Frequently Asked

Questions

 General FAQs

  • Atresia is a general term to describe the absence or narrowing of a natural passage of the body. Aural atresia refers specifically to the absence or narrowing (stenosis) of the external ear canal and usually occurs in conjunction with microtia. When someone has aural atresia, there is a high incidence of concurrent malformation of the external ear (microtia) and middle ear structures, but the inner ear (cochlea) and auditory nerve are frequently normal. In most cases, an eardrum does not develop, and instead, there is solid bone separating the middle ear from where the ear canal should have formed. Typically, the middle ear bones (ossicles) may be malformed as well. Aural atresia most commonly affects just one ear (unilateral) but can also occur in both ears (bilateral). The surgery to create a normal-sized ear canal from either a narrowed (stenotic) or absent ear canal is referred to as atresia repair canalplasty.

  • Microtia is a congenital deformity where the pinna (external ear) is underdeveloped, deriving from the Latin micro- and -otia meaning “little ear.” The degree of development of the outer ear can range from mild deformity to complete absence of the pinna (known as anotia). Microtia can be unilateral or bilateral. It usually occurs as an isolated abnormality but can occur in conjunction with hemifacial microsomia or other syndromes including Goldenhar Syndrome and Treacher-Collins Syndrome.

    Microtia is graded on a classification scale of Grades 1-4:

    Grade 1: Small ear with mostly normal ear anatomy, the ear canal may or may not be affected.

    Grade 2: Characterized by some ear anatomy, including a developed tragus. The bottom 1/3 of the ear is usually normal, no ear canal or a narrow canal.

    Grade 3: Most common form of microtia, characterized by small, undeveloped ear remnants and no canal.

    Grade 4: Also referred to as anotia, no ear remnants or canal present.

    Even in cases where the outer ear is normal, atresia can still be present. In microtia grades 2 or higher (2-4), some degree of atresia (ear canal narrowing or absence) is always present and must be screened for. If no outer ear develops, there is never a normal ear canal present.

  • Unfortunately, no. Evidence supporting the importance of binaural (two-eared) hearing continues to surface. Strong data shows children with a unilateral hearing loss have marked disadvantages in hearing, particularly in noisy environments and with sound localization. This produces deficits in development of normal speech & language, negatively impacts work and school performance, and increases risk of lifelong disability in several other areas. The brain system that provides these functions develops in the first 5-10 years of life; a window known as the “critical period” for hearing restoration. Because of this, we advocate hearing restoration surgery in qualifying patients at a young age. Frequently, if hearing is not provided in the early years, the brain cannot develop fully at a later time, limiting achievement and function in later life. Commonly, these disadvantages may begin to surface as a child’s demands in school increase around fourth grade, which is after the system has failed to develop.

    A child with unilateral hearing loss may be able to hear, process and perform very well in quiet environments. Because of this, it is common for patients to be told that one hearing ear is adequate. However, in environments with significant background noise such as a noisy classroom, the same child’s hearing and performance can drop nearly 50% without any intervention. In comparison, children with two hearing ears understand about 90% of language in background noise. Compared to their peers, children with unilateral hearing loss are over 10 times more likely to fail a grade in school, have more behavioral problems, suffer more frequent emergency room visits, make significantly lower salaries as adults, and have a greater need for educational assistance.

    For these reasons, the recommendation that “one ear is sufficient” is false and completely unjustifiable, and methods to provide hearing should be explored for all patients. Hearing can be provided for all patients affected by Congenital Aural Atresia & Microtia (CAAM), whether with canalplasty in qualifying patients, or with alternative devices.

  • At the California Ear Institute, which has some of the most experienced atresia repair surgeons in the world, atresia surgery in routinely completed in children at 3 years of age. It is preferred that the child weigh a minimum of 15 kilograms (30 pounds) pounds prior to surgery. There are other conditions, such as a cholesteatoma, that warrant earlier intervention on a case-by-case basis.

  • In addition to a full medical history, there are two specific examinations needed to evaluate patients for surgery candidacy: a temporal bone CT scan and a hearing test (audiogram). The patient must be a minimum of 2 years old before completing the CT scan in order to allow adequate development of the ear structures. For both the hearing test and CT scan, it is important to test both ears, as approximately 27% of patients with unilateral atresia microtia will have a co-existing hearing loss in the other ear that requires intervention.

