Ear deformities may be traumatic (due to injury) or congenital (present at birth). When trauamtic injuries to the ear occur, we first perform a careful evaluation to determine if any tissue is missing. Where all of the constituent parts of the ear remain present, careful suturing technique may be all that is required to repair the ear. When portions of the ear are missing, we employ surgical techniques in repairing the ear that are similar to techniques used in treating congenital ear abnormalities.
Congenital ear deformities encompass a wide range of abnormalities, from small ears and minor shape abnormalities to complete absence of the external ear. Some of the most common ear abnormalities are summarized below:
- Prominent ears
- Stahl’s ear deformity
- Constricted ear deformity
This ear deformity is the most most common ear abnormality in children, occuring when the ear protrudes farther from the skull than normal. Ear prominence may be limited to the upper, middle or lower third of the ear. Prominent ears may be the result of excess conchal cartilage, abnormal positioning of the ear cartilage or absence of normal folding of the ear cartilage when the ear is forming.
If the prominent ear deformity is noted in the first days of life, the abnormal shape and projection of the ear may be corrected non-surgically by ear molding techniques. In order for molding to be successful, treatment must be started in the first 2 weeks of life. When molding is not a possibility, either because of the deformity or because of later diagnosis, surgery may be required. Surgical treatment of prominent ears may involve removal of excess conchal cartilage, recreation of the absent helical fold and specialized suturing techniques to help minimize protrusion and reposition the ear. Although the timing of surgical correction varies, most surgeons perform surgery to correct prominent ears when the child is 4 or 5 years of age. Surgery is typically 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.
When Stahl’s ear deformity is diagnosed in the first days of life, it may be improved non-surgically by ear molding techniques. In order for molding to be successful, it must be implemented in the first 2 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 techniques to help the ear hold its new shape. Surgery is typically done as a day surgery procedure.
Constricted Ear Deformityia
The cupped or constricted ear deformity occurs as a result of hooding of the superior helix of the ear. Frequently, this condition is noted near the time of birth.
When identified in the first days of life, and when the ear is mildly affected, this deformity may be amenable to treatment without surgery using ear molding techniques. In order for ear molding techniques to be effective, they usually must be implemented in the first 2 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 techniques to encourage the cartilage to remain in its new position. As the severity of the the deformity increases, so does the complexity of the surgical correction.
This is also sometimes 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 palpable beneath the scalp skin.
Treatment of this condition involves releasing the cartilage from under the skin, re-contouring the cartilage and covering the released ear cartilage with either local skin flaps or skin grafts.
Microtia and Anotia
Microtia literally means “small ear” and may involve absence of part to nearly all of the external ear. 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, the majority of children who have one normal ear will not require hearing aids. Children with bilateral microtia, on the other hand, should be evaluated early to see if they will benefit from bone conductive hearing aids. Anotia is an 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.
Correction of microtia and anotia generally involves four surgeries. The first surgery is typically performed when a child is 5-8 years of age. By this age, the opposite normal ear has reached approximately 90% 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, harvested 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 in relation to the new cartilage framework. The third surgery involves release of the framework from the scalp, and placement of a skin graft posterior to the ear to allow the ear to project normally from the scalp. The fourth and final surgery involves creation of the conchal bowl (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.