Prominent Ear Correction (Otoplasty)
Prominent ears are a considerable cause for teasing at school and of self-consciousness in later life. It is a relatively common condition. Ears ‘stick out’ due to two main features:
- a very large concha – the hollow of the ear is very deep and effectively ‘lifts’ the ear off the side of the head
- lack of an antihelical fold – looking at an ear side on you will see that it has a fold that ‘turns the ear backwards’. Some lack this fold and hence the ears ‘stick out’
Treatment is relatively straightforward and involves correcting one or both of the above features. A cut is made behind the ear where it is least visible and through this the cartilage – the firm tissue under the skin that gives the ear its shape – is remodelled.
If the ‘concha’ is too deep some cartilage is removed or remodelled. If the fold of the ear is absent or underdeveloped then a fold is produced by cutting, reshaping and bending the cartilage into the desired shape. (In very young ears minimal cutting is required). The operation takes about 45 minutes per ear.
It can be done under local or general anaesthetic. Most adults have it performed under a local anaesthetic while most children have it performed under a general anaesthetic.
Following the operation a large head bandage is applied to hold the ears in their new position and to minimise swelling and bleeding. Between 5 and 10 days later the head bandage is removed.
Further to this I usually like a head band to be worn at night over the next 3-4 weeks. The cartilage has been in a ‘sticking out’ position for a long time and it takes a while to get used to its new position.
Traditionally the youngest age at which the operation is performed is age 6 or 7 years. This is because:
- The ears have reached almost 90% of their adult size at age 7
- At a very young age the ear cartilage is quite soft and is less able to hold the new shape into which it is moulded at the time of operation
- It is usually not until the child reaches school that they are aware that their ears are prominent. Because they need to wear a head bandage, it is preferable that the child is co-operative and this is much easier when they have reached an age of relative understanding
This however is not a rule set in stone. It is now recognised in young soft ears that if the ear can be held in a certain position long enough, the ear will “set” in this position. This enables the use of ear ‘moulds’ in infants under 6 months and the use of simpler operation techniques to achieve the desired ear shape in those a bit older.
The operation still requires a general anaesthetic, and point 3 above still pertains.
- Bleeding – if this occurs after the operation it must be stopped as if allowed to build up can cause thickening of the ear
- Infection – a possible complication with all operations but if present after an ear operation can permanently mis-shape the ear. If treated appropriately and early is usually a minor problem only
- Scars – usually the scars heal well and are hard to find. In a small number, however, the scars ‘overgrow’ – become hypertrophic or keloid. This is difficult to treat. It usually requires a course of steroid injections and at worst a scar revision followed by some radiotherapy. This complication cannot be accurately predicted. It is more common in children and those of darker skin colour Fortunately it is not common
- Numbness – of the top of the ear especially. This is usual after the operation and takes several months to recover
- Tenderness – the ear will feel tender if knocked for several weeks after an ear operation
Costs depend on whether the procedure is performed under a local or general anaesthetic.
A general anaesthetic is approx 2-3times more expensive as the price includes Hospital, Theatre and Anaesthetist costs.