Lawrence Chow / ENT Doctor
Modern Treatment Options for Microtia and New Future Medical Perspectives
Microtia Classification and Symptoms
Microtia is not merely a cosmetic issue, its manifestations range widely from mild underdevelopment of the auricle to its complete absence. It is clinically classified into four grades:
Grade I: The auricle is smaller than normal, but key structures are visible. The ear canal may be narrow or affected by aural atresia.
Grade II: The auricle is partially developed, often hook-shaped or S-shaped. The ear canal is usually affected by aural atresia.
Grade III: Only a vertical remnant of tissue is present (often described as a “peanut” shape). The ear canal is completely affected by aural atresia.
Grade IV: Complete absence of the auricle, with no residual tissue (anotia).
Approximately 50-60% of microtia patients have associated ipsilateral facial underdevelopment, such as Hemifacial Microsomia. Bilateral microtia accounts for about 10-20% of all cases; these patients typically face more complex hearing challenges.
Treating microtia requires the involvement of a multidisciplinary medical team, including:
ENT (Otolaryngologist): Evaluates ear structure and hearing function.
Plastic Surgeon: Performs auricular reconstruction surgery.
Audiologist: Conducts hearing assessments (Audiometry) and provides rehabilitation guidance.
Speech Therapist: Assists with speech development training.
Psychologist/Therapist: Provides psychological support and counseling.
Microtia Diagnostic Process
Initial evaluation typically begins in infancy, including a detailed physical examination, hearing assessment (Audiometry), and imaging studies. Hearing tests may include Auditory Brainstem Response (ABR) and Otoacoustic Emissions (OAE) to determine the type and degree of hearing loss. Imaging studies such as CT scans help assess the middle and inner ear structures, providing crucial information for subsequent treatment planning.
Timing and Sequence of Microtia Treatment
Treating microtia is a long-term process, requiring planning based on the patient’s age and specific circumstances:
Infancy (0-3 years): The focus is on hearing management and language development. Children with bilateral microtia should begin using a bone conduction hearing device before 3 months of age. Unilateral cases require regular hearing monitoring. Early intervention is crucial for language development.
Preschool Age (4-6 years): Hearing management and speech therapy continue, while preparation for surgery begins. Discussing the treatment process with the child using pictures and models helps their understanding.
Optimal Surgical Age (6-10 years): By this age, the rib cartilage is sufficiently developed for grafting, and the auricle size is close to adult size. The child also has better psychological readiness and ability to cooperate. Treatment is divided into two main parts—auricular reconstruction and hearing reconstruction—which may be performed in stages based on patient needs.
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- 小耳症（Microtia）耳廓重建手術
Auricular Reconstruction
Primarily employs the following three methods:
Autologous Rib Cartilage Reconstruction: This method typically requires 2-4 stages.
Stage 1: An autologous rib cartilage graft is harvested, carved into a 3D ear framework, and implanted under the skin.
Stage 2 (6-12 months later): Lobule transposition and auricular elevation.
Stage 3: Tragus formation and detail refinement; possible adjustment of the contralateral ear for symmetry.
Advantages: Uses the patient’s own tissue, high stability, low infection risk, appearance becomes more natural over time.
Disadvantages: Multiple surgeries, chest wall scar, longer recovery.
Alloplastic Implant (e.g., Medpor Implant): Uses a synthetic framework.
Procedure: Typically requires 1-2 stages. The implant is placed and covered with a temporoparietal fascia flap, followed by skin grafting.
Advantages: Fewer surgeries, no rib cartilage harvest, no chest scar.
Disadvantages: Higher risk of infection and extrusion; stability may be lower than autologous grafts.
Prosthetic Ear: An option for patients unsuitable for or unwilling to undergo surgery.
Attachment: Can be adhered with medical adhesive or attached via osseointegrated implants.
Advantages: No surgery required, highly realistic appearance, removable.
Disadvantages: Requires daily removal and cleaning, periodic replacement, long-term cost.
Hearing Reconstruction
Most microtia patients have conductive hearing loss, often due to aural atresia. Hearing rehabilitation options include:
Canalplasty: Creates a new ear canal and reconstructs the eardrum and ossicular chain. Success rates vary, with a risk of restenosis.
Bone Conduction Hearing Devices: Traditional devices: Held by a headband or softband.
Bone-Anchored Hearing Aid (BAHA): A surgically implanted abutment connects to an external sound processor.
Softband devices: Suitable for infants/young children, no surgery required.
Middle Ear Implants: Such as the Vibrant Soundbridge, which directly stimulates the ossicles.
Postoperative Recovery and Long-Term Follow-up
Adequate recovery is needed after each procedure. Long-term follow-up includes annual assessment of the auricle’s appearance and stability, regular audiometry (hearing tests), and psychological support.
