What Is Microtia?
Microtia is an outer ear abnormality that’s present at birth. It can range from a small, barely noticeable abnormality to a large structural change in the outer ear. Some babies with microtia are born with no outer ear at all.
Microtia Grading
Doctors classify microtia based on four grades.
- Grade 1: The abnormality is very minor.
- Grade 2: Babies are born with a small ear, but many major structures are still there.
- Grade 3: Babies have a “peanut ear,” or only small abnormal remnants of an ear structure.
- Grade 4: The outer ear is completely missing. Grade 4 microtia is also known as anotia.
How Common Is Microtia?
Microtia is not common. Experts estimate it affects around one in 3,800 babies in the United States, according to the Centers for Disease Control and Prevention. Although microtia can affect anyone, it’s more common in males.
Does Microtia Cause Hearing Loss?
Microtia by itself minimally affects hearing loss, but sometimes a baby will have hearing loss and microtia at the same time. Some babies with microtia also have ear canal abnormalities, which can cause hearing loss. But microtia and hearing loss are two distinct conditions that need to be evaluated separately.
Microtia itself isn’t a functional disability, but hearing loss can be a disability. Hearing loss could qualify your child for some disability benefits. Although microtia isn’t a disability, it can significantly affect social aspects of your child’s life.
Why Choose University of Utah Health?
Our microtia clinic includes a multispecialty team of board-certified facial plastic surgeons, pediatric otolaryngologists, head and neck surgeons, audiologists, and anaplastologists (prosthesis creators). These experts work together to offer comprehensive treatment for microtia and its associated conditions, including hearing loss.
Our collaboration with specialists across U of U Health means your child has easy access to a range of specialists as needed. Your child will receive care in our world-class pediatric hospital with access to all necessary resources for managing other conditions and complications.
Microtia Causes
The majority of babies with microtia have it for no known reason. Sometimes, babies have microtia because of a gene change (mutation) that occurs before they are born. Your baby has an increased risk of microtia if you have a family history of the condition.
Can Microtia Be Corrected?
There are several treatment options to correct microtia:
- Prosthesis placement—We will create a custom-fit prosthetic ear. We will attach the prosthesis to a baby’s or young child’s head with a special adhesive material. When children’s ears stop growing around 5-7 years old, we may place a permanent post for the prosthetic ear to attach to. Prostheses don’t last forever and need replacements every few years.
- Autologous rib reconstruction surgery—We will take pieces of your child’s rib cartilage to create an outer ear in two separate surgeries. We will wait until your child is about 7-8 years old so that their rib cartilage develops enough to use for the reconstruction.
- Medpor reconstruction surgery—A surgeon will use a 3D-printed implant to create an outer ear. Some surgeons will offer this procedure to children as young as 3-4 years. If you’re interested in Medpor reconstruction, we will refer you to a surgeon who performs the procedure.
When Is Surgery Needed for Microtia?
Surgery isn’t always necessary for microtia. You may choose not to correct microtia if your child isn’t bothered by it. Your child may still need surgery to treat hearing when they have microtia along with ear canal abnormalities that affect hearing.
What to Expect During a Surgery Consultation
Although we don’t recommend ear reconstruction surgery until children are 3 years or older, it’s helpful to have a consultation within your child’s first year of life. During this visit, we will evaluate your child for hearing loss, examine your child for signs of other craniofacial syndromes, and review treatment options. Your child’s multidisciplinary care team will help you understand the pros and cons of each treatment. They will also provide personalized recommendations for your child’s needs.
Ear Reconstruction Surgery
What happens during ear reconstruction varies depending on whether your child is having an autologous rib reconstruction or a Medpor reconstruction. Our surgeons will help you understand what to expect for each procedure.
Autologous Rib Reconstruction
An autologous rib reconstruction is a two-stage surgery:
First Procedure
- The surgeon begins the procedure by removing pieces of your child’s rib cartilage.
- Then the surgeon shapes the cartilage into an ear-like structure.
- The surgeon removes any abnormal cartilage from your child’s outer ear.
- Lastly, the surgeon places the rib cartilage beneath your child’s skin where the ear should be.
This first procedure takes 6-10 hours. Your child may spend several days in the hospital afterward. As your child heals, the rib cartilage will grow into your child’s tissues. This healing will take several months.
Second Procedure
The second procedure will take place about six months to one year later. During the second procedure, your child’s surgeon will:
- During the second procedure, the surgeon makes incisions (cuts) behind the new ear to lift it away from the head.
- The surgeon position sand elevates the new outer ear.
- Then the surgeon places additional cartilage banked from the first surgery behind the ear.
- To complete the surgery, the surgeon uses a skin graft to cover the back portion of the ear.
This second procedure takes around 2-4 hours. Your child may be able to go home the same day.
Medpor Reconstruction
Medpor reconstruction involves one procedure. Before the surgery, your child’s surgeon will create the 3D-printed Medpor implant. They will customize the implant to the size and shape of your child’s other ear so that your child will have a symmetrical appearance.
During the operation, your child’s surgeon will perform the following steps:
- Make an incision over where the ear should be.
- Remove any abnormal cartilage from the area.
- Place the Medpor implant.
- Use a tissue graft and a skin graft to cover the implant.
The procedure will take around 12-16 hours.
Recovery After Ear Reconstruction Surgery
Your child’s surgeon will place a surgical dressing over your child’s ear after either type of reconstruction. Your child will have to refrain from intense activity for about three weeks after an autologous rib reconstruction. Recovery recommendations after Medpor surgery will depend on your surgeon's preference.
Your specialist will schedule multiple follow-up appointments over the next several weeks to ensure the surgical sites are healing well. Your child will need to avoid contact sports for several months while their ear heals.
Is Microtia Surgery Covered by Insurance?
Many insurance plans cover microtia surgery. Ear reconstruction surgery cost can vary depending on several factors, including your insurance plan. Our team will help you understand your insurance coverage and costs before surgery.
Find a Plastic Surgeon Near You
Schedule an Appointment
Your insurance determines whether you need a referral to schedule an appointment with the microtia clinic. We recommend checking with your insurance provider before coming to the clinic. Call 801-587-2173 to schedule an appointment.
