Last updated: 11/24/2009

Congenital abnormalities of the ear

Diagnosis of microtia is made by the obstetrician or pediatrician at the time of the child's birth. The diagnosis of prominent or protruding ears, however, is somewhat more complex because the deformity...

is a matter of shape and proportion rather than the absence or major malformation of a body part. The head of a newborn infant is larger in proportion to its body than is the case in adults, and as a result, the shape of the ears may not concern the parents until the child is two or three years old.

Otoplasty to correct microtia is usually started when the child is at least five years old. The surgeon must remove a portion of rib cartilage in order to construct a framework for the missing ear, and children younger than five may not have enough cartilage. In addition, it is easier for the surgeon to use the child's normal ear as a model for the size and shape of the reconstructed ear when the child is five or seven years old. Otoplasty for microtia is preceded by consultations between the surgeon and the child's parents. Following the diagnosis, a comprehensive treatment plan is made that includes long-term psychosocial as well as surgical follow-up. The reconstruction of a missing ear must be done in several stages because the surgeon must allow for changes in the proportions of the child's face and skull as he or she matures as well as attempt to make the new ear look as normal as possible.

As of 2003, there is some debate among plastic surgeons concerning the best age for performing a setback otoplasty. Many recommend the operation when the child is between five and seven years old. One reason is that the human ear has attained 85–90% of its adult size by this age, and therefore the surgeon can estimate the final size and shape of the ear with considerable accuracy. In addition, the cartilage in the ear is still relatively soft and easier for the surgeon to reshape. Another reason for performing an otoplasty in children in the early elementary school years is psychological; name-calling and teasing by peers can be emotionally destructive for children in this age bracket. On the other hand, some surgeons have reported performing setback otoplasties on children as young as nine months with no disturbances in the growth of the ear or recurrence of the problem.

Preparation for otoplasty in children should include an assessment of the child's feelings about the procedure. Some surgeons consider opposition on the child's part to be a contraindication for surgery, as well as unrealistic expectations on the part of the parents. In general, a positive attitude is associated with faster recovery and better overall results.

Preparation for otoplasty in adults includes a physical examination and standard blood tests. Patients are usually advised to discontinue taking aspirin and any other medications that thin the blood for two weeks prior to surgery. Plastic surgeons strongly urge adult patients to quit smoking before the surgery, because smoking delays and complicates the healing process. Adult patients are also asked to shower and shampoo their hair thoroughly on the morning of the procedure. Men should have a haircut or trim a day or two before surgery; women should braid or pin their hair close to the head.

Trauma

Avulsion injuries caused by bites, thermal or chemical burns resulting from industrial accidents, and other traumatic injuries of the auricle are diagnosed by emergency physicians.

Plastic surgery for traumatic injuries of the auricle is preceded by thorough cleansing of the wound and debridement of damaged tissue. It is important to treat ear injuries promptly because the ears are not well supplied with blood vessels. This characteristic makes it easier for infection to develop in parts of the auricle where the skin has been torn open or crushed. In some cases, plastic surgery is postponed for a few days and the patient is given oral penicillin to prevent infection.