Congenital aural atresia: Transmastoid approach; an old technique with good results

zoheir el hoshi, mosaad abdel aziz, and mOHAMED Shabana, "Congenital aural atresia: Transmastoid approach; an old technique with good results", International Journal of Pediatric Otorhinolaryngology , vol. 72, pp. 1047-1052, 2008.


Objective: Congenital aural atresia prevents sound conduction to the inner ear, so the
child may suffer learning problems. Transmastoid approach is a safe method to create
functional pathway by which sound can reach the cochlear fluids but it leaves mastoid
cavity which may be problematic. The purpose of this study is to assess the feasibility
of improving hearing in those patients on the expense of mastoid cavity.
Methods: Forty children with congenital aural atresia were included in this study. All
had functioning cochlea on evoked response audiometry and normal cochlear morphology
with pneumatized mastoid on CT scan. Transmastoid approach was used for
reconstruction of the external auditory canal with covering of the newly created canal
using split thickness skin graft. Reconstruction of the tympanic membrane was carried
out by temporalis fascia graft. Follow-up of the patients for 3 years was carried out.
Results: Surgical success is considered on restoration of hearing and maintenance of a
patent, infection-free ear canal. This study showed a successful hearing result in 85%
of patients at 3 months postoperatively, this result diminished to 65% after 3 years.
The incidence of canal restenosis was 17.5%; the narrowing was in the outer
cartilaginous part. No cases developed facial nerve paralysis or sensorineural hearing
loss postoperatively.
Conclusions: Congenital aural atresia is one of the most difficult and challenging
surgeries for the otologic surgeon. However, in the hands of experienced otologists,
repair of this deformity can be performed safely and with predictable results using
transmastoid approach.
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