Underdeveloped ears and hearing loss can be treated through an ear reconstruction procedure known as microtia surgery. A rare ear-related issue, 1 out of 10,000 infants may be born with some type of microtia. Los Angeles plastic and reconstructive surgeon Dr. Andre Panossian is an expert at successfully treating microtia through ear reconstruction surgery – improving the ear anatomy in pediatric patients for better form and function.
Microtia is a developmental abnormality of the outer ear that is present at birth. The ear is small and misshapen, without the structural support that is present in fully formed ears.
In some cases, microtia also affects the patient’s hearing due to a narrow or absent ear canal, a presentation known as aural atresia. The condition is sometimes mentioned or written as anotia/microtia. While microtia describes an underdeveloped outer ear, anotia is the absence of the ear altogether.
Microtia and anotia are grouped into the following grades:
- Grade I: the ear and ear canal are smaller than average, though the parts of the ear are formed externally and internally
- Grade II: the external ear is misshapen, and the ear canal might be narrowed or unformed
- Grade III: the external ear is more extensively misshapen, small, and generally does not contain cartilage; the ear canal might be narrowed or unformed
- Grade IV: there is no external ear and the ear canal is generally unformed as well
- Grade 3 microtia is the most severe form of the congenital defect microtia, and anotia is the complete lack of an ear.
While it is not always known why babies are born with microtia, issues with the cells responsible for development or insufficient blood supply may be the cause of why microtia occurs. Certain diseases affecting the mother during her first trimester of pregnancy, like rubella, may also lead to microtia and hearing impairment. Additionally, there are medications that may contribute to this abnormality:
- Retinoic acid can be ingested or applied topically for various conditions
- Accutane is a medication that treats severe forms of acne
- Clomiphene is a medication used in fertility treatments
- Thalidomide was a medication marketed to relieve morning sickness until it was discovered that the drug caused birth defects
Some cases of microtia appear to be linked to both genetic and environmental factors, including exposure to the above drugs.
Is Microtia Considered a Disability?
When coupled with hearing loss, a child with microtia may be considered disabled. Typically, hearing loss that persists for a year or longer and is backed by medical tests are the requirements for a disability recognized by the government.
Limited hearing can affect a child’s communication skills and learning pace, so parents should be diligent about scheduling appointments with the necessary specialists from the very beginning. Social Security income may cover some of the medical expenses incurred as a result of the condition.
It is common for children with hearing loss to develop a learning disability because the hearing world is not tailored to their needs. They may benefit from enrollment in special schools or learning American Sign Language for communication. Speech therapy can help bridge the gap from signing to speaking once complete hearing has been restored.
Hearing Restoration Explained
The developmental issues in patients with microtia atresia, where the ear and ear canal are both affected, contribute to conductive hearing loss. Even with reconstruction, it may not be possible for the ear to function normally.
Bone conduction hearing devices, also known as BAHA or cochlear implants, transmit sound waves to the cochlea, which stimulates the auditory nerve. Traditional hearing aids amplify sound through the air, while these systems bypass the outer and middle ear to create neural signals, which the brain receives as sound.
Even if the cochlea is damaged in one ear, Dr. Panossian may be able to utilize the functioning inner ear bone to allow both ears to hear.
How Common is Microtia?
The rate of this abnormal formation of the ear is approximately 1 to 5 in every 10,000 births. For unknown reasons, members of certain ethnicities, including those of Native American and Japanese descent, are at a higher risk of developing the condition.
Microtia affects the genders disproportionately, with more boys than girls diagnosed with the condition. Additionally, it is more common for an infant to display microtia in the right ear than in the left.
How Ear Reconstruction is Performed
Rib cartilage graft, MEDPOR implant, and ear prosthetic
An ear affected by microtia can be repaired through an ear reconstruction surgery. During the plastic surgery portion of the procedure, the outer ear is rebuilt using rib cartilage or a plastic implant known as MEDPOR.
When cartilage is harvested during a rib graft, Dr. Panossian creates a small incision and material is removed to be repurposed as ear cartilage. When MEDPOR is utilized, the porous, biocompatible material fuses the natural tissues with synthetic to create a realistic ear replica. Either option will likely call for a skin graft to cover the newly constructed ear.
Younger patients of 4 or 5 years of age can undergo the surgical construction of a new ear with MEDPOR while children who are 8 years or older are eligible for ear surgery performed with their own rib cartilage. Surgeries performed with MEDPOR usually require only a single stage for implantation while cartilage might be added and modified in multiple stages over a period of months or years.
Dr. Panossian can provide in-depth information on these two options. In cases of microtia atresia with hearing loss, a bone-anchored hearing aid (BAHA) can be implanted during the plastic surgery or scheduled as a separate procedure.
Language development is important during the first year of an infant’s life, and proper hearing plays a crucial role, so some doctors opt to make this correction as early as 6 months of age. Cosmetic corrections will be postponed until the child is older.
