Effect of Using the External Auditory Canal Skin of the Healthy Side to Treat Unilateral Congenital Aural Atresia: A Randomized Clinical Trial.

OBJECTIVE

To evaluate whether contralateral EAC skin grafts improve postoperative EAC health in patients with unilateral CAA undergoing atresiaplasty.

METHODS

A Zelen-design randomized controlled trial was conducted at a tertiary referral hospital between July 2020 and February 2025. Seventy-four unilateral CAA patients were randomized into case group and control group. Case group: partial reconstruction using contralateral EAC full-thickness skin grafts; remaining defects repaired with 0.3-mm-thick temporal scalp grafts. Control group: entire EAC reconstructed with temporal scalp grafts during atresiaplasty. Pre- and postoperative pure-tone audiometry (PTA), high-resolution temporal bone CT, and postoperative otoscopic evaluation were recorded. Primary outcomes: hearing thresholds, complications (re-atresia or stenosis, tympanic membrane [TM] lateralization).

RESULTS

Complete recovery of the donor site from the healthy EAC was achieved in all 42 case-group patients. Fifty patients had follow-up >6 months, 28 patients were case group, and 22 were control group. There were significant air-bone gap (ABG) improvement between 2 groups (case group: 16.2 dB vs. control group: 9.1 dB; P <0.05). Case group demonstrated significantly less TM lateralization compared with control group ( χ 2 =4.711, P <0.05). TM lateralization correlated with poorer hearing outcomes ( P <0.001).

CONCLUSIONS

Contralateral EAC grafting techniques improved EAC health compared with conventional scalp grafts. Contralateral EAC grafting resulted in lower rate TM lateralization and better hearing outcomes than noncontralateral grafts.