The Auricular Reconstruction And Hearing Rehabilitation Of Congenital Microtia At One-stage

Background: Congenital microtia is a kind of auricular deformity because of the developing abnormally of first and second gill arch and the first branchial ditch in embryos. Most cases accompanied with atresia of external auditory canal and hearing loss while some accompanied with deformity of maxillofacial region. In past, the most interventions only focus on the morphological reconstruction, but ignoring the hearing rehabilitation, or alternative, or staging operation. This study, on the basis of previous studies, engaged in the one-stage operation in congenital microtia including auricular reconstruction and hearing rehabilitation.Objective: To explore the feasibility and the clinical effects of the auricular reconstruction and hearing rehabilitation of congenital microtia at one-stage.Methods: We collected 38 patients diagnosed as congenital microtia associated with the external auditory canal atresia from Shanghai Ninth People’s Hospital Affiliated Shanghai Jiao Tong University School of Medicine since January 2011. They were randomly divided into experimental group and control group(every group included 20 ears with microtia in 19 patients). All patients had signed informed consent before the surgery. The experimental group underwent the total auricular reconstruction with Medpor framework implantation and the surgery of hearing rehabilitation. Meanwhile the Experimental group were divided into two subgroups based on the thin-section CT scans of the temporal bone and Jahrsdoerfer grading system. Those whose Jahrsdoefer grade equal to or more than 6 were selected into the subgroup A which had received canaloplasty and tympanoplasty while those whose Jahrsdoefer grade are less than 5 points were selected into the subgroup B which had received BAHA implantation for hearing rehabilitation. The control group only received total auricular reconstruction with Medpor framework implantation.The clinical effects assessments were performed, at 3,6,12 and 24 Months postoperatively, including the success rate of the surgery, the symmetry of auricle, the detailed structures of auricle, the satisfaction of patients and the condition of hearing improvement.Results: The total 40 reconstructive ears were successful. One patient(experimental group) had undergone local exposed Medpor framework due to a trauma at 8 months after surgery, who was performed another local flap surgery and did not undergo re-exposed framework followed up for 6 months. Two cases of canaloplasty subgroups(n=18) occurred restenosis and atresia, accounting for 11.11%. In none of the patients occurred facial paralysis and other complications. The auricle symmetry indicators assessments did not show a significant difference between the experimental group and the control group, both getting more than 5 grade. The detailed structure assessments were not statistical significant at the grades equal to and more than 10, but when the grades more than 12 points there were significant difference between the experimental group and the control group(P=0.025). Patient’s satisfaction analysis showed that the rate of total satisfaction both accounted for 95% in two groups, while the rate of satisfaction(extreme satisfaction and satisfaction) accounted for 85% and 60% respectively, experimental group being higher than that of the control group although there were no statistical significant because of small sample(p=0.077). 18 patients of experimental group A obtained hearing improvement after hearing rehabilitation surgery. In those the efficient rate accounted for 90% and the average AC(air conduction) increased 22.3d B.Conclusion: The auricular reconstruction and hearing rehabilitation of congenital microtia at one-stage was feasible and safe in clinical practice. It could not only getting better hearing rehabilitation when undergoing auricular reconstruction surgery,...