Auricular reconstruction using Medpor combined with different hearing rehabilitation approaches for microtia

Abstract

Background

Congenital microtia-atresia affects patients in two specific ways: severe conductive hearing loss and difficulty in integrating into social environments due to auricle malformation.

Aims/objectives

To investigate the safety and efficacy of single-stage auricular reconstruction and hearing rehabilitation in children with microtia and external auditory canal atresia.

Material and methods

From January 2016 to December 2019, we included 32 patients with microtia and external canal atresia who received auricle reconstruction with high-density polyethylene (Medpor) framework and three different hearing rehabilitation approaches at the Ninth People’s Hospital affiliated to Shanghai Jiao Tong University School of Medicine. Twenty patients underwent the traditional external auditory canal and middle ear repair (EACR), eight patients were implanted with Bonebridge (BB) devices, and four patients were implanted with bone-anchored hearing aid (BAHA) in one stage. Postoperative changes in auricle morphology and hearing and speech recognition and occurrence of complications were evaluated.

Results

After 6–24 months of follow-up, the auricle shape recovered well in all three groups, and the average score of 14 fine structures in the auricle was 9.43 (EACR), 10.67 (BB), and 9.75 (BAHA) points. The average score of auricle symmetry was 6.83 (EACR), 6.00 (BB), and 6.44 (BAHA) points. No significant differences in auricle shape were observed among the three groups (p > .05). After surgery, the average hearing improvement in the BB group was 43.33 dB, and the average speech recognition threshold declined to 42.28 dB. In the BAHA group, the average hearing improvement was 35 dB, and the average speech recognition threshold declined to 33.5 dB, similar to that of the BB group. However, in the EACR group, the average hearing improvement was only 4.13 dB, and the average speech recognition threshold declined to 11.36 dB. No vertigo, tinnitus, cerebrospinal fluid leakage, facial nerve paralysis, osseointegration failure, and other complications occurred in all the patients. In the EACR group, auricle stent fracture, ear canal restenosis, and canal atresia occurred in one patient each. In the BAHA group, two patients developed local ear infections.

Conclusions and significance

The procedure of single-stage auricular reconstruction and hearing rehabilitation for microtia is feasible and effective. The appropriate method of hearing reconstruction should be determined by evaluating the development of the inner and middle ear of the patients. For those patients with poor development of the mastoid and ossicular chain, hearing aid devices are recommended to achieve a stable and significant hearing effect.

Chinese abstract

背景：先天性小耳-闭锁症以两种特定的方式影响患者：严重的传导性听力损失和由于耳廓畸形而难以融入社会环境。

目的：研究小耳症和外耳道闭锁患儿单阶段耳廓重建和听力康复的安全性和有效性。

材料和方法：2016年1月至2019年12月, 我们收治了32例小口气和外管闭锁的患者。他们在上海交通大学医学院的附属第九人民医院接受了用高密度聚乙烯（Medpor）框架进行的耳廓重建和三种不同听力康复方法。 20例患者接受了传统的外耳道和中耳修复（EACR）, 8例患者植入了骨桥（BB）装置, 而4例患者植入了骨锚式助听器（BAHA）。评估了术后耳廓形态的变化、听觉和言语识别以及并发症的发生情况。

结果：随访6-24个月后, 三组耳廓均恢复良好, 耳廓的14个精细结构的平均得分分别为9.43（EACR）、10.67（BB）和9.75（BAHA）。耳廓对称性的平均评分为6.83（EACR）、6.00（BB）和6.44（BAHA）。三组之间未观察到耳廓形状的显著差异（p> .05）。手术后, BB组的平均听力改善为43.33 dB, 平均语音识别阈值降至42.28 dB。 BAHA组的平均听力改善为35 dB, 平均语音识别阈值降至33.5 dB, 与BB组相似。但是, 在EACR组中, 平均听力改善仅为4.13 dB, 平均语音识别阈值下降至11.36 dB。所有患者均无眩晕、耳鸣、脑脊液漏、面神经麻痹、骨整合失败等并发症。在EACR组中, 每例患者都会发生以下其中一种：耳廓支架断裂、耳道再狭窄和管腔闭锁。在BAHA组中, 两名患者发生了局部耳部感染。

结论和意义：单阶段耳廓重建和听力康复对小耳症是可行和有效的。应通过评估患者内耳和中耳的发育情况来确定适当的听力重建方法。对于乳突和听骨链发育不良的患者, 建议使用助听器以达到稳定和显著的听力效果。

Keywords:

• Congenital microtia
• hearing reconstruction
• bone-anchored hearing aid (BAHA)
• Bonebridge (BB)
• external auditory canal and middle ear repair (EACR)

Acknowledgements

We thank International Science Editing (http://www.internationalscienceediting.com) for editing this manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by grant to Clinical Research Plan of SHDC [16CR3119B] and Clinical Research Program of 9th people's hospital, Shanghai Jiao Tong University School of Medicine [JYLJ028].