Can anyone have Canalplasty?
No, unfortunately not everyone can have Canalplasty. An individual with Atresia who is considering having canalplasty must become a candidate first. In addition to having a CT scan of the ear, based on the information that CT scan provides, a canalplasty surgeon will grade the individual’s ear anatomy on a 10 point scale to determine if canalplasty is an option for improving hearing loss. This 10 point scale is called the Jahrsdoerfer or “J” scale and was developed by Dr. Robert Jahrsdoerfer. The “J” scale is broken down on the following point system:
Scoring for the Jahrsdoerfer Grading System:
Stapes bone 2
Oval window open 1
Middle ear space 1
Facial nerve 1
Malleus-incus complex 1
Mastoid pneumatization 1
Incus-stapes connection 1
Round window 1
External ear 1
Total Possible Score 10
If an individual rates a 7 or higher on the scale (70% out of 100% chance of having hearing restored to normal or near normal range), he/she will most-likely be a candidate for canalplasty. Usually, if the individual rates a 6 or below, canalplasty is unlikely an option. However, in some cases some individuals may still be candidates even with a 6 rating depending on the actual anatomy of the ear. This is a decision that can only be made by a specialist in atresia repair. To learn more about additional options for canalplasty, please see the section under Canalplasty Technique on this website.
At what age is the earliest that someone can have Canalplasty?
The ages vary depending on surgeon preference. Some children can have canalplasty as early as 3 years of age, usually when considering Medpor reconstructive surgery. If considering Rib Graft reconstructive surgery, the earliest for canalplasty is 5 years of age. However, if a child has been diagnosed with a cholesteatoma, canalplasty can be performed during that same surgery if the child has a normal working ear. Some children are diagnosed with cholesteatomas as early as 2 years of age.
How long will it take for my hearing to improve following Canalplasty?
Once having Canalplasty, hearing can continue to improve anywhere from monthly to well over a year post op. Most hearing can be improved or restored typically anywhere between 20dB or better and 35dB. This is the typical outcome for most patients, but other challenges may present causing unexpected scaring or delays in healing. However, every patient is different and heals differently.
Will my hearing degrade even though I had Canalplasty?
It is always possible for hearing to degrade. However, the main goal for canalplasty is to restore hearing. It is possible that, depending on the individual and how successful the surgery turned out, that a revision surgery (or second surgery) may have to be performed. Keep in mind though, that as we age our hearing naturally degrades.
Is there maintenance for Canalplasty?
Yes. Once having Canalplasty, the patient will have to have their ears cleaned every six months to once per year. The newly reconstructed ear canal will tend to slough off dead skin cells and these dead skin cells or (debris) will need to be removed in order to maintain optimal hearing. An ENT can perform what is called a “deep microscopic” ear cleaning to remove the dead skin cells.
Will an ear that has had Canalplasty performed still leak ear wax (cerumin)?
No. Once canalplasty has been performed, the ear will not leak ear wax as the non-Microtic/Atretic ear will. Instead of ear wax, dead skin cells will slough off as mentioned above.
Will I develop ear infections following Canalplasty?
Any individual who has had canalplasty performed is not at any increased risk of developing ear infections when compared to someone who has not had canalplasty. If you do experience an ear infection, contact the surgeon who performed your canalplasty and seek guidance. It is possible that a generalized ENT who is local can assist you. Always seek medical guidance when you discover an ear infection.
Can I swim after having Canalplasty?
Yes. An individual who has had Canalplasty can swim and get water in their ear as long as their ear has healed correctly and completely. It is suggested to use swimmer’s ear drops after swimming in order to help dry the ear canals out. Swimmers ear drops help to be preventative in drying out the ear canal and absorbing any moisture that could build in the ear causing a potential ear infection.
Why should Canalplasty be performed after Rib Graft surgery instead of before Rib Graft surgery?
This question is asked time and time again. The reason is because if canalplasty is performed before Rib Graft surgery, there is a risk of causing scar tissue to the skin located directly behind the ear that would be used to cover a Rib Graft ear during reconstruction. Below are two responses from Rib Graft surgeons explaining this very same answer:
Response from Dr. Arturo Bonilla –
“Hi Melissa, I have attached some pictures of patients who have had atresia surgery before the microtia surgery. As you can see, there is a large amount of scarring and lack of skin flexibility where the ear should go. The skin is very tough and flat against the skull secondary to scarring. This makes the reconstruction with cartilage very difficult to have an ideal result.”
Response from Dr. Charles Thorne –
“In cases of microtia, I think it is always better to have the auricular reconstruction first, regardless of the technique. The only time when canalplasty should come first, in my opinion, is the rare circumstance when the atresia occurs in the setting of a nearly normal auricle. Hope that helps.”
The following images show scar tissue caused by canalplasty surgery, prior to Rib Graft surgery: Permission to post the following images has been granted by Dr. Arturo Bonilla, Founder of the Microtia Congenital Ear Deformity Institute. For more information on Dr. Bonilla, please click on the following link: http://www.microtia.net/ Please note: Dr. Bonilla and Dr. Thorne are Rib Graft surgeons and do not perform canalplasty.
When should Canalplasty be performed if choosing Medpor ear reconstruction?
If choosing the Medpor surgical technique for outer ear reconstruction, canalplasty (Atresia repair) can be performed before, during, or after Medpor. It is typical for canalplasty to be performed before a Medpor ear is created so that the Medpor framework is not compromised. Canalplasty can also be performed during the same time as Medpor reconstruction if choosing to have the combined Atresia/Medpor surgery currently performed by Dr. John Reinisch and Dr. Joseph Roberson. Canalplasty can be performed on a Medpor ear following Medpor ear reconstruction. However, there is a chance that the framework of the Medpor ear and skin graft could be damaged during canalplasty. Some canalplasty surgeons can be careful enough to perform canalplasty surgeries on a Medpor ear and some canalplasty surgeons will not consider canalplasty post Medpor surgery as an option.
Are there any associated risks with Canalplasty?
Yes, there are always risks involved with any surgery. With Canalplasty, it is always possible that infection may set in or develop. Although the goal is to improve hearing it is always possible that the surgery may fail to improve the hearing leaving it as is or perhaps causing further hearing loss. There is a risk that the eardrum may be perforated (which is rare) and a chance of long term dizziness inherited. Some patients have reported a slight change in their taste. There is also a chance of causing the facial nerve to weaken (which is rare) and the possibility of causing canal the newly created ear canal to collapse which is referred to as canal stenosis. There is a 15% to 20% chance of a patient requiring a revision surgery regarding the removal of excess scar tissue that may prevent the middle ear bones from vibrating freely. Although each patient heals differently, it is still very important to select a highly reputable surgeon when considering Canalplasty.
What if Canalplasty is not a success for me?
If Canalplasty is not a success, you can always consult with your surgeon and inquire about what other options you have, including asking your surgeon to explain why the surgery was not a success. You may also have another CT Scan taken and seek a second opinion with a different canalplasty surgeon. It is possible that another surgeon may be able to fix or correct your hearing from the previous surgery. If your hearing still can not be corrected or restored following an attempt at canalplasty, it is still possible that you can hear better through the use of a bone anchored auditory processor or BAHA.