Congenital Ear Deformities: What Should I Know?

Ears come in a variety of shapes and sizes. The same individual’s ears can even each be different from the other in subtle and obvious ways.  Thus, an ear deformity may range from a minor abnormality in which the ear is slightly folded to a major one where the ear may be absent. The deformity becomes more visible, and consequently, more problematic when it affects just one of the ears. Through this blog, I hope to answer some of the questions I hear from parents everyday about ear deformities and what we are doing at Texas Children’s Hospital to help each patient. Major ear deformities, which include an absence of the ear or a deformity involving any one of the structural components of the ear, require surgery for a more complete correction. This generally requires borrowing rib cartilage to fabricate a new framework for the ear and placing this into either an existing or a newly created skin envelope. Given the need for rib cartilage, these types of reconstructions are delayed until at least 5 to 7 years of age and may take several stages of surgeries to complete. Prominent ears are ears that “stick out” more than the accepted norm. This deformity is caused by the abnormal 3-dimensional folding of the ear. Naturally, each individual’s perspective of what is abnormal is highly dependent on multiple factors like a patient’s background, culture and surrounding societal norms. Prominent ears can cause significant social concerns for the child as well as the parents. This type of ear malformation can also be surgically corrected and is usually done around 4 to 5 years of age. At this age, the patient’s ear has completed the majority of its growth and it is also at an age in which the patient, and their peers, become more aware of the deformity. For this surgery, the ear is surgically manipulated to create the normal folding of the ear. This is an outpatient procedure and generally well tolerated by most patients with good results. There are other types of ear deformities that are related to the abnormal folding of the ear. The ear may not be prominent but abnormal folding of the cartilage or the skin can create a hooding or notching effect on the ear.  Some of these deformities can also be corrected and are also carried out around 4 to 5 years of age. Major deformities require surgery later in life. However, prominent ears and other minor deformities may be amenable to a more conservative option. If seen early enough, within first 2-3 weeks after birth, an attempt can be made at molding the ear to correct the deformity (see figure). The ears are able to reshape in the first few weeks of life, due to maternal estrogen in the infant. A molding device is applied and changed every 2 weeks for a total of 6 to 8 weeks. Molding does not work on every child but, if successful, can prevent the need for surgery in the future. We offer full spectrum of treatment for congenital ear deformities. For more information, please visit Texas Children’s Plastic Surgery Department.