Psychology & Function of the Outer Ear

In my experience, the child will discover that he/she is different at around age three to three-and-a-half. Classically, the parents find their child comparing sides in front of the mirror. They begin to refer to the microtic ear as their "little ear" or "closed ear." It is best to agree with the child that they were born with one big ear and one little one, and that when they are older, the little one can be made larger to match the other. Then, they should be treated absolutely normally, without making a fuss about the deformity. The only children who seem disturbed by microtia before the age of six or seven are those whose parents have transmitted their anxieties to the child.

Table 3 - Emotional Impact of Unrepaired Microtia
Rated by Patient and Family. Author's Series of 1,000 Cases.
Age (Years) Severe Moderate Mild
6-10 18.6 % 46.2 % 35.2 %
11-14 16.3 % 61.2 % 22.5 %
15-20 26.7 % 60.0 % 13.3 %
21-62 44.1 % 41.2 % 14.7 %

The first big psychological trial manifests in about the first grade in school, when children are continually exposed to a large group of their peers for the first time. It is at this time that our self-awareness is heightened as we begin comparing each other and forming a real concept of body image. This is when name-calling and teasing begins, and the microtic patient learns what it means to be "different" (see Table 3).

The "second round" comes with adolescence, when everyone is conforming to peer pressure to be accepted. This is the era of our lives when looks become very important and everyone wants to "fit in." Teenagers with microtia are very self-conscious about being different and are particularly motivated to having the ear repaired. However, they are also very critical and may have unrealistic expectations of what can be surgically produced.

In my experience, an untreated person never loses the desire to become whole and have his or her auricle corrected; to date, the oldest microtia patient whose ear I have repaired is 62! (see Table 4 and Fig. 6).

Figure 6 - Surgical repair of an older microtia patient.

Figure 6 - Surgical repair of an older microtia patient. Figure 6 - Surgical repair of an older microtia patient.
6a
6c
Figure 6 - Surgical repair of an older microtia patient. 6a - A 49-year-old man with microtia.

6b - Ear framework carved in one piece from his fused rib cartilages.

6c - Result achieved with the surgically completed repair.

6b

 

From Brent, B.: Auricular repair with autogenous rib cartilage grafts: Two decades of experience with 600 cases. Plastic & Reconstructive Surgery. 90: 355, 1992, with permission.

In addition to holding up our eyeglasses and funneling sounds towards our ear drums to improve hearing, ears make us look better and feel much better about ourselves as a whole person. This, then, is the driving reason for surgical creation of the outer ear. It is a psychoemotional aesthetic endeavor to restore self-esteem through restoring a symmetrical, normal self-image. Far from being "cosmetic surgery," repairing a congenital deformity permits a person to have a normal self-image, a normal life, and to be a normal, productive member of society.

If the ear goes uncorrected or a poor result is achieved by an inexperienced surgeon, the afflicted patient is likely to be plagued by feelings of low self-esteem which may last a lifetime.

Because of these implications, it is important for the pediatrician to direct the family to an experienced surgeon, even if distant travel is necessary to obtain subspecialized expertise.

Table 4 - Ages Operated Upon
Author's Series of 1,000 Microtia Patients.
Age Range (Years) Patients % of Total
5 1/2 28 2.8 %
6-7 472 47.2 %
8-10 211 21.1 %
11-15 143 14.3 %
16-20 74 7.4 %
21-40 65 6.5 %
41-62 7 0.7 %
Totals 1,000 100.0 %