Expert answers to questions about microtia

Microtia is a congenital condition in which a baby is born with a small or malformed external ear. Microtia can range from mild to severe. 

Cassandra A. Ligh, MD, FACS, is an expert plastic and reconstructive surgeon at Children’s Hospital of Philadelphia (CHOP). As a member of the team of CHOP’s Ear Deformities Program, Dr. Ligh has a particular interest in conditions that affect the ear. 

Here, Dr. Ligh answers questions that cover the main concerns caregivers have about microtia.

Q: What causes microtia?

Unfortunately, we don’t yet know the exact cause of microtia. Sometimes it happens as part of a genetic syndrome (like hemifacial microsomia or CHARGE syndrome), and some theories suggest environmental or developmental influences.

Q: How will this condition affect my child’s development?

Children with microtia should be seen by a multidisciplinary team consisting of a plastic surgeon and ear specialists (ENT surgeon and audiologist). They should be evaluated by ear specialists (ENT surgeon and audiologist) to assess their ability to hear. This is important for speech and language development. A plastic surgeon will evaluate the options to reconstruct or rebuild the external ear. 

Many children with microtia develop awareness that their ear(s) look different. Ear reconstruction surgery can help give a more normal appearance to their ear(s) and boost self-confidence in social interactions with peers. Our Psychosocial Support Services team includes clinical psychologists and a social worker who are here to help your family navigate these challenges and maximize your child’s well-being at home, at school and in your community. These professionals work with children, adolescents and their families to address psychosocial concerns before and after surgery and throughout the entire treatment process. This support is an important element of the care we provide. 

Q: What are the surgical options for ear reconstruction?

There are a few different ways to rebuild an ear, depending entirely on the severity of microtia and the reconstructive goals:

• Autologous reconstruction: Surgeons use cartilage from your child’s ribs to shape a new ear. In a second surgery, the ear is lifted away from the scalp, so it has a projected natural appearance.
• Porous polyethylene implants (Medpor^® or Su-Por^®): These are ready-made ear frameworks. Surgeons place the implant under tissue from the scalp, then cover it with skin.
• Other options:
  • Tissue expansion: A balloon is placed under the skin and slowly filled with water to stretch the skin, so there’s more available for reconstruction.
  • Cadaveric cartilage: Sterilized cartilage from a donor is used to build the new ear. This option doesn’t have as much long-term research behind it.

At CHOP, our surgeons believe there’s no one-size-fits-all approach. We’ll talk through the pros and cons of each option with you and your child, as there is no “perfect” single solution.

Q: When is the best time for surgery?

The “right time” depends on your child’s needs, your family’s priorities, and the type of reconstruction chosen. In general, surgery is best when your child is old enough to want an ear reconstruction and can follow the recovery instructions after surgery.

• Porous polyethylene implants or cadaveric rib cartilage reconstruction: Possible as early as ages 4–5, though it depends on the child’s maturity and ability to follow directions.
• Autologous rib cartilage reconstruction: Usually done between ages 6–10, when the ribs have grown enough to provide cartilage.
• Prosthetic ears (artificial ears): Rarely recommended for children. They are fragile, costly and require regular upkeep. These are usually better for adults

Q: How many surgeries will my child need?

This also depends on the type of reconstruction. In general:

• Porous polyethylene implant: Usually one surgery.
• Autologous rib cartilage reconstruction: Typically, two surgeries.
• Cadaveric cartilage reconstruction: Usually two surgeries.

Q: What will my child’s ear look like after surgery?

No two ears are exactly alike — even in people without microtia. After surgery, your child’s ears will look like siblings, not twins. Each option has strengths and limits when it comes to shape, size and symmetry. The final look depends on your child’s unique anatomy.