By: Nicholas Bastidas, MD, FAAP
Babys’ ears play a big role in helping them take in the world around them. They let them hear vibrations as sound, help them learn to talk, and even balance so they can begin to walk. As children get older, ear shape also can play a role in their social confidence.
For babies born with structural abnormalities of the ears, a range of treatment options can help prevent these conditions from affecting a child's development.
Of the roughly four million babies born in the United States each year, an estimated 15 percent or 600,000 of them have some abnormally shaped ears. Doctors used to believe that misshapen ears would correct on their own as a baby grew. Current research shows this is not the case, with about 70 percent of untreated ear deformities lasting into childhood.
A better understanding of the cartilage that forms the outer ear, as well as advances in biomedical engineering, have led to more treatment options to correct ear abnormalities in children. Some treatments help a child's ears work properly, while others are more about making them look better.
For example, surgery can rebuild parts of the ear that didn’t form fully and help a baby hear properly. For other cases, simple molding devices designed for infants to wear can help correct ear shape deformities.
Types of Ear Abnormalities
There are many different types of ear abnormalities, including:
Prominent Ear: Ear sticking out more than 2 cm from the head
Constricted (lop/cup) Ear: The outer rim of ear is rolled or folded.
Cryptotia: When the upper rim of the ear is tucked underneath scalp skin.
Stahl's Ear: Pointy shaped ear.
Microtia: The outer ear is underdeveloped or small.
Anotia: Missing ear.
Congenital Earlobe Deformities: Split or double earlobes, sometimes with skin tags.
Accessory Tragus (ear tag): Bump of skin or cartilage in front of the ear.
Ears that are folded, stick out or are otherwise irregularly shaped can be a source of embarrassment and teasing for young children. It’s often why they may want surgical correction (called otoplasty). However, there are non-surgical treatments that can be done shortly after birth that can avoid the need for corrective surgery, which is often postponed until a child is around five years old and requires an operation under general anesthesia.
Ear Molding. Using custom devices, pediatric plastic surgeons can mold the ears into a more “normal” shape, proportion or position. Generally, the earlier the ear is molded, the more successful the outcome. Less than three weeks of age is considered the ideal time to begin ear molding, though some improvement can still be achieved if started later.
There are several ear molding methods. One of the more common techniques involves placing a soft silicone cradle around the ear and applying plastic retainers to reshape the ear cartilage. The device is held on using tape and is worn for a period of 4-6 weeks. After the molding devices are removed, double sided tape may be placed to hold the position for another 2 weeks. An estimated 90 percent of all ear deformities can be corrected using this non-surgical method.
When Surgery Can Help
Otoplasty. Older children with ear malformations may not benefit much from simple techniques such as ear molding. For these children, surgical options, such as otoplasty, are available. Otoplasty reshapes the outer ear using permanent stitches placed through a hidden scar behind the ear. This procedure is performed as an outpatient surgery in early childhood after the ear has completed most of its growth.
Reconstructive surgery. Ear deformities such as microtia (small ears) may need more complex reconstruction procedures. Microtia reconstruction is often performed in two or three operations by pediatric plastic surgeons. The surgeons use either cartilage from the rib or a synthetic material such as porous polyethylene to build or shape the ears.
Ear reconstruction is usually delayed until a child is 6 to 10 years old when using rib cartilage, and 3 to 5 years old if synthetic material is used. An artificial, prosthetic ear may also be an option. The ear canal may be missing in children with microtia. As a result, these children may benefit from a bone anchored hearing aid (BAHA) to improve the quality of hearing.
Ear abnormalities such as microtia sometimes are related to
congenital disorders that may affect the other parts of the child's body such as the kidneys or other organs, so your pediatrician may recommend an
ultrasound or other tests.
About Dr. Bastidas:
Nicholas Bastidas, MD, FAAP, is a member of the American Academy of Pediatrics Section on Plastic Surgery. He also serves as Assistant Professor of Surgery and Pediatrics at the Hofstra School of Medicine, Northwell Health System and the Director of the Institute of Pediatric Plastic and Craniofacial Surgery (www.ippcs.org) based in New York.