Congenital aural atresia. A new subclassification and surgical management.

The four surgical methods currently in use to improve hearing in patients with congenital aural atresia are (i) fenestration of the lateral semicircular canal, (ii) type III tympanoplasty, (iii) canal plasty and (iv) canal plasty with homograft tympanoplasty. Because the surgery is difficult and the functional results are not always good, the criteria for surgery are also influenced as to whether the anomaly is unilateral or bilateral and what the cosmetic goal is. When aural rehabilitation and cosmetic surgery are contemplated, co-ordinated planning by the otological and plastic surgeon is necessary to attain the best end result. Of the 36 ears with a type II anomaly operated on at the University of Nijmegen between 1972 and 1983 by the technique of canal plasty, the average hearing gain was 20 db, with 18 patients having a 35 dB or better air conduction threshold. The functional results seem to be related to the degree of malformation involved. Classification of the malformations has proved to be useful in discussing the surgical results.