Management of Congenital Aural Atresia and Microtia

Abstract

Microtia is commonly associated with aural atresia, which will cause cosmetic problems as well as hearing impairment. The management of microtia and aural atresia should improve the aesthetic of the external ear and enhance functional hearing. The reconstruction of the auricle can be performed with autologous rib cartilage or a porous polyethylene framework. Surgeons ideally perform the autologous costal cartilage method at 9 years old or higher considering the development of costal cartilage. For porous polyethylene microtia repair, surgical reconstruction can be performed after 5 years of age. Atresiaplasty can be performed in patients who have normal inner ear function and a well-developed middle ear. The Jahrsdoerfer grading scale is used for assessment of middle ear anatomy and scoring 7 or higher expects good results. The other options for hearing rehabilitation include bone conduction hearing devices or middle ear implants. The surgery for bone conduction devices or middle ear implants can be proposed after 5 years of age. Atresiaplasty is recommended in combination with or after autologous rib graft microtia repair and before porous polyethylene microtia repair. The implantation of the hearing devices should not interfere with auricular reconstruction. It can be performed after autologous rib graft microtia repair or combined with ear elevation.