Congenital Aural Atresia/Reconstruction
Children with microtia usually also have congenital aural atresia which is lack of an opening for the ear canal, lack of an ear drum and moderate hearing loss. Some children may have a fairly normal outer ear, but have congenital aural atresia with no ear canal and hearing loss. Shortly after birth, the hearing is assessed with electronic hearing tests and hearing aids are used if the problem occurred for both ears.
The nerves of hearing are usually normal, but since there is no ear drum and canal, there is a significant hearing loss, which may be correctable with surgery. If the problem is only on one side, and the hearing is found to be good on the other side, no hearing aid is needed. For children with microtia and congenital aural atresia, reconstructive surgery can be performed to improve the cosmetic appearance and in some children with favorable anatomy, to improve the hearing.
Hearing reconstruction is more of a priority for children with atresia on both sides. Hearing reconstructive surgery is usually done for these children at age five or older after at least one auricle has been reconstructed for cosmetic purposes.
In children with microtia/atresia on only one side and in whom the other ear and hearing is normal, the hearing reconstruction is usually delayed until the child is old enough to take part in the decision regarding the risks of surgery. The risks include a very small chance of further hearing loss or damage to the facial nerve which provides motion to one side of the face. CAT scans are used prior to surgery to help decide which children have the best anatomy for reconstruction in terms of both safety and chances for good hearing.
Some children have favorable anatomy and others do not. For children with favorable anatomy, the operation is usually safe and has a high success rate for hearing improvement
