Timing of Atresia Repair (Canalplasty)
The timing for surgical atresia repair is controversial. Some otologists believe that normal hearing should be restored as early as possible, especially in patients with bilateral aural atresia, to help the child absorb speech patterns and to be ready for pre-school, kindergarten and elementary school. In properly selected cases, adequate-size ear canals have been created in children as early as 3 years of age.
However, some otologists prefer to wait until the child is at least 5 years old. They believe there is higher likelihood that new bone growth may narrow the new ear canal in younger patients, which could require an additional surgical procedure.
Although a recent study indicates that early atresia surgery performed before Medpor ear reconstruction compares favorably to surgery performed in older patients, the results should be considered short-term, as more time is needed for long-term follow-up of these cases.
Keep in mind that your child can wear a BAHA (bone-anchored hearing aid) until atresia repair can be performed. An otologist specializing in canalplasty can advise you as to the right timing for atresia repair, based on your child’s audiogram and CT scan results.
Timing also depends on the ear reconstruction technique:
In Rib Graft Surgery, the canal surgery must be performed after completion of the external ear.
In Medpor Surgery, the canal surgery is usually done before the ear reconstruction.
Rib Graft Ear Surgery
Because Rib Graft Ear Surgery uses the child’s rib cartilage to create the ear framework, the series of procedures cannot begin until the child is 6 or 7 years of age. Further, if the child is a very small 6-year-old, the surgeon may need to wait one year longer, so that enough rib cartilage is available. Conversely, in a large 5-year-old, the first procedure may be started at that younger age.
The Brent technique can begin the first stage of ear reconstruction when the child is 6 or 7 years old. There are generally 3 additional surgical procedures over 6 to 18 months, depending on the surgeon. Atresia repair is delayed until all of the stages of surgery are completed.
The Nagata technique requires more rib cartilage than the Brent technique, so repair cannot begin until the child is 10 years old. Although this technique requires only 2 stages, atresia repair is delayed until the child is 11 years of age.
Medpor Ear Surgery
Medpor Ear Surgery uses a porous polyethylene implant to create the ear framework. Because of this, Medpor Ear Reconstruction has been performed successfully on children as young as three years of age. To avoid damage to the reconstructed ear, Medpor surgeons and Otologists, including Dr. Lewin, prefer to perform canalplasty before Medpor ear reconstruction.