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

From 1988 to 1994, 75 patients with congenital aural atresias were operated on at the University ENT Department, Würzburg. Sixty-two patients (70 ears) could be followed up in their postoperative outcomes. The surgical approach used in all patients was a direct one through the atresia plate. To avoid infection and stenosis of the new meatus, a neo-tympanic membrane was built up in a far lateral position. This was possible by using a long ossicular prosthesis. The mean postoperative gain was 17.8 dB and the mean postoperative airbone gap was 31.0 dB. Twenty-two percent of the ears had postoperative infections or stenosis of the ear canal. Thirty-four percent of the ears had to undergo revision surgery. Jahrsdoerfer's grading system for congenital aural atresia showed good correlation in 64% of the ears when comparing preoperative status and postoperative outcome.