Congenital aural atresia surgery: anterior mastoid and transmastoid approaches

Abstract Background Aural atresia (CAA) is a congenital abnormality with hypoplasia or aplasia of the external auditory canal. Surgical procedures of CAA is not only difficult but has still not been embraced by surgeons. Many surgeons are doubtful to perform a repair due to poor hearing results and the risk of new canal stenosis. This article describes the writers’ expertise with surgical management of aural atresia. A retrospective study of 16 cases of CAA was undertaken in the Hearing and Speech Institute between 2015 and 2018. The study consisted of 16 patients, 8 patients for each group, 10 males and 6 females between 4 and 18 years of age with a median age of 6 years. Ten patients had bilateral atresia, and 6 had unilateral atresia. Postoperatively, patients were tested for hearing recovery and follow-up lasting up to 2 years to record any complications. Purpose of the study was to compare hearing effects and risks of anterior and transmastoid approaches to external and middle ear restoration in patients with CAA. Results All patients were satisfied with the surgery by improving the hearing up to 35 dB or less after 12 months. Four patients (25%) developed soft tissue meatal stenosis, with 2 patients in each group. There were no cases of bony canal stenosis. TM perforation was seen in two patients (12.51%), one patient in each group. Lateralization of the graft was seen in one patient in the transmastoid group, and no ossicular chain refixation. Five cases had postoperative otorrhea, one in the anterior mastoid group and four in the transmastoid group. There were no other complications. Conclusions Although the findings of the hearing are close. The previous approach, due to fewer postoperative complications, is now our favorite technique. Proper alignment and soft-tissue strategies are keys to the effective correction of the congenitally atretic ear canal.

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Long-term Outcomes of Clip Coupler Implantation in Patients with Unilateral Congenital Aural Atresia

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489420924058 ◽

2020 ◽

Vol 129 (12) ◽

pp. 1221-1228

Author(s):

Chunli Zhao ◽

Jinsong Yang ◽

Yujie Liu ◽

Mengdie Gao ◽

Peiwei Chen ◽

...

Keyword(s):

Speech Intelligibility ◽

Signal To Noise Ratio ◽

Bone Conduction ◽

Free Field ◽

Short Term ◽

Aural Atresia ◽

Long Term Follow Up ◽

Congenital Aural Atresia

Objective: To evaluate the long-term safety and efficacy of the Clip coupler attached to the stapes head in patients with unilateral congenital aural atresia (CAA). Methods: This single-center retrospective study included 16 Mandarin-speaking patients who had unilateral microtia accompanied by CAA. All patients were divided into two groups: the short-term follow-up group (n = 9) and the long-term follow-up group (n = 7). The floating mass transducer of the Vibrant Soundbridge (VSB) was positioned in the stapes head by the Clip coupler. The safety of the VSB was investigated by comparing preoperative and postoperative bone-conduction (BC) thresholds as well as by complications. The effectiveness was evaluated by functional gain (FG), word recognition score (WRS), speech reception threshold (SRT) and signal-to-noise ratio (SNR). Results: Pre- and post-operative BC thresholds were no different in all patients. And no complications developed. VSB-aided thresholds in the free-field had improved significantly in both short- and long-term follow-up groups. The improvements of WRS were observed in two groups. The monosyllabic VSB-aided WRS in the long-term follow-up group was significantly higher than that in the short-term follow-up group. When speech was from the impaired ear and noise presented to the side of normal ear (SVSBNCL), lower SNRs were found in two groups after VSB implantation. However, there was no statistical difference in aided SNR between the two groups at SVSBNCL status. Conclusions: Our results show that the FMT connected to the stapes head is a secure and useful device for patients with unilateral CHL/MHL, not only in terms of improved hearing thresholds, but also improved speech intelligibility in quiet and noisy environments.

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Long term results of postoperative canal stenosis in congenital aural atresia surgery

Acta Oto-Laryngologica ◽

10.1080/03655230701624814 ◽

2007 ◽

Vol 127 (sup558) ◽

pp. 15-21 ◽

Cited By ~ 8

Author(s):

Sun O Chang ◽

Jun Ho Lee ◽

Byung Yoon Choi ◽

Jae-Jin Song

Keyword(s):

Long Term Results ◽

Aural Atresia ◽

Canal Stenosis ◽

Congenital Aural Atresia

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Pediatric Tympanoplasties: Anatomical and Functional Results

Otolaryngology ◽

10.1016/j.otohns.2008.05.216 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P67-P67

Author(s):

João Ribeiro ◽

Rui Cerejeira ◽

Vera Soares ◽

Carla Gapo ◽

Jose Romao ◽

...

Keyword(s):

Postoperative Complications ◽

Functional Outcome ◽

Functional Results ◽

Ossicular Chain ◽

First Year ◽

Hearing Results ◽

Surgeon Experience ◽

Contralateral Ear ◽

Air Conduction

Objective The purpose of this study was to analyze the anatomical and functional results in 167 tympanoplasties performed in children. Methods A retrospective study of the anatomical and functional results of 167 tympanoplasties in children was performed. 91 ears had full records and were included in the study. Age, gender, size and site of perforation, status of operated and contralateral ear, underlying cause of the perforations, surgical technique, preoperative and postoperative hearing levels, postoperative follow-up time, and postoperative complications were recorded. Hearing results were reported using a 5-frequency (500,1,000, 2,000, 3,000, 4000 Hz) pure-tone average air-bone gap. Results Anatomical success was achieved in 85% of cases. 71% of the reperforations occurred during the first year of follow-up. The anatomical and functional success was 76% after a mean follow-up of 26.4 ± 16.2 months. The mean postoperative air conduction threshold significantly improved in the successful cases, with a mean audiological improvement of 12.54 ±7.3dB (p<0.05). The maximum mean postoperative gain was seen at 500 Hz 14.9 ±10.1 dB (P<.05). No postoperative sensorineural hearing loss was observed. 18% of minor postoperative complications were seen. Surgeon experience, intact and mobile ossicular chain, dry ear, and follow-up longer than 12 months (p<0.05) improves functional outcome. Conclusions We conclude that tympanoplasty in children is safe with anatomical and functional results comparable to that reported for adults. Dry ear over 6 months, surgeon experience, intact and mobile ossicular chain and follow-up >12 months significantly improves functional outcome.

