Late surgical intervention in congenital unilateral aural atresia: Audiological and functional outcomes in an adolescent patient

Congenital aural atresia results in conductive hearing loss due to absent or malformed external auditory canal. In unilateral cases, rehabilitation is often deferred, particularly when contralateral hearing is normal. However, emerging evidence highlights the impact of unilateral hearing loss on auditory processing and the potential for neural reorganization even after prolonged deprivation. An 18-year-old male with right-sided congenital aural atresia underwent atresiaplasty and tympanoplasty after declining amplification for many years. Preoperative imaging demonstrated favorable middle ear anatomy. Postoperative outcomes included improved air-conduction thresholds, enhanced speech understanding—especially in noisy environments—and successful comprehension of telephone speech via the previously non-functional ear. The patient initially experienced hyperacusis and diplacusis, which resolved over time, suggesting active cortical reorganization. This case illustrates the potential for meaningful auditory and functional recovery following late surgical intervention in congenital unilateral conductive hearing loss. Restoration of auditory input, even in adolescence, may promote central auditory plasticity and improve real-world listening abilities. Personalized treatment planning should consider anatomical, functional, and motivational factors, regardless of age.