Aural atresia is a birth defect affecting 1 in 10,000 births where the external ear canal is malformed or absent. It can occur unilaterally or bilaterally. Various surgical techniques have been developed over 70 years to reconstruct the ear canal and restore hearing. Modern techniques involve drilling away atretic bone, freeing the ossicles, placing grafts, and skin grafting without opening the mastoid bone to reduce complications. Outcomes are better for unilateral cases, while bilateral cases may use hearing aids until at least one ear can be reconstructed surgically. Careful patient selection and meticulous surgery can successfully restore hearing in many cases of aural atresia.

1. aural ATRESIA
• Dr surbhi
• Patna medical college

2. • 1 in 10,000 birth
• Unilateral atresia is 7 times of bilateral
• 10 percent syndromes associated

3. history
• Recognised over 70years
• Surgical techiques late 50s
• NAGER advocated taloring of surgical
techniques

4.  Group 1-
normal or stenotic canal
hypoplastic tympanic cleft
end aural approach
 Group 2-
fistulous track
Complete atresia
Bony atresia
Opening of antrum

5. • Group 3-
complete atresia
Non pneumatised
fenestration

6. • Based on severity
SCHIKNECHT divided aural atresia into 3 groups
 fenestration
 canalplasty
type 3 tplasty

7. belluci
• Seperated middle ear malformations
• minor-normal canal and tm
Stapes fixation,absence of ossicles and oval
window
Single crus
• major-aural atresia,absent canal and tm
Some degree of malformation

8. • JAHRSDOERFER
Ant approach in 1978
This is STANDARD APPROACH

9. • Atretic bone drilled away
• Ossicles freed
• Temporalis fascia used as onlay graft
• Split thickness skin graft
• meatoplasty

10. • With few modification this technique is used
• Gives improved result
• Without opening mastoid
• Fewer complications

11. Surgery for u/l vs b/l
• Unilateral-sorting of high risk on hrct
indicating low likelyhood of success
• Defined as post op srt less than equal to
30dBhl
• Criteria lenient in b/l cases
• Marginal candidate operated atleast one ear

12. Avoided in-
 No aeration
 Facial nerve at risk
 Low lying tegmen

13. Grading system
• 7-8 out of 10

14. • Other criteria
Audiometry
imaging

16. Other options
• For b/l cases baha for over 6yrs
• For those undergone surgery-conventional
behind the ear or in the ear

17. Options for microtia repair
• Porous polyethylene
• Autologus rib graft
• Silicone prosthesis
Porus polyethylene implant ie medpor used in
grade 3 microtia repair

24. • Small suction drains
• 3 months later-lobule
• 3rd stage-post auricular sulcus
• 4th stage-atresia repair and tragus

25. • Advantage of rib graft microtia-no concern for
regection

27. Who should be operated first
• Recently undertaken-atresia before medpor
• Decreases risk of exposure or extrusion
• A recent report-result of aresia surgery before
medpor comparable to atresia surgery after
rib graft

28. timing
• b/l atresia BAHA is used soon after birth
• No amplification required in u/l
• For rib graft delayed upto 6-7yrs
• For grade 2 , 3 microtia can be done at 5
• Medpor at 3yrs

29. Surgical techniques

31. • Bone is removed 360degree around
• Ossicular chain mobility
• Any malformation
• Fascia grafting
• Bone in the periphery is drilled
• For fascia which is placed in ossicular mass
• Skin graft harvested

33. • Has thicker and thinner border
• Thinner kept at level of ear drum
• Thicker sutured at meatus
• Skin graft is notched at medial end

34. • For successful hearing-thin TM AND SKIN
GRAFT
Silastic is placed over new tm
meatoplasty

36. Post op care
• Discharged on oral antibiotics
• Seen after 1 week where suture and packing
removed
• Second visit-1 month later
• Canal is debrided
• Audiogram
• no restriction after 1 month

37. complications
• Meatal canal stenosis
• Snhl
• Facial nerve injury

38. conclusion
• While Technically challenging, surgery can be
successful
• With pre op careful patient selection
• Meticulous surgery
• Restoring of hearing is one of the most
rewarding.

39. •Thank you