Synonyms: protruding ears, bat ears.
The physical problem
Prominent ears are an inherited problem affecting 1-2% of the population (although its diagnosis is somewhat subjective and this figure depends on what is considered to be a prominent ear). It may be unilateral or bilateral and arises as a result of lack (or malformation) of cartilage during primitive ear development in intrauterine life. The ear subsequently has abnormal helical folds or grows laterally. Occasionally, folds seen at birth resolve spontaneously.
Prominent ears do not tend to improve and about 30% of babies who have prominent ears are born with normal looking ears with the problem only arising in the first three months of life. This may be exacerbated when the soft cartilage is repeatedly bent over, particularly during breast-feeding. There are no functional problems associated with prominent ears.
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The psychological problem
The psychological distress caused by prominent ears can be considerable. Teasing at school causes both short-term unhappiness and can have a long-term impact on perception of self-image and self-worth. This is not a uniquely British phenomenon as is testified by the range of names attributed to this condition among a number of different countries: teapot ears (Austrian, German), pig's ears (Polish), cabbage leaf ears (French). Even the famous could not escape torment: "His ears make him look like a taxi cab with both doors open." (Howard Hughes about Clark Gable).
Prior to six months of age, the ear cartilage is very soft and may be amenable to moulding and splinting. Bandaging and taping have been used in the past but now sophisticated splints have been designed to correct problems more specifically. These have been successful when used in the young baby, so lessening the need for surgery. After six months, surgical correction is the only option.
Referring for surgery
Pinnaplasty or otoplasty can be carried out in the child from about 5 years of age - there is a balance to strike between doing it before the child goes to school (with possible teasing or bullying) and allowing enough time to see if the child perceives it as a problem - the latter are more likely to be co-operative with surgery and to be happier with results. Some surgeons have suggested operating before the age of 4 but this is not standard practice in this country. The operation can just as well be carried out on adult patients. Once the decision is made, referral can be made either to the local ear, nose and throat (ENT) team or to a plastic surgeon. The procedure is available on the NHS to children; most adults have to go privately unless the person can be shown to be in extreme psychological distress, in which case decisions are made on an individual basis.
- Anaesthetic - usually done under general anaesthesia in children and local anaesthesia in adults.
- Procedure - this may be carried out on one or both ears. It takes about an hour to complete (if bilateral) and involves an incision posteriorly, removal of a small amount of skin and refashioning of the underlying cartilage.
- Closure - the skin defect will be sutured (generally but not always absorbable sutures) and the ear(s) will be bandaged.
- Postoperative care - this procedure is usually done as a day case but patients should be advised to take at least 10 days off school/work. Regular simple analgesia is suitable but avoid non-steroidal anti-inflammatory drugs (NSAIDs) - increased risk of bleeding. Postoperative care varies according to local practice. Traditionally, the dressing has been kept on for about 7 days (the importance being to keep the ear in place following the surgery). However, a recent paper has recommended that it need not stay on any longer than 24 hours. Follow the advice of your local team and contact them if the dressing comes off before the recommended time.
- Some patients may be advised to wear a protective headband for several weeks thereafter (particularly at night).
- Hair can be washed after 14 days; patients should be advised to take particular care in cleaning that area and drying it well afterwards.
- Swimming should be avoided for at least 2 weeks, (ideally wait 4-6 weeks) and contact sports for 8 weeks.
- Patients can fly any time after the procedure.
- Follow-up is 2-3 months after the procedure.
- Generally rare (no more than 5% in total).
- Those associated with a general anaesthetic.
- Development of keloid scars (3%).
- Numbness of the ear(s), which may take several weeks to resolve.
- Asymmetry between the ears.
- Haematoma - seek advice from the operating team (patients sometimes need to return to theatre for clot removal).
- Dehiscence - if not secondary to infection, a small gap can usually heal with appropriate dressing (done by the operating team).
- Infection - if severe, this can lead to complete wound breakdown and the cartilage may get involved, so giving rise to long-term deformities which may need a further procedure to correct them.
This condition does not resolve spontaneously. After the age of six months, surgical correction is currently the only available method of addressing it.
There is generally an excellent rate of satisfaction after successful surgery with reports of improved self-esteem, social life and leisure activities.
Further reading & references
- Lin SJ et al; Ear, Prominent Ear, eMedicine, Dec 2009
- Setting back of prominent ears, British Association of Aesthetic Plastic Surgeons; Individual operations
- Cooper-Hobson G, Jaffe W; The benefits of otoplasty for children: Further evidence to satisfy the modern NHS. J Plast Reconstr Aesthet Surg. 2007 Nov 19;.
- Hamish J, Laing E; Prominent ears: a European Perspective. BMJ Dec 2005; 311: 1715.
- Bermant M; Otoplasty: cosmetic ear plastic surgery: big ears and protruding ears can be inherited from parents
- Schonauer F, La Rusca I, Molea G; Non-surgical correction of deformational auricular anomalies. J Plast Reconstr Aesthet Surg. 2009 Jul;62(7):876-83. Epub 2008 May 19.
- Gosain AK, Kumar A, Huang G; Prominent ears in children younger than 4 years of age: what is the appropriate timing for otoplasty? Plast Reconstr Surg. 2004 Oct;114(5):1042-54.
- Patient agreement to investigation or treatment - Pinnaplasty: correction of prominent ear(s). Addenbrooke's Hospital
- Ramkumar S, Narayanan V, Laing JH; Twenty-four hours or 10 days? A prospective randomised controlled trial in children comparing head bandages following pinnaplasty. J Plast Reconstr Aesthet Surg. 2006;59(9):969-74. Epub 2006 Mar 29.
- Faulconbridge RL, Bowdler D; ENT.UK: British association of otolaryngologists - head and neck surgeons. Protruding ears/bat ears/pinnaplasty
- Horlock N, Vogelin E, Bradbury ET, et al; Psychosocial outcome of patients after ear reconstruction: a retrospective study of 62 patients.; Ann Plast Surg. 2005 May;54(5):517-24.
|Original Author: Dr Olivia Scott||Current Version: Dr Hayley Willacy|
|Last Checked: 19/11/2010||Document ID: 823 Version: 22||© EMIS|
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