Frequently Asked Questions about Microtia and Aural Atresia

What is microtia?

Microtia means small ear and is a congenital birth deformity of the pinna (external ear). Microtic ears can vary from just small ears to a total absence of the external ear (anotia). Eighty percent of the time it is unilateral (one sided), 20% of cases are bilateral (affecting both sides).

How does microtia affect hearing?

In most cases there is about a 40% reduction in hearing in the microtic ear (similar to sticking your fingers in both your ears). They will also have problems locating where a sound is coming from.

Do children with bilateral microtia experience more problems?

Yes, they will have more of a hearing problem and should be fitted with special hearing aids before they are 6 months old. The sounds that babies hear in the first 12 months are very important for speech development and future success in school.

How often does microtia occur?

Microtia occurs in one of about 5,000 to 7,000 birth.

Did the parents have any effect on the problem?

The exact cause (etiology) of microtia is somewhat obscure, however, there is no evidence that the parents’ activities during pregnancy contribute in any way to this condition. And there is nothing that could have been done during a pregnancy to prevent microtia from occurring.

What are the chances of having a second child with microtia?

About one in 20, or 5%.

When will my child become aware of microtia?

Most children begin to notice their “little ear” when they look in a mirror at around age 3 ½ or 4. Or other children may mention it to them.

What should parents tell their child?

They can tell their child that they have a small ear the same way that some children are tall or short, or fat or thin, etc. They can also say that when they are older the doctor can make it bigger. The important thing is not to make much of a fuss about it. If the family is anxious or ashamed he child will be also.

Will my child need speech therapy?

Children should be assessed between 12 and 18 months, usually by a local early intervention program, to determine if speech therapy would be helpful.

Is microtia associated with any other problems?

The majority of children with microtia have no other medical problems. About 30% have underdeveloped bony and soft tissues on the affected side (hemifacial microsomia), and a small percentage of others experience other syndromes.

What is atresia?

Atresia, also known as aural atresia, is the absence or underdevelopment of the ear canal and middle ear structures. Patients who have atresia have no hearing on the affected side. Microtia is almost always accompanied by atresia because the external and middle ear develop at the same time in the womb.

How can the healthy ear be protected?

It is very important to aggressively treat any ear infections in the normal ear to protect its hearing. This is particularly important during the cold and flu season. It is also important to wear sports helmets and watch the volume on earphones.

What surgical treatments are available for microtia?

There are three treatment options for microtia. In the first an artificial, prosthetic ear is attached to the head. The second option is to insert an artificial ear framework under the skin. The third, and most popular option is to use one’s own rib cartilage to create a new ear.

Can one use rib cartilage from a family member or friend?

This is not recommended because tissue other than one’s own is “foreign tissue”. Transplanted foreign tissue would require the patient to take special drugs for the rest of his/her life to prevent rejection.

What is the best age to begin reconstruction?

Most parents and surgeons wait until the child is 9 years old. By then, the rib cartilage will be will be large enough to form a framework for the new ear.

Which surgery comes first, hearing or microtia?

It is best to perform the external ear reconstruction before the middle ear surgery that improves hearing.

How painful is the surgery?

The child will be asleep during major surgery with the anesthesia administered by a pediatric anesthesiologist. After surgery, patients go home with pain medication. Other surgeries are done on an outpatient basis, and recovery is relatively minimal.

Are there limitations on sports and other activities after surgery?

Most patients can return to swimming and other sports activities in 4 to 6 weeks after surgery. Thereafter their “new” ear can be treated much like their “old” ear.