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Gutierrez JA, Shannon CM, Nguyen SA, Meyer TA, Lambert PR. Comparison of Transcutaneous and Percutaneous Implantable Hearing Devices for the Management of Congenital Aural Atresia: A Systematic Review and Meta-Analysis. Otol Neurotol 2024; 45:1-10. [PMID: 38085758 DOI: 10.1097/mao.0000000000004061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
OBJECTIVE To compare audiometric outcomes, complications, and revisions required for percutaneous (pBCD) versus transcutaneous (tBCD) implantable bone-conduction devices for the treatment of hearing loss associated with congenital aural atresia (CAA).Databases Reviewed.PubMed, Scopus, CINAHL. METHODS A systematic review was performed searching for English language articles from inception to December 14, 2022. Studies reporting audiometric outcomes or complications for either pBCDs or tBCDs for the treatment of CAA were selected for inclusion. A meta-analysis of single means and meta-analysis of proportions with comparison (Δ) of weighted proportions was conducted. RESULTS A total of 56 articles with 756 patients were selected for inclusion. One hundred ninety patients were implanted with pBCDs, whereas the remaining 566 were implanted with tBCDs. Mean pure-tone audiometry improvement in the pBCD group (39.1 ± 1.1 dB) was significantly higher than in the tBCD group (34.6 ± 1.6 dB; Δ4.5 dB; 95% confidence interval, 4.2-4.7 dB; p < 0.0001). The average improvement in speech reception threshold was 38.6 ± 2.5 dB in the percutaneous group as compared with 32.7 ± 1.6 dB in the transcutaneous group (Δ5.9 dB [5.3-6.5 dB], p < 0.0001). Overall complication rates for patients implanted with pBCDs and tBCDs were 29.0% (15.7-44.4%) and 9.4% (6.5%-13.0%), respectively (Δ19.6% [12.0-27.7%], p < 0.0001). CONCLUSIONS Patients with CAA implanted with pBCDs had significantly better audiometric outcomes than those implanted with tBCDs. However, complication rates were significantly higher among the pBCD group.
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Affiliation(s)
- Jorge A Gutierrez
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
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Castiquini EAT, Alvarenga KDF, Souza LMD, Oliveira VVD, Chaves JN, Lourençone LFM, Brito Neto RVD. Hearing rehabilitation with Baha® transcutaneous and percutaneous systems. Codas 2023; 36:e20220271. [PMID: 37878957 DOI: 10.1590/2317-1782/20232022271pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 05/01/2023] [Indexed: 10/27/2023] Open
Abstract
PURPOSE Longitudinally verify the influence of auditory tonal thresholds obtained with transcutaneous and percutaneous bone-anchored hearing aids on speech perception in individuals with external and/or middle ear malformation and chronic otitis media. METHODS Observational, retrospective, longitudinal follow-up study of 30 unilateral users of the transcutaneous and percutaneous Baha® system for the collection of secondary data on pure tone thresholds obtained through free field audiometry and sentence recognition threshold in silence and noise in conditions: without the prosthesis; at the time of activation; in the first month of use (post 1); and in the third month (post 2). RESULTS There was a significant difference between pure tone thresholds obtained at frequencies of 3 and 4kHz with better results for the percutaneous technique at all evaluation moments. For both systems, better performance was observed in sentence recognition in silence and in noise, with a significant difference in activation (p<0.001), but it remained stable during the other evaluation moments. The percutaneous system showed better benefit in recognizing sentences in noise only on activation (p=0.036), when compared to the transcutaneous system. CONCLUSION The percutaneous system provided better audibility for high frequencies; however, such audibility did not influence sentence recognition in the silent situation for both systems. For the noise situation, better responses were observed in the percutaneous system, however, the difference was not maintained over time.
