Ear Surgery - FAQ

What is ear surgery?

Plastic surgery of the ear is most commonly performed to correct the position of the ears that protrude significantly from the sides of the head. Such protrusion make the ears appear to be larger than normal. Overly large ears are a rare condition called macrotia. Protruding ears may occur on one or both sides in varying degrees and are not associated with hearing loss. Even adult dissatisfaction with previous ear surgery is a basis for plastic surgery of the ear.

There are less common ear deformities that can affect one ear or both, abd may not affect hearing ability. The constricted ear, also called a lop or cup ear, has varying degrees of protrusion, reduced ear circumference, folding or flattening of the upper helical rim, and lowered ear position. The Stahl's ear is distorted in shape due to an abnormal position of the superior crus, or extra crus to the antihelix. In cryptotia, (or "hidden ear") the upper rim of the ear is buried beneath a fold or scalp secondary to abnormal folding of the upper ear cartilage toward the head. The folding is the reverse of that commonly seen in protruding ear

Microtia is the most complex congenital ear deformity. The outer ear appears as either a sausage shaped structure resembling little more than the earlobe, or it may have more recognizable parts of the concha and taugus or other normal ear features. It may or may not be missing the external auditory or hearing canal. Hearing is impaired to varying degrees.

Recostruction of microtia requires staged surgical procedures (usually three) to create a more normal external ear. These surgeries may be followed by surgery to improve hearing as well.

Treatment of protruding or disfigured ears is possible as early as age 5, when a child's ear cartiladge is stable enough for correction. Children who are good candidates for ear surgery are:

• Healthy, without a life-threatening illness or untreated chronic ear infections
• Cooperative and follow indtructions well
• Able to communicate their feelings and do not voice objection when surgery is discussed

Teenagers and adults defined as good candidates for ear surgery are:

• Healthy individuals who do not have life-threatening illness or medical conditions that can impair healing
• Non-smokers
• Individuals with a positive outlook and specific goals in mind for ear surgery

Where do I begin?

A consultation with your plastic surgeon is the first step to ear surgery for you or your child. It is designed to fully educate you in a non-pressured environment about:

• A discussion of your goals and an evaluation of your individual case
• The options available to correct your or your child's ear condition
• The prescribed course of treatment your plastic surgeon recommends
• The likely outcome of ear surgery and potential risks associated with any prescribed procedure

Your plastic surgeon will also answer your questions.

Evaluation

Overall health and personal outlook can greatly impact the clinical outcome and the personal satisfaction of ear surgery.

Safety and the success of ear surgery requires an honest discussion with your children about what they will experience and what is expected of them. Regardless of age, it is essential that you:

• Honestly share expectations for you or your child with your plastic surgeon
• Fully disclose health history, current medications and the use of vitamins
• Adults disclose the use of herbal supplements, alcohol, tobacco or drugs
• Commit to following all of your plastic surgeon's instructions precisely

Safety

By making the decision to consult with our plastic surgeons and following all the instructions given, you are taking an important step in assuring your safety or the safety of your child.

All of The Austin-Weston Center plastic surgeons are board certified by the American Board of Plastic Surgery.

My ear surgery

Each case of ear surgery is highly individual, as is the delicate and highly individual anatomy of the ear. Through an analysis of ear axis and positioning on the head, ear size and angle of protrusion, your plastic surgeon will tailor a technique to precisely correct the exact features that are disproportionate or deformed.

Repositioning protruding ears is the most common form or surgery performed. It is widely performed with a good record of safety and fulfilling patient goals. Even when only one ear appears to protrude, ear surgery may be performed on both ears to achieve a more balanced result. Just as all of our faces are assymetric to some degree, results of ear surgery may not be completely symmetric, although the goal is to create an ear as normal in structure and balanced in proportion to other facial features as possible.

Surgery for constricted ear and other deformities may use similar techniques as correction for protruding ears, in addition to other methods. These more complex techniques often utilize conchal cartilage that would otherwise be discarded, as graft to support and shape the restructured ear. A secondary procedure to obtain an optimal result may be necessary. An individualized plan is always required to define goals and achieve desired results.

Treatment or microtia involves an individualized surgical plan that may require multiple procedures to achieve desired results. While the goal is to create a normal appearing external ear, ear reconstruction may be combined with other surgery to improve hearing. Where cartilage - the flexible, bone-like structure that forms the outer ear - is badly misshapen or too little exists to create a more normal ear, reconstruction may require cartilage grafts. These are typically taken from the existing ear structure or the patient's ribs.

Ear surgery revision is sometimes requested by adults who are dissatisfied with a prior surgery. This may include an unnatural appearance, over correction where ears appear to be sharply "pinned" back and irregularities of the ear folds. Concern with residual earlobe prominence is also common.

Preparing for surgery

Your plastic surgeon will carefully explain the ear surgery you or your child will undergo. Prior to your procedure, you will be given specific instructions that may include:

• Pre-surgical considerations, diagnostic testing and medications
• Day of surgery instructions and medications
• Specific information related to the use of anesthesia

In addition, you will be asked to sign consent forms to assure your plastic surgeon that you fully understand the procedure you or your child will undergo, and any risks and potential complications. Risks associated with ear surgery include infection, blood clot or a collection of blood at the incision site and risks associated with anesthesia.

It is important that you address all your questions directly with yoru plastic surgeon. It is natual to feel some anxiety, whether excitement for the anticipated outcome or preoperative stress. Discuss these feelings with your plastic surgeon.

What to expect

Ear surgery will be performed in an accredited office-based surgical facility. General anesthesia is recommended in cases involving children, so that your child will sleep comfortably through the procedure. The decision for anesthesia will be based on the requirements of your specific procedure and considerations of patient and surgeon preference. In any case, your plastic surgeon and the assisting staff will fully attend to your comfort and safety.

Following surgery

Bandages or dressings will be applied to keep the surgical site clean, protect it from trauma and to support the new position of the ear during initial healing. Before being released following surgery, you or an accompanying family member, friend or caregiver will be given specific instructions that may include:

• How to care for the surgical site
• Keeping bandages or dressings intact
• Medications to aid healing and reduce the potential for infection
• Specific concerns to look for at the surgical site or in overall health
• When to follow up with your plastic surgeon

Progress and healing

Discomfort immediately following ear surgery is normal and can be controlled with pain medication. There may be an itchy feeling under bandages. It is essential that bandages remain intact and are not removed, for any reason. Failure to do so may result in loss of some of the correction and may require a secondary surgery.

A return to light, normal activity is possible as soon as the day following surgery, as long as the ears are protected.

Children should refrain from rough or agressive play until healing is complete.

The dressing will be removed by your plastic surgeon 5 to 7 days following ear surgery. The surgical wound will be cleansed and any external stitiches will be removed. You will be instructed on how to care for incision sites.

Healing will continue for several weeks and incision lines will slowly refine and fade. Continue to follow your plastic surgeon's instructions and attend follow-up visits as scheduled.

Result and outlook

The outcome of surgery to correct protruding ears is present almost immediately. Children accept their improved appearance quite quickly and a positive change in self-esteem can rapidly develop. It may take several months for swelling to completely subside and incision lines to refine and fade.

During this time, proper skin care and diligent sun protection are essential. In addition, the ears should be protected from extrme cold or injury.

The results of more extensive ear surgery and reconstruction may appear in phases and feelings of fulfillment will increase as the ears assume their new shape.