Expected Outcomes After Microtia Treatment
Improvements are expected in three key areas:
- Appearance: Outcomes vary based on the method chosen (autologous rib cartilage graft, Medpor implant, or prosthetic ear), each with distinct advantages and limitations regarding naturalness, feel, and maintenance.
- Hearing: Hearing can be partially improved with canalplasty or BAHA implantation, but typically not fully restored to normal levels.
- Psychological Impact:Improved appearance usually leads to significantly enhanced self-confidence and social engagement.
Future Perspectives and Emerging Technologies
The field of microtia treatment is continuously evolving. Research areas include tissue engineering (lab-grown cartilage), 3D printing for customized frameworks and surgical guides, and genetic studies on Microtia and Hemifacial Microsomia.
Conclusion: The treatment of Microtia is a journey requiring both patience and courage. However, with advancements in medical technology and the collaboration of multidisciplinary medical teams, patients can now achieve significant improvements in both appearance and functional recovery. It is crucial that treatment is tailored based on individual circumstances, family preferences, and professional medical advice to develop the most suitable personalized plan for each patient. For assistance, please contact ENT Head and Neck Surgery Centre (Tel: 3100 0555), where our ENT specialists will provide detailed diagnosis and formulate a treatment plan for you.
Source:
HK ENT Specialist Ltd.
ENT Head and Neck Surgery Centre
For ENT Services, Audiology & Speech Therapy,
Sleep Disordered Breathing Management,
Hearing Aid Prescription & Medical Cosmetic Services
https://www.hkentspecialist.hk
The Surgical Options for Children with Microtia
Unfortunately, microtia isn’t only about the atypical size and shape of the earlobe. Parents and pediatricians are more concerned about the partial or full hearing loss children with microtia will experience. Emphasis must be made that hearing loss has adverse effects on speech and language development, as well as on personal interactions.
The good news is that there are more than a few surgical options for the treatment of microtia. You and your child’s pediatric surgeon will discuss the risks and rewards of these options. You have to remember, too, that surgery may not yet be an option for your child, such as when he’s too young for it.
Rib Cartilage Graft Surgery
This is possibly the most complicated surgical treatment for microtia since it involves several procedures over several months, sometimes up to a year. Due to the possible complications, it’s only recommended for older children, usually between 8 and 10 years old.
Basically, rib cartilage is harvested from the patient’s chest. It’s then used in creating the shape of the external ear before being implanted under the skin where the ear should have been present. But the process doesn’t stop there.
More skin grafts and surgeries may be performed in addition to the new cartilage. These surgeries are done to ensure better positioning of the external ear.
The pros of rib cartilage graft surgery is that rib cartilage from the patient is less likely to be rejected by his body and it’s a sturdier material. But there may be pain, discomfort and scarring in the grafting site.
Medpor Graft Surgery
The Medpor graft surgery involves lesser number of times under the knife and younger age of patients than rib cartilage graft surgery. Basically, a synthetic material is implanted into the external ear to mimic its form and function. It’s then covered by scalp tissue, a way of achieving a more natural appearance.
It’s usually completed in a single session so children are less traumatized by the procedure. In fact, children as young as 3 years old are suitable candidates.
The results are more consistent since the synthetic material can be manipulated than a rib graft. But there are also risks to the Medpor graft surgery including the higher risk of infection. Children are also more likely to lose the implant due to physical trauma or injury.
There’s also the matter of pediatric surgeons either not offering or performing Medford graft surgery because the length of time that the implant lasts isn’t established yet. But if your pediatric surgeon can perform it, you may want to consider it.
If these two surgical options aren’t viable or successful for any reason, you may want to consider ear prosthetics. These look natural and, in fact, can be made based on the size of the normal ear. These can also be attached through an implanted anchor system or worn with a skin-friendly adhesive.
If you would like to learn more about microtia and its surgical options for children, please consult HK ENT specialist.
Source:
HK ENT Specialist Ltd.
Hong Kong based ENT clinic centre
For ENT Services, Audiology & Speech Therapy,
Sleep Disordered Breathing Management,
Hearing Aid Prescription & Medical Cosmetic Services
https://www.hkentspecialist.hk
Interesting Findings About Microtia That Pregnant Women May Want to Know
Pregnant women typically seesaw between being happy about their unborn babies and worrying about their babies’ health. Their concerns aren’t unfounded considering that congenital defects form within the womb, and these congenital defects can range from physical abnormalities to mental retardation.
Among these physical abnormalities are undeveloped external ears, a condition known as microtia. But it isn’t just the atypical size and shape of the earlobes that characterize microtia – it’s also characterized by hearing loss.
Are you intrigued by microtia yet? If you are, you will find these interesting findings about microtia in unborn babies and infants.
Its Cause Remains a Mystery
Scientists have yet to identify a specific cause of microtia. But there are a few theories including malfunctions in a gene located in chromosome 22.
