Current concepts in repair of aural atresia

Purpose of review To look at the current rationale behind surgical candidacy for aural atresia. In addition, we review recent technical aspects of the procedure, as it relates to outcomes. Recent findings Traditionally, aural atresia repair has been mostly reserved for bilateral atresia patients or occasionally unilateral patients with ideal conditions. Repair has also typically followed microtia repair with cartilage reconstruction. Developing literature, however, shows that the critical period of central auditory development precedes the typical timing of repair, particularly after rib cartilage microtia reconstruction. Newer synthetic microtia repairs have allowed atresia repair prior to microtia repair to capture the developmental advantages of binaural hearing early in life. We also review recent data on the use of ossicular prostheses in atresia repair regarding audiologic outcomes and other techniques attributed to better outcomes. Summary Atresia repair remains one of the most challenging otologic procedures. As techniques improve and we understand the developing auditory system, surgical criteria may shift, with more patients becoming candidates at a younger age.