Microtia: Treatment, Cost and Side Effects

Microtia is a congenital condition which is characterised by deformed outer ear. The ear does not develop completely which is supposed to form in the pregnancy’s first trimester. Microtia has been divided according to different grades that define the extent of deformity of the ears. The four different grades of microtia have been named as Grades 1, 2, 3 and 4. In grade 1 microtia the ear looks just a little smaller than a normal ear but the features of a normal ear are present. Grade 1 microtia may just have a few issues in the shape and from of the ear. In grade 2 microtia, the ear lacks several features of a normal ear, although about two third of the lower ear is still there. In grade 2 microtia, the ear canal is present but is very narrow. This condition is known as canal stenosis and grade 2 microtia can also be called “conchal type microtia”. Grade 3 microtia is the most common type amongst all the four types. The outer ear which is mainly composed of the ear lobe and the ear canal is extremely insignificant. The ear lobe is present just in the form of a tiny peanut and grade 3 microtia is also known as “lobular type microtia”. In grade 3 microtia the ear canal is absolutely absent. This absence of ear canal is known as aural atresia. Grade 4 microtia is characterised by no external ear. This condition is also known as anotia and is not very common. Microtia is not a genetically inherited disorder and can be present quite randomly. Treatment involves reconstruction of the outer ear using several techniques. The techniques used for microtia treatment are rib cartilage graft reconstruction, Medpor which is basically reconstructing the ear with a polyethylene plastic implant and ear prosthesis.

Treatment for microtia is initially done by providing hearing aids to the children during their early years, that is, at about 5 to 6 years. Hearing test is done with the help of BAER or Brain Stem Auditory Response Test within first two weeks of birth of the infant. CT scan or CAT scan of the middle ear can be done at about 5 or 6 year of age to determine the development of the middle ear bones. If the outer ear which consists of the ear lobe and the ear canal is under developed along with underdeveloped middle ear having underdeveloped ear drum and ear bones- hammer, anvil and stirrup, the sound waves do not reach the inner ear. This results in hearing impairment. A person with underdeveloped outer and middle ear also has malformed inner ear which leads to sensorineural loss of hearing. Although, hearing loss cannot be corrected with surgery, it can be fixed with the help of hearing aids. Surgery is required when the hearing loss is severe and no other method works to correct it. Surgical procedure is done only when the child has attained a particular age. Different surgical method can be done only at particular age. Rib cartilage graft reconstruction is usually done at about 7 to 8 years of age. In this technique bone grafts from the patient’s own ribs is taken out to reconstruct the outer ear. Polyethylene plastic implant is carried out in which a new constructed ear is placed on its appropriate area. This newly constructed ear is made using a porous framework. On this porous framework, a new ear is formed using the patient’s own tissue. Ear prosthetic is another method that is fixed on the appropriate site of the ear. A prosthetic ear looks very natural which is made of silicone and is of the same colour as that of the skin of the patient.

Person with hearing loss is first detected using BAER test or CT or CAT scans. If the disorder is not very profound, the patient is eligible for treatment with efficient hearing aids. If the hearing loss is severe, then the patient is eligible to undergo surgery.

Many people have small ear either due to their short stature or due to their family history but that does not mean they have microtia. If they do not have loss of hearing and have properly formed ears (and every part of the ear), he/she is not eligible for treatment.

Side effects of the treatment are minor. Patients may suffer some infections, tissue ischemia, loss of secondary soft tissue and secondary graft tissue loss.

After the surgery, follow up must be done. Proper pain management must be done before discharging the patient. The suction catheter from the ear is removed on the 4th or 5th day after the surgery. Dressings are removed after

It takes 4-5 weeks for the scar on the surgery site to recover completely and hearing begins from right after the surgery.

Price of treatment ranges from Rs. 1 lakh to Rs. 4.5 lakh.

Yes, the results of the treatment are permanent.

Alternative to the surgical procedure correction of hearing loss with the help of hearing aids. But if the conditions is too profound, only then surgery may be opted for.