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, who have only one side of the hearing, 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 canal atresia (presenting with moderate to severe conductive deafness), the treatment strategy should be a combination of hearing reconstruction and otoplasty. This treatment strategy is 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 the patient usually develops 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, it takes a certain period of time for the auditory center to integrate the auditory signals from 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. At present, with the advancement of anesthesia and otologic surgery techniques, some children with unilateral microtia with external atresia have been implanted with vibrating acoustic bridges at the age of about 2 years, completing hearing reconstruction before the auricular reconstruction and obtaining normal bilateral auditory development.