Microtia and Anotia

Microtia literally means “small ear” and may involve absence of part to nearly all of the external ear. In addition, children with microtia typically do not have an external ear canal or ear drum. The middle ear structures, however, are generally normal. As a result, most children with microtia will have some degree of conductive hearing loss in their microtic ear. Despite this hearing loss, the majority of children who have one normal ear will not require hearing aids. Children with bilateral microtia, on the other hand, should be evaluated early to see if they will benefit from bone conductive hearing aids.

Anotia is an rare condition characterized by complete lack of any external ear structures. Since children with microtia and anotia may have other congenital abnormalities that require comprehensive evaluation and treatment, they should be seen and evaluated by an experienced craniofacial team.

Treatment

Correction of microtia and anotia generally involves four surgeries. The first surgery is typically performed when a child is 5-8 years of age. By this age, the opposite normal ear has reached approximately 90% of its adult size, allowing more precise matching of the reconstructed ear to the normal side. In addition, by the time children are 5-8 years of age, they are usually large enough physically to allow the safe harvest of enough rib cartilage to construct the new ear. During the first surgery, rib cartilage, harvested from the lower rib cage, is shaped into the framework of an ear. This framework is placed underneath the skin in the area where an ear would normally be placed. Once this heals, the second stage involves rotation of the ear lobe into a “normal” position in relation to the new cartilage framework. The third surgery involves release of the framework from the scalp, and placement of a skin graft posterior to the ear to allow the ear to project normally from the scalp. The fourth and final surgery involves creation of the conchal bowl (the bowl of cartilage that leads to the ear canal). This stage involves taking cartilage and skin from the normal ear but does not change the shape of the normal ear.