© Borgis - New Medicine 3/1999, s. 37-38
Surgical management of unilateral congenital atresia of the ear
Department of Otolaryngology, Institute of the „Polish Mother´s Hospital”, Łód
Head of Dep.: Ass. Prof. Andrzej Makowski, M.D.
This paper presents the arguments of followers and opponents of surgical management of unilateral congenital „atresia” of the ear in childhood, and presents the reasons for surgery on children with unilateral developmental anomalies of the external auditory canal, and of the middle ear, performed in the Department of Otolaryngology. Among 8 children and teenagers (6 boys and 2 girls) aged 7-16 years, the principal indication for operation was the desire to correct the cosmetic defect and - in the second place - to improve hearing. The positive postoperative anatomical and functional effects obtained provided real satisfaction for the patients.
A medical team attending a child with congenital anomaly of the ears is primarily concerned with minimizing the negative effects of this condition on the mental and speech development of the child. There is no room for doubt as to the advisability of surgical management of bilateral congenital atresia of the ears which considerably delays the child´s development, but opinions are divided on the indications for surgery on a child with such an anomaly on one side only. The guiding principles for surgical treatment of the canal and middle ear are as follows: 1) to the cosmetic defect, i.e. to create an auditory developmental anomaly of the external auditory gain a conversational hearing level, 2) to correct the foramen and auditory canal, 3) to remove possible inflammatory changes and cholesteatoma. The authors, engaged in the treatment of congenital aural anomalies, unanimously stress the point that these anomalies, apart from their afore-mentioned retardant effect on the child´s mental and speech development, at the same time exert a negetive influence on the emotional state of the child. The latter effect manifests itself particularly in children and teenagers attending school. The developmental anomaly of the ear often gives rise to complexes, to a feeling of embarassment, self consciousness and defectiveness, and it is also a frequent cause of lack of acceptance from classmates. Belluci, House, Livingstone, Weerda and co-workers (1, 5, 7, 10) are among the opponents of surgical treatment for unilateral developmental anomaly of the ear in childhood and adolescence. These authors maintain that unilateral aural malformation does not affect speech development, and that the hearing improvement gained is of negligible benefit to children who become regular patients at outpatient clinics because of postoperative suppuration. Crabtree, Glasscock and Schwaber (2, 4) are non-commital on the question of early surgical treatment for unilateral aural malformation. Zuhlke (11) operates on unilateral anomalies on adults after due consideration relating primarily to the patient´s occupation. Ombredanne (9) was in favour of early surgical treatment of both unilateral and bilateral congenital aural anomalies. Gill, Jahrsdoerfer and Ombredanne (3, 6, 9), as followers of surgical treatment of unilateral aural anomalies, emphasise the significance of an improvement in directional hearing in the malformed ear, and the cosmetic and psychological importance of the cleared auditory foramen and the external auditory canal. Contraindications for surgical treatment of the ear with so-called congenital atresia are poor anatomical conditions, i.e.: 1. A small mastoid process devoid of pneumatization and a slit-like hypoplastic tympanic cavity, 2. Tympanic cavity situated behind the mandibulotemporal joint, 3. Lack of vestibular(oval) and cochlear (round) windows, 4. Anomalies of the inner ear, 5. Bad hearing or deafness in the other ear.
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