  • Prior to evaluation at age 2 years or older, it’s important to maximize your child’s ear health and hearing development. Language development proceeds rapidly in the first few years of life and the majority occurs prior to the “critical period” window of age 5-10. For all patients, we recommend wearing bone conduction hearing aids as soon as possible, usually in the form of a Bone Anchored Hearing Aid (BAHA) softband device. Softband wear is mandatory for patients with bilateral atresia; for patients with unilateral atresia, use is still recommended if possible. These devices send vibrations through the skull to stimulate the inner ear affected with a hearing loss from atresia, allowing developmental progress and sound stimulation until the patient is of age to undergo surgical evaluation. In patients who are not candidates for canalplasty surgery, the bone conduction hearing aids can be converted to a surgically implanted version that is an alternative option for hearing.

  • To evaluate the middle ear, a temporal bone CT scan needs to be performed. The parameters for ordering the scan for your doctor are as follows: without intravenous contrast, including internal auditory canals (IAC)/mastoid, with thinnest slices possible (1mm or thinner).

    While the risk of radiation in today’s scanners is much smaller than prior scans, we recommend every effort to be made to get the scan needed in one attempt and to avoid having to repeat scanning. In some areas, miniCAT scanners are available. These have greatly reduced radiation exposure and allow children to sit upright and avoid sedation in some instances (9% of the usual radiation dose of most commonly used CT scanners). If not accessible, a standard CT can be performed with sedation under general anesthesia for young children. Pediatric hospitals tend to be the best resource for these scans.

  • A CT gives a picture of the middle and inner ear anatomy not visible by physical exam. Using the CT scan, we can apply a grading scale for atresia known as the Jahrsdoerfer scale. This 10-point grading system was developed for determining surgical candidacy of atresia patients and allows us to estimate the chances of success and hearing outcome with atresia repair surgery.

    Scores of 8 or 9: Atresia repair is recommended

    Scores of 6 or 7: Atresia repair is typically recommended, with a slightly higher chance of requiring a middle ear bone prosthesis for hearing results

    Scores of 0 to 5: Atresia repair is generally not recommended

    While the J-scale is one of the best methods for guiding recommendations for atresia, it certainly is not a complete algorithm as there are some other factors important to consider, such as unilateral v. bilateral atresia, the benefit of sound awareness, and the ability for the localization of sound.

    Each patient’s situation is different and should be fully evaluated by a surgeon with significant experience in treating atresia and microtia patients. It is imperative the surgeon who is considering surgery review the CT scan personally.

    A CT scan also allows us to evaluate the patient for the presence of a cholesteatoma. All patients should be screened for cholesteatoma with a CT scan prior to ear surgery of any kind. If present, cholesteatomas require mandatory surgical removal regardless of CT scan score, as they will progressively enlarge over time and can become life-threatening to the patients if untreated.

  • A cholesteatoma is a destructive growth of skin cells (keratinized squamous epithelial cells), often described as a skin cyst or tumor, located in the base of the skull (mastoid) and/or middle ear. Cholesteatomas have a higher incidence in children with atresia and those with small or partial ear canals.

    Cholesteatomas grow over time and have the potential of eroding through bone as they enlarge. If erosion of the middle ear bones (ossicles) and/or inner ear structures occurs, hearing – or the potential for hearing in cases of atresia – can be permanently compromised. Other possible complications arising from cholesteatomas include dizziness, facial paralysis, and infection of the brain (meningitis), which can potentially be fatal.

    People with normal ear canal anatomy often experience painless drainage from the ear as an initial symptom, but patients with atresia or partial canals may not show any signs or symptoms of a cholesteatoma until it becomes infected. At this point, intervention is emergent. A pit where the ear canal should have formed may be a sign of buried cholesteatoma.

    The standard of care is to surgically excise the cholesteatoma after diagnosis in almost all cases to prevent the risks associated with leaving it untreated. ALL patients should be screened with a CT scan to evaluate for the presence of cholesteatoma.

    Cholesteatoma Video

    Are there other medical conditions associated with Congenital Aural Atresia & Microtia that a patient should be evaluated for?

    Congenital Aural Atresia and Microtia is frequently isolated, meaning that the patient has no other health problems or associated diagnoses. However, thorough workup should be performed in all patients by the child’s pediatrician or geneticist to screen for associated syndromes and/or abnormalities. In our experience in working with atresia patients around the world, we have found atresia microtia to be a component with an underlying syndrome in approximately 8% of patients. These syndromes include: Treacher Collins, Hemifacial Microsomia, Goldenhar, Crouzon’s, Pfeiffer, Apert, Nager/Miller, Klippel-Feil, Branchio-Oto-Renal or Melnick-Fraser, Pierre Robin, and CHARGE syndrome. Jaw or facial abnormalities are more frequent and may be seen in over 20% of patients with atresia and should be considered as part of the evaluation and treatment process.

