Smith was given a hearing aid by his mother, Christina D'Allesandro, and was using it regularly until he became depressed and refused to wear it to school in 2012. According to Smith, "superheroes don't wear blue ears". D'Allesandro was alarmed by this and emailed Marvel Comics in New York City for assistance with the situation. Designer and assistant editor, Nelson Ribeiro, then created the original image of the Blue Ear and sent it to the D'Allesandro family. Later, production artist Manny Mederos started working on a sketch of Blue Ear as a kid. Mederos told Huffington Post that during the creative process, Mederos had an idea: "Why not have the superhero be a young kid himself?" Marvel Comics responded by sending D'Allesandro comics of Hawkeye from the 1980s, when the superhero lost 80% of his hearing and had to wear hearing aids, along with a drawing of "The Blue Ear", a superhero based on Anthony, saying, "Thanks to my listening device I hear someone in trouble!"