The ears are very visible; they help define a person’s facial structure, and provide balance and symmetry to the face. When patients are born with malformations of their ears or have traumatic injuries to them, the asymmetry of the face is readily recognizable. At Children’s Memorial Hermann Hospital, we offer many options, both surgical and nonsurgical, to help restore the symmetry of the face by reconstructing or molding ear anomalies.
What are the causes?
Congenital Ear Deformation: The most common type of ear problems are noted right after birth. Many infants are born with ears that are folded or pressed against their head in the wrong position while developing in utero. Once the child is born, some of these shapes improve to look like a regular ear but others remain twisted or crushed. Early intervention with molding can help improve the shape of an infant’s ear, without the need for surgical correction later in life.
Microtia: Some infants are born without a particular part or the ear itself. This occurs when the cartilage of the ear does not develop normally and can be absent or present in only a small remnant of the ear. These patients may have issues with hearing in their internal ear, issues with the nerves or muscles of their face, or even problems with their teeth and jaws.
For most cases we do not know the causes of microtia, though some rare genetic diagnoses are seen. The condition can be on one side (unilateral) or both sides (bilateral) of the face. Patients who have suffered burns, trauma, or cancer of the ear can similarly present with malformation or absent ears and are similarly treated. In cases of microtia, a full reconstructive surgery to create a new external ear is needed and is usually performed around age seven to nine.
Prominent Ears: Since school-age children can be very self-conscious, one of the easiest things to be teased about is large or prominent ears. Children can have ears that are too big for their head or stick out too far from the sides of their face. This is rarely associated with any hearing issues or genetic conditions. However, ear shapes and position, like many other facial features, often run in families. A small outpatient surgery can reduce the size of the ears and shape them into a more natural, symmetric position to reduce teasing and issues with self-image for these children.
- Congenital ear deformation
- Traumatic or burn-related ear loss
- Prominent ears
Ear malformations are easily recognized with just a physical exam. For infants with congenital malformations, these are usually noticed shortly after birth or at their first pediatrician visit. Patients with congenital malformations, particularly microtia, may also have issues with hearing from the affected side or with some of the other nerves or muscles of the face.
The main symptom is a patient who is self-conscious of their appearance, particularly their ears. Patients with prominent ears are seen by their pediatrician or referred by the parents themselves after their child has voiced concern over the appearance of their ears.
Imaging & diagnostics
A post-natal hearing screen is used to determine whether any hearing abnormalities are present at birth. If any hearing issues are noted on this exam, further workup with an ear, nose, and throat (ENT) specialist may be needed to determine if a hearing aid would be appropriate.
Congenital Ear Deformation: For infants who present within the first month of life, custom molding devices are created and can be used to reshape the cartilage of the ear. These devices are glued to the sides of the child’s head with a cage-like structure of silicone. Small inserts and conformers are used to shape the abnormal parts of the external ear cartilage back into the proper shape. Each device is worn for two weeks at a time and changed to a new device in the clinic. A total of two to three devices are needed to complete the therapy, which lasts for a total of four to six weeks.
No surgery is needed to effect this change if started early. If there is a residual ear deformity at three months of age, it is unlikely to be affected by the molding device, and surgery during school age would be the only option for correction at that time. Risks and complication of the molding device include infections, irritation of the skin, erosion or wounds in the skin from pressure, or patient discomfort.
Microtia: For patients with a complete or near-complete lack of cartilage of the ear, an entire construct must be created and inserted under the skin to create a new ear. This is usually done around age seven to nine as the normal ears have reached full size and a symmetric ear can be designed and created.
This is a surgical correction that typically occurs in three stages over a six-month period and requires a hospital stay of two to four days for the first stage.
- During the first surgery, a section of the cartilage from the ribs is harvested through an incision in the chest. This cartilage is carved and sewn together to create a new ear structure that is the same size and shape as the normal side ear. If both sides are missing, a template from a child of a similar height can be used. This rib cartilage “ear” is then inserted under the skin of the face into the position where the ear should sit. A drain is placed under the skin to remove any liquid or air, and a pressure dressing is applied to allow the skin to adhere to the cartilage. The dressing and drain are removed after two days or at the time of discharge from the hospital. After this procedure, the ear cartilage is under the skin but flat against the side of the head, without projecting away from the head.
- The second surgery is performed three months later. The lobule or soft portion at the bottom of the ear is rotated and small corrections to the cartilage can be made. This is an outpatient surgery, meaning the child can go home following the surgery.
- In three more months, the third and final surgery is performed. During this stage, a small piece of rib cartilage is used as a wedge to place behind the ear and push it forward so that it now sticks off the side of the head in the proper position. A small skin graft is taken to line the back of the defect if needed. Generally, a one-night stay in the hospital is needed following this final stage.
Risks of surgery include infection or bleeding, wound healing complications, injury to the chest or lungs while harvesting the ribs, or injury to the nerves of the face. Long-term issues are rare unless the cartilage is damaged in an accident, but since it is the child’s own tissue, it generally heals very well. Follow-up is needed only if there are issues or complications.
Prominent Ears: Unlike infants with deformation of their ears, school-age children have cartilage that is stiffer and cannot be molded. Correction of prominent ears requires surgery. Each surgical plan is tailored to the exact issues that are present and concern the patient. Surgery is generally an outpatient procedure, meaning the patient can go home following surgery. The surgery takes about two hours and all the incisions are behind the ear or within the cup of the ear. The cartilage and skin of the ear are reshaped, and sutures are used to hold the ear back in a more appealing position. A large cup dressing is placed over the ear to hold it in place and is worn for one week following surgery. After that, a sports headband is used to hold the ears back in a position closer to the sides of the head for the next one to two months.
Risks and complications of surgery include bleeding and infection, asymmetry, recurrence of the deformity, and need for a revision surgery, though this is rare. No follow-up is needed unless the patient is unhappy with the appearance of the ears.
About the Team
Texas Cleft-Craniofacial Team
University of Texas Health Science Center Professional Building
6410 Fannin, Suite 950
Houston, Texas 77030
Plastic & Reconstructive Surgery Clinic: (832) 325-7234
Texas Cleft-Craniofacial Team: (713) 500-7302
Office Hours: 8:00 a.m. to 5:00 p.m. (Monday-Friday except major holidays)