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Houston Cranio Facial


Microtia is a congenital condition characterized by the underdevelopment of one or both external ears. This incomplete ear formation typically occurs during the first trimester of pregnancy while a child is still in the womb. Translated from Latin to “little ear,” microtia can cause the ears to appear smaller than usual. The condition is commonly associated with aural atresia, which refers to the absence or malformation of the internal ear canal. Dr. Eric Payne, our extensively trained craniofacial plastic surgeon, can treat microtia to reconstruct a natural-looking ear appearance. He works closely with ENT surgeons to help address any hearing issues caused by aural atresia.

What are the Causes of Microtia?

The exact cause of microtia is unknown, but it is believed that issues during early development of the embryo—such as a blockage to the blood supply or a drop in oxygen levels—can contribute to malformation of the ears. However, microtia can also be a randomly occurring event. In most cases, microtia is not genetic and a large majority of babies born with microtia have no family history of the condition. While it is hypothesized that some medications and environmental factors may influence the development of microtia, these theories are generally inconclusive. There are several studies that estimate between 1 in 2,500 to 1 in 5,000 babies are born with microtia, depending on one’s ethnicity.

What are the Different Grades of Microtia?

Microtia is categorized into four different grades of severity:

  • Grade I: The ear appears smaller than the average-sized ear, but the primary features of the ear structure are still present.
  • Grade II: Some parts of the ear are missing although the lower two-thirds of the ear framework are still intact. Sometimes called “conchal type microtia,” development of the ear canal is usually narrow.
  • Grade III: The external ear is largely absent but the remnant feature often resembles a peanut-shaped lobe. The ear drum and ear canal are typically missing.
  • Grade IV: The entire ear is completely absent.

The majority of microtia cases fall into the Grade III category, and the most severe form of the condition is usually rare. However, it is not uncommon for microtia to involve moderate to severe hearing loss. In cases where a child has a syndrome diagnosis like hemifacial microsomia, both the external and internal ear may not form correctly and decrease hearing function.

Microtia Atresia

The formation of the external ear is a separate process from inner ear development, which is responsible for transmitting sound to a child’s brain. When both the outer ear and the auditory ear canal do not form properly, this is referred to as microtia atresia. Whether the condition is the result of a missing, closed, or very narrow ear canal, infants born with atresia exhibit hearing problems that can often be detected through routine screenings. This can be treated with corrective surgery to create or widen the ear canal, and Dr. Payne will work with your pediatrician or ENT specialist to develop an effective treatment plan.

How is Microtia Repair Performed?

Ear reconstruction involves two to three procedures depending on the severity of the ear deformity. The original approach to microtia repair was to fashion an ear framework out of pieces of rib cartilage. The framework is placed below the skin where the child’s ear would normally appear. In the last several years, artificial material including silicone, rubber, and porous polypropylene (MEDPOR®) have been utilized to create the framework. In some cases, small screws are affixed to the side of a child’s head and a prosthetic ear is then attached to the screws.

At the Craniofacial and Plastic Surgery Center of Houston, we choose to use a child’s own tissue to assist in the reconstruction of their ear. We remove rib cartilage from the chest to sculpt an ear framework. The framework is then inserted into a pocket underneath the skin, which is closed with stitches. A drain is placed in the pocket to remove any fluid and assist the skin sticking down to the framework. A small catheter is then placed in the chest to deliver pain medicine to the area where rib cartilage was removed. The child spends one night in the hospital for monitoring and can then return home.

Later procedures can refine the original reconstruction as necessary. Goals may include elevating the ear off the side of the head, placing a piece of skin behind the ear, and refining the earlobe position.

What are the Risks of Microtia Ear Reconstruction?

When removing the rib, there is a minor risk of a small hole being made in the covering of the lung (pleura). If a hole occurs, it is repaired at the same time as microtia repair and monitored with an x-ray immediately after the operation. As with any surgery, there is also a risk of infection after the procedure. If developed, the infection must be treated immediately to prevent loss of the cartilage framework.

Do You Use Artificial Material for Microtia Repair?

At our practice, we believe the results of an ear reconstruction should last a lifetime to provide the greatest benefit. Artificial materials such as MEDPOR®, silicone/silastic, and rubber can lead to many early and late complications. These include the extrusion of artificial material, meaning the skin over the framework can break down and expose the material. If this occurs, the device must be removed immediately. There is also an increased risk of infection anytime artificial products are placed in the body, requiring removal of the material if an infection develops. Breaks in the framework similarly call for device removal.

How Much Does Microtia Surgery Cost?

The cost of microtia repair depends on the technique used during ear reconstruction, whether one or both ears are being addressed, and the severity of the condition. Medical insurance may cover some or all of the potential expenses and we encourage you to learn the scope of your benefits through your insurance provider. In any case, the Craniofacial and Plastic Surgery Center of Houston accepts financing plans through CareCredit® and Prosper® Healthcare Lending to make out-of-pocket costs more affordable. Simply apply online and once approved, each company offers an array of short- and long-term plans to suit your budgetary needs. Please call our office to learn more about your financing options and the costs typically associated with microtia repair.

To learn more about microtia or other ear deformities, please contact the Craniofacial and Plastic Surgery Center of Houston to schedule a consultation.