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Shin-ichi Ishimoto, MD; Ken Ito, MD; Tatsuya Yamasoba, MD; Kenji Kondo, MD; Shotaro Karino, MD; Hideki Takegoshi, MD; Kimitaka Kaga, MD

Arch Otolaryngol Head Neck Surg. 2005;131:326-329.

Objective  To evaluate the relationships between temporal bone abnormalities and the severity of microtia in Japanese patients using objective grading systems.

Design  Retrospective case series study conducted between 1992 and 2003.

Setting  Academic, tertiary care, referral medical center.

Patients  One hundred forty-two ears of 109 Japanese patients (85 male and 24 female patients; mean age, 12.8 years [range, 2-36 years]) with microtia.

Main Outcome Measures  The severity of microtia was classified according to Marx classification. Developmental abnormalities of the temporal bone were evaluated by a computed tomographic (CT) scoring system modified after the system used by Jahrsdoerfer and colleagues, using high-resolution CT scans of the temporal bone. Correlations between the scores obtained from these 2 grading systems were evaluated using a nonparametric statistical method.

Results  Male preponderance and incidence of bilateral cases of approximately 30% were observed in our Japanese patients with microtia. There was no significant difference in the severity of microtia between unilateral and bilateral cases. The mean ± SEM total points in the CT scoring system (full marks, 10) was 7.9 ± 0.4 for grade I microtia, 6.6 ± 0.6 for grade II, and 6.4 ± 0.3 for grade III; the total points correlated inversely with the microtia grade. Development of the auricle correlated significantly with aeration in the middle ear spaces but not with ossicular development or formation of the oval/round windows. Proportion of acceptable surgical candidates according to the CT scoring system (>5 points) was 79% for grade I microtia, 52% for grade II microtia, and 65% for grade III microtia.

Conclusion  The principle "the better developed the auricle, the better developed middle ear" was confirmed in Japanese patients with microtia; however, even with grade II/III microtia, more than half of the patients were considered suitable for atresia surgery.

Author Affiliations: Department of Otolaryngology, Faculty of Medicine, University of Tokyo, Tokyo, Japan (Drs Ishimoto, Ito, Yamasoba, Kondo, Karino, and Kaga); and Department of Otolaryngology, Saitama Medical Center, Kawagoe, Saitama, Japan (Dr Takegoshi).

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