The interplay of genetics and environment in the development of microtia in the womb is also not fully understood yet. In current medical literature, between 3 and 34 percent of patients with microtia have a genetic component.
Scientists, nonetheless, have confirmed that neurofibromatosis Type 2 (NF2), an autosomal dominant disorder, is a risk factor in microtia. If one parent has NF2, his or her children will have a 50-50 chance of getting microtia.
Yet another possible, but unconfirmed risk factor, is the use of isotretinoin, an anti-acne medication. Isotretinoin (Accutane) can result in a pattern of congenital defects believed to be a combination of genes and environmental factors.
It’s More Common in Some Areas
There are no generally accepted theories for why microtia has a higher incidence rate in Latin America, particularly Ecuador, and Asia than in other areas of the world. If you are in these areas, you may want to talk to your doctor about decreasing the risks of your unborn child getting congenital defects.
Boys also seem to be more affected by microtia than girls although both genders will experience similar signs and symptoms. The right ear also seems to be more affected than the left ear, but a small percentage of children with microtia will have it in both ears (i.e., bilateral microtia).
It Can Occur with Other Conditions
Microtia can also occur with other distinct medical conditions. The three more common conditions are:
- Treacher Collins syndrome (TCS) is a genetic disorder characterized by physical abnormalities eyes, ears and cheekbones, as well as the chin.
- Hemifacial microsomia (HFM) is a congenital disorder affecting the proper development of the ears, mouth and mandible.
- Goldenhar syndrome causes physical defects in the face and head. It’s a rare congenital disease.
There are also maternal behaviors and conditions that can increase the risk of microtia in unborn babies. Women with diabetes before their pregnancy have been shown to have higher risk compared to women without diabetes. Pregnant women on a diet characterized by low levels of folic acid and carbohydrates also seem to have an increased risk for their babies developing microtia.
If you would like to learn more about microtia and its treatment, please consult HK ENT specialist.
Source:
HK ENT Specialist Ltd.
Hong Kong based ENT clinic centre
For ENT Services, Audiology & Speech Therapy,
Sleep Disordered Breathing Management,
Hearing Aid Prescription & Medical Cosmetic Services
https://www.hkentspecialist.hk
Microtia and Surgery: The Reasons for Their Popularity Among Parents
Parents of children with microtia often choose surgery for their offspring. This isn’t surprising considering that microtia has physical and psychological impact on affected children. Parents being parents, they want to minimize the negative effects of microtia on their children.
Take note that microtia is a congenital deformity characterized by an underdeveloped external ear. Just as there are variations in size and shape in developed ears, there are also wide variances in microtia. Nonetheless, most children with microtia have moderate to severe conductive hearing loss due to the abnormalities in the outer ear.
Even with the risks including side effects and complications of microtia surgery, most parents of children with the condition opt for it. Here are two of the common reasons.
Social Interactions
Studies have shown that children with hearing impairments are more likely to have lower self-esteem and self-confidence. This is worsened by the visible signs of the hearing loss, such as in the case of microtia.
Their lower levels of self-esteem and self-confidence are attributed to their decreased ability to communicate with others. The inability to hear sounds and voices make them less able to recognize auditory cues and make appropriate responses. With these disabilities, they feel more isolated and less included in the everyday activities of their family and friends.
Their feelings of isolation become more pronounced in schools. Typically, school-age children with hearing impairments are either placed in a different class for the entirety of the school day or separated for part of the day in special education classrooms.
Even at home, children with hearing impairments can experience stress from their parents and siblings for the same reasons. They may feel isolated from certain activities, perhaps feel discriminated against even when there isn’t an intention.
With surgery, fortunately, children with hearing loss issues have the opportunity to be part of the hearing world. By opening up their hearing, so to speak, their social interactions with family and friends will blossom. In time, their self-confidence will increase – and that’s what parents who choose surgery for them want to happen.
Aesthetic Appearances
The more common reason for parents choosing surgery for microtia for their kids is to improve the appearance of their external ears. Unfortunately, children without a visible external ear or an abnormal external ear are likely to be ridiculed and bullied by their peers. Even their parents can be subjected to weird looks and awkward questions, if not rude comments, from others!
The stress of dealing with the stares, questions and comments, even the bullying, can really take its toll. Parents then are justified in their choice to ask their children’s pediatricians for surgical options to correct the abnormal ears.
The bottom line: If you are a parent with a child diagnosed with microtia, you are well-advised to explore the treatment options for the condition. Your child deserves it and you will breathe easier for it, too.
For details of the ENT services, diagnosis, and treatment, please consult HK ENT specialist.
Source:
HK ENT Specialist Ltd.
Hong Kong based ENT clinic centre
For ENT Services, Audiology & Speech Therapy,
Sleep Disordered Breathing Management,
Hearing Aid Prescription & Medical Cosmetic Services
https://www.hkentspecialist.hk
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