Pediatric prominent ears

What are pediatric prominent ears?

Prominent ears (“Dumbo ears”) are probably the ear deformity that most people are aware of. We all know people who have ears that stick out farther than the average person. Prominent ears are a frequent source of self-esteem issues in both children and adults because of the teasing that occurs as a result of the ears’ prominent appearance.

What are the causes of pediatric prominent ears?

• A loss of the antihelical fold

• Too much cartilage in the conchal bowl of the ear or

• A combination of the loss of the antihelical fold and conch excess

How are pediatric prominent ears treated?

1-2 months of life (ear molding)

There are several approaches to the treatment of prominent ears. The least invasive and a very effective approach is the application of ear molds to the ear(s) of a baby. If prominent ears are diagnosed in the first 1-2 months of life, ear molds may be applied to the ears with tapes and the ears will be reshaped without any surgery.

Unfortunately this property of the ears to be shaped with molds is only possible in the first 1-2 months of life. The ability of the ears to be molded during this time is believed to be due to the effects of maternal estrogen (hormones passed from the mother to the baby). Once the effects of the estrogen (hormones) are lost the ears can no longer be molded.

Again, the optimal time to start molding is in the first month of life, so it is important to schedule an appointment for ear molding as soon as an ear deformity is suspected.

After 2-3 month of life (otoplasty)

If prominent ears are diagnosed after age 2-3 months, the only way to reshape the ears is with a surgery called an “otoplasty”. Typically, we wait until at least age 5 to perform an otoplasty. It is important to allow the ear to grow close to the adult size to make sure that the correction from otoplasty will continue to look normal after growth of the ear is complete.

• Otoplasty usually requires placement of stitches in the cartilage of the ear (under the skin) to reshape and reposition the ear. The cartilage of the ear is very soft and weak before age five, so we usually wait until after five years of age to let the cartilage strengthen and increase the chance that the otoplasty will be successful.

Other considerations in terms of timing for surgery include the patient’s ability to be cooperative with the care required after surgery and the presence or absence of teasing from peers. In general we advocate for performing otoplasty before any issues with teasing arise. The ideal time for otoplasty is any time after 5 years of age, typically between 5-7 years old. The incidence of teasing increases significantly after age 7.

Otoplasty techniques may vary somewhat between surgeons. It is best to ask your surgeon what approach they use. In general, the otoplasty procedure must address the cause for the prominent ear. If there is a loss of the fold in the antihelix, then the procedure must restore this. The most common way to restore the antihelical fold is by placing sutures (stitches) in the cartilage under the skin on the back of the ear. An incision is made in the crease between the back of the ear and the head. The skin is elevated off of the cartilage to allow the stitches to be placed in the ear. The cartilage is what gives the ear its shape. The sutures are placed in a way that forces the ear to bend back to create a normal looking antihelix on the front of the ear. Often times sutures are needed in the conchal bowl also to rotate the ear backward and closer to the head. The incision is then closed with sutures that dissolve on their own. The sutures that create the new shape of the ear are not dissolvable, and remain under the skin without being visible to ensure the new ear shape is retained.

• Post-operative aftercare - After the otoplasty, a bulky dressing is worn for a few days for comfort. There is swelling of the ears for 1-2 weeks. A head band is worn at night to support the ears while sleeping for 3 months.