Atresia repair before microtia reconstruction: comparison of early with standard surgical timing.

OBJECTIVE To compare short-term results of atresia repair when performed before versus after microtia reconstruction. STUDY DESIGN Retrospective case review. SETTING Tertiary otologic referral center. PATIENTS Congenital aural atresia with or without microtia: 70 cases over 24 months. INTERVENTION Atresia repair before Medpor microtia reconstruction (ARM) versus atresia repair after microtia reconstruction with autogenous rib (ARR) versus atresia reconstruction without microtia (AR). MAIN OUTCOME MEASURES Surgical outcomes, short-term postoperative audiometric results (at least 4 months after surgery but within the first postoperative year), complications. RESULTS Data from the 3 groups are as follows: ARM, 31 patients with median age 4.2 years (range, 2.5-9.3 yr); ARR, 28 patients with median age 12 years (range, 6.9-61); and AR, 11 patients with median age 5.9 years (range, 5.5-59 yr). Preoperative computed tomographic grading using the Jahrsdoerfer scale demonstrated an average score of 7.4 (range, 6-9) for the ARM group, 7.7 (range, 6-9) for the ARR group, and 8.5 (range, 8-9) for the AR group. For patients scoring 8 to 10 on the Jahrsdoerfer scale, postoperative pure-tone average 2 for each group were as follows: ARM, 28 dB hearing loss (HL); ARR, 32 dB HL; and AR, 29 dB HL. For patients scoring 7 or less, postoperative pure-tone average 2 were as follows: ARM, 42 dB HL; and ARR, 41 dB HL (AR, no patients). Surgical complications of infection and facial nerve injury were not seen in any group. Meatal stenosis was higher in the ARR group. One patient in the ARM group suffered a high-frequency sensorineural HL. No patient receiving Medpor microtia reconstruction suffered a complication due to the presence of the ear canal before microtia reconstruction. CONCLUSION Early results of ARM compare favorably with results achieved with atresia repair after microtia reconstruction with autogenous rib cartilage and with atresia repair without microtia repair. Hearing outcome and complications in this study are also comparable with previously reported expert results. Because restoration of binaural hearing has been shown to be advantageous for auditory development and function, timing of atresia repair can be considered before microtia reconstruction on an individual case basis, provided preoperative computed tomographic evaluation shows an adequate chance of surgical success.