What is Microtia

Microtia is a condition in which a child is born with an abnormal ear. This condition can refer to a range of problems, including:

• Abnormally small ears.
• Absence of some or all of the usual external ear structures.
• Complete absence of the external ear.
• Abnormally narrow, blocked, or absent ear canal.

Microtia can occur on only one side (unilateral) or on both sides (bilateral). Your child’s ability to hear will depend on whether the interior structures of the ear are normal or not, as well as whether one or both ears are affected.

What are the causes?

The cause of this condition is usually not known. However, certain genetic conditions can cause microtia.

What increases the risk?

This condition is more likely to occur in babies:

• Whose mothers have diabetes.
• Who are male.
• Who are born in high-altitude locations.
• Whose mothers used certain medicines during pregnancy.

What are the signs or symptoms?

Microtia affects the appearance of the ear or ears. In some cases, this condition can also affect your child’s hearing.

How is this diagnosed?

This condition is diagnosed at birth. Your child will have hearing tests. These will be repeated as your child grows up. Your child may also imaging tests, such as:

• An x-ray.
• An ultrasound.
• A CT scan.
• An MRI.

How is this treated?

Treatment depends on the severity of the condition and can include:

• Procedures to improve or fix the appearance of the ear, such as:
  • Reconstructive surgery.
  • Receiving an artificial (prosthetic) ear.
• A procedure to rebuild the ear canal to improve hearing.
• Hearing aids.

Follow these instructions at home:

• If your child gets an ear infection, make sure to follow your child’s health care provider’s instructions on how to take care of your child. If your child is prescribed antibiotic medicines for his or her ear infection, make sure your child takes the antibiotic as told by his or her health care provider. Do not stop giving the antibiotic even if your child’s condition improves.
• Be alert to any changes in your child’s ability to hear.
• Be prepared to support your child through possible emotional reactions to having microtia. Your child’s emotional responses may change as he or she grows and develops.
• Have your child wear his or her hearing aid as told by your child’s health care provider, if this applies.
• Keep all follow-up visits as told by your child’s health care provider. This is important.

Contact a health care provider if:

• Your child develops ear pain.
• Your child has a fever.

Get help right away if:

• Your child has a change in his or her ability to hear.

Microtia Reconstruction

Microtia reconstruction is surgery to correct an ear deformity that is present at birth. Microtia can refer to many problems, including:

• Unusually small ears.
• Missing some or all of the usual external ear structures.
• Completely missing the external ear.
• An abnormally narrow, blocked, or missing ear canal.

Various surgical techniques can be used to reconstruct the ear. The most common technique involves using a cartilage graft from the child’s own body, usually from the rib area, to create an ear. In a few cases, the ear may be made using an artificial (polyethylene) implant.

Microtia surgery may happen in one or several stages. Your child may need several surgeries to reconstruct the ear.

Tell a health care provider about:

• Any allergies your child has.
• All medicines your child is taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems your child or family members have had with anesthetic medicines.
• Any blood disorders your child has.
• Any surgeries your child has had.
• Any medical conditions your child has.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines.
• Damage to other structures or organs near the ear or at the location of the cartilage graft.
• Trouble breathing.
• Scarring.
• An abnormal appearance of the reconstructed ear.
• A swelling made up of clotted blood (hematoma).
• A collapsed lung (pneumothorax).

What happens before the procedure?

Staying hydrated

Follow instructions from your child’s health care provider about hydration, which may include:

• Up to 2 hours before the procedure – your child may continue to drink clear liquids, such as water or clear fruit juice.

Eating and drinking restrictions

Follow instructions from your child’s health care provider about eating and drinking, which may include:

• 8 hours before the procedure – have your child stop eating foods.
• 6 hours before the procedure – have your child stop drinking formula or milk.
• 4 hours before the procedure – stop giving your child breast milk.
• 2 hours before the procedure – have your child stop drinking clear liquids.

Medicines

• Ask your child’s health care provider about:
  • Changing or stopping your child’s regular medicines. This is especially important if your child is taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your child’s blood. Do not give your child these medicines unless your child’s health care provider tells you to do that.
  • Giving your child over-the-counter medicines, vitamins, herbs, and supplements.
• Your child may be given antibiotic medicine to help prevent infection.

General instructions

• Your child may have blood testing and CT scans before the surgery.
• Ask your child’s health care provider how the surgical site will be marked or identified.
• Plan to have a responsible adult care for your child for at least 24 hours after your child leaves the hospital or clinic. This is important.
• Ask your child’s health care provider what steps will be taken to prevent infection. These may include:
  • Removing hair at the surgery site.
  • Washing skin with a germ-killing soap.
  • Taking antibiotic medicine.

What happens during the procedure?

