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Microtia and Aural Atresia Program

The Lurie Children’s Microtia and Aural Atresia Program offers a multidisciplinary team of specialists dedicated to the care of children with microtia, aural atresia and congenital ear anomalies. We provide an individualized plan for each child in order to deliver the best possible hearing, communication and cosmetic outcomes. This includes comprehensive diagnosis, education, rehabilitation and surgical options for children with microtia and aural atresia.

Our team of experts in microtia and aural atresia is led by Stephen Hoff, MD (Pediatric Otolaryngology), Akira Yamada, MD (Plastic & Reconstructive Surgery), and Colleen Ittner, AuD (Pediatric Audiology), as well as nursing specialist Armando Morales, RN.

We work closely with Lurie Children’s specialists in genetics, radiology, speech therapy, psychology and social work in order to offer the full spectrum of care for your child. Together, we will meet with you and your child and develop a comprehensive plan and discuss the possible therapeutic and surgical options that are available to them.


The Lurie Children’s Difference

Lurie Children’s expertise in microtia and aural atresia comes from the collaboration of three specialists who work closely together to ensure the best possible treatment for your child’s needs.

Drs. Stephen Hoff, Akira Yamada and Colleen Ittner are leaders in their respective fields of otolaryngology, plastic & reconstructive surgery and pediatric audiology. In addition to providing clinical care, they facilitate research in the areas of pediatric hearing loss, hearing loss treatment and ear reconstruction. The providers work with other specialists across in genetics, radiology, speech therapy, psychology and social work at Lurie Children’s to ensure your child is getting the best possible care in one place.

Conditions We Treat

  • Cosmetic ear deformities
  • Hearing loss
  • Speech and language therapy and assessments

Our Specialists

Stephen R. Hoff, MD

Dr. Stephen Hoff is a pediatric ear, nose and throat (ENT) doctor, with expertise in treating children with ear and hearing issues. As a pediatric otolaryngologist, he specializes in ear and hearing issues, including microtia and ear malformations. This includes performing surgery of the ear, including osseointegrated implants and cochlear implantation, to restore hearing for children and help them reach their maximum potential. He treats children with complex ear problems, such as cholesteatoma, congenital and acquired hearing loss, microtia and ear malformations, eardrum perforations and recurrent ear infections.

Akira Yamada, MD

Akira Yamada, MD, PhD, is a pediatric plastic and reconstructive surgeon, who has been practicing for over 30 years. He is an international expert in the area of microtia ear reconstruction surgery, and at Lurie Children’s, he works closely with a multidisciplinary team to provide a complete spectrum of care for all microtia patients. When reconstructing an ear, Dr. Yamada is able to create a three-dimensional framework of the ear by using the patient’s own rib cartilage. His patients have shown tremendous improvement from before and after ear reconstructive surgery as shown in the photo gallery.

Colleen Ittner, AuD

Colleen Ittner, AuD, has been a pediatric audiologist at Lurie Children’s for more than 10 years. She specializes in treating patients with hearing loss who are candidates for bone conduction devices, hearing aids or cochlear implants. She also performs auditory brainstem response (ABR) evaluations to diagnose hearing loss in infants and children.

Armando Morales, RN, BSN

Armando Morales, RN, BSN, has worked as a pediatric nurse at Lurie Children’s (formerly Children’s Memorial Hospital) for his entire career and has had the opportunity to work in multiple leadership roles in the organization. He has worked in Pediatric Otolaryngology since 2011 and helped develop, and now coordinates, the Microtia Clinic at Lurie Children’s.

What to Expect

When you make an appointment with our microtia team and the diagnosis is established, Lurie Children’s microtia providers will counsel patients and their families about the medical and possible surgical care involved.

After your child is examined and the care plan is determined, our multidisciplinary team will follow your child throughout their development from the start of their treatment into the teenage years. The team visit approach streamlines the evaluation and treatment process, quickly connecting you with the best specialists to manage your child’s condition. Each treatment plan is customized for the child as we consider the medical and developmental needs of the child, as well as the needs of the family.

What is Treatment Like? 

