EAR RECONSTRUCTION SURGERY

Ear Deformities

1. What causes ear to excessively protrude?
   • All mammals need to move their ears to protect themselves. When eating or drinking from a stream animals move their ears to quickly hear any predators early that may be stalking them to eventually eat them. Those animals with muscles attached to their ears were better able to hear. If these animals moved their ears, they can hear these predators earlier and hopefully run away to protect themselves. However, as man evolved, he used developed weapons to protect himself form dangerous predators. Therefore, when they were able to protect themselves with weapons, moving their ears for protection was not essential for survival. Their offspring without muscles were able to survive and past their genes (without ear muscles). Without these ear muscles, the ears (auricles) may protrude because there is nothing to “hold” them in their proper place. This is why some individuals have protruding ears (because their ear muscles have not developed). Approximately 4% of adults still have strong auricular muscles and are able to move their ears, and also have these muscles keep their ears from protruding.
2. What is microtia?
   • Microtia (micro= small, otia= ear) means small ear. This is a deformity that children are born with. It occurs in 1 in 6,000 births.

     There are four (4) grades of microtia.

     Grade I: This is usually a small ear that has all of its components (anatomical subunits) present.
     The ear can be misshapen, and appears abnormal. Many of these types of ear deformities can be repaired NON-SURGICALLY if molding procedures if treated within the first few days of birth.

     If this deformity is recognized later on, the excessive protrusion can be corrected WITHOUT incisions, using an “incisionless” otoplasty techniques without any surgical cutting.

     Grade II: These are ears that are small and have parts that have not developed and are misshapen.

     Grade III: This is a severe type of ear deformity where only the lobe of the ear is present. This is usually associated with no ear canal (atresia) and a loss of hearing in that ear.

     Grade IV: This is the most severe ear deformity where that are no parts of an ear and not ear canal.

3. What causes microtia?
   • The outer ear begins to form around the first three weeks of pregnancy, many times before the mother is even sure she is pregnant. The baby (embryo) looks like a fish at this and has gills. The first two gills form the outer ear. As these gills develop into an outer ear, they also migrate (move) from beneath the chin to the proper position on the skull. Adverse events that may occur during these critical first few months of pregnancy can cause mal development of the outer ear.

     Drugs: like Accutane and Thalomide are known to adversely affect proper development of the ear.

     High fevers: during the first few week of pregnancy may affect the blood supply to the developing ear and affect proper development of the ear.

     Hereditary factors: An abnormal family inherited gene may affect proper development of the ear.

4. What are the chances of having another child with microtia or my child having an offspring with microtia?
   • With most families there are no hereditary factors that cause microtia. “It just occurs.” These children and parent have a 1:25 chance of having another child with microtia. However, some patients are born with several other abnormalities along with microtia (such as Treacher Collins, Goldenhar, CHARGE, and Nagger Syndromes). These patients have a definite chromosomal issue and have a much higher chance of having another child with similar deformities.
5. What other deformities are associated with microtia?
   • During the first twelve weeks of pregnancy while the ears are developing and moving to their proper position, other organs are also are developing. There it is important for your doctor to evaluate the nerve of the face, kidneys, pattern of heart rate, development of the neck, and the hearing. We therefore recommend that all children with microtia have genetic counseling.
6. When should hearing be tested?
   • All children should have their hearing tested in the hospital with screening testing called BAER
     (brainstem audiometry evoked response) audiometry. Children with microtia in BOTH ears (bilateral) need to have hearing aids placed within a few months of birth. There is usually no necessity to have a hearing aid for children with only one ear affected.
7. Are children with microtia troubled psychologically?
   • Studies have shown that children begin to have “body awareness” at age 3 to 3 ½ years of age. By age 5 when school starts, some children begin to have emotional issues and teasing by their classmates. We finde if the families tell the children that there are “special” and present little emotional overlay, the affected children do much better.
8. When should children have their ears constructed?
   • We are now using a prefabricated material (porous polyethylene) MEDPOR instead of using a child’s ribs. The advantages are that reconstruction can begin as early as 3 ½ to 4 years of age, there is no chest deformity of chest pain when we used to use rib grafts, and the reconstructed ears have a more normal feeling and appearance.
9. What material is used?
   • As mentioned, we are using a synthetic material called MEDPOR to reconstruct the ears. This allows us to create an ear in only two stages instead of four to five stages. There is considerably LESS discomfort than using ribs.
     • Advantages of MEDPOR Reconstruction:
       1. No chest pain.
       2. No chest deformities.
       3. Two surgeries in place of four.
       4. Earlier age for reconstruction. Can begin reconstruction at age 4-5 instead of 6-7 years old.
       5. Reconstructed ear is “softer” and more normal appearing.
10. When should hearing be corrected?
    • Hearing should be corrected AFTER the outer ear is constructed. There are several factors that determine what the best procedure is to correct the hearing. If there is only a minor deformity of the ear canal, we often make a canal. However, more frequently we are improving the hearing by placing a “bone conductive type” hearing aid (BAHA).
11. Are there any limitations after surgery?
    • After three months post-operatively, patients have no limitations on their physical activities. They can have pierced ear rings inserted, but only in the ear lobe area. Many of our patients have played football wearing helmets without any risk to their constructed ears.