Over the past 30 years, our hospital has seen nearly 10,000 patients with ear deformities that used to be attempted with open ear canals. Since 2010 to the present, medical and technological advances have maximized convenience and results for both doctors and patients. What do the ratings for ear canal opening say? Problems with any of the three structures involved in opening the ear canal can affect whether or not the ear canal can be opened or the hearing results after surgery. Many parents come to my clinic and say, “We want to open our ear canals. And that’s what we’re talking about. The diagram above is the scoring system we are referring to. 8 or higher is the score I would recommend for opening the ear canal. 9 anatomical structures out of 10, of which the stapes is worth 2 points. When you see this, parents and friends, you should be able to see the importance of the stapes. How is normal hearing conducted? Priority is given to improving air conduction hearing Air conduction: sound → outer ear (auricle collects sound, ear canal conducts sound) → middle ear (tympanic membrane and auditory chain, etc.) → inner ear (cochlea and semicircular canals, etc.) → auditory nerve → cerebral cortex (auditory center) Many small-eared children have narrowed external auditory canals, but from the results of the hearing test, the hearing may be even worse than in atretic ears. Stenosis of the external auditory canal, as the name suggests, the ear canal is smaller than the normal structure. But the hearing is worse because the middle ear is less developed. If there is no cholesteatoma and the middle ear deformity is severe, only external otoplasty is feasible (auricular reconstruction has been completed or the auricle is still available). Alternatively, follow up closely and seek medical attention if inflammation is detected. Low atresia scores (with stapes) or decreased hearing results after open ear canal surgery are preferred to artificial middle ear implant devices, such as vibrating sound bridges. The vibrating sound bridge is the only artificial middle ear implant device currently available in China. It directly vibrates the auditory ossicles, simulating the normal air conduction pathway. In this patient, the right ear is atresia and the left ear is normal. (In CT, the left side is the right ear and the right side is the left ear.) Thus, improving air conduction hearing requires that the patient be in a better condition for their own development, but the degree of hearing improvement is also great. Does narrowing of the external auditory canal always mean cholesteatoma? Stenosis of the external auditory canal needs to be watched out for by patients with small ears and parental disorders. Cholesteatoma, also known as an epidermoid cyst, is generally a cystic mass formed by skin desquamation, cholesterol crystal accumulation, and epithelial encapsulation, and is not a tumor. In otology, cholesteatoma of the external auditory canal and cholesteatoma of the middle ear are common. The exact cause is unknown. In patients with stenosis of the external auditory canal, the incidence of cholesteatoma is slightly higher than normal, but not necessarily 100%. The most common clinical symptoms are a bump on the back of the ear, and pus flowing from the ear with a foul odor. After the onset of ossicular stenosis, lesion excision and auricular reconstruction surgery are not performed at the same time. And, once the disease develops, surgery is necessary. As mentioned above, patients with stenosis of the external auditory canal may have worse hearing than those with atresia, mainly due to middle ear malformations. If the middle ear deformity is severe and the outer ear canal stenosis is accompanied by a cholesteatoma, surgery must be performed. In this case, surgery is done to remove the lesion, not to improve hearing.