A less permanent solution to a small, deformed, or nonexistent ear is the use of prosthetics (ears made out of synthetic material). Small anchors are surgically implanted into the bone and a custom-made silicone ear is attached. The prosthetic ear can be worn while bathing and swimming, but patients may opt to remove it when asleep.
Artificial ear attachments are less expensive than ear reconstruction but are not permanently attached to the side of the head and therefore do not offer the same long-term aesthetic correction of the ear.
Surgical procedures for atresia ear canal are completed after Dr. Panossian reconstructs the external ear following a rib cartilage graft. This ensures the integrity of the blood supply, which can be compromised following other procedures.
A canalplasty is performed to construct or create a larger ear canal, improving a patient’s hearing. Techniques require entrance through the skull to form the canal and a skin graft to line the new opening. Manipulation of existing bones and tissue might be necessary for the best results.
Cosmetic Ear Surgery
Some patients see Dr. Panossian for cosmetic ear surgery to address other ear deformities and concerns. Children may be born with prominent, protruding ears, prompting some parents to move forward with otoplasty, or ear pinning surgery.
This plastic surgery is performed through a small incision made in the back of each ear. Cartilage is removed or adjusted and the ears are permanently positioned closer to the head. Many young children undergo this procedure before entering elementary school to prevent ridicule and bullying from their classmates.
Dr. Panossian can also alter the look of the ears through an earlobe reduction. While the procedure can be performed on younger patients, it is generally adults who have stretched earlobes. This laxity may occur with age, after years of wearing heavy earrings, or the body modification practice of earlobe stretching with gauged earrings. Other patients may have naturally long earlobes that they wish to correct.
Earlobe contouring in patients with “megalobe” can be completed through discreet incisions along the bottom of the lobe or through a wedge-shaped cut to remove excess skin. The adjacent skin is sutured together to create a more visually appealing earlobe.
Another reason patients may request an earlobe repair procedure is due to a tear in the tissue. This can happen when earrings are pulled from the piercing, splitting the lobe from the hole to the bottom of the lobe. Injuries from facial trauma, like impact sports or a car accident, might also require reconstruction or cosmetic surgery to repair an earlobe.
The Consultation for Microtia Reconstruction
Most microtia cases are addressed during the affected patient’s early years to avoid social challenges during childhood. Parents or guardians may be asked to have records from their child’s pediatrician and any pediatric care specialists sent to Dr. Panossian’s Pasadena office. The doctor will examine the affected ear and may confirm an existing diagnosis before suggesting which pediatric plastic surgery would be most beneficial.
Dr. Panossian will discuss the benefits and risks of each procedure, and suggest the best time during the child’s development to complete the surgery. A rib cartilage harvest cannot be performed until a child’s prepubescent years due to the nature of the tissue. Older children also tend to tolerate minor rib cartilage pain better.
Pediatric Surgical Candidates
Before accepting a patient into his care, Dr. Panossian may request additional medical information, including a hearing test, imaging, and bloodwork. Because some children with microtia may have additional cognitive or physical disabilities, he will discuss any limitations of the procedure with the patient and their parents or guardians.
Though proper hearing is important for patients to lead a more normal life, procedures should never be allowed to compromise a child’s well-being.
Preparing for Ear Reconstruction Surgery in Los Angeles
Prior to the procedure, Dr. Panossian’s staff will communicate and facilitate any additional prerequisites for surgery. In some cases, the doctor may request existing medical records, or ask the child’s parents to arrange a consult with their primary care physician or any specialists involved in the care of the patient’s ears.
Patients who plan to have an ear reconstruction will undergo the operation at a medical center or hospital in Pasadena, CA. Those traveling to the Los Angeles area should arrange to stay at a nearby hotel for a comfortable recovery. Microtia ear reconstruction is typically performed under local anesthesia and is usually completed on an outpatient basis after the first surgery.
Recovery Tips Following Microtia Surgery
Patients are discharged home following the procedure, and often feel groggy for the next couple of days. There may be some discomfort in the chest as well as the ear if a rib graft was used. Surgical drains might be placed to reduce fluid buildup and to relieve swelling and pressure. Bandages will control bleeding and help protect the newly reconstructed ear.
Parents should prepare a comfortable recovery area since young patients often do not communicate their needs well. Sleeping in an elevated or upright position helps to reduce swelling and discomfort and ensures that the modified ear is not disrupted. Medications should be given on a strict schedule to help control infection, swelling, and pain.
In a week or two, bruising will disappear. One week after microtia reconstruction, sutures will be removed from the ear. Dr. Panossian is delicate with the small anatomy, and this part of the process should not be painful. Patients should not engage in strenuous activities for 4-6 weeks, at which time most of the swelling will have subsided.
