Surgical approaches to congenital atresia of the external auditory canal

During the past 4 years, 22 patients with congenital atresia of the external auditory canal underwent 24 initial operations by either an anterior or transmastoid approach. No attempt at randomization was made, but the two groups were similar in number and pathology (in 14 cases approach was anterior and in 10 cases approach was transmastoid). Followup ranged from 6 months to 4 years. Hearing results were similar in the two groups (71% with air-bone gap less than 30 dB). There were no instances of facial nerve injury or sensorineural hearing loss. Facial nerve monitoring was used. Complications of stenosis and drainage were more common with the transmastoid approach. In both groups, hearing results were accomplished with the patients' intact ossicles or prosthetic reconstructions. Meticulous soft-tissue technique, with split-thickness grafts covering all exposed bone, is the key to preventing stenosis. For the three cases of patients with thick, acellular atresia plates, a different approach was developed. Maintaining proper orientation during the medial dissection is more difficult in these cases. By opening the antrum primarily and identifying the lateral canal, ossicles, and facial nerve, an ear canal can then be created anteriorly with these landmarks in view. An intact canal wall-like procedure is carried out. Although hearing results are similar, the anterior approach, because of fewer postoperative complications, is now our procedure of choice. Proper orientation and soft-tissue technique are the keys to successful correction of the congenitally atretic ear canal.