Ear Deformities
Ear deformities occur when there is a problem in one of the anatomical and location structures of our ear. These problems can be too small to affect the person, or they can occur in cases where the ear does not develop at all or remains very small. In children born with this type of deformity, some conditions such as internal organ and facial development anomalies and mental retardation also occur. Therefore, the baby should be taken for a detailed analysis. Some ear deformities are accompanied by developmental disorders in the inner ear. Therefore, children born with these problems should undergo a detailed ENT examination.
What are the deformities seen in the ear?
Congenital ear anomalies are mostly seen in male children and in the right ear. These anomalies are; the ear pinna is not formed at all (anotia), the earlobe or pinna is formed to a very small part (microtia), the upper part of the ear pinna is narrow or short (lop ear) and the ear pinna is large (protruding ear). The most common of these disorders is protruding ears. Protruding ears can cause psychological problems, especially in childhood, due to comments and jokes from the environment. Today, it is often possible to get rid of this problem with surgical intervention.
Although the cause of ear deformities is not yet known for sure, it is stated that the problems may be caused by factors such as the baby being exposed to poor circulation in the womb and the mother using certain medications during pregnancy.
What is the problem of prominent ears?
The most common ear deformity is the prominent ear. Prominent ears are caused by the angle between the ear and the head being larger than normal. This condition does not mean the size of the ear but the angle between them being larger. This condition, which is not considered important during the newborn period, is perceived as a problem by the child himself from the age of 4, when the child starts to make friends and socialize, and this anxiety continues to increase until the school registration process.
Aesthetic appearance is a major social problem for children in the ages when psychological change and development occur. Children with prominent ears are ridiculed by their friends, and this situation causes permanent marks on the child’s psychology that are difficult to compensate. The treatment for the prominent ear problem is surgery. Due to the psychological reasons mentioned, surgery should be performed in the pre-school period.
What are the other problems that may accompany prominent ears?
Ear development continues throughout pregnancy. In this process, the earlier the time of developmental deterioration, the more severe the disorder or developmental delay. The ear takes its main shape in the 3rd – 6th weeks of pregnancy, the shape of the ear reaches its adult shape at the end of the 20th week and continues to develop until the age of 3 after birth. In other words, the complete absence of the ear or its severe deformity occurs in the first 7 weeks of pregnancy, and milder deformities occur after the 7th – 8th week.
Other anomalies accompanying prominent ear usually increase with the degree of the auricle being affected. The auricle deformity may be accompanied by complete obstruction in the external auditory canal or milder developmental delay, adhesions in the middle ear ossicles, developmental or inner ear anomalies. In addition, facial developmental delay is a frequently seen anomaly depending on the severity of the involvement. Unless it is very obvious, it cannot be noticed except by an expert in the field.
If the deformity in the auricle is only due to the failure to form the required angles, the development of other structures related to the ear is usually normal. However, if the developmental disorder in the auricle is severe, there is a high probability that the child will have problems with hearing. This is a matter that should not be ignored.
Hearing should also be evaluated in these children or adults. While familial transmission is more evident in cases accompanied by hearing problems, hereditary characteristics are less effective in isolated prominent ear deformities. In addition, measles infection during pregnancy and the use of certain medications can cause these anomalies.
How is protruding ear treated?
Protruding ear treatment is divided into two categories: preventive and surgical treatment.
1) Preventive – Non-Surgical Treatment:
Ear deformities are noticed by conscious parents in the early period, immediately after birth, and a mold is prepared and supported according to the shape the ear should be, and this is based on the principle that it develops and shapes in the desired way.
The 2-3 weeks after birth are the period when the flexibility of the auricle decreases rapidly. Therefore, the mold (splinting) application during this period is actually very effective and 80% of the time surgical treatment is not needed. This treatment period is usually between 3 and 12 weeks.
2) Surgical Treatment:
First of all, deformities should be detected, and surgical planning should be started by taking into account the patient’s age and the degree of hardness of the ear cartilage. Pre-operative photography is very important. A good evaluation of the underlying anatomical disorder that causes the prominent ear deformity before surgery will ensure that the correct surgical technique is applied and therefore optimal surgical results are obtained.
85% of ear development in children is completed by the age of 3, and 90% by the age of 7. In light of this information, the procedure for correcting prominent ears in children is recommended between the ages of 4 and 6, considering the psychological aspect. In addition, the ear continues to develop after surgery.
How is prominent ear surgery performed?
When deciding on surgery in children, their wishes should be taken into account. If the children are willing, they will be more compliant with the dressings after the operation. While surgery is usually performed under general anesthesia in children, it can be performed under general or local and sedation anesthesia in adults.
Prominent ear surgery (Otoplasty) takes 1.5-2 hours. Complicated cases may take longer. The surgical technique may vary depending on the problem in the ear. The cartilage tissue is usually reached with an incision made from the back of the ear. Sometimes sections are removed from the cartilage tissue or the ear is shaped by gently filing the cartilage without removing the tissue. The ear is folded back without disrupting the anatomical fold structure. In addition, permanent stitches are placed to prevent it from opening again. Since this surgery is performed with an incision made from the back of the ear, no scars are encountered later. No matter which technique is applied in the operation, a dressing is applied with appropriate pressure to support the ear that underwent surgery and to maintain the given shape.
What is the post-operative process like?
The dressing mold created after the surgery also prevents feared complications such as bleeding and blood accumulation. This mold is usually checked on the first day after the operations and completely removed on the fifth day. However, a hair band is worn and used especially at night for three weeks. Children can return to school 7 days after the surgery, but it would be useful to inform the child’s teacher about activity restrictions. Adults can return to work within 5-7 days. The stitches either dissolve on their own or are removed within a week. It is recommended to stay away from any activity that may cause bending and folding in the ears for 4 weeks. After approximately 6 weeks, the ears begin to take their final shape and the patient continues their life with their new ear canopy (pinna).
Although the final recovery takes about 6 months, the patient notices the formal improvement in their ears on the first day. When performed according to the rules, prominent ear surgery is a surgery that makes the patient and the surgeon smile in a very short time and actually involves a lot of work in a short time.
What are microtia and anotia?
Congenital, only a very small part of the earlobe or pinna is called microtia. Treatment of this problem is usually waited until the child is 5-6 years old, but if the anomaly is bilateral, surgeries should start at age 4.
In general, the ear skeleton is first created from the child’s own tissue (cartilage taken from the rib). Then the earlobe is shaped. Several correction surgeries may be required after these surgeries.
Another method is to make a prosthetic ear. The prosthesis is placed in the skull with screws by a plastic surgeon. Magnetic silicone ear prosthesis can also be applied in the treatment of microtia and anotia deformities.
Microtia and anotia surgeries are operations that require patience because the ear is almost completely gone. Treatment should be continued patiently until the ear takes the desired shape.
Sources:
- Cleveland Clinic
- Yale Medicine
- US National Institutes of Health (NIH)