Microtia Treatment and Testing
What Should We DoIf We Have A Child With Microtia?
The first priority during infancy is to ensure that thereis sufficient hearing for language development. An accurate hearingtest (audiogram) will be recommended as early as possible to establishthe need for a hearing aid. There are two types of hearing tests,BAER testing (brain stem auditory evoked response testing) and behavioraltesting. BAER testing is performed before the child is old enoughto cooperate with behavioral testing. Reliable behavioral testingis the procedure of choice when the child is mature enough to cooperate.If the deformity is unilateral (occurs on one side only) and theopposite ear functions normally, a hearing aid will not be necessary.This is the case in the majority of patients.
What if SufficientHearing Does Not Exist?
If the deformity involves both ears, a hearing aid will be recommendedimmediately. Amplification needs (hearing aids) should ideally bemet within the first few months of life. Surgery to restore hearingmay not be recommended for several years.
How Often ShouldHearing and Language be Monitored?
Regular monitoring of hearing and language is critical andshould be performed at least as often as outlined in the attachedprotocol.
Do Patients withMiocrotia/Aural Atresia Require Any Other Tests?
We recommend a high resolution, three-dimensional CT scanof the temporal bones at approximately age five in order to ruleout a benign tumor of the middle ear known as a cholesteatoma whichis more common in aural atresia patients. In addition, the CT scanwill indicate if the middle ear structures are adequate for surgicalreconstruction of the external auditory canal. While all patientsare candidates for reconstruction of the external ear, not all patientsare candidates for reconstruction of the canal and middle ear.
Protocol for Audiologic Testing
- Bilateral (both right and left sides) auralatresia
- An audiogram is recommended within the first few days of life priorto discharge from the hospital. The test is repeated until consistent,reliable results are obtained.
- An audiogram is then performed every three months until age twoand then every six months until age four.
- All patients with bilateral microtia require amplification (boneconduction hearing aids) within the first few months of life.
- A speech evaluation is recommended as soon as the child is fittedwith a hearing aid. Patients with bilateral atresia may require speechtherapy as often as 2,3 times per week for the first three years oflife.
- Unilateral (one side) aural atresia
- An audiogram should ideally be performed within the firstfew days of life prior to discharge from the hospital.
- The test is repeated every three months until age two, and thenevery six months until age four. In the event of a problem such asan infection in the normal ear, more frequent audiograms may be recommended.
- In general, patients with unilateral atresia do not require a hearingaid unless prob, lems develop in the unaffected ear, or language/learningdifficulties exist in the early stages of development.
- A speech evaluation is performed within the first two months oflife and is repeated at six month intervals. Some unilateral patientsmay require speech therapy as the localization of sounds is a potentialproblem.
