Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Institute of Otology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Shanghai Key Laboratory for Transitional Medicine of Nose and Ear Diseases, Shanghai, China.
Acta Otolaryngol. 2021 Jun;141(6):572-578. doi: 10.1080/00016489.2021.1900601. Epub 2021 Apr 6.
Congenital microtia-atresia affects patients in two specific ways: severe conductive hearing loss and difficulty in integrating into social environments due to auricle malformation.
AIMS/OBJECTIVES: To investigate the safety and efficacy of single-stage auricular reconstruction and hearing rehabilitation in children with microtia and external auditory canal atresia.
From January 2016 to December 2019, we included 32 patients with microtia and external canal atresia who received auricle reconstruction with high-density polyethylene (Medpor) framework and three different hearing rehabilitation approaches at the Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine. Twenty patients underwent the traditional external auditory canal and middle ear repair (EACR), eight patients were implanted with Bonebridge (BB) devices, and four patients were implanted with bone-anchored hearing aid (BAHA) in one stage. Postoperative changes in auricle morphology and hearing and speech recognition and occurrence of complications were evaluated.
After 6-24 months of follow-up, the auricle shape recovered well in all three groups, and the average score of 14 fine structures in the auricle was 9.43 (EACR), 10.67 (BB), and 9.75 (BAHA) points. The average score of auricle symmetry was 6.83 (EACR), 6.00 (BB), and 6.44 (BAHA) points. No significant differences in auricle shape were observed among the three groups ( > .05). After surgery, the average hearing improvement in the BB group was 43.33 dB, and the average speech recognition threshold declined to 42.28 dB. In the BAHA group, the average hearing improvement was 35 dB, and the average speech recognition threshold declined to 33.5 dB, similar to that of the BB group. However, in the EACR group, the average hearing improvement was only 4.13 dB, and the average speech recognition threshold declined to 11.36 dB. No vertigo, tinnitus, cerebrospinal fluid leakage, facial nerve paralysis, osseointegration failure, and other complications occurred in all the patients. In the EACR group, auricle stent fracture, ear canal restenosis, and canal atresia occurred in one patient each. In the BAHA group, two patients developed local ear infections.
The procedure of single-stage auricular reconstruction and hearing rehabilitation for microtia is feasible and effective. The appropriate method of hearing reconstruction should be determined by evaluating the development of the inner and middle ear of the patients. For those patients with poor development of the mastoid and ossicular chain, hearing aid devices are recommended to achieve a stable and significant hearing effect.
先天性小耳畸形会对患者造成两方面的严重影响：严重的传导性听力损失和由于耳廓畸形而导致难以融入社会环境。
目的/目标：研究一期耳廓重建和听力康复治疗小耳畸形伴外耳道闭锁患儿的安全性和疗效。
自 2016 年 1 月至 2019 年 12 月，上海交通大学医学院附属第九人民医院共纳入 32 例小耳畸形伴外耳道闭锁患者，采用高密度聚乙烯（Medpor）支架进行耳廓重建，并采用三种不同的听力康复方法。20 例患者行传统外耳道中耳修复术（EACR），8 例患者植入 Bonebridge（BB）设备，4 例患者一期植入骨锚式助听器（BAHA）。评估术后耳廓形态和听力及言语识别的变化以及并发症的发生情况。
三组患者术后随访 6-24 个月，耳廓形态恢复良好，耳廓 14 个精细结构平均评分为 EACR 组 9.43 分、BB 组 10.67 分、BAHA 组 9.75 分；耳廓对称性平均评分为 EACR 组 6.83 分、BB 组 6.00 分、BAHA 组 6.44 分。三组患者耳廓形态评分差异无统计学意义（ > .05）。术后，BB 组平均听力提高 43.33dB，言语识别阈平均下降至 42.28dB；BAHA 组平均听力提高 35dB，言语识别阈平均下降至 33.5dB，与 BB 组相似；而 EACR 组平均听力提高仅 4.13dB，言语识别阈平均下降至 11.36dB。所有患者均未发生眩晕、耳鸣、脑脊液漏、面神经瘫痪、骨整合失败等并发症。EACR 组中 1 例患者发生耳廓支架断裂，1 例患者发生外耳道再狭窄，1 例患者发生外耳道闭锁；BAHA 组中 2 例患者发生局部耳感染。
一期耳廓重建和听力康复治疗小耳畸形是可行且有效的。应根据患者中耳内耳发育情况，确定合适的听力重建方法。对于乳突和听小骨发育不良的患者，建议使用助听设备，以获得稳定且显著的听力效果。