  • There are currently two major approaches to the outer ear reconstruction, which impact the timing of the ear canal surgery.

    The traditional technique historically is known as rib graft. With this technique, cartilage is harvested from the patient’s own rib cage and carved to mimic an ear. This cartilage is then implanted under the skin of the head. Rib graft auricular reconstruction requires multiple surgeries to complete. The initial reconstruction generally begins around age 6 and requires 3-4 surgical procedures (for unilateral microtia) and is completed on average by age 11. The major disadvantage of rib graft reconstruction is that all outer ear surgeries must be complete and 6+ months of healing passed before it is possible to proceed with ear canal surgery. This means delaying hearing restoration to later in life, which misses the “critical period” of brain development related to sound (typically occurring at 5-8 years of age).

    In contrast, another technique in microtia repair uses a material called porous polyethylene (“PPE,” or often referred to as Medpor) instead of rib cartilage. This technique has several major benefits, primarily being that surgery can occur as early as 3 years of age and requires only one single operation to complete. The Medpor technique is much less painful for the patient and typically provides superior aesthetic outcomes compared to rib graft reconstruction. Most importantly, Medpor reconstruction is completed either after ear canal surgery or at the same time as ear canal surgery. Our team at the California Ear Institute pioneered the combined atresia microtia (CAM) surgery to allow hearing restoration and outer ear reconstruction in a single outpatient procedure.

    With Medpor, atresia repair can be done either before the outer ear reconstruction or at the same time as the Medpor reconstruction. This allows early hearing restoration and optimal brain development during the critical period of speech & language acquisition (age 5-8).

  • Yes, in many patients combined reconstruction is possible! In 2008, Dr. Joseph Roberson and Dr. John Reinisch joined to perform the world’s first procedure in which atresia repair and Medpor auricular reconstruction were combined into a single surgical procedure. Since that time, we have routinely performed combined atresia microtia (CAM) surgery with excellent results.

  • There are two primary reasons why canalplasty should precede Medpor (PPE) outer ear reconstruction.

    First, early restoration of hearing with canalplasty is of paramount importance, and should ideally be completed prior to age 5-8, when a critical period of brain development around speech & language occurs.

    Second, the complication rate for both the Medpor and canal is increased by significantly when the Medpor is performed prior to the canal. Because a plastic surgeon’s work is done superficially, he or she is unable to determine where the future ear canal should be located in relation to the patient’s middle ear, and the Medpor implant may be placed in an incorrect position, making ear canal creation impossible or extremely difficult. In addition, completing canal surgery after Medpor reconstruction has a significantly increased risk of complications for both the ear canal and outer ear. This includes Medpor implant damage or loss, or descent of the implant over the ear canal, which can result in chronic infections and debris buildup. At times, an ear canal procedure can safely be done after Medpor by a very experienced surgeon, but we highly recommended that canalplasty be performed before or at the same time as Medpor reconstruction.

  • For separate canal and outer ear procedures, it is recommended that there be at a minimum 4 months and ideally 6 months of healing after canal surgery prior to proceeding with Medpor outer ear reconstruction. between canal surgeries in children who have bilateral atresia.

  • If the patient is not a good candidate for creation of an ear canal, there are other avenues that can provide hearing. The best alternative is a type of surgically implanted hearing aid known as a bone anchored hearing aid (BAHA). These devices consist of an implanted abutment (typically a magnet) under the skin that allows the patient to wear an external processor. The processor receives sound and converts it to sound vibrations, which are then transmitted through the bone of the skull to the inner ear and hearing nerve. While implanted devices do not provide the benefits of two-ear hearing unique to canalplasty (directional sound and improved hearing in background noise), they are an excellent alternative for patients in whom canalplasty is not possible.

  • Yes, in most cases patients remain candidates for outer ear reconstruction even if ear canal surgery is not possible. Please contact your plastic surgeon of choice directly to discuss outer ear reconstruction.

