When a child is born with an absent ear, keeping the opposite functional eardrum healthy takes on an even greater importance. I recommend that parents who have a child with microtia be on the lookout for any sign of an ear infection on the opposite side (it is not really possible to get an ear infection on the microtic side). Multiple ear infections on the unaffected side may diminish hearing; therefore, parents should have a low threshold for bringing their baby to the pediatrician (or pediatric Ear, Nose and Throat specialist) to check for possible ear infections. In general, the vast majority of children with microtia never need any hearing aids. It is important to have your child's hearing tested periodically to ensure the health of the unaffected ear.

There are two options to rebuild the ear, one is to get an artificial ear, and the other is to rebuild the ear using the child's own rib (also called an autogenous reconstruction). I believe that it is important that the child participate in the decision as to which to ear would be best. The pro and cons of each method of reconstruction are discussed in an office visit. For those families choosing an autogenous reconstruction, the outer ear is typically reconstructed around age eight, but on occasion may be done as early as six. The best time to rebuild the ear is determined by the child's size (more importantly, how big the child's ribs are) and how the child is coping socially. Ears are reconstructed over a series of three operations.

The first stage ear reconstruction, in a child with hemifacial microsomia is shown above (upper row, left). Cartilage is taken from the child's rib (parents cannot donate their rib cartilage) and this cartilage is carved and assembled to match the opposite ear (upper row, right). It is then inserted under the skin. I do not place any bandages for the first stage, although most doctors do wrap up the entire head with a bandage; I have learned that these bandages do not do anything to help the child, and only make the operation more difficult for the child. Two additional stages are required to complete the reconstruction; both performed as outpatient procedures. The second stage involves cutting behind the ear and lining this space with a skin graft. After surgery I cover this new skin with a yellow bandage (bottom row, left) that is removed about a week later. The appearance of the ear after the second stage is seen in the photograph on the bottom row, middle. The third operation creates the appearance of an ear canal, but it does not help hearing. Following this third, and smallest procedure, the ear is finished (bottom row, right).

There are a number of variations on the techniques used to rebuild an ear, and different doctors may use different techniques. Many people may have seen a picture of an experimental mouse with an ear growing on it's back. Unfortunately, attempts to transfer these grown ears to the head have ended up looking terrible. The experience and the artistic ability of the doctor performing the operations are probably more important than the specific technique the doctor chooses. Before undergoing ear reconstruction, it is wise to ask your doctor to see examples of his or her work. It is very difficult to impossible to rebuild an ear that did not turn out well the first time.

Following outer ear reconstruction, it is also possible for children to undergo inner ear reconstruction (by a specialized ENT) in order to rebuild the absent eardrum. This is done to try to improve hearing on the affected side, and achieve some stereo hearing that improves the localization of sound. This operation is not without some downsides that need to be discussed with your doctor. I also strongly recommend speaking with other patients who have undergone inner ear reconstruction before deciding to proceed with inner ear surgery. For those who decide to proceed with inner ear surgery, it is important to first finish building the external, or outer ear.

Causes | Can my child hear out of this ear?
<<More About Microtia