Atresia Repair (Canal Surgery)

Atresia Repair (canal surgery) attempts to surgically restore hearing by creating a skin-lined ear canal with an “eardrum” that allows sound waves to be transmitted to the middle and inner ear. This surgery is only performed by an Otologist specializing in atresia repair. Atresia repair can be done as early as 3-6 years old, depending on the specialist. An audiogram and a high resolution CT scan are needed to determine if your child is a good candidate for atresia repair.

 As with any surgery, there are multiple risks of atresia repair including:

  • Infection
  • Canal “closing” (stenosis)
  • “Eardrum” separation (requires surgery to correct)
  • Facial nerve injury/facial paralysis
  • Hearing nerve injury
  • Permanent hearing loss
  • Loss of the initial hearing improvement over time
  • Failure of the atresia repair, requiring surgery to close the canal

The complexity and high risk of infections coupled with the African climate, makes this not a favourable option by many surgeons.


Treatment Option A – No treatment

Any child or adult who is born with Microtia does not have to have surgery if he/she does not wish to. If you like your little Microtia ear and would like to keep it just the way it is, you absolutely have the right and the choice to do so. However, if you believe that by having surgery, you will personally live a happier life, be able to wear glasses, be able to hear better through Atresia repair (canalplasty) if you are a candidate, and no longer be bullied, then of course surgery is an option that can help

Treatment Option B – Rib Cartilage Technique

The Rib Graft technique is known as the “Gold Standard” for ear reconstructive surgery and has been around since the 1920’s. Rib Graft surgery utilizes the body’s own biological tissues (rib cartilage and skin). When the body’s own tissues are utilized for building a Rib Graft ear, the ear will grow with the body because all tissues used are living.

Photos provided by Dr. Duane Mol (

Treatment Option C – 3D Lewin Ear

The “Lewin Ear Implant" is a 1-piece implant based on “ideal” ear anatomy, best used for bilateral Microtia patients. The “3D Lewin Ear Implant” is based on the actual patient’s natural ear. Both are FDA approved 3-dimensional ear implants designed by Dr. Lewin and manufactured by Su-Por from a single piece of porous polyethylene

The implant is completely covered with nearby tissue from under the scalp called the temporoparietal fascia (“TPF flap”). This thin vascular flap has arteries, veins and nerves coursing through it that grow into the implant and give sensation to the skin grafts that cover the ear.

When fully healed, a complete ear is made in one operation. The 1-piece PIER technique (developed by Dr. Lewin) creates the appearance of an ear canal due to the 3 dimensionality of the implant and the new way the tragus is constructed. Some patients may require a second surgery.

Photos from Dr. Lewin’s Website (

Treatment Option D – Medpor Technique

The Medpor surgical technique for ear reconstruction has been around for over 20 years. A Medpor ear is made up of a synthetic material consisting of a porous high-density polyethylene (PHDPE) (also known as a PPE ear implant) that is then covered by a skin graft. The same Medpor material has been used in facial craniomaxillofacial surgeries for over 40 years. Although a Medpor framework is not made up of living tissue, such as the rib cartilage used in the Rib Graft technique, Medpor material does become vascularized as the blood vessels of the living tissue (skin graft) covering the ear weave throughout the porous holes within the synthetic framework. It has been noted, that when a Medpor ear is removed for repair, it “bleeds.”

The “Medpor Technique” was pioneered by Dr. John Reinisch (USA) in 1991. Dr. Reinisch has been utilizing Medpor for Microtia exclusively for over 25 years with successful results. Medpor material has proven to hold up for at least 35 years (to date). Since the material is considered a “newer” material, it is quite possible that the material may last even longer than historical data proves. Medpor eliminates the additional stage required for harvesting rib cartilage used in rib graft procedures, including the elimination of an additional scar from where the rib graft is taken. Medpor surgery can be achieved in just one surgery stage. Sometimes, a second stage may be needed to fine tune the ear lobe.

Photos provided by Dr. Duane Mol (

Treatment Option E – Prosthetic Ear

A silicone prosthetic ear is a reconstructive option for patients born with Microtia and other birth differences such as Treacher Collins or Goldenhar syndrome; as well as those who have suffered traumatic injury or undergone cancer resection surgery (auriculectomy). A certified anaplastologists creates a remarkably life-like ear prosthesis matching the shape, skin tones, and textural detail of a healthy ear.