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Major Congenital Ear Malformations: Surgical Management and Results

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948809700612 ◽

1988 ◽

Vol 97 (6) ◽

pp. 641-649 ◽

Cited By ~ 28

Author(s):

Paul R. Lambert

Keyword(s):

Facial Nerve ◽

Nerve Injury ◽

Ossicular Chain ◽

Nerve Monitoring ◽

Aural Atresia ◽

Facial Nerve Injury ◽

Proper Patient Selection ◽

Facial Nerve Monitoring ◽

Speech Reception Thresholds ◽

Congenital Aural Atresia

Fifteen patients with major congenital aural atresia underwent operations using an anterior (trans-atretic bone) approach. Facial nerve monitoring was used in all cases and there were no instances of facial nerve injury. Postoperatively, two thirds of the patients had speech reception thresholds of 30 dB or better; the air conduction threshold (averaged for 500, 1,000, and 2,000 Hz) improved at least 25 dB in 80% of the patients and at least 30 dB in 60% of the patients (follow-up, 10 to 29 months). Minor revision surgery was necessary in three patients. On the basis of this series, several conclusions were made. First, one of the most important factors in proper patient selection is the degree of middle ear development on computed tomography, both in terms of size and ossicular formation. Second, every attempt should be made to keep the ossicular chain intact (versus use of a prosthesis), as this appears to optimize hearing results. Third, embryologic considerations and surgical experience predict a mobile stapes in the majority of major atresias. Lastly, facial nerve abnormalities are to be expected, especially in patients with significant microtia, but facial nerve monitoring will help minimize the risk of facial nerve injury.

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Referrals and Imaging Strategies: Congenital Aural Atresia, External Auditory Canal Stenosis

Imaging of the Temporal Bone ◽

10.1055/b-0034-87697 ◽

2009 ◽

Keyword(s):

External Auditory Canal ◽

Aural Atresia ◽

Canal Stenosis ◽

Congenital Aural Atresia

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Long-term Stent Use Can Prevent Postoperative Canal Stenosis in Patients with Congenital Aural Atresia

Otolaryngology ◽

10.1177/0194599811426257 ◽

2011 ◽

Vol 146 (4) ◽

pp. 614-620 ◽

Cited By ~ 23

Author(s):

Il Joon Moon ◽

Yang-Sun Cho ◽

Juyeon Park ◽

Won-Ho Chung ◽

Sung Hwa Hong ◽

...

Keyword(s):

Aural Atresia ◽

Canal Stenosis ◽

Congenital Aural Atresia

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Thermography as a Component of Telemedicine for Diagnosis, Therapy and Follow-up of Joint Bleeding, Soft-tissue Bleeding and Micro-bleeding

10.1055/s-0039-1680188 ◽

2019 ◽

Author(s):

M. von Depka ◽

B. Nawroth ◽

C. Wermes ◽

A. Henkel-Klene ◽

C. Detering

Keyword(s):

Soft Tissue ◽

Diagnosis Therapy

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Inflammatory Myofibroblastic Tumour in Antimesenteric Border of Descending Colon of Children: A Case Report

Journal of Paediatric Surgeons of Bangladesh ◽

10.3329/jpsb.v3i1.23908 ◽

2015 ◽

Vol 3 (1) ◽

pp. 47-50

Author(s):

Shahnoor Islam ◽

AKM Amirul Morshed ◽

Afiqul Islam

Keyword(s):

Soft Tissue ◽

Spindle Cell ◽

Inflammatory Myofibroblastic Tumour ◽

Pathological Findings ◽

Soft Tissue Lesion ◽

Soft Tissue Tumours ◽

Inflammatory Pseudotumour ◽

Erythrocyte Sedimentation ◽

Antimesenteric Border

Inflammatory myofibroblastic tumour (IMT) occurring at intraabdominal sites in children has rarely been described. Inflammatory pseudotumour is a soft tissue lesion that may be confused with a sarcoma. It is abbreviated as IMT. Inflammatory myofibroblastic tumour, also known as soft tissue tumours, atypical fibromyxoid tumours, pseudosarcomatous fibromyxoid tumour, plasma cell granuloma, pseudosarcomatous myofibrotic proliferation, post-operative spindle cell nodules. In this paper, we describe a case of inflammatory myofibroblastic tumour (IMT) with an unusual constellation of clinical, pathological findings. A 10-year-old girl had an 7-cm intraabdominal mass accompanied by severe anemia, fever, constipation, weight loss, thrombocytosis, elevated erythrocyte sedimentation rate. Laparotomy was performed. The final pathologic diagnosis was IMT. At the most recent follow up (12months) after excision of the tumour, the patient was symptom-free and there was no evidence of tumour recurrence.J. Paediatr. Surg. Bangladesh 3(1): 47-50, 2012 (January)

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