Aural Atresia Surgery
For children born with aural atresia, a surgical treatment offers the possibility of normal or near-normal hearing. But it’s not the right choice for every child.
At UVA Health Children’s, we’ll talk to your child and your family about the benefits, risks, and whether or not we think they’ll be able to benefit from the procedure. If your child isn’t a candidate, or you decide the surgical repair isn’t the right fit for you, we’ll also talk through other options for your child.
Making Sure Your Child Is a Candidate for Atresia Surgery
We want to help every child enjoy all of the sensory pleasures of life. But for some children, atresia surgery will not help and puts a child through an unnecessary surgery. Careful evaluation of hearing testing and a CT scan of the ear bone helps us determine if your child is a candidate for atresia surgery. We want to make sure your child is likely to be helped before scheduling surgery.
To be a good candidate, a child must:
Have conductive hearing loss, not sensorineural hearing loss
That means that their inner ear is intact. For children with sensorineural hearing loss (SNHL) a hearing aid or even a cochlear implant (if the hearing loss is severe or profound) is a better solution. Comprehensive hearing testing performed by our skilled pediatric audiologists can help us determine the type (conductive or sensorineural) and degree of hearing loss in your child.
Be the right age
We recommend waiting for surgery until a child is 6-7 years old.
Have favorable anatomy
A CT scan of the ear bones can be performed to determine if your child is a candidate for atresia surgery based on the anatomy of the middle and inner ear. It is important to know that not all children with aural atresia are candidates for atresia surgery. But all children with aural atresia are candidates for a bone-conducting hearing device. Your ENT surgeon will help guide you through the options to make the best decision for your child.
Be cooperative
Children must be able to sit in the exam chair and be cooperative with the care after surgery – cleaning the ear, removal of packing.
What Happens in Atresia Surgery?
Aural atresia surgery involves rebuilding the ear canal and middle ear. That means creating the parts of the middle and outer ear canal. To do this, your surgeon will use a connective tissue graft to build the eardrum and a skin graft from your child’s upper arm or upper leg to line the new ear canal.
This procedure takes a few hours, during which your child will be under general anesthesia. That means that your child will spend the night recovering in our children’s hospital.
Follow-Up Care for Atresia Surgery
One week after surgery, your child will come back to the office to have the delicate packing removed. Usually, afterwards, children notice that their hearing is starting to improve.
4-5 weeks after surgery, we’ll clean the new ear canal and get our first after-surgery hearing test. This test helps us understand how much hearing a child has regained. For some, it’s total. Others only report some improvement.
Revision Surgery
Between 10-15% of children who undergo aural atresia surgery will need a revision. That could be due to:
- Narrowing of the opening of the ear canal
- New bone growth is causing a decline in hearing
- Chronic moisture or drainage from the canal
- Hearing loss/decline in hearing
For most children, though, the results will be lifelong.
Frequently Asked Questions: Aural Atresia Surgery
It’s good to have questions when your child is getting ready for surgery. We encourage you to talk through your concerns with your provider, who can offer advice that’s tailored to your family’s circumstances.
These are some of the questions people frequently have that we can answer in advance.
When Can My Child Go Back to Normal Activities?
For about a week, it’s good to keep your child away from people who may have the cold or the flu. Upper respiratory infections can increase the chances of getting an ear infection.
After a week, your child can go back to school, but no PE or heavy physical activity.
Have your child avoid activities that could result in a fall or head injury, like contact sports or riding a bike, until your doctor says it’s okay. Usually, this will be after the 4-5 weeks postoperative visit.
What If My Child’s Hearing Doesn’t Improve?
Rarely does a child not have improvement following surgery. If this happens, please alert your doctor. We can talk you through the next steps, including advanced hearing aids, which will work with your child’s new ear canal.
My Child Only Has Atresia in One Ear. Should We Still Get the Surgery?
This is a decision for your child and your family to make. Not being able to hear out of one ear can make it hard to hear when there is background noise, or locate the source of a sound. In parties, restaurants, noisy classrooms, or while driving. Most people agree this is a useful skill. But it must be weighed against the risks of surgery.
Is Surgery Risky?
General anesthesia always carries some risk. But we have pediatric anesthesiologists who are trained to provide support to children.
Other risks include:
- Infection
- Hearing loss/No improvement in hearing
- Eardrum perforation
- Dizziness/Imbalance
- Taste changes
- Facial nerve weakness
- Narrowing of the canal, necessitating additional surgery
We would love to be able to give you the percentage chance for each of these, but those are patient-dependent. Once your surgeon sees your child’s CT scan, they’ll be able to talk through what they see as being your child’s risk. Most of these risks are rare. Your child’s candidacy for atresia surgery is dependent on the hearing test and anatomy as seen on the CT scan.