Microtia and Atresia Program

Hearing Rehabilitation

Children with aural atresia, or ear canal deformities, can have conductive hearing loss which makes it difficult to understand speech or identify where noises are coming from. Hearing loss in one of the ears may lead to speech and language delays, attention and concentration difficulties, and academic issues. Our ultimate goal is to have the child hear well out of both ears. This can be accomplished in one of the following ways:

A bone conduction hearing aid is only needed on the side with hearing loss, but some children may need hearing aids in both ears. The device consists of a microphone and sound processor in one piece. The transmission of sounds to the inner ear happens through vibrations carried through the soft tissue and bones of the skull. The device can be secured next to the affected ear with the use of a head band, an arc around the neck or an adhesive. More information about the different models can be found at the links provided below.

Bone conduction implants use the same concept of transmission of sound to the inner ear through bone vibration. They have two separate parts: one that is implanted directly into the bone next to the ear and an outside hearing aid which connects to it.

BAHA Connect and Oticon Ponto require the placement of a small screw coupled with a metallic button in the bone behind the ear. This external metallic button is visible through the skin, and the external hearing aid attaches to it.

Cochlear Osia's internal receiver and bone vibrator are placed completely under the skin, and the outside hearing aid attracts to it as a magnet. Implantation of these devices requires an outpatient surgery that takes one hour or less.

Because the sound transmission is more direct to the bone, the quality of sound is enhanced. Retention of the outside component is easier with the button or the magnet, avoiding the use of a head band, arc or adhesive. BAHA and Ponto are FDA-approved for use in children older than five years of age. Cochlear Osia is currently FDA-approved for use in children older than 12.

Repairing aural atresia requires surgery to create an ear canal. The soft tissue and bone that are blocking the connection to the middle ear are removed, then the canal is lined with a skin graft.

The choice for aural atresia repair depends on each patient's anatomy. Generally, the closer the underlying anatomy is to normal, the higher the chances of success in creating an ear canal that remains open and provides hearing close to normal. We evaluate the anatomy with a CT scan of the temporal bones and meet with the patient and their family regarding expected benefits and risks. Healing after surgery is slow and may take several months and the new ear canal will require some maintenance. Patients will need to use a custom-made earplug nightly for a period of six months, and receive periodic cleanings at the ENT office one to four times per year to remove flaky skin.

For those patients with microtia, atresia repair is recommended only after the two stages of ear cartilage reconstruction are completed.