[Microsurgery of large middle ear abnormalities. Technical surgical considerations]

Area of Science:

• Otolaryngology
• Surgical Innovation
• Auditory Reconstruction

Context:

• Congenital aural atresia presents significant hearing loss challenges.
• Surgical intervention aims to restore auditory function and ear canal patency.
• Previous techniques faced limitations in preventing stenosis and infection.

Purpose:

• To assess the efficacy of a direct surgical approach for congenital aural atresia.
• To evaluate postoperative hearing outcomes and complication rates.
• To determine the correlation between preoperative grading and surgical results.

Summary:

• A cohort of 70 ears with congenital aural atresia underwent surgery using a direct approach with a laterally positioned neo-tympanic membrane and ossicular prosthesis.
• The mean postoperative hearing gain was 17.8 dB, with a mean air-bone gap of 31.0 dB.
• Complications included infection or stenosis in 22% of ears, and 34% required revision surgery. Jahrsdoerfer's grading system correlated with outcomes in 64% of cases.

Impact:

• This surgical technique offers a potential for hearing improvement in congenital aural atresia patients.
• Understanding complication rates and revision needs informs surgical planning and patient counseling.
• The study highlights the importance of surgical technique in minimizing stenosis and infection, and validates a grading system's utility.