Candidacy for surgical reconstruction is best determined between five and seven years of age. By that time, the majority of mastoid growth has occurred, and the microtia repair, if needed, is well underway. In the vast majority of patients, reconstruction of the aural atresia is considered for the purpose of improving hearing. In the fewer children who are at high risk for the development of acquired canal cholesteatoma, surgical reconstruction of the canal is beneficial even if improvement in hearing is not a realistic goal. High-resolution computed tomography of the temporal bone is necessary to determine whether improved hearing would be a realistic outcome of atresia surgery.
All atretic ears have abnormal middle-ear anatomy to a greater or lesser degree.
The degree of abnormality of these structures as determined by computed tomography typically excludes half of atretic ears from reconstructive surgery. The skin is closed over the magnet. Sound is transmitted directly to the temporal bone and inner ear via magnetic coupling of the external and internal portions of this device. A child with right microtia and aural atresia. She has a conductive loss secondary to congenital ossicular fixation in her normal-appearing ear.