Prominent ears or protruding ears are developmental problems. The ears are flat and stands out of your head during the early stages of your development (fetal stage). B you are born it is supposed to roll and fold forming helix and antihelix and eventually it gets closer to the head.
Prominent ears can happen due to interruption of the various stages of formation of folds ( helix and antihelix) and cavities ( concha and scapha) of the ears. This often is a cause of embarrassment and bullying and people tend to grow long hairs to cover the ears. they affect males and females equally statistically. 5% of people tend to have this problem.
What exactly is the problem in prominent ears and does it require correction?
There are various components of prominent ears such as absent antihelical folds, overdeveloped conchal cartilage and or increased auriculocephalic angle ( angle between ears and skull bones).
It requires correction only if it is excessive or if it is bothering the person. If it is noticed during childhood it may be a cause of concern to parent more than the child. it is best to seek professional advice to decide whether or not it needs correction.
Are there any tests required before proceeding for treatment?
The most important test is physical examination of the ear. The surgeon will assess the following
Auriculocephalic angle at three places- upper, middle and lower part
Asymmetry of the ears- If there is more than 3 mm difference in protrusion of the ears it is considered asymmetrical
Helix and Antihelical folds
Conchal depth and scapha
Size and protrusion of the ear lobes
Finally length and breadth of the ear to ensure it is not other abnormalities such as stahl’s ear or microtia.
Associated ear symptoms such as hearing problem, ear infections etc
Medical health check if indicated
What are the options for correction of prominent ears?
Non surgical options are limited. Taping and splinting the ears against the skull before six months of age has been shown to be effective. there are various devices that is customized for a child. It may have to be used for several months
Minimal invasive surgery: If a child presents at an early age it is possible to insert sutures percutaneously to fold the ears. this requires very small incisions at three to four places to insert the sutures. However, it is unpredictable method and may not last very long.
Otoplasty: It is a surgical procedure to correct the prominent ears. In Children it is performed under general anaesthesia whereas in adults it can be done under local anaesthesia with or without sedation. An incision is made at the back of the ear in elliptical fashion to remove the excess skin. Then the cartilage is incised from the top part all the way to the concha. the cartlage is than roled and fixed with 4-0 nylon sutures. If the cartilages are thick mild scoring can be performed for better molding. if there is prominence of conchal cartilage than it can be trimmed down at this stage. This is followed by reduction of the auriculocephalic angle by fixing the concha to the mastoid fascia. Finally the ear lobes are corrected by excising skin and fatty tissue in a fish tail incision pattern. The skin is appropriated with absorbable sutures.
What is the postoperative care after otoplasty?
A bandage is applied after the surgery for 24 hours. This is followed by application of a head band 20 hours a day for one week. then head band can be used for 12 hours a day for a month. It can be painful the first night so a strong pain killer is advisable. Patients can return to work in one week.