Surgery of congenital aural atresia.

The treatment of congenital aural atresia has changed in recent years. Better imaging capabilities, the development of tympanoplasty techniques, modification of mastoid dissection, and facial nerve monitoring have resulted in greater patient benefit with less patient risk. Success rates continue to be high, and the incidence of complications has decreased. A series of cases was reported in 1985, and now the authors review 92 congenital aural atresiaplasties performed over the following 9 years. Closure of the air-bone gap to less than 30 dB was achieved in 60% of primary surgeries and 54% of revisions. The most common complications were external auditory canal stenosis and lateralization of the tympanic membrane. External auditory canal stenosis due to bony regrowth was seen in 12% of primary cases and 11.5% of revisions; soft tissue stenosis was seen in 10% of primaries and 4% of revisions. Tympanic membrane lateralization was seen in 9% of primary surgeries and in 15% of revisions. Carbon dioxide and argon lasers (HGM Medical Laboratories, Salt Lake City, Utah) and Merocel stenting wicks with split-thickness skin grafting were used to try to improve long-term hearing outcome and decrease postoperative external auditory canal stenosis. With meticulous surgical technique by an experienced otologic surgeon and appropriately selected patients, this problem can be managed effectively.