Long-Term Audiological Outcomes After Surgical Repair for Congenital Aural Stenosis.

Abstract

To evaluate long-term hearing improvement and risk for deterioration following surgical repair of congenital aural stenosis (CAS) using an endaural approach. Retrospective cohort study. Patients who underwent modified meatoplasty with an endoaural-conchal incision combined with canaloplasty and tympanoplasty for CAS between 2014 and 2025. Postoperative hearing improvement was assessed at 3, 6, 12, 18, 24, 36, 48, and >60 months. Longitudinal trends were analyzed using mixed-effects models. Hearing deterioration, defined as an air-conduction (AC) threshold increase exceeding 10 dB from the first postoperative audiogram, was analyzed using the Kaplan-Meier method and Cox regression. A total of 77 patients (78 ears; aged 4-48 years) were included. The mean (SD) follow-up duration was 25.2 (27.9) months, and the mean preoperative air-bone gap (ABG) was 52.1 dB. The average greatest ABG change (ΔABG) was 23.8 dB. Within the first postoperative year, 66.7% achieved an ABG ≤ 30 dB. Adjusted mixed-effects analysis showed no significant overall ΔABG during follow-up (P = .291). Postoperative ABG values were significantly better than preoperative values at all time points. The ABG at 12 months was higher than that at 3 months (P = .021). Hearing deterioration differed significantly between groups stratified by the median preoperative AC threshold (61.7 dB HL), which remained an independent predictor in the Cox analysis (P = .027). CAS repair yielded durable postoperative improvement. If deterioration occurred, it was mostly confined to the first year. Preoperative AC thresholds may help predict the risk for deterioration.