We use a rigorous preoperative evaluation to determine which of our pediatric patients are appropriate candidates for surgery and offer unilateral atresiaplasty to good candidates based upon this evaluation (regardless of the status of the contralateral ear). As in all realms of surgery, the success of aural atresia surgery rests upon the experience of the surgeon in choosing the appropriate patient and knowing how to avoid the potential complications that can occur. The advent of HRCT has allowed for the development of strict criteria for choosing potential surgical candidates. By following these criteria, a reasonable estimation of the probability of surgical success in terms of restoration of hearing can be surmised. The facial nerve monitor is helpful and should be used in all cases, but is no substitute for a detailed knowledge of facial nerve anatomy. Certain conditions, such as occult cholesteatoma, will dictate management and produce a need for early surgical intervention. In other cases, management must be individualized, tailored to the patients and their families' needs and desires, and then carefully planned and orchestrated. Experience has suggested that patients with isolated atresia are more likely to be suitable candidates than are patients with concomitant microtia or other auricular anomalies.2 For patients who are not suitable candidates, other options such as bone anchored hearing aids should be considered.


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2. Jahrsdoerfer RA, Yearkley JW, Aguilar EA, et al. Grading system for the selection of patients with congenital aural atresia. Am J Otol. 1982;13:6-12

3. Jahrsdoerfer RA. Congenital atresia of the ear. Laryngoscope 1978;88:1

4. De la Cruz A, Linthicum FH, Jr, Luxford WM. Congenital atresia of the external auditory canal. Laryngoscope 1985; 95:421-427

5. Jahrsdoerfer RA, Lambert PR. Facial nerve surgery in congenital aural atresia surgery. Am J Otol 1998;19:283-287

6. Bess FH. The unilaterally hearing-impaired child: a final comment. Ear Hearing 1986;7:52-54

7. Altmann F. Congenital atresia of the ear in man and animals. Ann Otol Rhinol Laryngol 1955;64:824-858

8. Jahrsdoerfer RA. Surgical Correction of Congenital Malformations of the Sound Conducting Mechanism. In: Glasscock ME, Shanbaugh GE Jr, eds. Surgery of the Ear. 4th Ed. Philadelphia: WB Saunders; 1990:321-334

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