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Review
. 2022 Dec 26:9:944223.
doi: 10.3389/fsurg.2022.944223. eCollection 2022.

Integrated microtia and aural atresia management

Mai Thy Truong  1 , Yi-Chun Carol Liu  2   3 , Jocelyn Kohn  4 , Sivakumar Chinnadurai  5   6 , David A Zopf  7 , Melissa Tribble  8 , Paul B Tanner  9 , Kathleen Sie  10 , Kay W Chang  1
Affiliations
Review

Integrated microtia and aural atresia management

Mai Thy Truong et al. Front Surg. .

Abstract

Objectives: To present recommendations for the coordinated evaluation and management of the hearing and reconstructive needs of patients with microtia and aural atresia.

Methods: A national working group of 9 experts on microtia and atresia evaluated a working document on the evaluation and treatment of patients. Treatment options for auricular reconstruction and hearing habilitation were reviewed and integrated into a coordinated care timeline.

Results: Recommendations were created for children with microtia and atresia, including diagnostic considerations, surgical and non-surgical options for hearing management and auricular reconstruction, and the treatment timeline for each option. These recommendations are based on the collective opinion of the group and are intended for otolaryngologists, audiologists, plastic surgeons, anaplastologists, and any provider caring for a patient with microtia and ear canal atresia. Close communication between atresia/hearing reconstruction surgeon and microtia repair surgeon is strongly recommended.

Keywords: aural atresia; aural atresia surgery; auricular reconstruction; bone conduction implant (BCI); ear canal reconstruction; ear canal stenosis; microtia; microtia surgery.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer [BK] declared a past collaboration with the author [KC] to the handling editor at the time of review.

Figures

Figure 1
Figure 1
Classification of Microtia Severity.
Figure 2
Figure 2
(A) Child with visible canal opening on the right, but severe bony external canal stenosis demonstrated on non-contrast CT scan (long white arrow). Normal canal size is noted on the contralateral side (short white arrow). (B) Child with complete atresia on the right, demonstrated on non-contrast CT scan. Normal canal size is noted on the contralateral side (short white arrow).
Figure 3
Figure 3
Infant undergoing unsedated (natural sleep) auditory brain stem testing (ABR).
Figure 4
Figure 4
(A) Coronal and (B) axial non-contrast temporal bone CT scan demonstrating severe EAC stenosis with cholesteatoma.
Figure 5
Figure 5
Non-Surgical Bone Conduction Devices. Bone conduction sound processors. (A) Cochlear BAHA® with softband. (B) Ponto® with softband. (C) Med-El ADHEAR® with adhesive gel pad. (D) Cochlear BAHA SoundArc®.
Figure 6
Figure 6
Surgical bone conduction devices. (A) Cochlear BAHA® with osseointegrated percutaneous abutment. (B) Ponto® with abutment and screw for osseointegration. (C) Cochlear BAHA ATTRACT® with subcutaneous magnet. (D) Med-El BoneBridge® with subcutaneous magnet. (E) Cochlear OSIA® with subcutaneous magnet. (F) Medtronic magnetic implant.
Figure 7
Figure 7
Surgical markings demonstrating course of the superficial temporal artery (dotted line), bone conducting hearing aid primary and “sleeper” implant sites (white arrows).
Figure 8
Figure 8
Silicone ear prosthesis compared to the contralateral well-developed ear.
Figure 9
Figure 9
(A) Elevated temporoparietal fascia flap (TPFF). (B) Porous polyethylene auricular framework.
Figure 10
Figure 10
Autologous Cartilage Reconstruction. (A) Typical areas of costochondral cartilage harvest. (B) Example of auricular subunits created from costochondral cartilage. (C) Pre surgical picture of microtic ear. (D) Assembled costochondral auricular framework. (E) Immediate postoperative appearance after Stage 1 costochondral cartilage reconstruction.
Figure 11
Figure 11
Recommended timing of key events for the hearing management and reconstruction of microtia and aural atresia.
See this image and copyright information in PMC

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