La reparación de atresia aural es una cirugía compleja que sólo debe ser realizada por cirujanos con mucha experiencia. En esta cirugía, uno de los puntos más delicados a evitar es alguna lesión del nervio facial, cuyo trayecto discurre en gran parte por las estructuras del oído medio.

El procedimiento tiene por objeto mejorar la audición en el oído siguiendo los siguientes pasos:

  1. La creación de un conducto auditivo que comunique con el oído medio.
  2. La liberación, reparación o sustitución de los huesecillos del oído medio.
  3. La creación de una membrana timpánica o tímpano, a partir de tejido del propio paciente
  4. El recubrimiento del nuevo canal auditivo con un injerto de piel
  5. La creación de una apertura externa, el meato
  6. El recubrimiento del canal nuevo con antibióticos esponjas empapadas para promover el proceso de curado.

Un escáner CT (tomografía computarizada) y una audiometría tonal  son las pruebas básicas que se  realizan  para determinar si un niño es un candidato para  cirugía funcional a la edad adecuada en cada caso. Imágenes de alta resolución axial y coronal de las estructuras internas del oído se toman para crear una puntuación en la escala de 10 puntos de Jahrsdoerfer. La puntuación tiene en cuenta la presencia del estribo, martillo, yunque, la ventana redonda, y otras estructuras del oído. Los mejores candidatos para la cirugía tienen puntuaciones de 8 o superior, y la mayoría de los médicos recomiendan un tratamiento alternativo para las puntuaciones por debajo de 6. La prueba de audiometría refleja  los umbrales de conducción ósea  y aérea para determinar la posibilidad quirúrgica.

Dado que atresia y microtia normalmente van de la mano, el tipo de cirugía reconstructiva del oído externo elegido determinará el momento de la cirugía de reparación de atresia. El escáner CT se realiza generalmente a los 2,5 años de edad ya que las mastoides crecen y cambian rápidamente a edades más tempranas. La primera cirugía de reparación de la atresia se puede realizar como muy pronto a los 3 años. Sin embargo, si se decide por la reconstrucción del pabellón auricular externo mediante un injerto de costilla, entonces la reparación de la atresia se realiza después de la primera cirugía reconstructiva. El orden inverso se sigue si uno opta por la reconstrucción usando Medpor; en este caso, la reparación de atresia se realiza en primer lugar.

Algunos cirujanos expertos en la reparación de la atresia son:

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