Pediatric Ear Abnormalities

Sana Bhatti, MDMississippi Center for Advanced Medicine

Objectives

1. Understand the normal anatomy of the ear. 2. Identify common congenital ear abnormalities as they present in

the neonatal period.3. Recognize the psychosocial impact of ear differences on pediatric

patients.4. Facilitate prompt diagnosis of congenital ear abnormalities and

refer patients to specialists so that non-surgical treatment can be initiated in the neonatal period.

Normal Ear Anatomy

Helix

Antihelix

Tragus

Anti-Tragus

Lobule

Superior Crus

Inferior Crus

Triangular fossa

Scapha

Concha

Congenital Ear Abnormalities

• Categorized as either:• Malformations – due to disrupted embryogenesis• Deformations – due to external forces

• 15-20% Newborns• Can be mild and only affect the external ear • Can be associated with hearing loss, anomalies of other structures

such as the jaw, orbit, nerves, muscles, soft tissues, kidneys.

Ear Abnormalities

• Step 1: Diagnosis• Malformation • Deformation

• Treatment • Timing

• Referral to plastic surgeon

Malformations

1. Anotia2. Microtia 3. Cryptotia4. Pre-auricular sinuses & remnants

Microtia

1. External ear with absent skin or cartilage that is small, collapsed or only has an earlobe present

2. Can occur as an isolated birth defect, or as a part of a spectrum of anomalies or as a component of a syndrome.

3. Most often a/w conductive hearing loss 4. Prevalence varies geographically and is reported to be from 0.83 to

17.4 per 10,000 births• males (2 or 3:1• unilateral (70-90%)• right-left-bilateral ratio is 6:3:1.26

Microtia Treatment

• Involves multidisciplinary approach

• Restoration of hearing• Surgical reconstruction of the

external ear • Initial treatment consists of an

ABR, frequent ear evaluations (high risk for ear infections), renal ultrasound

Microtia Surgery

• Refer to plastic surgeon early on • Higher prevalence of mood disorders• Ear reconstruction typically begins at age 6 or older

Microtia Surgery • Several surgical options

1. Autologous2. Composite reconstruction 3. Osteointegrated prosthesis

Autologous

Osteointegrated ProthesisComposite reconstruction

Cryptotia

• Hidden ear• Superior portion of ear buried

underneath temporal skin • Treatment

• Nonsurgical molding • Surgery involving release of

superior ear and full thickness skin grafting for sulcus creation

Pre-auricular Anomalies

• Pre-auricular sinuses and remnants

• Screening renal ultrasounds not recommended

• Do not regress overtime• Treatment

• Sinuses- if infected, abx & surgical excision

• Remnants- surgical excision

Deformations

1. Stahl’s ear2. Constricted ear3. Prominent ear

Management of Ear Deformations

• Nonsurgical correction can be made by forcing the ear cartilage into proper position and maintaining it there for several weeks

• Should start in the first week of life• Molding can help correct deformation due to circulating

maternal estrogen, which peak at 3 days of life and then normalize around 6 weeks of age

Is the child eligible for ear molding?

• Stahl ear• Prominent ear• Lop ear• Helical rim abnormalities • Cryptotia

What does ear molding look like?• Non-surgical, no

anesthesia• Low risk• Biweekly visits• Typically takes 6 weeks to

treat

Ear Molding

BEFORE AFTER

AFTERBEFORE

BEFORE AFTER

What about older children?

• Many kids and adults grow up with ear anomalies without having ear molding as a baby

• Self conscious, end up covering their ears with their hair • Sometimes bullied at school• Children, teenagers and adults have cartilage that is too stiff for

molding and will require surgical correction, this is called an otoplasty, also known as ear pinning

Otoplasty

• Common procedure for prominent ears • Surgical • General anesthesia for younger children and teenagers• General anesthesia, sedation or local anesthesia for adults• Outpatient procedure that usually takes about 2 hours• Post-operative care requires staying away from contact sports for 4-6

weeks

What is an otoplasty?

Treating Ear Abnormalities• Mild deformations affecting

only the external ear • Nonsurgical ear molding• Surgery for older children

and adults

• Microtia• Multi-disciplinary

craniofacial team• Hearing aid ASAP• Surgical correction can

begin as early as age 6

Ear Abnormality

DiagnosticSurgery

Nonsurgical CorrectionHearing

Renal US

MalformationMicrotia + + + -Cryptotia - - Possible +

Pre-auricular remnant

- + + -

Pre-auricular sinus

- - If infected -

DeformationProminent - - If not corrected

with molding +

Stahl - - If not corrected with molding

+

Constricted - - If not corrected with molding

+