Narrowing of the ear canal is called “atresia”. It can range from a slight narrowing to complete absence of the external ear canal. There may also be changes in the shape of the pinna (“microtia”) and malformations of the middle ear structures, including missing hearing bones, with occasional abnormalities of the inner ear. Aural atresia occurs in 1 in 10,000 to 20,000 live births, with atresia of only one side being three times more common than atresia of both sides.

Atresia of the external ear requires evaluation by a multidisciplinary team including an otolaryngologist, audiologist and radiologist. An absent ear canal leads to a conductive hearing loss even if the inner ear and nerve function is normal. In addition to hearing loss, a narrow canal can predispose to infections or, in more severe cases, to cysts of the middle ear called cholesteatomas.

The external ear canal can be surgically reconstructed to improve hearing. Or, bone conduction hearing aids may be an option. Both of these solutions are useful for hearing only if the middle ear and inner ear hearing structures are intact or, in the case of the middle ear, can also be reconstructed. At House Clinic, surgery is recommended for patients with atresia of one or both sides at 5 to 6 years of age. Surgery includes auricular reconstruction and atresiaplasty. The repair of the external part of the ear (microtia repair) should be done first. In order to maintain the good initial surgical results and to avoid late complications, such as narrowing of the ear canal, the patient needs diligent postoperative office care. At House Clinic, we also offer to patients who have severe malformations, and for that reason are poor surgical candidates, a special type of hearing aid called BAHA (bone anchored hearing aid).