Cochlear Implantation Using the Endomeatal Approach in a Child with a Extremely Hypoplastic Mastoid / 대한이비인후과학회지

The classic surgical technique for cochlear implantation was first introduced by House in 1961. This technique includes a mastoidectomy and a posterior tympanotomy, which has been most widely used for cochlear implantation. However, this approach may result in the injury of the chorda tympani nerve or the facial nerve. To avoid the risk of the neural injury, several alternative surgical methods have been developed. The endomeatal approach is one of the several alternative techniques. We present, along with a review of literatures, a case of cochlear implantation using the endomeatal approach performed in a child with an extremely hypoplastic mastoid.

Anatomic Variants on Computed Tomography in Congenital Aural Atresia and Stenosis

OBJECTIVES: To quantitatively analyzing the anatomic variants on temporal computed tomography (CT) in congenital external auditory canal stenosis (EACS), congenital aural atresia (CAA), and normal ear structure. METHODS: Through a retrospective study, we analyzed 142 temporal high-resolution CT studies performed in 71 microtia patients. The following 6 parameters were compared among the three groups: Marx classification, medial canal diameter, vertical facial nerve (VFN) anterior displacement, tegmen mastoideum position, tympanic cavity volume, and malleus-incus joint or malleus-incus complex (MIC) area. RESULTS: The results showed that the microtia distributions in the Marx classification in these three groups were significantly different, as 86% (31 of 35) of ears with major microtia (third-degree dysplasia) had an atresia, and in 54.8% (23 of 42) of the minor microtic (first-degree or second-degree) ears, the bony or cartilaginous part of the external auditory canal was stenotic. Measurement data also showed that the potential medial canal diameter of the atresia group was obviously shorter than that of the stenosis group. The VFN anterior displacement and temporomandibular joint backward-shift together lead to medial canal diameters in ears with atresic canals that is smaller than those with stenotic canals. The tegmen mastoideum position was not significantly different between the three groups. CONCLUSION: The mal-development of the external auditory canal is significantly associated with auricle and middle ear developmental anomalies. Compared with CAA ears, EACS have better development of the auricle, canal, tympanic cavity and MIC and relatively safer surgical operation except for the position of the tegmen mastoideum and the VFN.

A Case of Image-Guided Surgery in Congenital Aural Atresia / 대한이비인후과학회지

The repair of congenital aural atresia remains one of the most challenging otologic procedures because of the scarcity of surgical landmarks, the complexity and the variety of the temporal bone anatomy, and the limited space for reconstruction. The risks of facial nerve injury and profound sensorineural hearing loss following atresia surgery are common concerns. Furthermore, the rarity of the disease makes it difficult to improve surgical learning. Image-guided surgery may aid otologic surgeons in repairing atresia as it allows identifying the exact position of surgical instruments in relation to the specific anatomy. To our knowledge, there have been no published reports on image-guided atresia surgery in Korea. Herein, we report a case of congenital aural atresia, which was repaired using image-guided surgical technique.

Congenital Aural Atresia Associated with Cholesteatoma / 대한이비인후과학회지

Congenital aural atresia (CAA) with variable degrees of microtia are combined with many other otologic or facial anomalies. Among them, cholesteatoma developed behind atretic plate is rarely reported. Since Von Luders had first reported about this condition at 1912, several authors had described CAA associated with cholesteatoma. In their reports, atretic canal cannot prevent the development of cholesteatoma. We reviewed 4 cases of CAA associated with cholesteatoma with medical records and preoperative temporal bone CTs retrospectively. All the cases were unilaterally presented and corrected by canaloplsty. Keratin materials were demonstrated at the medial side of atretic ear canal.

Surgical Management of Congenital Aural Atresia / 대한이비인후과학회지

BACKGROUND: Some authors recommend the surgical correction at early childhood in the selected cases of unilateral atresia as well as bilateral atresia. It has been enabled due to the improvement of imaging technique and it gives cosmetic satisfaction and biaural hearing. OBJECTIVES: The authors laid emphasis on the timing of canaloplasty in unilateral atresia, stage of canaloplasty, and postoperaitve hearing results. MATERIALS AND METHODS: A retrospective review of surgical results of congenital aural atresia from 1983 to 1995 in Seoul National University Hospital was performed. RESULTS: Forty four patients had unilateral atresia and 16 patients had bilateral atresia. Age range at the time of surgery was from 5.3 years to 14.6 years: average age was 8.1 years. Otoplasty was performed in 22 ears by plastic surgeons. It took precedence over canaloplasty in 17 ears. The endaural anterior approach through incision from temporal area to cavum cocha was performed in these cases. Meatal stenosis was the most common postoperative complication, but it has been decreased since the introduction of modification of anterior approach. The surgical attempts to improve hearing could not be performed in 14 ears due to various reasons. The audiologic follow-up period in the remaining 60 ears ranged from 1 year 9 months to 8 year 8 months(mean, 3 year 8 months). By analyzing final air conduction level, it was possible to attain 30 dB or better in 18(30%) of 60 cases and 40 dB or better in 36(60%) of 60 cases. CONCLUSION: The authors recommend the surgical correction at early childhood in unilateral atresia. and the otoplasty should be performed at first and it seems to be better in view of early audiologic rehabilitation that canaloplasty would be performed before the stage of elevation of rib cartilage graft. Meatal stenosis can be reduced by modification of anterior approach.

Surgical Experiences of Congenital Aural Atresia Analysis of 53 Cases / 대한이비인후과학회지

Congenital aural atresia requires reconstructive surgery because of its negative effect against hearing and cosmetic problem. Two surgical methods, anterior and transmastoid approaches, have been designed for the surgery and many surgeons have advocated any techniques depending on their surgical experiences and advantages of each method. We analyzed retrospectively 53 cases of congenital aural atresia operated with the use of one of both approaches, and got the clinical, audiological and surgical results as follows. 1) Postoperative dressing period was shorter in the anterior approach(34.5 days) than in the posterior one(44.2 days). 2) Hearing results are better in the anterior approach. 3) Postoperative complications include granulation tissue formation, drum lateralization, external auditory canal stenosis and temporary facial nerve weakness. And it happened more frequently in the anterior approach than the posterior one. 4) Facial nerve anormaly was noted in 16 cases(30.2%) and cholesteatoma in 5 cases(9.4%).