POSTOPERATIVE AND
FOLLOW UP CARE FAQs

  • In atresia patients, the external auditory canal failed to form properly, resulting in an absent or partially formed ear canal. In most patients, instead of a canal extending from the outside to the middle ear, the space where the ear canal should have formed is instead made of solid bone, and no eardrum is present. Internally, the middle ear space cavity and structures remain intact, but a canal and eardrum must be made and connected to the middle ear bones to restore hearing.

    During canal surgery, the bone and tissue where the ear canal should have formed is delicately removed by special instruments to create an open pathway down to the middle ear bones. The middle ear bones are examined and, in some cases, may need to be replaced with a prosthesis to achieve an optimal hearing result. Note: because of the minute size of these structures, even the world’s best CT scanners are not even powerful enough to determine the connection between the middle ear bones with 100% accuracy. This can only be determined at the time of surgery when the bones can be examined and touched under microscopic magnification.

    Once the middle ear bones are confirmed to be functioning properly, an eardrum is created from the patient’s own tissue. This tissue is known as “fascia” and is harvested from the muscles around the ear canal. The new eardrum is then connected to the middle ear. Once healed, this tissue becomes a living, functioning eardrum that closely mimics a normal eardrum. A skin graft is taken from the scalp and used to line the new ear canal and surface of the new eardrum.

    Finally, the skin graft lining the ear canal is sutured to the existing skin around the opening of the newly made canal. The canal is carefully filled with sponge packing and soaked with antibiotics to protect the new ear canal while it heals.

  • One benefit of the California Ear Institute being a private institution as opposed to large educational facility is that you can be assured that Dr. Roberson always performs the canal surgery himself. In addition to Dr. Roberson, our team consists of an experienced staff of anesthesiologists, surgical techs, nurses, physician assistants, and doctors who collaborate to extend the best possible care to patients.

  • The pain experienced with surgery is much less than one might expect. At the end of every surgery, numbing medicine is administered so that the patient experiences no pain when waking up. After several hours, when the medicine wears off, mild pain may develop. All patients are provided with prescription-strength pain medication after surgery for use as needed, but in general, most patients’ pain is controlled by over-the-counter pain medicines such as Tylenol. It is common for kids to be completely without discomfort within only a few days.

  • Yes! Temporary restrictions on water exposure are in place immediately following, but once the ear canal is completed healed (approximately 2-3 months after surgery), swimming and bathing can resume. Typically, after the first cleaning with your local ear doctor is completed (~6 weeks after your final postoperative visit at the clinic), the ear canal can be safely exposed to water.

    Usually, no drops or special care is needed after water exposure. Rarely if patients experience infections or water trapping in the ear canal, we often advise placing several drops of rubbing alcohol (isopropyl alcohol 70%) in the canal after swimming to prevent infection.

  • The ear canal needs to be kept dry for the first 2-3 months following surgery. During bath time, placing a cotton ball coated lightly in Vaseline over the entrance of the canal can help prevent water from entering. Specific instructions will be provided during your postoperative visits.

  • Hearing improvement after surgery is gradual. Immediately following surgery, the ear canal is filled with sponge packing to support the repair and skin graft inside the canal. This surgical packing is typically removed ~3 weeks after your surgery date, after which some improvement in hearing levels is usually observed. The hearing will continue to steadily improve (with normal fluctuation day to day) for several months thereafter, and usually reaches a maximum around 5-6 months after surgery. For this reason, we wait to check a hearing test until this time.

  • Typically, results are stable, and no additional surgery is needed. However, while we do our very best to predict hearing outcome using CT scan and intraoperative exam, it is not possible to predict hearing outcomes with 100% accuracy. We estimate that 10% of patients may require a second surgery at some point in their lifetime.

    Rarely, a second-stage surgery for the placement of a middle ear bone prosthesis is indicated in some patients. This decision is made based on hearing testing results and middle ear bone anatomy, which is evaluated under the microscope during surgery. Patients who show a lack of adequate improvement in hearing after surgery and who have a known middle ear bone abnormality may be candidates for a second procedure to replace the middle ear bones with a prosthesis (PORP). In certain cases, the decision to place a prosthesis is made at the initial surgery if it is clear that the bones will not be functional for sound conduction.

    The complications for which an additional surgery may be recommended include lateralization of the eardrum, infection, or perforation of the ear drum, and/or mucosalization of the canal (also known as “wet ear canal”). Many complications can be managed without needing to intervene surgically.

