Unilateral aural atresia in childhood: case selection and rehabilitation.

The classic management of children and adolescents with unilateral aural atresia, with or without microtia, is to assess audition, to exclude cholesteatoma formation both clinically and radiologically, to offer amplification in unilateral cases, and to consider surgical repair in bilateral cases. However, evidence indicates that children with unilateral hearing loss from any cause are at risk for delayed language development, attention deficit, and poor school performance. Favourable factors for reconstruction of hearing include a normal bone line with good word discrimination, a normal or recognizable auricle (microtia grade I or II), radiographic evidence of an air-containing middle ear cleft with an estimated volume close to the normal side, the presence of ossicles, the facial nerve running in its expected (though abnormal) course, and the absence of any syndrome affecting mid-face development or of any associated mandibular malformation. In unilateral pediatric cases, only minor auricular malformations (grades I and II) were considered for otologic repair. If microtia was more severe (grade III and IV), or if the child had any other mid-face or mandibular problem, otologic repair was delayed until these were corrected. In many cases, otologic repair was deferred throughout childhood. A summary of selection criteria, case examples, and outcomes of surgery will be presented. Carefully selected unilateral cases may be reconstructed during childhood. Unfavourable cases should be amplified or observed.