Prominent ears have been an aesthetic concern throughout history, with otoplasty dating back to the fifth century BC. An estimated five percent of the population has an ear malformation, with one or two percent of the population sporting prominent ears.
Prominent ears protrude from the head more than is typical, resting at a twenty-five degree angle, which makes them stick out. Sometimes bullies in the playground will refer to this as "dumbo ears".
Although doctors can correct some ear deformities at birth, prominent ears are a issue that may not overly concern the parents of an infant. However, as the child grows and faces the world, they can become subconscious about their ears. There are a few options that can help, including a relatively new medical device that can reshape the ear without surgery.
Why are prominent ears a problem?
Although ear deformities can cause problems with ear function, prominent ears have little effect on hearing. Despite this, prominent ears can be a health issue when they cause psychological problems.
Schoolyard children tend to tease classmates with ears that protrude, and this bullying can affect the child's self-esteem. Feeling self conscious about prominent ears can then persist into adulthood. These children and adults may turn to plastic surgery in an effort to feel better about their ear shape and regain their self-confidence.
What causes prominent ears?
Prominent ears can be caused by an absent or poorly-developed antihelical fold, a deep conchal bowl, or a protruding earlobe. The cartilage may be overdeveloped or underdeveloped or there may have been an injury that affects the ear shape. These deformities may correct on their own soon after birth, or the ears may appear normal at first and develop an unusual shape later.
What are the options for correction?
A number of options are available for correcting the appearance of prominent ears, including new technologies.
Otoplasty is surgery to correct the ear shape. Although these procedures are effective, risk is involved. Outpatient procedures can use local or general anesthesia and there is downtime. The patient must wear a large bandage over their ear for a period of days and a loose covering for the next few weeks for protection after surgery.
An otoplexy, also called ear pinback or pinnaplasty, is the most common solution for prominent ears in older children or adults. In this surgical procedure, the plastic surgeon makes an incision and repositions the concha closer to the ear and removes excess skin and cartilage from the ear's rim. The doctor then sutures, or "pins", the ear in a position closer to the head. Although this is a common procedure, it does carry surgical risks and downtime for the patient.
Some people have microtia, which is a small pinna, the outer part of the ear. Plastic surgeons can reconstruct the ear to a more usual size and shape using cartilage from the ear or rib cage. This helps give the patient the appearance of a full ear.
Some people have macrotia, which is characterized by unusually large ears. By removing excess skin and cartilage from certain areas of the ear, ear reduction surgery can make the ears appear smaller and improve their position.
Soon after birth, an infant's cartilage is still malleable thanks to the presence of estrogen. If a child is born with an ear shape abnormality, physicians can correct this abnormality by taking advantage of the soft state of the cartilage. These abnormalities may include prominent ears, a constricted ear, or Stahl's ear.
The major downside of these procedures is that they are only effective in the weeks after birth. After this time, the cartilage is no longer malleable and the procedures will not be effective. This means they are usually only used to correct deformities at birth but cannot help someone who feels that their ears stick out too far later in life.
Traditionally, doctors have corrected an infant's ear shape by taping them. Using medical tape, the doctor will flatten the ear and use tape from the ear to the child's head to hold the ear in place. This taping can continue for about six to eight weeks, but after this time, there is less estrogen present and the cartilage is no longer malleable. Continuing to tape the ears will no longer be effective.
In this procedure, the doctor will use a splint to mold the ears into the desired shape. The splint can be held down using medical tape, making this an upgrade to the taping method although similar.
Earwell and Ear Buddies
Earwell and Ear Buddies are both external devices that are variations of the splinting and taping methods. These specially-designed devices are fitted onto the ear externally to reshape the infant's cartilage.
Earfold Implantable Clip System
The Earfold device is a relatively new option for prominent ears, gaining approval in Europe in 2015. This device is an alternative to otoplasty and can be inserted in a minimally-invasive outpatient procedure. Earfold is made using nitinol, a nickel and titanium alloy that regains its original shape once inserted in the ear, coated in gold so it is not visible beneath the skin and with biocompatible properties so it is not toxic or harmful to the body.
The approximately twenty minute procedure begins with the doctor clipping a pre-fold device onto the ear, allowing the patient to see how their ear will look once the procedure is complete. The surgeon then cleans the ear with antiseptic, injects a local anesthetic, and cuts a small incision into the skin. Using the specially-designed introducer, the doctor places the implant beneath the skin. Once it is in place, the device eases back into its original shape to fold back the cartilage, reshaping the ear. After closing the incision and applying a small dressing, the procedure is complete.
The Earfold implantable clip system has two advantages: it is a minimally-invasive procedure and it works on adults and children over the age of seven. While taping and splints are options for infants whose cartilage is still soft, these procedures do not work for older children and adults.
Earfold can correct prominent ears in most cases, where the prominent ears are caused by an absent or poorly-developed anti-helical fold. The device can also sometimes improve prominence when it is caused by a deep conchal bowl, but it will not completely correct ear shape in these cases.
When children and adults experience bullying or low self-esteem because of their ear shape, there are options available to improve their appearance. With new medical devices like the Earfold available, these options are expanding from surgery into minimally-invasive procedures.