Microtia, a congenital condition involving underdeveloped or absent outer ears, poses significant challenges for kids and families. ARCHANA JYOTI explores the medical, psychological, and societal aspects of the disorder
Microtia affects one out of every 3,000 newborns. It happens when the ear or ears do not fully develop during the first trimester of pregnancy; as a result, the kid is born without any ear or with ears that are small or underdeveloped. Although microtia is identified at birth, the condition’s cause is not fully understood. It can cause facial difficulties and hearing impairments in newborns.
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By Prof (Dr) Vinay K Tiwari
Dean, North DMC Medical College & Bara Hindu Rao Hospital, Delhi
Senior Consultant, Burns, Plastic and Maxillofacial Surgery
Congenital ear deformities indeed present a unique set of challenges, both anatomically and socially. The incidence rate of 1 in 3000 live births, excluding prominent ear deformity, highlights the importance of understanding and addressing these conditions. While in India, there may be less stigma attached to some particularly related deformities like ‘Bat ear’, the situation differs in Western countries, where societal perceptions can be harsher.
Prominent ear deformity, often colloquially referred to as “Bat ear,” stands out as the most common among congenital ear anomalies. This prominence can lead to social challenges, with children sometimes being unfairly labeled as “imbecile” or “stupid.” Consequently, there’s a significant demand for corrective surgeries in Western countries to address these deformities and mitigate associated social stigma.
In India, microtia, characterized by varying degrees of underdevelopment or absence of the external ear, presents another significant challenge. Unilateral involvement is common, and the severity ranges from minor defects to total absence (anotia). The intricate anatomy of the ear, with its complex cartilage structure and close adherence to the skin, complicates reconstruction efforts.
Ear reconstruction for microtia typically involves a staged approach. The first stage involves creating a 3D cartilaginous framework, often sourced from autogenous rib cartilage (typically from the 6th to 9th ribs). The optimal age for this procedure is usually between 7 to 10 years when rib cartilage is soft and moldable. Alternatively, some surgeons opt for ready-made frameworks composed of inert materials like Medpore or silicone. Careful dissection is essential during rib cartilage harvesting due to the proximity of vital thoracic structures.
In the second stage of reconstruction, typically performed around six months after the initial procedure, the framework is lifted from the back and skin grafted. Subsequent stages may involve further refinement and correction, such as lobular correction.
Various techniques, such as the Brent, Nagata, and Fermin techniques, have been developed to address the complexities of ear reconstruction. These techniques offer surgeons options for achieving optimal outcomes based on individual patient needs and anatomical considerations. Overall, ear reconstruction for congenital deformities requires a nuanced understanding of anatomy, meticulous surgical technique, and a tailored approach to each patient’s unique circumstances.
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By Dr Mahesh Mangal
Chairman, HOD, and Senior Consultant
Plastic and Cosmetic Surgery
Sir Ganga Ram Hospital, Delhi
Microtia is a birth deformity. The ear develops by six developing points and whenever there is some problem in the development of these points it results in ear defects. Ear anomalies have a wide spectrum ranging from complete absence of external ear to minor deformities.
It is not very uncommon in India. Hearing takes place by two mechanisms, one is through the bone around the ear and another is through the internal ear. Whenever the internal ear is affected or it is not developed, then
the person hears through bone conduction. In cases of bilateral microtia, the development of the internal ear is affected which results in loss of hearing and development of the patient. But not so in cases of unilateral microtia.
Microtia is also synchronic in some patients and they have other facial deformities as well.
Reconstruction in microtia is a multi-stage procedure. It takes three to four stages, a duration of one to one and a half years to complete all these stages. Usually, the procedure is started at the age of nine to ten years and by that age adult size of the ear is achieved.
In cases of unilateral microtia, we take the image of a normal ear and accordingly, the size and shape of the ear are reconstructed. Patients who do not prefer multistage procedures are given the option of osteo-integrated artificial ear implants for reconstruction. In a private hospital setup, a patient has to pay for treatment procedures. But in a government hospital, it is free of cost.
Microtia is not preventable it is a congenital anomaly and happens in the first three months of pregnancy. It is very difficult to diagnose by ultrasound during pregnancy as the ear is such a small structure.
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By Dr Sonam Rathi
Consultant ENT
Apollomedics Super Speciality Hospital
Lucknow, Uttar Pradesh
Ear deformities from birth broadly include those affecting the outer ear/pinna & Ear canal-like altered shape or absence of pinna- Anotia/microtia/macrotia/Bat ear/Cup ear/Cryptotia /Coloboma/Stahl’s ear/Satyr ear/Darwin’s Tubercle/ Preauricular skin tags and sinus or atresia or stenosis of the ear canal.
It can involve the middle part of the ear or inner ear- which is not visible but causes hearing loss.
Microtia can affect hearing- if the canal is narrow or completely blocked-conductive hearing loss. Also, sensorineural hearing loss is associated with malformation/deformity of the inner or middle ear
It can also be due to factors during pregnancy in the mother like consuming alcohol or some medication for acne such as Isotretinoin or due to malfunction of thyroid hormone Thalodimide. Some Genetic abnormalities & syndromes such as Treacher Collins, Trisomy 13,18,21, Klippel Feil syndrome, TORCH infection, Rh incompatibility, radiation, and even Gestational Diabetes are also responsible.
Yes, most of these are correct. Requiring multistage pinna reconstruction using rib cartilage or artificial prosthetic materials, formation of the ear canal, or simply an artificial pinna prosthesis if the patient wants just a cosmetic correction
A Graduated Approach is needed including Pinnaplasty – Otoplasty, Incisionless otoplasty, Nonsurgicand al Otoplasty, along with correction of hearing loss if any. Cost ranges from a few thousand for a prosthesis to 3-4 lakhs for multistage pinna reconstruction.
Parents of Microtia Kid Navigate Journey with Love
As the parents of a girl child with microtia, our journey has been filled with conflicting emotions and difficult decisions. On one hand, we want nothing more than to ensure the best possible outcome for my child—to give her every opportunity to thrive, to overcome any obstacles she may face, and to live a happy, fulfilling life.
But on the other hand, we’re faced with the harsh reality of our child’s condition—the likely surgeries, the therapies, the financial burdens, and the emotional toll it will take on our family. We’re forced to grapple with questions of risk and uncertainty, wondering if the benefits of treatment outweigh the potential drawbacks and if we’re making the right choices for our child’s future.
As my daughter grew older, she’s ten years old now, and became more aware of her differences, she began to ask questions of her own. Why do I look different? Why do people stare at me? Will I ever be like everyone else? And as much as we tried to reassure her and provide answers, we couldn’t help but wonder if we were doing enough to help her feel accepted and loved just the way she is.
But amidst all the questions, one thing will remain constant: No matter how difficult the road ahead may be, we’ll stand by her side every step of the way, offering support, encouragement, and unconditional acceptance, no matter what.
(Agony of a parent of a child with Microtia disorder)