What to Expect After an Ear Reconstruction
A rib cartilage graft reconstruction usually requires multiple procedures to complete, while a MEDPOR ear reconstruction is typically performed in one session. Each will produce a realistic ear shape that is aligned with the normally-developed ear, but there may not be as many details present in the reconstructed ear. A skin graft of the patient’s own tissue will cover the ear, and incisions will be hidden in the natural folds of the ear whenever possible. Any scarring will fade over time.
Osseointegrated implants that are anchored in the bone will pair a silicone-crafted removable ear that can be temporarily attached. The procedure is less extensive than a full ear reconstruction and may be performed at Dr. Panossian’s Los Angeles-area practice with local anesthesia. The prosthetic ear will closely match the patient’s skin color, but will not look as realistic as surgically reconstructed ears. In some cases, the implant material can cause skin irritation and may need to be replaced with another material.
Why Choose Dr. Panossian?
- Andre Panossian, MD earned his undergraduate degree from UCLA and was recognized with the highest honors.
- Dr. Panossian completed his medical degree at Tufts University School of Medicine in Boston.
- The doctor earned a spot in a competitive dual residency program combining general surgery and plastic surgery residency at the Keck School of Medicine of USC.
- Dr. Panossian went on to complete a fellowship in craniofacial surgery at the Hospital for Sick Children in Toronto and Harvard Medical School.
- As a reconstructive plastic surgeon, Dr. Panossian offers his patients an array of treatment options, each of which is delivered with precision and skill. He specializes in both pediatric and adult care and is an expert in facial anatomy.
- Dr. Panossian performs both plastic and reconstructive surgery, combining medicine with art for the best results possible.
- He is board-certified by the American Board of Plastic Surgery.
- The doctor is internationally recognized for his work and is trusted by patients in the Los Angeles area and beyond.
Microtia Frequently Asked Questions
The cost for ear reconstruction surgery varies widely depending on whether or not the patient has insurance and uses an in-network provider; which type of procedure is performed; if the ear canal is reconstructed; and if a cochlear implant is installed.
The complexity of the case will also affect the total cost of the procedure. During a multi-step rib cartilage reconstruction, patients will likely be charged per surgery. Dr. Panossian’s staff can provide estimates to patients after reaching out to their insurance company.
The pinna of the ear, the outer ear structure, is unique to each individual. During surgical reconstruction, Dr. Panossian pieces together the patient’s cartilage or MEDPOR porous polyethylene using special surgical tools to sculpt either material.
In many cases, microtia affects one ear while the other is a normal size and shape. Dr. Panossian can use the unaffected ear as a template to construct a close replica. Pediatric and adult size ears may require different techniques.
In most cases, insurance companies will not pay for an earlobe reconstruction. The treatment is considered cosmetic and does not contribute to the necessary functions of the ear, like hearing.
Most patients undergo earlobe surgery to reconstruct the lobe as the result of aging or a mishap with a piercing. Some patients intentionally stretched their earlobes but regret the permanent change. The cost for the procedure is relatively low per ear, from $400-$1,200.
Growths on the ear can be excised away or removed with a laser during cosmetic ear surgery. These formations may be small or very prominent and can occur in different locations on the ear. Insurance does not typically cover the cost of elective improvements, but in many patients, an accessory auricle is a minor growth that can easily be removed.
Dr. Panossian performs plastic surgery of the face and body and specializes in craniofacial and reconstructive surgery. The surgeon is meticulous in his methods and frequently operates on children with deformities and issues of the nervous system, including paralysis of the face and neurofibromatosis. Dr. Panossian is passionate about improving irregular anatomy to create more normalcy in his pediatric patients’ lives.
An underdeveloped ear has no bearing on a child’s cognitive abilities, but hearing loss can affect a young person’s ability to learn in a hearing-centric environment. Parents should schedule appointments with medical specialists regarding the child’s hearing for early intervention.
Infants can be fitted with hearing aids that allow them to develop communication skills. Teaching a hearing-impaired infant American Sign Language is also an effective way to minimize any delays that hearing loss may cause.
Microtia is a congenital abnormality that cannot be detected prior to birth. Though advanced imaging techniques are utilized, it is not typically possible to determine if the ears are forming normally. There is a greater concern for organ and limb development, and discovering microtia would not change the condition.
Intervention cannot begin until the child is born. Even then, certain surgeries must be postponed until the child can successfully undergo ear reconstruction surgery. The best way to minimize risk factors is to follow your OBGYN’s medical advice and avoid all medications that are thought to contribute to microtia.
Schedule a Consultation with Dr. Panossian
If your child has been diagnosed with microtia or another ear deformity, then Dr. Panossian may be able to help. Schedule an ear reconstruction consultation at our Pasadena office to learn more about the available treatment options and your child’s candidacy. Call 626-765-6885 today to make an appointment with our welcoming staff.