Microtia is the medical term for an incompletely formed ear that may range from an ear that is smaller than normal to just a bit of tissue at the location where the ear would normally be. Atresia is the absence of an ear canal in the middle ear. Microtia and atresia can occur alone or together, and they can also be associated with hemifacial microsomia. If both ears are affected, Treacher Collins syndrome may be involved.
There are several treatment options for a child with this condition, depending in part on how severely the ear is affected. In some cases, no treat ment is necessary. For more severe cases, a new ear can be crafted from the child's rib cartilage in two separate operations. Because the cartilage must be mature, this technique is not offered until a child is at least 10 years old. After the cartilage is removed, surgeons carve it into an ear shape and slip it into a pocket of skin on the side of the child's head. At this stage it looks like an ear, but it lies flat against the side of the head where it will gradually stick. Six months later, a second operation is carried out to release the ear and create a groove behind it. The new ear is usually stiff but looks like an ear, feels warm, and will eventually have sensation. It will not grow, but by age 10, most children's ears are already adult size.
However, if a child had previous surgery to the ear or other scars, it might not be possible to use this technique to form a new ear. In this case, surgeons can insert a prosthetic ear anchored to fixtures embedded into the bone at the side of the child's head. The prosthesis is made of a soft sili-cone material and looks quite lifelike. The two required operations can be carried out when a child is about seven or eight years old. Any skin tags and vestiges in this area need to be removed prior to fitting the implants. During the first operation, surgeons place three titanium implants into the bone on the side of the small ear. In the second operation three months later, doctors will attach two screws to the implants.
A few months after the second operation, a bar will be fitted, and the new ear will be made to the same size, shape, and color of the child's other ear, which will clip onto the bar.
A good prosthesis of this kind will last about two years and can be worn even while swimming. The prosthesis can be worn at any time, but is generally taken off at night. The area around the screws that keep the ear attached to the skin must be cleaned every day.
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