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Affiliation(s)
- Eliane Aparecida Techi Castiquini
- Divisão de Saúde Auditiva, Hospital de Reabilitação de Anomalias Craniofaciais - HRAC, Universidade de São Paulo - USP - Bauru (SP), Brasil
| | - Kátia de Freitas Alvarenga
- Departamento de Fonoaudiologia, Faculdade de Odontologia de Bauru - FOB, Universidade de São Paulo - USP - Bauru (SP), Brasil
| | - Lucilena Miranda de Souza
- Programa de Residência Multiprofissional em Saúde Auditiva, Hospital de Reabilitação de Anomalias Craniofaciais - HRAC, Universidade de São Paulo - USP - Bauru (SP), Brasil
| | - Valdéia Vieira de Oliveira
- Divisão de Saúde Auditiva, Hospital de Reabilitação de Anomalias Craniofaciais - HRAC, Universidade de São Paulo - USP - Bauru (SP), Brasil
| | - Juliana Nogueira Chaves
- Divisão de Saúde Auditiva, Hospital de Reabilitação de Anomalias Craniofaciais - HRAC, Universidade de São Paulo - USP - Bauru (SP), Brasil
| | - Luiz Fernando Manzoni Lourençone
- Hospital de Reabilitação de Anomalias Craniofaciais - HRAC, Universidade de São Paulo - USP - Bauru (SP), Brasil
- Curso de Medicina, Faculdade de Odontologia de Bauru - FOB, Universidade de São Paulo - USP - Bauru (SP), Brasil
| | - Rubens Vuono de Brito Neto
- Departamento de Fonoaudiologia, Faculdade de Odontologia de Bauru - FOB, Universidade de São Paulo - USP - Bauru (SP), Brasil
- Hospital de Reabilitação de Anomalias Craniofaciais - HRAC, Universidade de São Paulo - USP - Bauru (SP), Brasil
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Shannon CM, Gutierrez JA, Nguyen SA, Meyer TA, Lambert PR. Comparison of Outcomes of Surgery Versus Implantable Device for the Treatment of Hearing Loss Associated With Congenital Aural Atresia: A Systematic Review and Meta-Analysis. Otol Neurotol 2023; 44:758-766. [PMID: 37464461 DOI: 10.1097/mao.0000000000003950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
OBJECTIVE To compare audiometric outcomes, complications, and revisions required for implantable bone-conduction devices (BCDs) versus atresia surgery for the treatment of hearing loss associated with congenital aural atresia. DATABASES REVIEWED PubMed, Scopus, CINAHL. METHODS Databases were searched for English articles from inception to July 1, 2022, for studies reporting audiometric outcomes or complications for either BCDs or atresia surgery for the treatment of congenital aural atresia. Main outcome measures included pure-tone audiometry, air-bone gap, speech reception threshold, associated complications, and rates of revision for each treatment option. RESULTS We identified 973 abstracts, of which 89 were selected for data extraction and analysis. A total of 2,611 patients were included, 1,901 in the atresia surgery group and 710 in the BCDs group. A meta-analysis of single means was conducted for age and audiometric outcomes, and a meta-analysis of proportions was conducted for complications and revisions. The average short-term improvement in pure-tone audiometry for the BCDs group was 34.4 ± 1.6 dB compared with 22.4 ± 1.5 dB for the atresia surgery group, representing a significant difference (12.0 dB; 95% confidence interval, 11.9-12.2; p < 0.0001). A smaller proportion of complications were reported in the devices group (16.9%) compared with the atresia surgery group (45.7%). In addition, a smaller proportion of cases in the devices group required some degree of revision (17.8%) compared with the atresia surgery group (23.0%). CONCLUSIONS This study demonstrates that implantable BCDs have significantly better audiometric outcomes as well as a lower rate of complications and revisions required compared with atresia surgery.
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Affiliation(s)
- Christian M Shannon
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
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Luque CG, Liu AQ, Pauwels J, Leitmeyer K, Chadha NK. Patient reported outcome measures in unilateral aural atresia treated using a transcutaneous bone conduction implant (The Cochlear Baha Attract®). Int J Pediatr Otorhinolaryngol 2023; 165:111451. [PMID: 36649663 DOI: 10.1016/j.ijporl.2023.111451] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 12/17/2022] [Accepted: 01/11/2023] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Unilateral aural atresia (UAA) is a congenital condition that is associated with maximal conductive hearing loss. The primary objective of this study was to assess the long-term compliance, complications, and quality of life of pediatric patients with UAA who had transcutaneous bone conduction hearing implants (TCBI). METHODS Retrospective consecutive case series at a single centre between 2014 and 2018. Inclusion criteria consisted of UAA patients between 5 to 17 years-old receiving the Cochlear Baha Attract ® device. Demographic and audiologic data was extracted from charts. A prospective telephone survey was done, with patients and their families completing the Glasgow Children's Benefit Inventory (GCBI). Basic descriptive statistics, paired t-tests, and a univariate analysis were completed. RESULTS Data was successfully collected from all 9 eligible children who received the Cochlear Baha Attract ® device for UAA (100%). The mean follow-up duration was 33 months after TBCI (9-60 months). The mean daily use was 7.7 h/day. Pure tone average and mean speech in noise scores were both significantly improved when comparing the unaided condition to the aided condition with TCBI (p < 0.001). The majority (89%) of patients had an improvement in GCBI; the median GCBI score was +14.6, indicating overall positive benefit. A linear regression showed no demographic variables were significant for mean daily use or GCBI scores. CONCLUSION This preliminary study showed that patients with a TCBI for UAA had high long-term compliance and daily usage rates. TCBI improved the quality of life for the majority of patients and significantly improved hearing measures.