There are several treatment options for microtia: reconstruction of the ear, a prosthetic ear or medical monitoring without surgical treatment. Lurie Children’s Microtia and Aural Atresia Program staff counsel parents on all of the options during the initial clinic visit.

One way it is treated it to perform ear reconstructions using cartilage, which is sculpted into a new ear and placed under the skin on the microtia side. The cartilage is from the child’s own ribs. This method is preferred rather than using synthetic implants (which is another option) because the cartilage is part of the child’s own body, and after surgery and the ear heals, there are no restrictions on activity. Reconstruction with rib cartilage has been a proven technique for 60 years. Most children do not undergo surgery to treat microtia until the ear has stopped growing, usually around 10 years of age. Age 10 is best time to do cartilage surgery because enough amount rib cartilage is available to make a full ear shape framework, and rib cartilage does not become rigid until age 15. Even after 15 years of age, rib cartilage surgery is still possible for some patients.

At Lurie Children’s, a two-stage surgery method is used. The first stage to create the ear shape and the second stage is for ear elevation. If there is redundant skin left over after stage two surgery, the abundant skin can be trimmed surgically. Our preferred method is to use your child’s own rib cartilage for the ear framework because of its proven sustainability, synthetic framework (known as MEDPORE) is an option if a family does not wish to use rib cartilage for the ear framework, or wishes to have the ear shaped earlier than age 10. The timing of this surgery is a little bit earlier -- around 6-9 years of age -- when fascia (connective tissue around an organ) is thinner to cover the framework. This method is one-stage surgery that spares rib cartilage harvest. However, this method needs more skin harvest and may leave more skin scars.

Click here for more details about the surgical options for ear reconstruction.

Aural Atresia and Hearing Loss Management

Children with unilateral or bilateral aural atresia and/or microtia will obtain an audiological evaluation to diagnose the degree and type of hearing loss. The type of audiological evaluation will vary depending on the age of the child. Information obtained on the audiological evaluation will be used to determine candidacy for a bone conduction hearing device(s). Bone conduction hearing devices pick up sound and convert it into vibration. The vibration of sound is transferred to the cochlea.

Infants and young children with aural atresia and an associated conductive hearing loss are typically fitted with non-surgical transcutaneous bone conduction hearing device(s). These devices are worn on a softband, headband, or coupled to a medical grade adhesive.

Older children may explore surgical candidacy for bone conduction hearing devices. Lurie Children’s was one of the first centers in the U.S. to implant the Baha® Attract system. This is a passive transcutaneous system that uses a sound processor coupled to a magnetic baseplate. The device converts sound into vibrations that are transferred through an external magnet. The magnet is attracted to a surgically implanted magnet and titanium implant. The implant transfers sound through vibrations from the skull to the inner ear and cochlea.

Other surgical options include active transcutaneous systems. Active transcutaneous systems use a sound processor connected to surgically implanted magnet and transducer. Sound vibrations are sent directly to the implant which transfers the sound to the inner ear and cochlea. Lurie Children’s is currently implanting the Cochlear Osia® and MEDEL BONEBRIDGE® systems.

These surgically implanted devices are safe and implanted with one surgery. Activation of the device will be completed by your audiologist approximately one month after surgery. Bone conduction hearing devices are expected to improve a child’s ability to hear and develop spoken language, while also improving understanding in difficult listening situations such as a classroom or noisy environment.

Appointments

If you’d like to request an appointment with Dr. Hoff, please contact Armando Morales at 312.227.6802.

If you'd like to request an appointment with Dr. Yamada, please contact 1.800.KIDS.DOC (800.543.7362)

Research

The leaders of Lurie Children’s Microtia & Aural Atresia Program are involved in research related to pediatric hearing loss and treatment. See a list of publications for each provider below by clicking on their name below.

Philanthropy

Your support is vital in helping us continue to make a difference in the lives of patients and families. Lurie Children’s relies on philanthropic funding to enhance its programs, services and research for children. The generosity of The Davee Foundation in Chicago provided start-up funding for our program.

To learn more, please e-mail the Ann & Robert H. Lurie Children’s Hospital of Chicago Foundation at foundation@luriechildrens.org or call 312.227.7500.

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