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Small Ear (Microtia)

What is microtia?



Microtia is usually broken down into four categories:

  • Grade I - is a slightly small ear with identifiable structures and a small but present external ear canal.
  • Grade II - is a partial or hemi-ear with a closed off or stenotic external ear canal producing a conductive hearing loss.
  • Grade III - is absence of the external ear with a small peanut vestige structure and an absence of the external ear canal and ear drum.
  • Grade IV - is absence of the total ear or anotia.


The surgical intervention for correction of microtia/atresia at the New York Eye and Ear Infirmary is performed utilizing a unique and rarely found team approach. Patients who present with microtia/atresia and/or associated hemi-facial deformities are evaluated by the microtia/atresia team of the Otology Center.

Each patient undergoes a thorough team approach evaluation to detect the level of external ear, external ear canal, middle ear and facial and bite deformities through the Otology Center at the New York Eye and Ear Infirmary. The workup for these patients consists of a hearing test, CT scan of the temporal bone to detect the exact course of facial nerve and delineation of the amount of middle ear and external canal deformity, and x-rays of the face and mandible to detect hemi-facial deformities and bite irregularities. Following this evaluation, treatment options are reviewed and recommended to the parents of the child with the ear deformity. Treatment of the microtia may or may not include surgery. Parents of children who do not want surgery can opt for an external prosthesis, which can be fixed to the side of the patient’s face with titanium pins or glue. Patients who have the most common auricular deformity, Grade III, require a four to five stage reconstruction procedure performed over a one to two year period to achieve optimal surgical correction.


Three months following the primary procedure (which allows for healing and stabilization of the framework), the second stage is performed. This consists of removing the upper portion of the peanut vestige and then flipping the lower portion posteriorly and hooking this up to the reconstructed ear framework. This uses the abnormal skin to create an earlobe. This is an outpatient procedure where the patient goes home on the same day. This now provides the patient with a realistic looking ear but one which is still flattened down and tethered to the side of the head.

During the intermission between the second and third stages, the patient is encouraged to undergo laser hair removal, as the hair almost always grows down onto the skin that covers the upper part of the ear framework.

The third stage consists of lateralizing, or moving away from the side of the head, the cartilage framework. This is accomplished by elevating the framework away from the deep muscle and soft tissues (preserving a thin layer on the cartilage itself), and then placement of a skin graft and additional cartilage behind the framework to allow for permanent lateralization. This procedure generally requires a 2-3 day hospitalization. At this point, the patient has a relatively natural looking ear.

