This consensus report represents a distillation of current opinion regardin
g diagnosis and management of congenital aural atresia. It also takes into
account the philosophical differences which exist in Europe. Congenital aur
al atresia requires prompt diagnosis, genetic counselling and an early asse
ssment of hearing. In bilateral atresia, early amplification with a bone co
nduction hearing aid is essential for proper speech development. Further re
habilitation in bilateral cases is managed with surgical reconstruction in
selected patients or by implantation of a bone-anchored hearing aid. Atresi
a repair surgery is worthwhile if proper patient selection is made by use o
f stringent audiological and radiological criteria and state of the art sur
gery is performed. The divergent views concerning indications, ideal age fo
r surgery and surgical approach to achieve better hearing are discussed. Re
view of the literature demonstrated that even in the hands of the best surg
eons a mean hearing gain of only 20-25 dB is achieved in atresia Type II, w
ith 30-35 dB in Type I. Therefore, surgical reconstruction should only be d
one in the more favourable cases where post-operative hearing of <25-30 dB
is attainable. Less favoured patients should be helped with bone-anchored h
earing aids, as this type of surgery does not interfere with the future use
of new techniques.