Abstract
Introduction Management of microtia-atresia commonly requires preference-sensitive decisions regarding hearing rehabilitation and cosmetic ear reconstruction surgery (ERS). These choices are often parent-directed in childhood, yet comparative data describing concordance and discordance among parent, child, and adult stakeholder perspectives on treatment priorities, outcomes and satisfaction remain limited. Methods We conducted a cross-sectional survey study using a survey instrument developed by the study team with multidisciplinary input from audiology, otolaryngology, and psychology to assess condition-specific knowledge, perceptions, and treatment decision-making regarding hearing intervention and ERS. Survey domains included demographics, awareness of intervention options, decision regret, and quality of life. Participants were parent-child dyads (children ages 10-17 and their parents) and adults with microtia-atresia. The survey was distributed electronically via Qualtrics through advocacy organizations, professional listservs, and social media groups. Results Parent-child agreement was high for bone conduction device (BCD) decisions, with frequent complete agreement and high satisfaction with hearing outcomes. Children strongly prioritized hearing over appearance (93.3%), and most pediatric surgical BCD users reported all-day device use. In contrast, ERS-related items demonstrated consistently low parent-child agreement with directional discordance. Children reported substantially higher decisional regret than parents (77.8% vs. 11.1%) and lower satisfaction with cosmetic outcomes. Adults with microtia-atresia demonstrated response patterns more closely aligned with children than parents, including elevated regret following ERS and strong endorsement of satisfaction related to surgical BCD intervention. Many adults reported limited awareness of BCD options despite prioritizing hearing as the most important consideration. Conclusion Children with microtia-atresia consistently prioritized hearing over cosmetic appearance and report high satisfaction with surgical hearing intervention. In contrast, cosmetic reconstruction decisions demonstrate disagreement between parent and child perspectives, with children reporting greater dissatisfaction and regret. Adult responses reinforced the durability of pediatric self-report and underscored the importance of incorporating the child’s perspective into shared decision-making. Early counseling should emphasize timely hearing intervention and balanced discussion of reconstructive outcomes to support informed, patient-centered care.