Atresia Repair is the surgical procedure to create a normal sized ear canal.
Atresia Repair attempts to give natural hearing to the ear by opening the ear canal, freeing the ear bones (ossicles), constructing an ear drum (tympanic membrane), lining the new canal with a skin graft and creating an opening (meatus).
Atresia Repair requires a comprehensive surgical plan that should also take into consideration the type of ear reconstruction surgery (if chosen). Generally, the type of outer ear reconstruction chosen will determine the timing of Atresia Repair. If you choose to have a Rib Graft ear reconstruction, then Atresia Repair is performed after the reconstructive surgery. However, if you chhose to have a Medpor ear reconstruction, Atresia Repair should be performed prior to this type of ear reconstruction.
Atresia Repair is a technically difficult procedure requiring very specialised equipment, and should only be attempted by suitably qualified surgeons with significant experience.
Not all patients are candidates for Atresia Repair. Candidacy is determined by a CT Scan and a hearing test (audiogram).
A CT Scan (Computer Tomographic Scan) is used to see inside the bone and inside the structures of the middle ear. A high resolution axial and coronial CT Scan of the temporal bone is required to determine the internal anatomy of the ear. Atresia Repair candidacy is scored using a rating scale from 1-10 (the higher the rating, the better the chance of success) by the surgeon after viewing the CT scan.
Click here to view the Jahrsdoerfer 10 Point Grading Scale used to grade the ear anatomy.
Ratings of 8, 9 or 10 are the best candidates for surgery. Atresia Repair is possible where ratings of 6 or 7 are given. Atresia Repair is generally not recommended for patients with a rating under 6 as the chance of success is lower and there are better options available to provide sound to that ear.
The recommended age for a CT Scan is 2.5 years. Scans should not be done in children under the age of 2.5 solely for the purpose of Atresia Repair assessment unless there is another medical need requiring a scan, as CT scans done earlier may need to be repaeted due to mastoid growth. Atresia Repair can not be done before the age of 3 so 2.5 years is the earliest that a decision can be made on whether this surgery is a possibility.
An audiogram determines if a child has normally functioning inner ear. A comprehensive audiogram which includes bone conduction thresholds is necessary to determine if a patient is a good Atresia Repair candidate.
Atresia Repair is a very difficult and challenging surgery. Surgeons must not only be qualified to perform this procedure, but to get consistenly good results, they must have a significant amount of experience and perform this surgery regularly.
Monitoring of the facilal nerve is essential to avoid any injury to the facial nerve.
Atresia Repair surgery involves –
1. Creating an ear canal by removing the bone between the surface and middle ear space.
2. The middle ear bones (ossicles) then need to be freed, repaired or replaced.
3. An ear drum (tympanic membrane) is then created using the patient’s tissue.
4. The new canal is then lined with a skin graft.
5. The external opening is created (meatus).
6. The canal is then filled with layers of sponge packing soaked in atibiotic drops to faciltate healing.
Combined Atresia Repair & Medpor Procedure
In January 2008, two doctors from California, USA (Dr Joseph Roberson & Dr John Reinisch) combined to perform the world’s first procedure where Atresia Repair & Medpor ear reconstruction were combined into a single procedure. Dr Roberson and Dr Reinsich had previously collaborated in the care of hundreds of atresia and microtia cases, however this was the first time the two surgeries had been combined into the one surgical procedure.
This new advance offers patients the advantage of fewer surgical procedures and less travel expenses when treating microtia & atresia.
For more information on this combined procedure, refer to http://www.atresiarepair.com/news-atresia-repair-medpor-combined-surgical-procedure.htm