Treatment Timeline

The Guiding Principle is to establish maximum and early hearing in both ears to allow normal brain and auditory development. The following chronologic listing is a guideline of tasks to accomplish in the first 3 years of life.  Individual patients may need alteration to this protocol based on their specific needs and characteristics.  Advice in your situation can be accessed from out organization.

For Evaluation by Dr. Roberson

0-3 months:
Hearing Test to establish hearing status in both ears
Consider bone conduction surface device for unilateral – for bilateral condition it is mandatory to initiate non-surgically implanted Surface Bone Conduction (see below) by 4 months of age

0-6 months:
Screen for congenital syndrome or related conditions – associated syndromes

0-36 months:
For unilateral cases, maximize hearing in the ‘good’ ear

9-18 months:
Speech and Language evaluation – determine if development is on track compared to normal hearing children

@ 30 months or later:
CT scan to determine hearing strategy – Atresia Grade – CT scan, note:  CT scans are only done before 2.5 years of age in children where cholesteatoma is a concern

By 36 months:
Determine method of microtia (outer ear) repair as the selected technique for reconstruction of the outer ear determines timing and sequence of surgical therapy.

Rib Graft microtia 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.

Medpor microtia repair:  three options exist

• Ear Canal surgery first (3 years of age minimum and 15kg)  followed 4 or more months later by Medpor
• Combined Atresia Microtia (CAM) repair:  Ear Canal + Medpor at one surgery
• Medpor first to be followed by Ear Canal surgery:  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