Aural atresia

1 in 10,000 birth
Unilateral atresia is 7 times of bilateral
10 percent syndromes associated

1. aural ATRESIA Dr surbhi Patna medical college

2. 1 in 10,000 birth Unilateral atresia is 7 times of bilateral 10 percent syndromes associated

3. history Recognised over 70years Surgical techiques late 50s NAGER advocated taloring of surgical techniques

4. Group 1- normal or stenotic canal hypoplastic tympanic cleft end aural approach Group 2- fistulous track Complete atresia Bony atresia Opening of antrum

5. Group 3- complete atresia Non pneumatised fenestration

6. Based on severity SCHIKNECHT divided aural atresia into 3 groups fenestration canalplasty type 3 tplasty

7. belluci Seperated middle ear malformations minor-normal canal and tm Stapes fixation,absence of ossicles and oval window Single crus major-aural atresia,absent canal and tm Some degree of malformation

8. JAHRSDOERFER Ant approach in 1978 This is STANDARD APPROACH

9. Atretic bone drilled away Ossicles freed Temporalis fascia used as onlay graft Split thickness skin graft meatoplasty

10. With few modification this technique is used Gives improved result Without opening mastoid Fewer complications

11. Surgery for u/l vs b/l Unilateral-sorting of high risk on hrct indicating low likelyhood of success Defined as post op srt less than equal to 30dBhl Criteria lenient in b/l cases Marginal candidate operated atleast one ear

12. Avoided in- No aeration Facial nerve at risk Low lying tegmen

13. Grading system 7-8 out of 10

14. Other criteria Audiometry imaging

15. Other options For b/l cases baha for over 6yrs For those undergone surgery-conventional behind the ear or in the ear

16. Options for microtia repair Porous polyethylene Autologus rib graft Silicone prosthesis Porus polyethylene implant ie medpor used in grade 3 microtia repair

17. Small suction drains 3 months later-lobule 3 rd stage-post auricular sulcus 4 th stage-atresia repair and tragus

18. Advantage of rib graft microtia-no concern for regection

19. Who should be operated first Recently undertaken- atresia before medpor Decreases risk of exposure or extrusion A recent report-result of aresia surgery before medpor comparable to atresia surgery after rib graft

20. timing b/l atresia BAHA is used soon after birth No amplification required in u/l For rib graft delayed upto 6-7yrs For grade 2 , 3 microtia can be done at 5 Medpor at 3yrs

21. Surgical techniques

22. Bone is removed 360degree around Ossicular chain mobility Any malformation Fascia grafting Bone in the periphery is drilled For fascia which is placed in ossicular mass Skin graft harvested

23. Has thicker and thinner border Thinner kept at level of ear drum Thicker sutured at meatus Skin graft is notched at medial end

24. For successful hearing-thin TM AND SKIN GRAFT Silastic is placed over new tm meatoplasty

25. Post op care Discharged on oral antibiotics Seen after 1 week where suture and packing removed Second visit-1 month later Canal is debrided Audiogram no restriction after 1 month

26. complications Meatal canal stenosis Snhl Facial nerve injury

27. conclusion While Technically challenging, surgery can be successful With pre op careful patient selection Meticulous surgery Restoring of hearing is one of the most rewarding.

28. Thank you