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Relationship Between Middle Ear Volume and Long-term Audiological Outcomes in Congenital Aural Atresia Repair

Imbery, Terence E.*; Maldonado, Michael; Mukherjee, Sugoto; Kesser, Bradley W.*

doi: 10.1097/MAO.0000000000002233

Objective: To assess the association of middle ear volume with long-term hearing outcomes in congenital aural atresia (CAA) repair.

Study Design: Retrospective chart and radiological review.

Setting: Single academic tertiary referral center.

Patients: Children and adults who underwent CAA repair between 1995 and 2016. Patients were divided into “best” and “worst” audiometric groups, based on stability of postoperative air conduction pure-tone average (AC PTA) results. Ten patients were included for study in the “best” group, and 12 in the “worst” group.

Intervention(s): CAA repair.

Main Outcome Measure(s): Long-term (> 1 yr) postoperative three-tone (500, 1000, 2000 Hz) AC PTA, speech reception threshold (SRT), air bone gap, and semiautomated calculated middle ear volume from preoperative computed tomography (CT) scans.

Results: Statistically significant differences were noted between “best” and “worst” groups in AC PTA, SRT, and air bone gap (p < 0.001). Mean middle ear volume in the “best” group was 434.6 mm3 (range 326.3–602.1 mm3) and 339.5 mm3 (range 199.4–502.1 mm3) in the “worst” group (p = 0.02). The majority in both groups were right ears (p = 0.38), and males outnumbered females in the “best” group (9 out of 10; p = 0.018). Preoperative Jahrsdoerfer grading scores were similar between groups (p = 0.31). Mean follow-up for the “best” and “worst” groups was approximately 3.5 and 4.5 yr, respectively.

Conclusions: For patients undergoing CAA repair, larger middle ear volume is associated with stable and better long-term audiometric outcomes.

*Department of Otolaryngology, University of Virginia, Charlottesville

Radiology Associates of Richmond, Richmond

Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia

Address correspondence and reprint requests to Bradley W. Kesser, M.D., Division of Otology-Neurotology, Department of Otolaryngology, University of Virginia, P.O. Box 800713, Charlottesville, VA 22908-0713; E-mail: Terence E. Imbery, M.D., University of Virginia, Charlottesville, VA; E-mail:

The authors disclose no conflicts of interest.

Copyright © 2019 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company