Treatment - Surgical Options

Atresia Repair followed by Medpor reconstruction
Atresia Repair with Medpor reconstruction - CAM
Rib Graft followed by Atresia Repair
Atresia without microtia or partial/stenotic canal repair
Atresia Repair following Medpor reconstruction- (Not recommended)

Atresia Repair Canalplasty

Surgery is an option, and in certain situations necessary, for treatment of atresia in these situations:

to create an ear canal allowing for hearing restoration
replacement or alteration of one, two, or all three of the middle ear bones if inadequately formed for sound conduction
placement of a hearing device to convey sound to the inner ear through a different mechanism than sound through a canal
to remove abnormal tissue (cholesteatoma) that can enlarge and destroy normal structures thereby threatening the patients function and health
to reconstruct congenital malformations associated with AM such as jaw malformation, abnormalities of the boney structure of the face or eye, soft tissue asymmetry, or facial nerve abnormalities, among others

The timing of atresia repair canalplasty is influenced by the absence or presence of microtia and in cases where microtia is present, the desired route of auricular reconstruction. In this section, surgery to create a functioning ear canal is detailed and demonstrated with both drawings and corresponding video from actual operations. Canal reconstruction can occur in the following orders:

Atresia Repair followed by Medpor reconstruction- can be performed starting at 3 years of age and 15kg, with the medpor reconstruction occurring at a minimum of 4-6 months following
Atresia Repair with Medpor reconstruction (CAM)
Rib Graft followed by Atresia Repair- ear canal surgery is performed after all stages of rib graft repair are completed and healed for several months. Rib graft surgery is usually initiated at 5-6 years of age and requires 3-4 stages. Hearing should be bridged during this phase with surface bone conduction devices
Partial/stenotic canal repair in the absence of microtia- can be performed starting at 3 years of age and15kg
Atresia Repair following Medpor reconstruction- this is strongly discouraged as the complication rate for the medpor ear with ear canal surgery has been shown to be higher than other options. In addition, the medpor surgeon cannot know where the ear should be located so the ear canal ‘lines up’ with reconstructed outer ear.

In this section, surgery to create a functioning ear canal is detailed and demonstrated with both drawings and corresponding video from actual operations.

First, bone is sculpted away to form a bony channel very similar – if not identical – to how the ear canal should have formed had it developed normally. By removing the bone with high-speed precision diamond drills, the surgeon exposes the middle ear bones. An eardrum is created to capture the sound, vibrating the middle ear bones, transmitting the sound to the functioning inner ear and subsequently transmitting a nerve signal to the brain as a normally hearing ear would. The newly created ear canal and eardrum is covered with skin to reconstruct normal. Minor variations of surgery are tailored depending on status of the outer ear reconstruction, whether the canal is performed before medpor microtia reconstruction, in conjunction with medpor reconstruction, or following rib graft reconstruction.

More info regarding advanced skin graft technique for lining the newly created ear canal (PDF)

When a canal is partially formed, the canal is enlarged utilizing many of the same processes as mentioned above. A normal eardrum is needed for optimal hearing results. With partial canals, a partial eardrum may or may not be present. If it has not formed, the eardrum is created and in cases where it has only partially formed, the eardrum is enlarged. Skin grafting may be utilized in a partially formed ear canal as well.

After Atresia Repair, Before Microtia Repair

After Atresia Repair, Before Microtia Repair

After Microtia Repair

After Microtia Repair

Pre-Op

A CT and an audiogram are necessary to conduct the atresia repair assessment.

Surgery

Overview for All Atresia Repairs

Create Canal
Repair or Replace Ossicles
Create Ear Drum
Line Canal with Skin Graft

Differences between outer ear reconstruction techniques

Rib Graft repair, atresia repair comes AFTER outer ear reconstruction
Medpor, atresia repair comes BEFORE outer ear reconstruction

Initial incision and canal placement looks different depending on whether microtic ear has been repaired