Ear deformity is a common aesthetic complaint among children and adults. Mr Shailesh Vadodaria describes the non-surgical and surgical treatment options for correcting prominent ears
A prominent ear is classified as the absence or poor formation of the anti-helical fold. A prominent ear can also have an obtuse concho-mastoid angle behind the ear so that it protrudes away from the head. It is an aesthetic deformity and doesn’t affect the function of the ear.
Prominent ears occur in approximately 1–2% of the UK population. The condition is often passed down through a family and can occur in only one ear or both ears. In India, prominent ears are considered to be a sign of good luck and the larger the ear lobes a person has, the greater their intellect is.
Many parents therefore choose not to correct their child’s prominent ears. However, in countries like Africa, prominent ears are considered a sign of bad luck and so parents would want to fix their child’s prominent ears as soon as possible. A prominent ear can be known by different names in other countries, such as “elephant ears” in Eastern countries or “jug ears” in the Western world.
There are many reasons why a person may choose to correct their prominent ears. A child with prominent ears will have ears close to adult size when they are six years old, making the abnormality more noticeable. This can lead to bullying and teasing.
Some adults have said that the name-calling has had an effect on their self-esteem and so makes them shy around people.
It can also affect their behaviour at family functions and make it unlikely for the person to want to take any pictures to remember the event. It can also make it harder for those in certain professions to do their job—a builder, for example, wouldn’t be able to hold a pencil behind their ear.
The operation is performed under general anaesthesia in children. In adults and young adults the operation can be performed under local anaesthesia, but a patient can choose to have it under general anaesthesia instead.
There are some advantages for an adult having the operation done under local anaesthesia—the procedure is safe, simple, cost effective and time efficient. The patient is awake and aware so finer refinement can be possible at the end of the procedure and the bandage is easier to wrap around the head of the patient.
There are different approaches as to how to correct a prominent ear. One non-surgical approach for children is referred to as “moulding”. A mould is made to gently reshape the child’s ear cartilage which is softer and mouldable for a short time after birth.
These moulds would have to be worn by the baby all day and every day for the first few months. Although it is a non-invasive technique, it may not correct prominent ears in all children.
It can be very demanding for parents and may not be very comfortable for children. Children who did not have the benefit of moulding during childhood or the moulding was unsuccessful can have surgical correction of prominent ears after five or six years of age.
The operation, called a pinnaplasty, can utilise various surgical approaches. The most frequently used procedure is where a dumbbell-shaped incision is made behind the ear and skin is removed. The cartilage is pinned down with permanent stiches to allow it to bend backwards towards the head.
Sometimes it is necessary for a small part of the cartilage to be removed to complete the procedure. Dissolvable stiches are then used to suture skin. A dressing is placed to keep the ear comfortable and in place. The operation usually takes between one to two hours.
The suture technique is safer than scoring as it is less invasive and there is minimal danger of conchal cartilage infection. It is also easier to revise if the suture technique is used instead of scoring.
The dressing is kept on for up to seven days as it is important to keep the ear in place following surgery. It is necessary for the ear to remain undisturbed so the site must not be scratched. After the dressing is removed, patients are given a headband to wear for six to twelve weeks at night only. Swimming and contact sports should be avoided for four to six weeks.
As with any operation under general anaesthetic, there is a risk of complications related to a patient’s heart or lungs. There is also a minor risk of infection but the surgeon will prescribe a course of antibiotics and pain control medication. There is a small chance of keloid scars formation, but these can be addressed with a minor procedure at a later date.
Rarely, the ear might begin to protrude after the surgery so the operation will be performed again. There are also possibilities of bleeding, undercorrection, overcorrection and asymmetry, which may require revisional surgery.
Mr Shailesh Vadodaria is a consultant aesthetic, plastic and reconstructive surgeon based in Harley Street