  • Since 2008 with a new technique, we use a very thin skin graft taken from the scalp to line the new ear canal. The size of the graft is approximately 2x3 inches (5x7 cm). Formerly, these skin grafts came from either the abdomen or the thigh, but these areas resulted in some discomfort for the patients and at times poor scarring outcomes. In contrast, the skin grafts taken from the scalp are extremely thin, such that the hair follicles are not included in the skin graft when it is harvested. As a result, hair growth on the scalp is unaffected and returns normally within weeks after surgery, while no hair grows in the canal. These grafts are much less painful for the patient, do not leave a visible scar, and are ultimately fully concealed in the patient’s hair once healed.

    For patients undergoing combined atresia microtia (CAM) procedures, the same scalp skin graft is utilized to line the new ear canal. In addition, the plastic surgeon will require additional full-thickness skin grafts to cover the new ear implant. These grafts are most commonly taken from the groin area (where the leg meets the body), as well as from the skin covering the original microtia remnant.

  • Worldwide, stenosis or narrowing of the ear canal is the most common complication of canalplasty surgery, occurring in 20-30% of cases. In our center, we have developed special surgical techniques as well as use of a custom mold in the healing period that have effectively reduced the incidence of stenosis in our patients to less than 2% of cases.

    At the final postoperative visit, patients are standardly fitted with a custom silicone-based mold that is worn at night while sleeping only for 4 months after returning home (or until directed to discontinue use). Use of the mold has drastically reduced the incidence of narrowing of the created canal. In the rare event that ear canal stenosis occurs beyond this time period, the vast majority of cases can be treated successfully using topical medicines and do not require re-operation.

    Please note for patients having separate ear canal and Medpor surgeries, a new ear canal mold should be made at CEI 3-4 weeks after the Medpor surgery is complete. Please contact us to schedule a visit.

  • Like any kind of surgery, canalplasty surgery has inherent risks that should be understood. The main risks associated with canalplasty are:

    • Stenosis or narrowing of the ear canal: Worldwide, stenosis is the most common complication with canal surgery, occurring in 20-30% of cases. Due to our unique surgical techniques and use of a postoperative canal mold, we have reduced the incidence of stenosis in our surgery patients to less than 2%. Even if narrowing does occur, the vast majority of cases can be treated with topical medicines and do not require re-operation.

    • Injury to the inner ear (sensorineural hearing loss): In <1% of cases, injury to the inner ear may rarely occur, which results in partial or total loss of the hearing nerve function.

    • Injury to the facial nerve: With any surgery of the middle ear, injury to the facial nerve is possible. Worldwide, this occurs in 1-2% of cases. Fortunately, in over 4,000 atresia-related surgeries to date, Dr. Roberson had never had an injury to the facial nerve. While it is still possible, the likelihood of injury is extremely low. For further precaution, we use facial nerve monitoring during surgery to provide an additional layer of protection against injury of the facial nerve.

    • Infection, Perforation, or Eardrum Lateralization: Postoperative infection, eardrum perforation, or lateralization (a change in the eardrum position) after surgery are possible but rare. The risks of each of these is typically less than 1%.

    A comprehensive list of Risks and complications is provided to all patients in advance of surgery. We would be happy to discuss any concerns or questions you have regarding the risks associated with canal surgery. For more information, please contact our medical team at atresiarepair@calear.com.

  • No; while we are careful to be selective in the evaluation process, all surgeries have inherent risks and complications. For patients who are found to be surgery candidates, specific statistics are discussed regarding the likelihood of achieving results that bring a patient’s hearing into the normal range after surgery (0-30 dB). While there are some variables that we have been able to overcome with experience in treating this condition (for example, ossicular prosthesis placement in the cases of a fibrous incudostapedial joint), surgical outcomes are not always predictable and cannot be guaranteed. In formulating an individual treatment plan, chances of success and failure are discussed openly.

  • Postoperative infection is a rare but possible complication of any surgery. In our surgeries, rates of postoperative infection are extremely low thanks to multiple lines of defense in place, including use of antibiotics during and after surgery. If a postoperative infection develops, treatment may range from use of antibiotic eardrops and/or oral antibiotics to surgical intervention, in the most extreme cases.

    After successful reconstruction, a surgically repaired ear is still susceptible to developing standard ear infections, just like a normal ear. This includes infection of the middle ear space behind the eardrum (otitis media) as well as infection of the ear canal skin (otitis externa). Fortunately, assuming proper maintenance and cleaning after surgery, the reconstructed ear is not at any increased risk for infection compared to normal ear. Treatment for these conditions is likewise the same in a normal versus a surgically reconstructed ear, and typically consists of oral antibiotics (otitis media) and/or antibiotic ear drops (otitis externa). Attentive monitoring and treatment of middle ear infections of both reconstructed and normal ears is warranted by a primary care physician or local ENT.

