Yes, when both ears are small or absent this is called bilateral microtia or bilateral anotia.
If the ear canal and ear bones are affected then the child will not have normal hearing. However, even if there is no ear canal (aural atresia) the child with microtia can still hear some sounds because the nerve used for hearing may still function normally.
Children may notice their ear difference as early as 2 or 3 years of age. When they are in pre-school or kindergarten they may find other children reacting to them differently and become more aware of their difference.
It will be helpful to get ideas and support from your pediatrician and other clinicians. Be open and honest so your child is comfortable that you are ok with his or her ear difference. Open discussion will help your child with feeling that ist is ok. You could kind of casually rehearse what your child might want to say to friends when confronted about the ear difference. For instance your child could say, “so my ear doesn’t look the same but I still play just like you and everybody else.” We know microtia plays into one’s identity, but it is just a small aspect of a wonderful complex person. Treat your child with love and support without undue focus on the microtia. Support of their own unique wonderful self will foster self-esteem for a long full happy life.
- No treatment (leave the microtia alone).
- Surgical reconstruction of the ear (Rib cartilage or artificial plastic like Medpor is used to create the implanted shape).
- Ear prosthesis to cover or replace the microtia.
This becomes a personal choice and often your observation of your child becoming aware of their difference is the time to discuss the options. Much consideration should be given to any decision involving surgery.
One paper discussing the subject is: Surgical Versus Prosthetic Reconstruction of Microtia: The Case for Prosthetic Reconstruction
Challenges of successfully wearing any prosthetic device – including silicone prosthetic ears for children – are relative to the way they are crafted and cared for. Of course, any prosthesis is removable so it requires some care and cleaning. Therefore, the edges of the prosthesis where they blend with the skin may become loose or worn causing them to be more visible. They then may require rebonding with adhesives or refinement of the material. Skin color and the coloration of the prosthesis both change from sun exposure over time so the prosthesis will eventually need retinting or replacement in order to continue to match and blend in.
Many of the challenges of prostheses are so well addressed by dedicated silicone ear prosthesis specialists that prosthesis wear becomes a far superior choice relative to the alternative of accepting the attention of untreated microtia or having complicated surgery attempts to build an ear that never looks normal, let alone one that matches the unaffected side. It is true that any prosthesis no matter how expertly crafted will lose color over time and have margins that may be visible to you. However, planning for retinting or replacement of the prosthesis and realizing that expertly planned margins are rarely detectable by others make the accurate prosthesis the optimal lifetime choice.
Proponents of ear reconstructive surgery will also point out that a disadvantage of the ear prosthesis is that its routine removal and the lack of sensation when touching the prosthesis reminds the patient that its not part of their body. However, like a removable denture or hairpiece all prostheses have functions so valuable they far outweigh going without. So one must weigh the few minutes involved in daily prosthesis attachment and removal against many hours each day feeling uncomfortable hiding a poorly formed or failed surgical reconstruction by wearing a long hair style or just accepting the same looks, stares and questions that arise from living with untreated microtia. An artistically rendered and well maintained ear prosthesis is virtually undetectable. Decades of practice has proven that a relationship develops between prosthetist and patient and the care and passion going into the prosthesis translates to a confidence for the patient of feeling and looking completely balanced, normal and unremarkable throughout their daily life.
As soon as parents have concerns it is advisable to start identifying professionals offering the various treatment options. This way parents can be prepared with options tailored to the specific diagnosis of their child and the availability of professionals who are experts representing the best treatment options. This is important since there are very few talented and focused surgical and prosthetic professionals that truly specialize in the ear. It cannot be overstated how crucial it is to NOT select a surgeon or an ear prosthetist until you have been shown many pictures of patients before and after their respective treatments to demonstrate the experience of the provider and the results they achieve. This is especially true of any surgical intervention because any failed first surgery causes scar tissue to form. This makes it even more difficult if not impossible for a surgeon to go back and repair or improve the look of the reconstructed ear. No one is happy with a surgical reconstruction that does not even look like an ear, or a poorly rendered prosthetic ear that is easily detected. The gold standard is seeing close-up photographic results as evidence of artistry and expertise.
It may be very helpful for the child months before beginning school at age 5 or 6 to have some opportunity to test and wear an ear prosthesis. This way with no surgery no bridges have been burned, and the child can have the opportunity to contribute to the decisions involving his or her ear.
Surgical Versus Prosthetic Reconstruction of Microtia: The Case for Prosthetic Reconstruction
by Gregory G. Gion, BA, BS, MMS, CCA*
The auricular prosthesis and the autogenous reconstruction must ultimately be judged on their ability to free the patient from the stigmatization of their condition. Excellent esthetic results are key in providing patients with the confidence that their correction will go undetected. There are other technical and psychological issues that impact prostheses success in particular, but the wide variability in esthetic quality available historically and around the world today might still be unnecessarily complicating if not biasing the treatment selection process.
THE AESTHETIC EAR PROSTHESIS
This guide is prepared to introduce the option of wearing an aesthetic ear prosthesis within the context of all the options currently available to patients and parents of children with microtia.