Friday, January 16, 2009


Microtia: A Common Birth Defect
Every year one of every seven to eight thousand children is born with a common birth defect referred to as "Microtia." Not a life-threatening condition, microtia typically occurs in one ear, but can affect both ears.

While many children born with microtia are normal in all other respects, some have other health conditions including defects of the face and head. Microtia can be, but is not always, a hereditary condition.

Often a mother exposes the fetus to foreign substances without knowing they may harm the developing fetus. Accutane, a drug prescribed to relieve acne for example, if taken in the early weeks of pregnancy may result in microtia or other birth defects. There are likely other toxins doctors do not know of that may result in microtia.

Usually the ear forms during the early weeks of the first trimester, when the fetus is most at risk for birth defects. Sometimes doctors do not know the cause or causes for microtia. For some, the causes for microtia remain a mystery.

What is Microtia?
When a normal ear develops, it includes an external ear fully formed, and a middle ear that carries sound waves to the brain. Patients with microtia do not have a normal external ear. Instead, many come into this world with a small nub or nodule where the ear should exist.

Usually this occurs when the outer ear partially forms during fetal development. Because the internal ear canal becomes blocked, most patients experience difficulty hearing. Some may hear distorted sounds, while others may not hear at all. This is more common among children born with microtia affecting both ears.
There are four distinct grades of microtia, ranging from mild to moderate.

* Grade I microtia results when a child develops an almost normal looking ear that is smaller than normal, but functioning.

* Grade II microtia involves developing a partial external ear, resulting in partial loss of hearing. Patients with grade II microtia may have a closed external ear canal, allowing them to hear only muffled sounds.

* Grade III microtia, the most common form of microtia, involves the lack of an external ear and ear canal, as well as eardrum. Patients with Grade III microtia often have a tiny nub or piece of skin where the external ear should reside.

* Grade IV microtia is the most severe form of the defect, where patients have no ear and accompanying anatomical structures of the ear.

Thanks to modern technology, for patients with partial hearing, and part of the ear or a nub may undergo surgery to produce a normal-looking ear. Typically, children make better candidates for surgery than adults.

How Microtia Affects Children
For most children, having a birth defect as small as results in few problems, until the child reaches the school years. When children are five and older, they start realizing their ear is different from that of their peers.

Many children become the target of cruel taunting or unwelcome stares from other children and even adults that are not familiar with the defect. With time, children with microtia often become self-conscious and may suffer from low self-esteem or other emotional problems.

Despite a parent's best efforts at helping their child feel normal, for most children, it is difficult to live in a world where you "look" different and subsequently "feel" different from your peers.

New Treatments For Microtia
In the past, doctors had few tools available to help children born with microtia. Many doctors recommended patients do nothing, and suggested parents work closely with their child and a psychologist to overcome the stigma associated with a birth defect.

Some patients preferred to cover their deformity in times of old. For many, wearing an artificial ear or prosthesis felt better than showing the world their deformed ear. Unfortunately, prosthetic devices created for the ear can be cumbersome. Most patients must replace them a minimum of twice each year as the child grows. For adults, wearing the prosthesis is less of a problem.

Thanks to modern technology and the work of an innovative plastic surgeon, Dr. Robert Ruder, children can now undergo surgery that essentially creates a new ear.

How To Create The Human Ear
Patients interested in surgery must undergo a several tedious surgeries. Surgery to correct microtia occurs in distinct stages over two years. However, once completed, most patients report they are happy with the results.

Many patients not only look normal, they also hear better because microtia may not affect the inner ear canal. Dr. Ruder created a procedure that allows a new ear to be crafted from grafts of human skin and a tiny piece of the patient's rib.

Sound like a miracle? For many this new surgery is, changing the lives of hundreds of patients suffering from microtia. While expensive, some insurance companies cover part or all the cost of surgery.

Microtia surgery is ideal for young children, but does present complications for adult patients interested in the surgery. While a doctor may rebuild an ear in an older patient, often the result is less aesthetically pleasing as it might be in a child. Regardless, children and adults alike are eager to take advantage of the latest technologies.
Microtia surgery can help children grow up to lead normal, happy and confident lives.
Microtia refers to a condition in which the ear is underdeveloped. Microtia occurs in about one out of every 7,000 to 8,000 births. No one can say for sure why microtia occurs. It usually affects one ear, but may affect both ears. Often microtia is associated with other conditions or syndromes that disfigure the face or head. Even if one or both parents have microtia, the condition is not necessarily passed on to their children.

Like the external ear, the middle ear, which transmits the sounds that are heard, may also be incompletely formed. As a result, hearing in the microtic ear may be markedly distorted or completely absent. As a rule, the degree of hearing impairment is usually associated with the severity of the microtia. It is a good idea to have your child's hearing evaluated and monitored regularly by an otolaryngologist.

Even though your child may not seem to be bothered by the malformed ear, feelings of self-consciousness may potentially develop. The deformity of the outer ear often draws attention from others, especially children. Children generally become very aware and curious of differences in their bodies around the age of 4 or 5. By age 6 or 7, children begin to tease other children who do not look 'normal'. As a result, the child with a microtic ear may not be accepted by other children of the same age. This can produce feelings of self-consciousness and inadequacy.

There are three possible treatment options for the child with microtia. The first option is to do nothing, however, the potential to develop psychological scars remains. The second option is to cover up the deformity. An artificial ear, called prosthesis, can be worn to hide the microtic ear. The ear prosthesis requires replacement about twice a year to keep the size and color matched to the child's growth. The third option is to surgically correct the deficit. Surgical correction is done in a series of stages and can be completed within two years. These options can be discussed with the doctor to help you choose which option is best for your child.


riz said...

really. wow. very informative. thanks!

Problem Solving of Surgery said...

Hi Riz, thank you for your common. If you do not understand, please you ask me via comment.

khaye said...

I love this post!

Problem Solving of Surgery said...

Why do you love this post, Khaye?