Microtia mostly develops unilaterally. Our statistics show that 75% of patients with microtia are unilateral, with the right side being more prevalent and the proportion of men and women being slightly higher. Patients with microtia often develop atresia of the ear canal, resulting in moderate to severe conductive deafness. Because one ear is normal, speech development is usually not impaired in these patients, so treatment of patients with unilateral microtia has previously focused on auricular reshaping rather than on hearing reconstruction in the affected ear. With the advancement of auditory research, the need for hearing reconstruction in patients with unilateral microtia is gradually being recognized by otologists and audiologists. Normal people have bilateral hearing and therefore have the ability to localize sound sources and to recognize speech in noisy environments. In contrast, patients with unilateral microtia have only one side of their hearing and therefore have difficulty identifying the source of sound and perform poorly in noisy environments. In clinical practice, many children with unilateral microtia with atresia are able to form speech normally; however, in complex auditory environments (classes, group conversations, noisy backgrounds), there is a gap between the patient’s auditory and communication abilities compared to normal individuals. Therefore, in patients with unilateral microtia with associated aural atresia (presenting with moderate to severe conductive deafness), the treatment strategy should be a combination of hearing reconstruction and otoplasty. This treatment strategy has been generally accepted in Western countries, but currently in China, many patients with unilateral microtia (or the parents of the child) still do not know much about hearing reconstruction. This lag in understanding has caused many unilateral children to miss the best time for hearing reconstruction; moreover, traditional hearing reconstruction surgery can damage the flap area needed for auricular reconstruction and affect future auricular reconstruction, so doctors can usually only perform hearing reconstruction after auricular reconstruction. When should hearing reconstruction be performed? In patients with unilateral microtia with aural atresia, external sounds cannot be effectively transmitted to the inner ear to trigger hearing, so patients usually develop conductive deafness on one side (hearing loss mostly at 60 decibels, which is moderately severe deafness). The development of hearing in these patients depends mainly on the hearing of the normal side, i.e., a unilateral hearing pattern is gradually developed. After reconstruction of the hearing on the affected side through treatment, the auditory center needs a certain period of time to integrate the auditory signals of both sides. Usually, the earlier the hearing reconstruction, the shorter the adaptation period required for auditory integration and the smaller the difference in hearing between the two sides; conversely, the longer the period and the larger the difference. Therefore, for children with unilateral microtia, hearing reconstruction should be performed early to achieve normal and balanced development of bilateral hearing. Currently, the options for hearing reconstruction in patients with unilateral microtia are: 1. After 6 months of age: the patient undergoes a hearing examination, is fitted with a bone-conduction hearing aid, and undergoes a non-surgical hearing reconstruction program; 2. After 6 weeks of age: a CT examination is performed to inspect the patient’s ear development (based on the Jarhsdoeger scale with a score out of 10), and the child’s surgical treatment plan is determined; ① A score greater than or equal to 8, depending on the location of the middle cranial fossa and TMJ (not included in the scoring criteria), the decision is made whether to open the ear canal; ② Patients who are not suitable for opening the ear canal (generally scoring 4-7), if they have a well-moving stapes, can be implanted with a vibroacoustic bridge to reconstruct the air-conduction transmission process of sound; ③ Patients with a lower score, who cannot open the ear canal or implant a vibroacoustic bridge, can only choose a bone conduction implant system, such as the Baha Bone Bridge. It is important to note that the above hearing reconstruction options need to be combined with the child’s physical development. As for otoplasty, Tong Ren Hospital currently uses a direct burial approach for otoplasty. The surgery is usually performed in two stages. If the patient is suitable for open ear canal, I will generally use the ear reconstruction phase I to perform the open ear canal at the same time; if the patient is suitable for implantation of vibrating sound bridge or bone bridge, I will generally use the ear reconstruction phase II to perform the implantation surgery at the same time. We try to shorten the surgical cycle as much as possible and save time.