Otoplasty: when to correct prominent ears, in children and adults

Parents usually ask me two things about a child’s prominent ears: whether they need correcting, and when. Adults who have lived with their ears for years ask whether it is worth doing now. The answers depend less on the ears than on the person they belong to.

What makes an ear stand out

Prominent ears are among the most common ear differences present from birth. An ear is considered prominent when it stands more than two centimetres from the side of the head, and the condition is usually on both sides. It causes no functional problem: hearing is not affected.

The cause is in the shape of the cartilage. In most prominent ears the antihelical fold, the Y-shaped ridge near the centre of the outer ear, is underdeveloped or absent, so the outer rim of the ear tips outward. Often the concha, the bowl-shaped hollow beside the ear canal, is also large and deep, and it pushes the whole ear away from the head. Many ears have some of each, and the examination establishes which, because the operation corrects whichever is present.

Why five is the earliest age

Ears grow early. About ninety per cent of their growth is complete by the age of five, and they are close to adult size between five and seven. Surgery is therefore considered from five.

From five onwards the timing is a judgement rather than a rule. Prominent ears can be a cause of teasing, particularly during the school years, and for some children that is reason enough to correct them early. For others it is better to wait, so that the earlobe has grown further and the child is old enough to be part of the decision. The first thing to tell a child is that looking different is not something to be embarrassed about. Surgery is an option, not an obligation.

In an adult

Adults have the same correction, with the advantage of making the decision entirely for themselves.

The practical difference is anaesthesia. Children have otoplasty under general anaesthesia. In adults it is usually done under local anaesthesia with light sedation: the anaesthetic is injected into the skin of the ear, which stays numb for about two to three hours. In both, it is a day case and no overnight stay is needed.

The operation

All incisions are placed behind the ear, in the natural fold where the ear meets the head, so the scar is hidden.

Where the antihelical fold is missing, it is created with fine sutures placed behind the ear that bend the cartilage into a natural-looking fold. This is the Mustardé technique, and sutures are the least invasive way to reshape an ear. Where the concha is too deep, some of its cartilage is removed, or scored and reshaped, so that the ear can sit closer to the head. This is the Davis technique. The two are combined when an ear needs both.

The aim is an ear that sits in harmony with the rest of the face.

Afterwards

A head bandage is worn for the first three days to hold the ears in their new position. Discomfort is usually mild and controlled with the pain relief prescribed. The sutures are removed at a follow-up visit eight to ten days after surgery.

Light activity can start the day after the operation. Adults are usually back to normal activities within a week. Children return to school after five to seven days and to sport after one to two months.

The ears look better gradually over the four to six weeks after surgery, and the result is usually permanent. Skin care and sun protection matter while the skin heals.

A split earlobe

A related request is the repair of an earlobe torn by a heavy earring or by an earring being pulled. This is a short, minor procedure under local anaesthesia: an incision is made along the split and the two edges are brought together with fine sutures, which come out four to five days later.

Dr. Stavrou performs ear correction in accredited medical centres in Cyprus, Greece and Malta.