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Affiliation(s)
- Carolina Grau Luque
- Division of Pediatric Otolaryngology-Head & Neck Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Alice Q Liu
- Division of Pediatric Otolaryngology-Head & Neck Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Julie Pauwels
- Division of Pediatric Otolaryngology-Head & Neck Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Katharina Leitmeyer
- Division of Pediatric Otolaryngology-Head & Neck Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Neil K Chadha
- Division of Pediatric Otolaryngology-Head & Neck Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada.
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Liu Y, Zhao C, Yang J, Chen P, Gao M, Wang D, Zhao S. Audiological and subjective benefit with a new adhesive bone conduction hearing aid in children with congenital unilateral microtia and atresia. Eur Arch Otorhinolaryngol 2021; 279:4289-4301. [PMID: 34816297 DOI: 10.1007/s00405-021-07168-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 11/02/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE This study aimed to evaluate the audiological benefits and subjective satisfaction in using a new adhesive bone conduction hearing aid in children with congenital unilateral microtia and atresia. METHODS We evaluated the effectiveness of the hearing aid using the sound field hearing threshold, speech recognition ability under quiet and noise, and subjective questionnaires in 13 children (5-15 years old). RESULTS The mean sound field hearing threshold significantly improved with a gain of 25.4 ± 4.9 dB HL. Mean word recognition scores were ameliorated in quiet and noise by 1.9 ± 2.5% and 7.3 ± 5.3%, respectively. Speech recognition ability results in noise varied; when the speech signal and noise were presented from the front, the mean speech recognition ability improved by 2.5 ± 1.6 dB signal-to-noise ratios (SNR). When noise was presented towards the normal hearing side, speech understanding was improved by 2.9 ± 1.6 dB SNR. When the speech signal was presented from the atretic side with noise from the normal hearing side, an improvement of 5.7 ± 3.4 dB SNR (p < 0.001) was noted. However, when noise was presented towards the newly aided atretic ear, no statistical significance was found. The questionnaire results indicated that the hearing device provided benefits in speech recognition ability in different complex situations, with high satisfaction rates. CONCLUSION The adhesive bone conduction hearing aid investigated here offers a concealed and aesthetic method to improve hearing in children with congenital unilateral microtia and atresia during their early years, with high subjective satisfaction.
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Affiliation(s)
- Yujie Liu
- Department of Otolaryngology Head and Neck Surgery, Ministry of Education Key Laboratory of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Chunli Zhao
- Department of Otolaryngology Head and Neck Surgery, Ministry of Education Key Laboratory of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Jinsong Yang
- Department of Otolaryngology Head and Neck Surgery, Ministry of Education Key Laboratory of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Peiwei Chen
- Department of Otolaryngology Head and Neck Surgery, Ministry of Education Key Laboratory of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Mengdie Gao
- Department of Otolaryngology Head and Neck Surgery, Ministry of Education Key Laboratory of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Danni Wang
- Department of Otolaryngology Head and Neck Surgery, Ministry of Education Key Laboratory of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Shouqin Zhao
- Department of Otolaryngology Head and Neck Surgery, Ministry of Education Key Laboratory of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
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Muzzi E, Marchi R, Orzan E. Endoscopic-assisted pediatric transcutaneous bone-anchored hearing implant: how I do it. Eur Arch Otorhinolaryngol 2021; 278:1699-1703. [PMID: 33598729 DOI: 10.1007/s00405-021-06690-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 02/08/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Conventional technique for transcutaneous bone-anchored hearing implants surgery requires the elevation of a large retroauricular skin flap to expose the site of implantation, that may cause a large scar and the interruption of retroauricular vasculature. METHODS A less invasive, endoscopic-assisted modification of the surgical technique is described, which provides access to the implant site through two small skin incisions and the creation of a pocket in the retroauricular area. CONCLUSION Endoscopic-assisted bone-anchored hearing implant surgery could be a viable option for transcutaneous bone-anchored hearing implant surgery, especially for pediatric patients.
