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

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.

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.

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.

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.