Congenital atresia ear reconstruction is a surgical procedure to create an ear canal in children born without one. The procedure aims to improve hearing and the appearance of the ear.

Congenital atresia occurs if a newborn does not have an ear canal, which is the tunnel leading from the outer ear to the eardrum.

The condition causes conductive hearing loss, in which sound cannot reach the outer or middle ear. It usually only affects one ear but may affect both.

Congenital atresia ear reconstruction is a surgical procedure to treat congenital atresia by creating an ear canal to improve hearing. Another term for this procedure is atresiaplasty.

This article looks at what to expect before, during, and after congenital atresia ear reconstruction, potential risks, and the outlook.

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The purpose of congenital atresia ear reconstruction is to create an ear canal to improve hearing.

Surgery may improve the ability to tell which direction sounds are coming from and improve hearing with background noise. Other treatments include using a hearing aid.

Reconstruction of the outer ear may also be necessary to improve the ear’s appearance.

There are different methods of atresiaplasty, but the most common method involves the following:

  • A surgeon will drill into the atretic plate, a bony structure within the ear, to form an ear canal.
  • Surgeons may then implant a graft to reconstruct the outer ear. They either create the graft from a person’s rib cartilage or use a synthetic graft.
  • Surgeons then carry out ossiculoplasty to restore the mechanisms in the middle ear that transmit sound.

Before having ear reconstruction surgery, doctors carry out hearing tests to rule out abnormalities in the middle and inner ear.

The level of hearing loss before surgery can affect the procedure outcomes. A better level of hearing before surgery can mean a greater improvement in hearing after surgery.

Doctors also carry out a CT scan to examine the facial nerve, bones in the middle ear, and other structures and vessels of the ear.

A doctor will use the Jahrsdoerfer scale to grade the level of atresia depending on which anatomical features are present in the ear. The higher the score out of 10, the better the surgery outcomes may be.

Doctors use this scale to determine who is a suitable candidate for atresiaplasty. A score below 5 may suggest poor suitability.

Where possible, doctors will recommend delaying surgical treatment until a child is 5–6 years old. This is because rib cartilage, which doctors use to reconstruct the auricle, or the outer ear, does not reach a suitable size until around this age.

It is also preferable that children are old enough to understand why they are having the surgery and can follow the necessary aftercare. The risk of the ear canal narrowing also reduces with age.

Before the surgery, it is important to follow any instructions from a doctor, such as whether a person can eat or drink before surgery.

After the surgery, doctors will place packing material into the ear canal to keep the reconstruction in place. This packing may remain in the ear for 3 weeks while it heals.

A doctor will conduct a follow-up audiogram 6–8 weeks after surgery. An audiogram shows the level and type of hearing loss a person has.

Atresiaplasty may help improve hearing. It can improve hearing with background noise and the ability to determine which direction sounds come from. Reconstruction of the outer ear can improve its appearance.

People who score higher on the Jahrsdoerfer scale may have better outcomes with atresiaplasty. A score of 7 or above out of 10 means atresiaplasty has a 90% chance of resulting in near-normal hearing.

A score of 6 or lower means a 40% chance of surgery resulting in near-normal hearing. A score below 5 does not suggest good outcomes with surgery.

There is a 40% chance of the ear canal narrowing after atresiaplasty. If autoimmune or genetic conditions are also present, the outcome can be less favorable, and the person may also require bone-conduction hearing aids.

Learn about Medicare and hearing aids.

Possible negative outcomes following atresiaplasty include:

Learn about types of hearing doctors.

The outlook for congenital atresia and reconstructive surgery may depend on the severity of the atresia and any other abnormalities present.

In most cases, the overall outlook is positive. After atresiaplasty, hearing usually improves from the highest levels of conductive hearing loss to mild hearing loss.

Atresiaplasty can improve the ability to locate where sounds are coming from and to hear better with background noise.

Even with successful surgery, people may not have completely normal hearing, but it may be near-normal.

People with congenital atresia are born without an ear canal, which causes hearing loss.

Congenital atresia ear reconstruction is a surgical procedure to create an ear canal to improve hearing.

The suitability and success of surgery can depend on various factors, such as the child’s age, the ear’s anatomy, the severity of the condition, and the level of hearing loss before surgery.

If a child is a suitable candidate for atresia ear reconstruction, there is a high chance of success, which may result in near-normal hearing.