Concurrent One-Stage Polyethylene Ear Reconstruction and Bone Conduction Hearing Device Placement: A Novel Technique and Case Series

Auricular microtia commonly presents with conductive hearing loss, imparting appearance and functional differences. Single-stage microtia reconstruction with porous polyethylene implant and vascularized temporoparietal fascia flap is frequently employed at our center. Bone conduction hearing devices (BCHD) have gained popularity to treat conductive hearing loss with increasing device sophistication. BCHD placement is typically done in a delayed fashion, but with recent FDA approval for children as young as 5 years old, it is possible at the time of external ear reconstruction. We present a novel technique modification allowing for concurrent single-stage ear reconstruction with BCHD placement and compare early outcomes between a series of five patients who underwent concurrent reconstruction and five who underwent staged reconstruction. All patients in both groups achieved adequate tissue healing with similar time course of recovery, with average follow-up of 4.3±2.4 months. One patient in the concurrent cohort experienced polyethylene exposure post-operatively, requiring debridement and secondary tissue-transposition revision but without effect on the BCHD. When comparing procedural length, concurrent procedure length was significantly shorter than total time for staged reconstruction and implant placement (304±61 vs. 459±51 minutes, p=0.002). Further, time from index procedure to BCHD activation was significantly shorter in the concurrent cohort as compared to the staged cohort (59±45 vs. 403±220 days, p=0.024). Overall, these preliminary findings suggest that performing concurrent single-stage polyethylene ear reconstruction and BCHD placement is feasible, reduces operative time, and did not result in excessive complications in this small series.