Surgical management and its post-operative complications in congenital aural atresia

The post-operative complications and hearing results of surgical intervention for congenital aural atresia were investigated. Seventy-five ears with congenital aural atresia were operated on for hearing loss from 1982 to 1996. Tympanoplasty was performed on 37 ears and canaloplasty on the remaining 38. Hearing improvement rates were 70.3% and 31.6%, respectively. The post-operative complications included stenosis of the created auditory canal (29.3%), deterioration of the improved hearing (21.3%) and infection (12.0%). Reoperations were performed on 6 cases for restoring hearing, 16 for stenosis and 6 for infection. Reoperative findings demonstrated that scar formation in the canal caused the stenosis of the newly formed external canal and that lateralization of the new tympanic membrane and subsequent detachment from the ossicles caused the deterioration of improved hearing. Using cartilage and pedicled skin flap prevented stenosis at the orifice of the newly formed external canal. Maintaining hearing improvement requires creating a wide ear canal using as many pedicle flaps as possible and attaching a new tympanic membrane firmly to the ossicles.