Prominent Ears
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What are prominent ears?
Prominent ear deformity is an abnormal ear shape that causes the ears to stand out away from the head making them more visible and socially notable. While this is sometimes described as having “big ears” the ears themselves are typically normally sized.
Before and After Slideshow
Prominent Ears Child Before/After
What causes prominent ear deformity?
As the ear develops during pregnancy it undergoes a complex sequence of growth and folding to form the delicate structure of the outer ear. Prominent ear can result when this process produces too much height in the concha (the bowl of the ear) or the anti-helical fold is too weak.
Will this affect my child’s hearing?
No. The shape of the external ear has very little impact on hearing. In general, children with prominent ears have normal hearing and correction of the external ear shape will neither improve nor worsen their hearing.
Will it go away on it’s own?
Prominent ear is often first noted by parents shortly after birth. However, many assume or are even told by physicians that this will correct on its own or the child will grow into it. Unfortunately, this is generally not the case with only about 1/3 resolving spontaneously and the remainder persisting until adulthood. Those that do correct typically do so in the first week of life.
For this reason any child with an ear anomaly that lasts beyond the first week after birth should be assessed by a pediatric plastic surgeon as they will likely require treatment to correct the ear shape.
How are ear deformities treated?
The treatment of ear deformity depends both on the type of malformation and the age of the child at the time of treatment. Many of children with ear malformations such as prominent ears can be treated with non-surgical ear molding if started in the first month of life. For children that present at a later age, repair typically requires otoplasty surgery and is delayed until the child is closer to 5-6 years old. In this way, the ears have time to grow and mature but the deformity is still treated before a strong social stigma develops among the child’s peers. However, deformity can still be treated in teenage years or even into adulthood for those that desire it.
How do I know if surgery is needed?
There is no hard and fast cut-off for when a child would benefit from an otoplasty. This is because not only are each child’s physical ears unique, but is each child’s social and psychosocial setting is as well. Said plainly, some children with a milder physical difference may experience more teasing or emotional difficulty than another child with an objectively greater physical deformity. For this reason, each child must be looked at as a unique individual and a decision made only after discussion with the surgeon, the parents and, when old enough, the child themselves.
What other ear deformities can occur?
While prominent ear deformities are the most common congenital difference seen in ears, several other deformities can occur.
Stahl ear
Stahl ear, sometimes called Spock ear or elf ear, is an abnormally pointed upper ear that results from an extra, abnormal fold in the ear cartilage. While normal ears have two crura (branches of the antihelix), Stahl ear has a third crus that crosses the scapha and causes the helix to unfurl leading to the abnormal shape.
This can be treated with both ear molding or otoplasty depending on the patient’s age.
In a lop ear the superior portion of the helix and scapha lack support and fold over. While this can resemble a constricted ear deformity, there is no missing tissue in a lop ear deformity.
This can be treated with both ear molding or otoplasty depending on the patient’s age.
Conchal crus
In a conchal crus deformity an abnormal ridge connect the root of the helix to the antihelix dividing the concha into 2 sections. While less socially obvious than many other ear deformities, this deformity can cause difficulty when using earbuds later in life.
This can be treated with both ear molding or otoplasty depending on the patient’s age.
Cryptotia
In cryptotia the upper portion of the ear remains fails to project out from the head and remains buried beneath the surrounding skin. In mild cases this can be addressed with non-surgical molding but in many cases there is a lack of skin and surgery is required to correct the problem.
Constricted/Cup ear
Constricted/Cup ear describes a group of deformities where the top edge of the ear (helial rim) is tight or folded over. The degree of constriction can vary from mild, where little to no tissue is missing, to severe where the entire upper portion of the ear is constricted and the majority of the normal structure is lost.
Because of the varied severity of deformity, treatment is likewise highly varied. Mild cases may potentially be treated by ear molding. Moderate cases may require otoplasty for surgical ear reshaping. Severe case may require complete auricular reconstruction similar to microtia/anotia.
Microtia/Anotia
Microtia and anotia are a complex group of malformations where large sections of the ear fail to form entirely resulting in very small and misshapen ear. These malformations require a different approach than most ear deformities.
Pre-auricular skin tags / Accessory tragus
These small growths of skin and/or cartilage often occur just in front of the ear and are a result of abnormalities during the development of the ear.
Ear lobe deformities
While the lobule is typically spared even in severe ear deformities, there are rare cases of deformity of the lobule itself. The most common of these is a cleft ear lobe where the lobule is split into two parts or appears to be missing a wedge of tissue. Correction of these deformities typically involves a small surgery any time after 1 year of age.
