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David C. Shonka Jr, MD; W. J. Livingston III, MD; Bradley W. Kesser, MD

Arch Otolaryngol Head Neck Surg. 2008;134(8):873-877.

Objective  To determine the predictive ability of the Jahrsdoerfer grading scale score in congenital aural atresia surgery.

Design  Retrospective review of medical records.

Setting  Tertiary referral center.

Patients  One hundred eight patients with aural atresia.

Main Outcome Measures  Demographic data, preoperative Jahrsdoerfer score, and postoperative audiometric outcomes were reviewed. One month postoperative, 4-tone pure-tone averages and speech reception thresholds were compared between ears scoring 6 or lower, 7, and 8 or higher on the Jahrsdoerfer grading scale. The percentage of ears with a speech reception threshold of 30 dB hearing level or lower for each group was calculated and compared between groups. Individual anatomical structures on the Jahrsdoerfer grading scale were evaluated for their ability to predict postoperative audiometric success.

Results  Of 116 ears evaluated, postoperative 4-tone pure-tone averages and speech reception thresholds were significantly poorer in ears scoring 6 or less on the Jahrsdoerfer grading scale compared with ears scoring 7 or higher (P < .02, t test). Ears scoring 6 or less had a 45% chance of achieving a postoperative speech reception threshold of 30 dB hearing level or lower, while ears scoring 7 or higher had an 89% chance (P < .01, ² test). Lack of middle ear aeration was the only anatomical factor predictive of poor audiometric outcome.

Conclusions  Compared with patients with a Jahrsdoerfer score of 6 or lower, patients with a score of 7 or higher had significantly better hearing postoperatively. Middle ear aeration may be the most important predictor of postoperative hearing outcome. The Jahrsdoerfer grading scale is an invaluable tool in the preoperative evaluation of patients with congenital aural atresia.

Author Affiliations: Departments of Otolaryngology–Head and Neck Surgery, University of Virginia Health System, Charlottesville (Drs Shonka and Kesser), and University of Rochester Medical Center, Rochester, New York (Dr Livingston).

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