DID YOU KNOW:

Facts about HEARING RESTORATION

When is hearing restoration necessary?
Children born with ear deformities often suffer hearing loss
due to the absence of their ear canals and/or middle ear
structures. The impact of hearing loss on the child’s speech
and language development has been well documented.
Children born with both ears deformed need immediate
attention and hearing rehabilitation in order to avoid the
devastating effects of early deafness on their growth
and development. They are immediately fitted with a
bone-conduction hearing aid until they are of age to under-
go more-definitive therapy. Children born with one normal
ear and one deformed ear are rehabilitated from age five
and on. The need of both ears in sound localization and
better speech understanding in noise is well proven. While
children with one good ear may do well with preferential
seating in school, restoring and recovering hearing from
both ears is far superior.

Hearing restoration is achieved in one of two ways:

1 2
The ear canal may be recreated using soft
tissue and bone-remodeling techniques until the
middle ear is reached. The ossicles (three bones
in the tympanic cavity of the ear) are then tested
and repaired or replaced as necessary, and the eardrum is
recreated using grafts. If feasible, such surgical reconstruc-
tion offers the child natural hearing without use of hearing
aids. These procedures, however, may not be feasible
in cases of severe middle-ear deformities, particularly
when accompanied by an abnormal course of the facial
nerve. Risks of these procedures include facial nerve injury,
failure to correct the hearing loss, recurrent ear infections,
and reclosure of the newly created canal.
A less invasive hearing rehabilitation technique
consists of the implementation of a titanium
fixture on the surface of the mastoid bone
behind the ear, which, following a few months
of integration with the bone, is connected to a cochlear
stimulator, also known as the BAHA (bone anchored
hearing aid). This technique is far less risky, and more
predictable, than the reconstruction described earlier.
The titanium implantation is further combined with the
auricular reconstruction procedure, thus cutting down
significantly on the number of procedures these children
require. Both ears can be implanted in cases of bilateral
deformities, thereby ensuring binaural hearing and better
sound localization.
Combining the external ear reconstruction with func-
tional restoration of hearing provides these children with
a significant cosmetic improvement and recovery of useful
hearing, while enabling them to mingle with their peers,
participate in activities, learn and compete in the classroom,
and eventually in the workplace.

LBFF Medical Advisory Board Member

Darius Kohan, M.D.
Dr. Darius Kohan is a board certified otolaryngologist with a
specialty in otology and neuro-otology. He serves as the chair of
the Department of Otolaryngology, Cornell University/Columbia
Presbyterian Hospital System, Brooklyn Hospital Center and as
Director of Otology, Manhattan Eye, Ear, Nose, and Throat
Hospital, New York City.
As a dedicated member of the LBFF Medical Advisory
Board, Dr. Kohan oversees hearing restoration surgeries for
LBFF patients. He performs both internal and external hearing
reconstruction as described in the accompanying article.