Ear Deformities

Ear deformities may be traumatic (due to injury) or congenital (present at birth). When traumatic injuries to the ear occur, we first perform a careful evaluation to determine if any tissue is missing. If all the tissue is there, suturing may be all that is needed to repair the ear. When portions of the ear are missing, we use surgical techniques to repair the ear.

Congenital ear deformities include a wide range of abnormalities, from small ears and minor shape abnormalities to the complete absence of the external ear. Some of the most common include:

Prominent Ears

This is the most common ear abnormality in children. It occurs when the ear protrudes farther from the skull than normal. Prominent ears occur when a child has extra cartilage in his ear, has an unusual positioning of the cartilage or the cartilage didn’t fold normally when the ear was forming.

Treatment

If the prominent ear deformity is noticed in the first days of life, the abnormal shape and projection of the ear may be corrected non-surgically by ear molding techniques. To be successful, treatment must be started in the first two weeks of life. When molding is not a possibility, surgery may be required. Surgical treatment of prominent ears may involve removing excess cartilage, creating the missing fold and suturing to help minimize protrusion and to reposition the ear. Most surgeons perform corrective surgery when a child is 4 or 5 years of age. Surgery is usually done as a day surgery procedure. 

Stahl Ear Deformity

A Stahl’s deformity occurs when the upper ear has an extra fold of cartilage, resulting in a pointed appearance. Children and parents are often unaware of this deformity until they get closer to school age.

Treatment

If Stahl's ear deformity is diagnosed in the first days of life, it may be improved non-surgically by ear molding techniques. To be successful, it must be done in the first two weeks of life. When molding therapy is not an option, surgical correction may be required. Stahl's abnormalities are often surgically treated when the child is 4-5 years of age. Correction often involves removal of cartilage to eliminate the pointed portion of the ear and suturing to help the ear hold its new shape. Surgery is typically done as a day surgery procedure. 

Constricted Ear Deformity

The cupped or constricted ear deformity is usually noted near the time of birth.

Treatment

When identified in the first days of life, and when the ear is mildly affected, this deformity may be treated using ear molding techniques. For ear molding techniques to be effective, they usually must be done in the first two weeks of life. When this deformity is more severe or is diagnosed later in childhood, surgery may be required as the child approaches 4-5 years of age. Surgical correction of mild deformities typically involves unfurling the cartilage and using suturing to encourage the cartilage to remain in its new position.

Cryptotia

This is also referred to as the “hidden” ear deformity. In cryptotia, the cartilage of the upper ear is present, but hidden underneath the skin of the scalp. While at first it may appear that the upper portion of the ear is absent, careful inspection often reveals that the cartilage is present and can be felt beneath the skin.

Treatment

Treatment of this condition involves releasing the cartilage from under the skin, re-shaping the cartilage and covering the ear cartilage with either local skin flaps or skin grafts. 

Microtia and Anotia

Microtia literally means “small ear.” Part or almost all of the external ear may not be present. In addition, children with microtia typically do not have an external ear canal or ear drum. The middle ear structures, however, are generally normal. As a result, most children with microtia will have some degree of conductive hearing loss in their microtic ear. Despite this hearing loss, most children who have one normal ear will not require hearing aids. Children with microtia on both sides should be evaluated early to see if they will benefit from conductive hearing aids.  

Anotia is a rare condition characterized by complete lack of any external ear structures. Since children with microtia and anotia may have other congenital abnormalities that require comprehensive evaluation and treatment, they should be seen and evaluated by an experienced craniofacial team. 

Treatment

Correction of microtia and anotia generally involves four surgeries. The first surgery is usually performed when a child is 5-8 years of age. By this age, the opposite normal ear has reached approximately 90 percent of its adult size, allowing more precise matching of the reconstructed ear to the normal side. In addition, by the time children are 5-8 years of age, they are usually large enough physically to allow the safe harvest of enough rib cartilage to construct the new ear.

During the first surgery, rib cartilage, taken from the lower rib cage, is shaped into the framework of an ear. This framework is placed underneath the skin in the area where an ear would normally be placed.

Once this heals, the second stage involves rotation of the ear lobe into a “normal” position.

The third surgery involves release of the framework from the scalp, and placement of a skin graft behind the ear to allow the ear to project normally from the scalp.

The fourth and final surgery involves creating the bowl of cartilage that leads to the ear canal. This stage involves taking cartilage and skin from the normal ear but does not change the shape of the normal ear.