Hearing Considerations in Microtia & Atresia

Microtia is frequently accompanied by aural atresia — the absence or narrowing of the ear canal — along with abnormalities of the middle ear. Together, these cause conductive hearing loss, meaning sound cannot travel efficiently through the outer and middle ear to reach the inner ear. In most cases, sensorineural hearing — the inner ear’s ability to process sound — remains intact, which means there are effective options for restoring hearing.

In early childhood, children with unilateral microtia often appear to develop normally, and parents may not notice a significant difference compared to siblings. As a result, hearing loss in these children has historically been undertreated. However, as children grow older and communication becomes more complex, the impact becomes harder to ignore. Difficulties with sound localization and speech comprehension — particularly in noisy environments like classrooms — become more apparent. Children with microtia often unconsciously turn their unaffected ear toward sound, a sign that the hearing difference is real and worth addressing.

Early intervention matters. Addressing hearing loss during critical periods of brain development can have a lasting positive impact on language acquisition, learning, and social confidence.

At the time of ear reconstruction, we can place an OSIA — no additional incisions are needed, the patient avoids a second anesthesia, and because the surgical site is already exposed, placement is quick and safe. Dr. Tahiri uses the latest generation magnetic OSIA, which requires no external screw protruding from the scalp, making it more discreet and comfortable for everyday life.

The OSIA is an active osseointegrated implant that uses a small implanted receiver to convert sound into vibrations, delivering clearer and more robust hearing than traditional passive bone conduction devices. It is discreet, highly effective and can be placed at the same time as ear reconstruction, avoiding a separate surgical procedure entirely.

Importantly, it guarantees hearing.

Dr. Tahiri has extensive experience combining OSIA placement with ear reconstruction, and for many families it has become the preferred choice for hearing restoration.

For carefully selected patients, surgical reconstruction of the ear canal — known as atresiaplasty or canalplasty — offers the possibility of hearing through natural sound conduction. Candidacy is assessed using a CT scan of the temporal bones, which can be performed once a child reaches around 2.5 years of age. The Jahrsdorfer grading scale, a 10-point system based on key anatomical features, is used to determine whether a patient is a suitable surgical candidate. Patients with lower scores, or those with craniofacial syndromes such as Treacher Collins or craniofacial microsomia, may not be ideal candidates due to underdeveloped middle ear structures.

When the anatomy is favorable, the goals of canalplasty are to create a functioning, skin-lined ear canal and a mobile eardrum connected to a healthy middle ear chain. One significant advantage of the PPE/SUPOR™ reconstruction technique is that canalplasty can be performed either before or simultaneously with ear reconstruction — something not possible with traditional rib cartilage techniques. When both procedures are performed together, it is known as Combined Atresia Microtia (CAM) reconstruction. Dr. Tahiri’s team has more experience with this combined approach than any center in the world.

For patients who are not candidates for canalplasty, a faux canal can be created at the time of ear reconstruction for cosmetic purposes, while an OSIA provides reliable hearing restoration.

Our team works closely with audiologists and otologists to ensure every child receives a hearing plan tailored to their specific anatomy and needs. If you have questions about your child’s hearing options, we are here to help guide you every step of the way.