Aural atresia and its treatment

Aural atresia represents a common congenital condition which virtually means the absence of an external ear canal but, in spite of the malformation of the middle and the external ear, the inner ear and the auditory nerve are frequently normal. The condition most commonly effects just one ear, but sometimes it can occur in both ears and it is accompanied by microtia, the incomplete development of the auricle, which is also known as “small ear”. Ears affected by microtia can vary in appearance but they are usually shaped like “peanut” or “figure-of-eight” and some of them may have a easy recognizable auricular appearance and the ear canal might be open.

Doctors do not know exactly the reasons why aural atresia occurs; in fact most often it has no known cause. Therefore,  the disease is considered “idiopathic” which means that at this time no one knows what causes it. Yet, one infrequent reason seems to be the environmental exposure such as a dangerous medicine taken during pregnancy which causes changes in the formation of structures of the embryo. An unhealthy diet, household agents or lifestyle, diabetes and genetic represent reasons slightly associated with microtia, although there is no certainty.

There are several methods through which ears with atresia can be  reconstructed but a a comprehensive assessment and a deep understanding of the needs of a child are required in order to establish the adequate treatment and the right time to perform it. An effective communication between the otologist and the facial plastic surgeon is more than essential because each child and each ear deserve a customized approach. Most of the time, treatment for microtia involves reconstructive surgery to rebuild the outer ear but this is a very delicate procedure that requires experience and expertise. This condition can be corrected due to the advances in plastic surgery  but the child should be at least 6 years old in order to have enough rib cartilage for surgeons to use to reconstruct his ear and  also because at this age, his ear will have approximately his adult size thus doctors can maximize symmetry with  his other ear.

As we already mentioned, one option of correcting aural atresia with microtia is using rib cartilage graft and this procedure works best, in spite of the fact that it is quite difficult and delicate. It involves a lengthy series of operations and patients must return at two months interval for reshaping. The entire procedure takes about six months to a year and it requires a long period of recovery. The good news is that after this surgery the results are incredible and the ears look relatively normal.

Another option in terms of treatment for atresia is the prosthetic ear reconstruction which means that a realistic ear can be attached to the child's skull but unfortunately, it will never feel like being part of the child's body. Although  a porous polythene material has been developed which perfectly mimics the tissue of the ear and it is held into place with strong titanium inserts, this solution is not indicated because the new ear will not develop feeling or response to the body. Aural atresia can also be corrected with ear implant which is a quite simple procedure that involves a minor surgery and provides natural-looking results. It is a good alternative to rib cartilage reconstruction given that the first one involves several risks. Of course, there is always the option of not providing a treatment for microtia, case in which, as the child grows, it will not be just a deformity but rather a threat for a good hearing. Apart from this, it can also cause embarrassment  and suffering throughout the lifetime.