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Affiliation(s)
- Enrico Muzzi
- Otorhinolaryngology and Audiology, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Via dell'Istria 65/1, 34137, Trieste, Italy.
| | - Raffaella Marchi
- Otorhinolaryngology and Audiology, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Via dell'Istria 65/1, 34137, Trieste, Italy
| | - Eva Orzan
- Otorhinolaryngology and Audiology, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Via dell'Istria 65/1, 34137, Trieste, Italy
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Ghadersohi S, Haville S, Hedman M, Adkisson K, Cooper E, Kaizer A, Gitomer SA, Kelley PE. Socioeconomic and clinical factors influencing treatment selection in microtia and aural atresia. Int J Pediatr Otorhinolaryngol 2021; 141:110551. [PMID: 33338703 DOI: 10.1016/j.ijporl.2020.110551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Patients with microtia and aural atresia have multiple options for treatment of conductive hearing loss (CHL) and auricle reconstruction; however, little is known about the factors influencing treatment selection. This study aims to review the socioeconomic and clinical data of microtia/atresia patients to evaluate congruency with national data and whether these factors affect treatment decisions. METHODS Retrospective review of patients evaluated in the microtia and atresia multidisciplinary clinic (MDC) at a tertiary academic children's hospital between 2008 and 2018. Outcomes included demographic, socioeconomic and clinical factors associated with hearing surgery and framework surgery. RESULTS 373 patients were seen in the Microtia MDC: 193 (51.7%) were male, 187 (50.1%) identified as Hispanic and 23 (6.2%) identified as Asian. 267 (75.6%) patients received a nonsurgical bone conduction hearing device (BCHD); fitting at a younger age was associated with better nonsurgical BCHD compliance. Multivariate analysis was performed on the patients that were eligible for surgery based on age and appropriate follow-up. 70 (18.8%) patients had placement of an osseointegrated BCHD; inconsistent compliance with nonsurgical BCHD decreased the odds of proceeding with osseointegrated BCHD placement. 60 (16.1%) patients underwent framework surgery for external reconstruction. Placement of osseointegrated BCHD was the only factor that was associated with proceeding with framework surgery. Other assessed demographic and socioeconomic factors were statistically not associated with selection of surgical intervention. CONCLUSION Fitting a nonsurgical BCHD at a younger age is associated with higher likelihood of nonsurgical BCHD compliance, that is in turn associated with patients and families proceeding with osseointegrated BCHD and framework surgery.
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Affiliation(s)
- Saied Ghadersohi
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, USA; Division of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, CO, USA.