  • Once the reconstructed ear is fully healed, it can largely be treated like a normal ear. The primary difference is that a surgically reconstructed ear canal does not have the capability to clean itself like a regular ear canal does. Because of this, regular cleanings of the ear canal to remove debris buildup must be performed under a microscopic by an ear, nose, and throat doctor (also known as an otolaryngologist or otologist). Failure to maintain regular cleanings places the patient at increased risk for developing an infection or damage of the repair. For this reason, they are of high importance. On average, cleanings are needed 3-4 times in the first year after surgery; 2-3 times the second year; and 1-2 times per year thereafter for the patient’s lifetime. Your ear doctor can help determine the appropriate interval for cleanings based on how much debris is present and how much time has elapsed between cleanings. Typically, the first cleaning after surgery is recommended ~6 weeks after your last postoperative visit at the clinic.

    Otherwise, no specific long-term care is required, aside from monitoring of the hearing as needed with hearing tests (audiograms). Patients can participate in all normal activities without restrictions.

  • No, you cannot clean the ear canal yourself. The canal must be cleaned by an ear doctor with a microscope. Attempting to clean the ear yourself risks damage to the repair, as microscope magnification is needed to safely remove debris from the delicate eardrum.

    Ear cleanings are relatively simple and can be performed by any ear doctor with a microscope around the world. It is not necessary to return to CEI for routine cleanings.

  • For patients undergoing ear canal surgery only, a 3-week stay is required after surgery. This allows for completion of postoperative visits at the clinic to care for the ear canal as it heals. For patients having the combined atresia microtia (CAM) procedure, a 4-week minimum stay is advised, and travel will be required to Los Angeles for follow up appointments during a portion of that time. All patients will be provided with a detailed schedule of visits prior to arrival in California for surgery.

  • All patients are scheduled for a preoperative appointment with our staff at the California Ear Institute, typically the day before surgery (or at times the week prior, if the surgery falls on a Monday). At this visit, detailed instructions on what to do for the day of surgery will be provided, including when to arrive at the clinic and what to expect.

    During surgery, we typically provide updates by text or email approximately every 2 hours. Once surgery is complete, we will bring you to the recovery room so that your child wakes up with you already there. The patient is monitored for ~1 hour before being discharged. During this time, you will receive a bag of supplies to care for the ear, and our staff will provide detailed instructions on how to care for your child.

    A schedule of all postoperative visits will be provided prior to your arrival at the clinic. You are free to travel home immediately following the final scheduled postoperative visit.

  • Costs for surgery are variable and depend on the complexity of the surgery and the patient’s insurance plan (if applicable). There are three sources of billing for atresia repair surgery:

    • Facility Fees: costs associated with the operating center where surgery is performed, including the supplies, materials, and time the surgery takes

    • Anesthesia Fees: costs associated with general anesthesia for surgery

    • Surgeons Fees: costs for the surgeon/s completing the surgery, which depends on the procedures performed and the complexity of the procedures

    In the USA, insurers will inform you what they will pay for surgery based on CPT codes. For domestic patients, our staff can help provide you with those codes and/or work with your insurance company to determine the estimated reimbursement from the insurance company for the cost of the surgery. For international patients, CPT codes do not apply, and we have established fees for the facility, anesthesiology, and surgeons.

    Please contact us by email at atresiarepair@calear.com for any questions regarding the financials of surgery.

  • In order to reserve a surgery date, a full evaluation must first be completed to determine if the patient is a candidate for surgery. For patients who are found to be candidates, a $5,000 deposit is required to reserve a surgery date, with the total cost of the surgery due 8 weeks prior to surgery date.

  • Yes. We provide standard documents/letters for all patients which can be submitted to your local embassy for travel visa and funding purposes. However, please note these can only be provided once a surgery date is scheduled and $5,000 reservation deposit is received, as a specific surgery date is necessary to issue the documents.

  • At the California Ear Institute, a team of trained professionals has been hand selected to care for patients diagnosed in atresia and microtia. We care very much about the health and well-being of our patients and seek to extend the best care possible. For any additional questions, you can email us at atresiarepair@calear.com and we would be delighted to assist you.