• An IV will be inserted into one of your child’s veins.
• Your child will be given one or more of the following:
  • A medicine to help your child relax (sedative).
  • A medicine to make your child fall asleep (general anesthetic).
• Your child may have a flexible tube (catheter) inserted into his or her bladder to drain urine.
• Your child may have a tube put through the nose or mouth into his or her stomach (NG tube).
• The surgeon will make an incision over your child’s ribs and remove cartilage from the ribs. This incision will be closed with stitches.
• The surgeon will cut the cartilage and shape it to make a structure for the ear.
• A skin pocket or flap will be made where the new ear will be placed on the scalp. The skin may need to be stretched to make the pocket.
• The cartilage structure will be placed inside the skin pocket or flap. It will be shaped to look like a normal ear. The skin pocket or flap will be closed with stitches.
• Small tubes may be placed to drain fluid from around the ear or the rib area.

The procedure may vary among health care providers and hospitals. It may take several surgeries to complete the reconstruction of your child’s ear.

What happens after the procedure?

• Your child’s blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until he or she leaves the hospital or clinic.
• Your child will be given medicine for pain as needed.
• Your child’s bed will be kept at an upright angle.
• Your child may have small tubes left in place to drain extra fluid from the area around the ear.
• Your child may have a drain in his or her rib area to drain fluid.
• Your child may be taught breathing exercises.
• If your child is of driving age, do not let him or her drive for 24 hours if he or she received a sedative.

Summary

• Microtia reconstruction is done to correct an ear deformity that is present at birth.
• The most common surgical technique involves using a cartilage graft from the child’s own body, usually from the rib area, to create an ear.
• Microtia surgery may happen in one or several stages.

Microtia Reconstruction, Care After

This sheet gives you information about how to care for your child after the procedure. Your child’s health care provider may also give you more specific instructions. If you have problems or questions, contact your child’s health care provider.

What can I expect after the procedure?

After the procedure, it is common for children to have:

• Swelling. This can affect how the ear looks. It may take several weeks for the swelling to go down and for the ear to take its shape.
• Pain, either in the ear or where a graft (skin, cartilage, or bone) was taken.
• Bruising, either in the ear or where a graft (skin, cartilage, or bone) was taken.
• Some drainage of fluid or blood.
• Numbness in the affected area.
• Itching.
• A feeling of heaviness or discomfort in the ear.

Follow these instructions at home:

Incision care

• Follow instructions from your child’s health care provider about how to take care of your child’s incisions. Make sure you:
  • Wash your hands with soap and water before you change your child’s bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your child’s dressing as told by your child’s health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your child’s health care provider tells you to do that.
  • Do not remove your child’s drains or tubes until your child’s health care provider tells you. Follow instructions from your child’s health care provider about how to take care of your child’s drains and tubes.
• Check your child’s incision areas every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.
• Your child should avoid putting pressure on the ear, especially when he or she is sleeping. Your child may have a hard plastic covering for the ear, or he or she will be asked to sleep without pillows for a period of time.

Activity

• Have your child avoid activities that take a lot of effort for at least 2 weeks or as told by your child’s health care provider.
• Do not let your child lift anything that is heavier than 10 lb (4.5 kg), or the limit that you are told, until your child’s health care provider says that it is safe.
• Have your child avoid contact sports for 4–6 weeks or as told by the health care provider.
• Have your child return to his or her normal activities as told by your child’s health care provider. Ask your child’s health care provider what activities are safe for him or her.

General instructions

• Give over-the-counter and prescription medicines only as told by your child’s health care provider.
• Do not give your child aspirin because of the association with Reye syndrome.
• Do not let your child shower, wash his or her hair, take a bath, swim, or use a hot tub until the health care provider approves. You may need to give your child sponge baths while the incisions heal.
• If your child is of driving age, do not let the child drive for 24 hours if he or she received a medicine to help him or her relax (sedative) during the procedure.
• Keep all follow-up visits as told by your child’s health care provider. This is important.

Contact a health care provider if:

• Medicine does not control your child’s pain.
• Your child has more redness, swelling, or pain around the incision area.
• Your child has more fluid or blood coming from the incision area.
• Your child’s incision area feels warm to the touch.
• Your child has pus or a bad smell coming from the incision area.
• Your child has a fever.
• Your child has trouble swallowing.
• Your child’s stomach hurts.
• Your child feels nauseous or vomits.
• Your child has a burning feeling while urinating, or he or she is urinating more often than usual.
• Your child has a new cough.
• Your child is constipated or has diarrhea.

Get help right away if:

• Your child has chest pain.
• Your child has shortness of breath.
• Your child’s incision opens up.
• Your child’s dressing becomes soaked in blood, or bleeding does not stop after 10 minutes of applied pressure.
• The skin covering your child’s ear changes color or looks pale.
• Your child has pain or tenderness in his or her ear.
• Your child has any sudden change in his or her hearing.
• Your child’s reconstructed ear is injured.

Summary

• After the procedure, it is common for children to have pain or swelling.
• Follow instructions from your child’s health care provider about how to take care of your child’s incisions.
• Check your child’s incision areas every day for signs of infection.