| | - Salina Haville
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, USA; Division of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, CO, USA
| | - Megan Hedman
- Audiology, Speech Pathology and Learning Services, Children's Hospital Colorado, Aurora, CO, USA
| | - Kirsten Adkisson
- Audiology, Speech Pathology and Learning Services, Children's Hospital Colorado, Aurora, CO, USA
| | - Emily Cooper
- Department of Biostatistics and Informatics, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Alexander Kaizer
- Department of Biostatistics and Informatics, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Sarah A Gitomer
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, USA; Division of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, CO, USA
| | - Peggy E Kelley
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, USA; Division of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, CO, USA
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Hernández S, Ospina JC, Gutiérrez-Gómez E, Rodríguez-Ruiz MT, Escobar JL. Long term cutaneous complications related to bone conduction hearing implants. A retrospective study (2004-2018). Auris Nasus Larynx 2021; 48:878-884. [PMID: 33531159 DOI: 10.1016/j.anl.2021.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/18/2020] [Accepted: 01/20/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to establish the frequency of cutaneous complications due to surgically implanted bone conduction hearing aids in recipients treated at a tertiary otolaryngology center. Additionally, based on the literature review, we propose a scale to standardize the report of cutaneous reactions related to transcutaneous systems to objectify future studies. METHODS A retrospective chart review was conducted for patients who were implanted with bone conduction hearing systems between 2004 and 2018. Patients with minimum follow up of 6 months were included. Patient demographics, surgical characteristics and clinical course was analyzed by number and skin reactions. Transcutaneous and percutaneous systems were analyzed separately. The study was approved by the local IRB. RESULTS A total of 104 devices were implanted on 88 patients with an average follow up of 4.04 (range of 0.5 - 10 years). Out of the total of patients, 49 (55.7%) developed at least one episode of inflammatory/infectious skin reaction at surgical incision site. A total of 148 episodes of local infections during the entire follow-up period were registered, mostly mild in severity with no triggering factors identified. The majority of the initial episodes of infection occurred within the first 3 years of follow-up. Out of the total of patients, 47 (53.4%) reported pain at the surgical site at some point throughout follow-up, not associated with clinically evident infection. CONCLUSION The incidence of skin complications in our series seemed higher compared to previous reports. Minor complications were the most common and responded well to topical treatment. No triggering factors were identified as the cause of the infections, nor to explain the frequency or the severity of such an adverse reaction. Isolated pain was present in the majority of patients with conductive hearing devices, even without signs of active infection. Due to its high incidence it should be assessed in all patients that receive an implant. Based on a search of the literature, a scale to standardize cutaneous complications of transcutaneous implants was undertaken, but further studies are needed to validate such a scale.
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Affiliation(s)
- Santiago Hernández
- Neuro-otology, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Juan C Ospina
- Pediatric ENT, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Elisa Gutiérrez-Gómez
- Division of Otolaryngology, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Carrera 7 40-62, Desk 712, Bogotá, Colombia.
| | - María Teresa Rodríguez-Ruiz
- Division of Otolaryngology, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Carrera 7 40-62, Desk 712, Bogotá, Colombia
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Cuccolo NG, Zwierstra MJ, Ibrahim AM, Peymani A, Afshar S, Lin SJ. Reconstruction of Congenital Microtia and Anotia: Analysis of Practitioner Epidemiology and Postoperative Outcomes. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2318. [PMID: 31624696 PMCID: PMC6635187 DOI: 10.1097/gox.0000000000002318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 05/01/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Microtia refers to a congenital malformation of the external ear that is associated with a range of functional, psychosocial, aesthetic, and financial burdens. The aim of this study was to analyze the epidemiology and postoperative complication profile of microtia reconstruction. METHODS A retrospective review was conducted using data from the 2012-2017 the American College of Surgeons National Quality Improvement Program Pediatric databases. Patients with a diagnosis of microtia or anotia were identified using International Classification of Diseases codes. Demographics and postoperative complications were analyzed using Chi-square and t tests for categorical and continuous variables, respectively. Multivariable regression was performed to control for confounding variables. RESULTS A total of 466 cases were analyzed, of which 290 (62.2%) were performed by plastic surgeons and 176 (37.8%) by otolaryngologists (ear, nose, and throat physicians [ENT]). Autologous reconstruction was the predominant approach [76.2% of cases (n = 355)] in this cohort. ENT physicians operated on a significantly younger patient population (mean age 8.4 ± 3.2 years versus 10.0 ± 3.2 years, P< 0.001) and had higher rates of concurrent atresia/middle ear repair [21.0% (n = 37) versus 3.7% (n = 17)] compared with plastic surgeons. The rate of all-cause complications was 5.9% (n = 17) in the plastic surgery cohort and 4.0% (n = 7) in the ENT cohort (P= 0.372). Multivariable regression did not reveal any statistically significant predictors for all-cause complications. CONCLUSIONS Reconstruction of the external ear for patients with microtia/anotia is a safe procedure, with low rates of postoperative complications, readmissions, and reoperations. Autologous reconstruction remains the preferred modality for repair of the external ear and simultaneous atresiaplasty/middle ear repair does not increase the risk of complications.
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Affiliation(s)
- Nicholas G. Cuccolo
- From the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Mass
| | - Myrthe J. Zwierstra
- From the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Ahmed M.S. Ibrahim
- From the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Abbas Peymani
- Department of Plastic, Reconstructive and Hand Surgery, University of Amsterdam, Amsterdam, Netherlands
| | - Salim Afshar
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Mass
| | - Samuel J. Lin
- From the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
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