When a child is born with a defect, deformity, or absence of an ear or both ears, this condition is called microtia. If the child is born with microtia, you will need to have your child undergo reconstructive surgery. There are clinics that provide microtia surgery in New York in order to restore your child’s hearing and appearance.
The operating room will be equipped with machines that are designed for children. The most worrisome part of the surgery is anesthesiology that is why only highly skilled pediatric anesthesiologists will administer the anesthesia to the child. Thus, you should see to it that you only choose a clinic that has highly trained and experienced professionals.
Definition of Microtia
When a child has an incompletely formed ear, the medical term for this condition is microtia and the severity of this condition ranges from a partially formed ear to a lump of tissue. There are even cases of microtia wherein the ear canal is very narrow or absent altogether.
One or even both ears can be affected with microtia. When one ear is affected, this is known as unilateral microtia which is the most common form of microtia because 90% of microtia cases are unilateral. When both ears are affected, this type is known as bilateral microtia, and this type of microtia happens in one out of 25,000 births. Furthermore, microtia is more common in males than females and the right ear is more susceptible to microtia than the right ear.
Problems Commonly Associated with Microtia
The first problem associated with microtia is hearing loss. Aside from the apparent visual deformity of the ear, children that have microtia are often experiencing hearing loss because of the closure of the ear or the absence of the external ear canal. The absence of hearing loss can also cause an impediment to the development of the child’s speech.
The second problem associated with microtia is ear infection for obvious reasons that the deformity will make it challenging to clean the ear and is easily exposed to bacteria.
The third problem associated with microtia is self-consciousness because the child will eventually become aware of the defects that their bodies have. When the child reaches the age of 6 or 7, other children may tease the child who has microtia on the mere fact that they do not look normal thereby making the child feel self-conscious and inadequate.
Diagnosing Microtia in Children
Children born with microtia should undergo early evaluation of the organ systems of their ear and their hearing. The first consultation regarding the child’s condition should be done shortly after birth in order to give the parents an understanding as to what treatment option will the child have.
For cases involving unilateral microtia, the full hearing facilities of the child are usually retained in the unaffected ear and retaining the sense of hearing on the affected ear. So, although the ear canal is closed, the still-functioning inner ear can still absorb sound. In the first few months of the life of the child, he or she will undergo an audiogram, and then a radiologist will assess the structure of the middle ear and ear canal by using a CT scan.
For cases involving bilateral microtia, these children have a higher risk of hearing loss which leads to poor speech development. For children having bilateral microtia, this will require an earlier intervention and the child should undergo an audiogram during the first few days of life, and this is ideally done before being discharged from the hospital after birth. The audiogram will be done repeatedly until a consistent result will be achieved. Furthermore, a CT scan will also be conducted in order to evaluate the middle ear if it or cannot be surgically reconstructed. For children who have bilateral microtia, they will most likely be using bone-conducting hearing aids before they undergo surgery.
Surgical Procedure for Unilateral Microtia Cases
A patient having unilateral microtia will not be needing any hearing aid and his or her speech development will remain normal. The procedure for the correction will usually commence when the child will reach 5 years old because this is the time when the ear is already 85 to 90 percent of its adult size.
Generally, surgeons are more inclined to construct the ear as completely as possible before the child will reach the first grade because this is the usual phase where the child will be teased more by their peers. But, surgery can also be performed either earlier or later, and this will depend on the rate of development of the patient. This surgery will be done in stages and this is usually separated by about 6 to 12 months.
Below are the stages for unilateral surgery
- The first stage of the surgery is that the surgeon will extract a part of the rib from the child and then they will use this portion to sculpt the framework for the reconstructed ear.
- In the next stage, the surgeon will then form the ear lobe
- The third stage will involve elevating the ear using a skin graft
- The fourth stage will involve forming the tragus which is the cartilage that covers the opening inside the external ear. This is done by using a skin or a cartilage graft and then the conchal area will be forged by using a skin graft.
Surgical Procedure for Bilateral Microtia Cases
Patients with bilateral microtia are operated on early at around age 4 and they have greater hearing damage that needs to be repaired for natural speech to improve as quickly as possible. For ears of smaller size, the surgeon can use less cartilage from the ribs because they don’t need to fit the size of a normal ear.
For patients who have bilateral microtia, the reconstruction will start at the outer ear before opening the ear canal.
The surgical procedure for bilateral microtia is not the same as that of patients having unilateral microtia because, in the first stage of the procedure, the surgeon will not have to operate on both sides at once. For the first step, each ear is split by rib grafts for four to six weeks. The next three phases can occur at the same time. Then surgeons may choose to dig the ear canal to maximize hearing after another 6 to 12 months.