Medically reviewed by Dr. Youssef Tahiri
If your child was born with microtia, you may be struggling to understand why. How did this condition develop? Is microtia genetic? Did you do something to cause your child’s condition? Although scientists still have a lot to learn about the causes of microtia, Beverly Hills specialist Dr. Youssef Tahiri wants parents to know that this rare condition is not their fault. As researchers work diligently to learn more about the underlying causes of microtia, there is still a large amount of information available about the condition. Parents can help their children by learning more about microtia, its effects, and the various treatment options available. To speak to a microtia expert and explore various state-of-the-art treatments, contact Dr. Tahiri today.
Definition of Microtia
Microtia literally means small ear. Children with this rare condition have a small, abnormally-shaped or absent external ear. Most children have this condition only on one side (unilateral), however it can occur on both sides (bilateral). Typically, microtia only involves the outer ear, but can also cause difficulty hearing and determining the direction of sound. In some cases, a child with microtia will have no hearing in the affected ear, due to the absence of the ear canal. This is called aural atresia. A child with microtia and aural atresia in both ears will be significantly hard of hearing and require a hearing aid. Children with aural atresia typically also have incomplete formation of the small middle ear bones and may lack an eardrum.
Dr. Tahiri specializes in microtia surgery for children. Patients from all over the USA and beyond visit his Beverly Hills office to discuss microtia and surgical treatment.
Microtia is a congenital condition, which causes a child to be born with a small, malformed, or missing ear. For 90% of microtia patients, the condition only affects one ear. Because microtia is so rare, it is rarely detected on prenatal ultrasounds. The condition can also come as a surprise to parents because children with microtia rarely have a family history of the irregularity. Microtia is especially rare in the U.S., where only 1 in every 8,000-10,000 children is born with this condition each year. Incidents of microtia are higher in other countries, however, particularly in Central and South America, and China sees more instances of microtia than anywhere else in the world. Dr. Tahiri sees patients from around the world. His institute is globally recognized, thanks to his innovations and advanced surgery for aesthetic correction and hearing restoration.
Stages of Microtia
There are four stages, or grades, of microtia:
Dr. Tahiri is renowned for his ability to treat all four stages of microtia.
Effects of Microtia
Children with all stages of microtia may face harassment and bullying, particularly at school. However, the most obvious difficulty for microtia patients is the decreased hearing ability resulting from a narrowed or missing ear canal. Although patients can still hear out of the unaffected ear, diminished hearing can make it difficult to detect individual sounds in noisy environments. When a patient can only hear on one side, the brain has difficulty filtering out background noise and determining which direction noises are coming from. This diminished hearing can cause trouble for patients, especially in school and social settings. In some cases, it can also lead to speech impairment.
Parent’s Guide to Microtia
What is Microtia?
Microtia is a congenital deformity resulting in an abnormally small, malformed or absent external ear. One in 8000–10,000 children are born with microtia every year. The cause of microtia is still unknown. It is important to know as a parent that there is nothing that you could have done differently during your pregnancy that would have changed your child’s condition.
Can my child hear? Will this affect my child’s speech development?
Most children with microtia do have hearing loss in the affected ear because often there is no canal to transmit sound waves to the inner ear. This is called aural atresia. Children with microtia and atresia affecting one ear will have problems locating the direction of sound and have trouble hearing a conversation in noisy environments, but the need for a hearing device is controversial. When your child begins school, you should make sure you child has preferential seating that will enable them to hear the teacher best. If your child has microtia with hearing loss on both sides, it is important to improve your child’s hearing with a bone-conducting hearing aid such as BAHA. It should be fitted before the age 6 months. The sounds that babies hear in the first year of life are very important for speech and language development.
Is there a surgery to improve my child’s hearing?
There is a surgical procedure that involves making an ear canal and an eardrum called an atresia repair or canalplasty. A CT scan of the middle ear should be done at 2½ years old to determine if your child is a candidate for the surgery. Most microtia patients have normal inner ears, and therefore, approximately 60% of children with aural atresia can have significantly improved hearing from a canal and ear drum reconstruction. This surgery can be done when your child is at least 3 years of age or older.
One Surgery: Medpor Ear Reconstruction and Ear Canal
Can Microtia be associated with other conditions or symptoms?
The most common condition in which microtia is seen is Hemifacial Microsomia, in which half the face does not grow in proportion to the other. The degree of hemifacial microsomia varies from barely perceptible to very noticeable. Treacher Collins Syndrome involves both ears and also affects the eyes which appear to have a downward slant or “pulled down appearance.” The cheek bones are small and the eyelids and jaw are affected. Goldenhar Syndrome may involve one or both ears and is characterized by incomplete development of ear, nose, soft palate, lip, and jaw as well as potential benign tumors of the eye.
What treatments are available for my child’s microtia?
There are 3 types of treatments for microtia:
Silicon Ear Prosthetic
A prosthetic ear can be created to look very similar to a patient’s normal ear. The specialist who can make and color the prosthesis is called a prosthodontist. There are two methods that are used to attach the ear prostheses. One uses a glue to adhere the ear to the skin. The second method uses titanium implants which are placed onto the bone around the ear. The prosthesis can then be “snapped” into place (called an osteo-integrated prosthesis.)
Rib Cartilage Reconstruction
Using a child’s rib cartilage to carve an ear framework has been the standard of care for more than 50 years. Cartilage reconstruction is an invasive technique that requires between 2–5 surgeries. Ear reconstruction with rib cartilage must be delayed is old enough to have sufficient cartilage to make an adult-sized ear, typically between 7–10 years of age. First the cartilage from several ribs is removed through an incision on the child’s chest. The cartilage is then carved and pieced together to create an ear framework. This framework is buried under the scalp and after the ear has healed, more surgeries are required to complete the reconstruction: elevating the ear away from the scalp, repositioning the earlobe and other adjustments.
MEDPOR® Ear Reconstruction
MEDPOR® is a surgical technique that uses a porous polyethylene framework along with the child’s own tissue to create an ear. Our team has further innovated a technique with minimal scarring. Reconstruction with MEDPOR® can usually begin at age 3. If only one ear is involved, the MEDPOR® framework is customized to match the normal ear, but is created slightly larger so the ear will be adult-sized. The framework is then covered by the patient’s own tissue (called a flap) which is brought down as a thin “living membrane” from underneath the scalp. In most cases, only one surgery is required to reconstruct the ear. Atresia repair can be done before or after MEDPOR®. A combined one stage reconstruction of both microtia and canal surgery using MEDPOR® is possible.
One Surgery: Medpor Ear Reconstruction
Learn more about treatment options
Fortunately, Dr. Tahiri offers advanced treatment for both the cosmetic problems and the hearing difficulties associated with microtia. The innovative MEDPOR® (or OMNIPORE®) technique allows him to create an external ear structure using a child’s own tissues – a procedure which offers a number of benefits. He also works with an otologist to enhance hearing and, if possible, create a new ear canal to more fully restore this sense. Contact Dr. Tahiri to learn more about microtia and his renowned treatment options.