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Microtia (meaning ‘Small ear’) is a congenital deformity of the pinna (outer ear). It can be unilateral (one side only) or bilateral (affecting both sides). It occurs in 1 out of about 8,000-10,000 births. In unilateral microtia, the right ear is most typically affected.
There are four grades of microtia [2]:
Grade III is most common, and can be corrected by surgery. Typically, testing is first done to determine if the inner ear is intact and hearing is normal. If hearing is normal, the next step (if a canal is not visible externally) will be to determine if a canal exists, by CT scan. For younger patients, this is done under sedation. Age when outer ear surgery can be attempted depends on the technique chosen (see below). The earliest age surgery can be attempted is age 3 for Medpor and 6 for Rib Cartilage Grafts. However the vast majority of surgeons, including the world experts in ear reconstruction recommend waiting until a later age, such as 8-10 when the ear is full adult size.
There are two separate issues in microtia surgery:
Unilateral deafness is not generally considered a serious disability, especially when the person is able to adjust to it from birth. In general, there is little to gain from an intervention to enable hearing in the microtic ear, except in bilateral microtia. However, children with untreated unilateral hearing loss are eight to ten times more likely to have to repeat a grade in school.[citation needed] If surgery or aids are not used, special steps should be taken to ensure that the child is accessing and understanding all of the verbal information presented in school settings. Age for BAHA implantation depends on whether you are in Europe (18 months) or the US (age 5).[citation needed] If the child is under the age for surgical implantation, the BAHA can be worn on a headband
For auricular reconstruction, there are four different options:
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