Microtia

Undoubtedly, you were distressed when you saw your baby’s malformed ear. That’s understandable—no parent wants his or her child to be born with a congenital anomaly.

At Children’s Hospital Boston, we view the diagnosis as a starting point: Now we’re able to begin the process of treating any hearing loss your child may have—and making plans for reconstructive surgery.

At Children’s, we consider you and your child integral parts of the care team and not simply recipients of care. You and your care team will work together to customize a plan of care for your child.

How will my child’s microtia be treated?
Treatment of microtia usually involves reconstructive surgery to rebuild the outer ear.

This is a very delicate procedure that requires expertise in pediatric plastic surgery.

Surgical procedures usually begin when your child is at least 6 years old for two reasons:

We recommend waiting so that your child has enough rib cartilage for surgeons to use to reconstruct his ear.

Also, at 6 years old, his ear will approximately its adult size, so surgeons can maximize symmetry with his other ear.

What's the surgery like?
Surgeons in Children’s Microtia Program typically perform an autologous reconstruction.

Autologous reconstruction—using your child's own tissue
A new ear is made from your child's rib cartilage and placed under the skin on the side of the scalp where the ear would be.

Because this process uses your child’s own tissue, it will continue to grow as your child grows.
In addition, if the ear becomes injured, it can heal itself.?
This reconstruction process involves between two and four separate surgeries depending on your child’s type of microtia. The typical surgeries are as follows:

• first operation—harvesting and carving rib cartilage from your child to build the framework of the ear
• second operation—refining and repositioning the ear lobe and reconstructing the contour of the ear canal
• third operation—elevating or lifting of the ear

We usually space these procedures out by six months each, so that your child can heal before the next stage.

If doctors decide that your child needs surgery on her middle or inner ear, this is done after the outer ear reconstruction is finished.

Some hospitals perform reconstructions using synthetic materials. At Children’s, we prefer the autologous procedure. However, plans of care are developed on a case-by-case basis and after speaking with our specialists, alloplastic reconstruction may also be considered.

What if my child has bilateral microtia?
Treatment for the much less common bilateral microtia (microtia of both ears) is a more complicated for various reasons—but the general idea is the same.

Plastic surgeons will reconstruct your child’s ears so that they look relatively normal.

Are there alternatives to surgery?
While we believe that the most effective way to correct microtia is with reconstructive surgery, there are a few other options:

Prosthetic ear—A realistic ear can be attached to your child’s skull.
The prosthetic ear will never feel like a part of your child’s body (and will need to be removed at night), which may make this a less-than-ideal solution for some children.

Ear implant—This procedure involves minor surgery and can achieve realistic-looking results.
This surgery may be a good option if too much scarring prevents an autologous ear construction.

No treatment—If your child has a relatively mild form of microtia, you may opt to not have any reconstructive surgery done.

Your doctor can best advise you which is the best option for your child.

What happens if my child has a hearing loss?
If your child has a hearing problem related to his microtia, your audiologist and pediatrician will arrange for your child to be seen by an otolaryngologist (ear, nose and throat specialist) and will guide you to other services to help your child learn to communicate.
Our Diagnostic Audiology team will:

• monitor the hearing loss
• provide counseling to you and your family regarding the hearing loss
• recommend hearing aids and ways to maximize the use of what hearing your child does have
• refer your child for additional language or developmental assessments
• direct you to community resources for educational or financial assistance
• refer your child to Habilitative Audiology to learn about the option of a cochlear implant if your child has a severe to profound hearing loss in both ears

Supportive care
We want to maximize the safety and effectiveness of whatever therapy you and your child’s doctor decide upon.

Supportive care involves preventing and treating infections and side effects of treatment to keep your child as comfortable as possible while we’re working to reconstruct her ear.

Follow-up care
A schedule of follow-up care will be determined by your child's physician and other members of your care team to monitor your child.