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Chapter 5

Bringing It All Together

What’s the Best Treatment?

The chart below ranks treatment options by their proximity to “normal” hearing, with #1 being best/closest:


The chart below compares attributes of the individual treatment options above:


Red “X” is negative and “+” is a positive attribute for each condition.

International Conferences

Multiple times each year, the professionals at Global Hearing travel around the world to host conferences in various international locations to offer advice and evaluation for patients and their families. Patients who choose to have treatment with us then travel to our facility in California for surgery and postoperative care.

We do not do surgery in other countries. The postoperative care is so critical to success, it would be a bad idea to do surgery and leave patients in the care of local medical professionals who are not experienced in our techniques and methods.

The upcoming conference schedule—to date having including countries such as Russia, China, Korea, Mexico, South America, and Europe—is available at You can also register for these conferences at the same link.

Some patients or parents choose to travel to our facility for surgical treatment. For ear canal surgery, we ask you to stay for a three- or four-week period after surgery. For CAM repair, we request a four-week stay. Other, more minor procedures require less time in California for healing.

After these amounts of time, the ear canal and eardrum (and outer ear in the case of CAM) are sufficiently healed (usually about 90%) to be able to travel and fly safely. The risk of most complications has passed at that point as well.

Upon returning home we ask you to follow a schedule to send us updates including images taken with your mobile phone. We send a bag of medications home with you in case a complication arises that we need to treat. Many times, the medicine needed to treat certain complications may not be available in the patient’s home country, so it’s better to have it and not use it than to need it and not be able to find it!

Remote Consultation

On a regular basis, I have remote consultations with patients around the world using online video conferencing. Prior to these consultations, I must receive the patient’s CT scan (performed at a minimum of 2.5 years of age or older) and an audiogram within the past one month so that I can review the tests and determine surgical candidacy. The remote consultation then gives me an opportunity to discuss my findings and suggestions with families personally, and to help them develop an individualized treatment plan. Many families from our conferences around the world send data to our office after consultation at a conference for review and grading via HEAR MAPS score.

The following items are ideal for us to determine your child’s HEAR MAPS score:

  • A recent audiogram performed on both ears (whether affected or not affected). This can be emailed to our office or mailed to us along with the following items:
  • Photos of the patient from four angles: front, right, and left, and from below the chin looking up, as well as close-up images of the affected ear.
  • A temporal bone CT scan (your child should be at least 2.5 years of age for the CT). This entails having the scan performed, getting the images printed onto a CD, and mailing the disc to our office prior to any consultation with us. If only the film sheets themselves are available, you can likewise mail these to our office. In some cases, online file sharing is possible. I prefer to have the original digital images so I can use customized software to model the inner and middle ears.


A complete listing of how to make an appointment and what is needed can be found on our website at

In-Office Consultations

You are welcome to contact California Ear Institute (CEI) to make an in-person appointment at our office in California.


Our contact and mailing information is:

Global Hearing

The International Center for Atresia & Microtia Reconstruction

1900 University Avenue, Suite 101

East Portola Valley, CA 94303 USA

Phone 650-494-1000

(dial 011 first if calling from international numbers)

Email for appointments and inquiries:

Global Hearing and CEI

Why would people travel from around the world to California for CAAM surgery with Global Hearing? That is an excellent question for anyone investigating options to receive care for this condition.

Many surgeons around the world discourage surgery for CAAM. In our experience, however, extreme attention to detail, state-of-the-art equipment and facilities, and a dedicated world-class team can and do produce excellent, long-lasting results in properly selected patients. Surgeons need to know when to say no to trying to surgically create an ear canal—and when to use an alternate strategy to get hearing to an ear.

Through a rich and long history in the treatment of CAAM, Global Hearing has pioneered several techniques and strategies that translate to improved results for patients. These include the following:

Three New Surgeries for CAAM

  • Canal surgery before microtia surgery
  • Micro-incision canal surgery
  • CAM repair in a single surgery

Complication Reduction:

  • Reduction of stenosis incidence to under 2%
  • Reduction in the displacement of the eardrum to under 3%
  • Reduced scarring, faster healing, and reduced pain with a skin graft
  • Reduced skin problems of the ear canal using Angel Graft technique

Middle Ear Bone Reconstruction

  • First to recognize fibrous IS joint in CAAM patients in 27% of cases

It is our experience that nearly every ear can hear. The question is how to achieve that goal for each child.

CEI is an internationally known center of excellence for the treatment of ear disease. Founded in 1968, CEI has become a treatment resource for tens of thousands of patients, with its rich heritage of state-of-the-art treatments and surgeons. In addition, the Institute has been fertile ground for advancements in ear disorder treatment, with several surgical procedures, several companies, and many new implantable devices that have come from its talented staff of physicians and scientists.

Providers at CEI focus solely on one area of expertise, including audiology and hearing devices, cochlear implants, craniofacial disorders, maxillofacial issues, sinus disease, sleep apnea, and plastic surgery. Located in Silicon Valley adjacent to Stanford University, CEI enjoys a rich and rewarding practice in a gorgeous environment.

We feel privileged and blessed to have received the trust of so many patients with CAAM. When I think of what my own children mean to me, I realize there may be no higher compliment than a parent putting trust in someone to operate on and care for their child. Treatment is still improving, and we will continue to strive for better and better outcomes as we tackle CAAM. Thank you to all who have allowed us to treat their family!


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