data Synthesis: Comparison of studies was based on a structured review. Meta-analysis was not feasible because of the heterogeneity of outcome measures, the limited number of relevant papers (9), and diverse types of treatment (5). Conclusions: Treatment of UCHL results in bilateral hearing instead of binaural hearing. The large intersubject variability in benefit of treatment is unexplained with a clear improvement in the minority of listen...
Hearing Results of Surgery for Acquired Atresia of the External Auditory Canal
Otology & Neurotology, 2019
Objective: To evaluate short-and long-term hearing results of surgery for acquired atresia of the external auditory canal (EAC) in a large patient cohort and to define preoperative audiometric conditions useful for patient counseling. Study Design: Retrospective cohort study. Setting: Academic tertiary referral center. Patients: Seventy-eight ears from 72 patients with postinflammatory acquired atresia of the EAC who underwent canal-and meatoplasty were included. Patients with involvement of the ossicular chain, (syndromic) external ear malformations, or congenital aural atresia were excluded. Intervention: Canal-and meatoplasty. Main Outcome Measures: Mean pure-tone averages of thresholds at 0.5, 1, 2, and 3 kHz (PTA 0.5,1,2,3) for air conduction (AC), bone conduction, and air-bone gap (ABG) were calculated preoperatively and at short-term (0.55 yr) and long-term follow-up (>0.55 yr). Additionally, the numbers of ears with a closed ABG 10 dB and 20 dB, and with Social hearing (defined as: AC PTA 0.5,1,2,3 35 dB) were assessed. Results: At short-term follow-up AC PTA 0.5,1,2,3 improved by 18 dB. Social hearing was obtained in 81% of the ears. Postoperatively, 35% of the ears had a closed ABG 10 dB, 83% was closed 20 dB. During follow-up, significant deterioration of 5 to 7 dB occurred for AC thresholds at 0.25, 0.5, and 1 kHz. Conclusions: Surgery for acquired atresia of the EAC is often beneficial. This study suggests overall advantageous surgery when the preoperative indication criteria ABG PTA 0.5,1,2,3 >20 dB and AC PTA 0.5,1,2,3 >35 dB are applied.