Microtia

What is Microtia?

• Microtia means a small external ear. This condition can range in severity from a small ear that has all of its parts, including an ear canal and a normal-appearing shape, to one that has no ear canal and only a small remnant of skin and cartilage.
• It can occur either on one or both sides. Microtia often occurs as an isolated problem and is not associated with other abnormalities. There are, however, syndromes such as Treacher Collins and Hemifacial Microsomia in which microtia also occurs.

What are Microtia symptoms?

• Symptoms are minimal and mostly involve impaired hearing if the internal structures are also involved.
• There is a significant psychosocial impact that ear deformities cause.

What are treatment options for hearing and appearance in microtia patients?

• A multidisciplinary approach is required. This is often provided by a craniofacial team usually located within a tertiary care or university center.
• The choice of the best treatment method for your child must involve open discussions between the members of the craniofacial team, the family/caregivers and, most importantly, the child. There is not one best option for treatment in all children. The best treatment option remains the one that best suits the child’s needs and desires.

Hearing 

• Children with one-sided microtia who have one normally hearing ear have normal hearing in one ear and do not require specific treatment. There are centers that offer the creation of an external opening and ear drum when normal middle ear structures are present. A detailed examination, investigations and discussion with an ENT surgeon are necessary prior to proceeding down this treatment path. 
• In children with both sides affected, hearing aids are recommended to ensure normal hearing and speech and language development. Broadly, two types of 3 hearing aids exist: those that are worn on a headband and others that are anchored to the skull bone.
• Communication between the surgeon doing the ear reconstruction and the one placing the bone anchored hearing aids is very important to ensure that the hearing aids do not interfere with appropriate positioning of the ear. This type of communication occurs readily within a craniofacial team environment.

Appearance

• The child will live with having microtia and the consequences of its treatment his entire life. Therefore, it cannot be overstated that the principles of treatment for facial appearance should be guided by the child.
• Surgery or prosthesis fitting occurs between 6-10 years of age. This timing varies, depending upon how the child is coping socially and psychologically and also on the growth of the face and body.
• Treatment options include no intervention versus reconstruction of the external ear. The reconstructive options include: having a prosthesis made, surgical reconstruction that uses a combination of synthetic material and the patient’s own tissues, or surgical reconstruction using only the patient’s own tissues.

• No Intervention – Ear reconstruction is not a necessity. This is true especially if the child does not perceive having microtia as a problem both psychologically and emotionally. The options for the creation of a new ear change very little as the child with microtia grows and so the subject of ear creation can be discussed and performed at any time including adulthood.
• Prosthetic Reconstruction – A prosthesis is completely artificial and usually made of silicone from a mold that often uses the opposite ear or a parent’s ear as a template. The prosthesis can either be held onto the head with adhesive or using magnets or clips. The magnetic or clip-on prosthesis requires a minor surgical procedure to place bone screws permanently into the skull.
• Combined Prosthetic and Own-Tissue Reconstruction – This form of treatment uses a premade synthetic ear framework that is then covered by the child’s own local tissues. The framework is made of a plastic material that has holes within it allowing blood vessels and tissue to grow into it over time. Therefore, the framework eventually becomes a part of the child.
• Total Reconstruction Using Only Own Tissue – This type of reconstruction uses the child’s rib cartilage (usually 3 ribs) to create an ear framework that is carved out of the harvested cartilage. The framework is then placed under the skin in the appropriate position. A second operation, 3-9 months after the first, is performed to lift the ear into a position similar to the opposite ear. Sometimes a third and even fourth operation is necessary to fine-tune the appearance of the reconstruction and move the ear lobe.