Dear Sir / Madam
My name C., I am married to a Chinese lady. We currently reside in China. Weilie was born with most of one ear missing and the entrance to that ear sealed by skin, the other ear is perfectly normal. (She is now 26 years old)
We would like to request your advice perhaps through experience with similar cases, on what the possiblitlites are of this being examined and rectified through surgery proceedures. I am from the UK and would further like to request your recommendation of an Institution or specialist clinic where Otolarngology is practiced in that region. Alternativley perhaps you could recommend such an Institution in the USA where such an examination could be performed.
Thank you for your time in addressing this. Your help is very much appreciated.
Kind regards,
Reply: ---------------------------
There are a number of different general approaches to the management of this complicated problem. First of all, one might elect to focus on the cosmetic aspects of the ear deformity and rely on a special form of hearing aid to address the hearing problem. In this general approach, one can furthermore deal with the cosmetic problem in different ways. The science and artistry of medical prosthetics has become highly sophisticated such that one can now create an artificial ear that looks quite natural and can be anchored to the body by magnets or screws which are surgically implanted or by high quality adhesives. The only actual surgery that would be involved with this approach would be fairly minor involving removal of the vestigial ear components and possibly the implantation of osseo-integrated anchor devices (magnets, screws, etc to attach the artificial ear). Alternatively, the cosmetic problem can be addressed entirely surgically which would involve harvesting suitable cartilage for the creation of a rigid framework and then in a series of staged operations (usually 4 or more) a new ear is created. There are only a handful of surgeons in the US (and probably the world) that have significant experience with this complicated type of surgery. Even in their hands, many would argue that the surgical results do not often match those that can be achieved with artificial prostheses.
The simplest means of dealing with the hearing problem associated with this type of deformity is with a hearing aid. Surgically implanted hearing aids might be recommended in some cases of congenital auricular deformities. Alternatively, one could consider surgical treatment of the hearing problem, since in many cases of ear deformities such as this, the nerve of hearing functions quite normally, and the problem is primarily associated with the atresia of the ear canal, lack of an ear drum, and usually some deformity of the tiny ear bones in the middle ear. The canal atresia, lack of ear drum, and middle ear ossicular abnormalities can all be reconstructed surgically - this however is extremely complex surgery because of the lack of usual landmarks and the three-dimensional complexity of internal ear anatomy. One of the most significant risks of this type of surgery has to do with the potential for injury to the facial nerve which controls the muscles of expression in the face. This nerve normally courses through the temporal bone through the ear. In an atretic ear, the course of the facial nerve may be quite aberrant and therefore susceptible to surgical injury. This type of surgery is therefore generally done by highly experienced otologists.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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