, Volume 55, Issue 7, pp 895–911 | Cite as

Grading system for the selection of patients with congenital aural atresia for active middle ear implants

  • Henning FrenzelEmail author
  • Georg Sprinzl
  • Gerlig Widmann
  • Dirk Petersen
  • Barbara Wollenberg
  • Christian Mohr
Head and Neck Radiology



Active middle ear implants (aMEI) are being increasingly used for hearing restoration in congenital aural atresia. The existing gradings used for CT findings do not meet the requirements for these implants. Some items are expendable, whereas other important imaging factors are missing. We aimed to create a new grading system that could describe the extent of the malformation and predict the viability and challenges of implanting an aMEI.


One hundred three malformed ears were evaluated using HRCT of the temporal bone. The qualitative items middle ear and mastoid pneumatization, oval window, stapes, round window, tegmen mastoideum displacement and facial nerve displacement were included. An anterior- and posterior round window corridor, oval window and stapes corridor were quantified and novelly included. They describe the size of the surgical field and the sight towards the windows.


The ears were graded on a 16-point scale (16–13 easy, 12–9 moderate, 8–5 difficult, 4–0 high risk). The strength of agreement between the calculated score and the performed implantations was good. The comparison of the new 16-point scale with the Jahrsdoerfer score showed that both were able to conclusively detect the high-risk group; however, the new 16-point scale was able to further determine which malformed ears were favorable for aMEI, which the Jahrsdoerfer score could not do.


The Active Middle Ear Implant Score for aural atresia (aMEI score) allows more precise risk stratification and decision making regarding the implantation. The use of operative corridors seems to have significantly better prognostic accuracy than the Jahrsdoerfer score.


Aural atresia Active middle ear implant Computed tomography Grading system 



Active middle ear implant


External ear canal atresia


External ear canal stenosis


Oval window


Round window


Coefficient of determination


Vibrant Soundbridge™


Conflict of interest

We declare that we have no conflict of interest.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Henning Frenzel
    • 1
    Email author
  • Georg Sprinzl
    • 2
  • Gerlig Widmann
    • 3
  • Dirk Petersen
    • 4
  • Barbara Wollenberg
    • 1
  • Christian Mohr
    • 4
  1. 1.Department of Otorhinolaryngology and Facial Plastic OperationsUniversity Hospital Schleswig-HolsteinLübeckGermany
  2. 2.Department of OtorhinolaryngologyUniversity Hospital InnsbruckInnsbruckAustria
  3. 3.Department of RadiologyUniversity Hospital InnsbruckInnsbruckAustria
  4. 4.Department of NeuroradiologyUniversity Hospital Schleswig-HolsteinLübeckGermany

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