Every family with a baby with microtia is bound to ask:
What can be done?
The truth is that, while surgery can help, a kid with microtia aural atresia is always going to have to deal with the medical, hearing and physical appearance issues related to the condition.
This page addresses some of the surgical options and post surgical expectations.
Multiple Surgeries
Most people with unilateral microtia do not do any surgery, and they are fine. When I was five years old, I started to go through a series of surgeries to repair my outer and middle ear. By the time I was six, I had had three major surgeries.
Microtia Repair
A very skilled and experienced reconstructive surgeon is needed to reconstruct the outer ear. Most people probably haven't given it much thought, but the outer ear is an extremely unique part of the body with lots of curves, bumps and ridges. Not only must the surgeon have expertise in anatomy, biology and medicine, but the surgeon must be an artist.
There are two main techniques for re-creating the outer ear: the rib cartilage technique and the Medpor technique. A skilled and experienced surgeon is needed for either approach.
Rib Cartilage Microtia Repair
Dr. Burt Brent, a professional artist and surgeon famously pioneered this technique. Dr. Brent is retired now, and unfortunately, his website is down, so I can't find his photo gallery. Dr. Brent (who I met with a couple of times) is a really kind, talented person who really loved making beautiful ears (and sculpting nature). Many surgeons still working use Dr. Brent's techniques.
This technique uses the cartilage between the patient's ribs to serve as a frame for the outer ear. There are several advantages to this approach, including the fact that the ear is made completely of the patient's own biological material. Therefore, when the ear is injured, the healing process is just like the healing process anywhere else on the body. The biggest disadvantage of this technique is that the patient must have enough rib cartilage for the surgeon to be able to fashion an ear frame, and this requires waiting until the patient is at least eight years old or so. In addition, the surgery, itself, is longer and more involved because of the multiple areas from which cartilage and skin are harvested. Finally, the skill and experience of the surgeon is extremely critical, as the surgeon must shape and sculpt the ear frame in real time during the actual surgery.
Medpor Microtia Repair
The Medpor technique uses Medpor, a synthetic material, for the outer ear frame. This technique was pioneered by Dr. John Reinisch who is a very talented plastic surgeon who specializes in microtia repair. A big advantage of the Medpor technique is that the frame can be shaped in advance of the surgery. Other key advantages of the Medpor approach are that the patient can be as young as four years old, the surgery takes less time (though still a long time) and the procedure doesn't require surgery on the abdomen and rib cage.
Emerging Technologies
Exciting biomedical technologies are happening all the time that may expand the possibilities for outer ear reconstruction. A groundbreaking technology by 3DBio Therapeutics (with surgery performed by Dr. Arturo Bonilla) is currently in clinical trial and uses an ear frame made of cartilage cells cultured from a patient's own ears and then re-framed using a specialized 3-D printer.
Atresia RepairAtresia repair can be done by an otolaryngologist (ear-nose-throat, ENT) surgeon who specialises in creating an ear canal and eardrum and implanting a titanium implant to mimic the stapes bone, the smallest bone in the human body. Creating the ear canal is called canalplasty. Most kids born with Grade III microtia are lacking an ear canal and a fully-formed middle ear. This is major surgery.
My Surgeries
My microtia repair was performed by Dr. Sheryl Lewin, an extraordinarily talented, smart and warm reconstructive surgeon who has a background in architecture as well as medicine. Dr. Lewin uses the Medpor technique. She is passionate about helping kids, and it shows.
My atresia repair was performed by Dr. Joseph Roberson, a pioneer in this field and a foremost expert in atresia repair. He, too, has been a warm and exceedingly kind doctor to me over the years.
Paying for Surgeries
I was only five years old when my surgeries were done, so I wasn't involved in the finances. However, I would be remiss to not mention finances. My understanding now is that I was lucky because my mother worked for a large company, and the company's group medical insurance provided at least partial coverage for the financial cost of these surgeries.
Doctors and Their Philanthropic Work
Many people in the United States and around the world either lack geographic access to surgeons who specialise in these procedures and/or lack the funds to pay for them. That is why, when you research the microtia community, you will be heartened to see that so many of these doctors truly care about their patients. A good number of them (including the ones I used) have set up foundations and/or have volunteered their time and expertise to travel around the world and work pro bono to help patients who, due to geography or lack of resources, would not be able to have this surgery otherwise.
Surgery Itself
I was only five years old when I had these surgeries, so I don't remember much. Here is what I remember: I got to take long road trips with my parents. I got to visit my grandmother. I got to miss school. When I woke up from the surgery, there was this stuffed Teddy Bear sleeping next to me, and the Teddy Bear had a bandage wrapped around its head. I still have that bear. After the surgery, I slept a lot, and when I wasn't sleeping, my grandmother made me whatever I wanted to eat. I got to watch a lot of Star Wars DVDs. Once I could leave the house, I got to visit a lot of parks.
When the purple bandages came off, my ear looked great. Plus, I could hear a tiny bit out of my right ear! While I think it would have been fine to not have surgery, I am glad and grateful that I had both the microtia and atresia repair surgeries - and that I did them with Dr. Lewin and Dr. Roberson, respectively.
The bad news is that shortly after this successful surgery, I was tackled in the playground at recess, and I fell on my ear, cracking the Medpor frame. (No, I wasn't being bullied. I was tackled by my brother...) After it became evident that I had to do something about it, I went back into surgery for a repair of the outer ear frame.
Then my ear looked good again and remained that way for a number of years. For example, here is a photo of my repaired ear from around 2017, six years after the surgery.
Ongoing Medical Concerns
I'm an athlete (see "
Sports" tab), and I started to focus on water polo and spend several hours in the pool every day. Tons of time in the pool has taken a toll on my outer ear and ear canal. The skin on my re-constructed outer ear looks like scar tissue, and the ear opening, too, looks swollen. I now put a
silicone ear plug in my ear (the kind you can buy at a drugstore or online) and I cover it with
waterproof transparent film (which can also be purchased at a drugstore or online) when I swim in order to avoid infections.
Unfortunately, I've lost the little bit of hearing that I had in my right ear through the atresia repair because my ear drum was punctured, and due to Covid and school obligations, I haven't been able to visit Dr. Roberson in years.
Sometime in the next few years, I will look into options for improving both the aesthetic and hearing of my ear. For now, I'm able to live OK and happily with the current "maintenance" status.
Final Thoughts on Surgeries
A lot - the majority - of kids with unilateral microtia do not do any reconstructive or atresia repair surgery. I think that most adults with microtia that you talk with would say that they were OK or fine when they were kids. Sure, they got comments, but like me, they developed coping mechanisms which probably only made them into stronger people. They would probably say that since they've lasted this long, they're not going to do surgery as adults.
For bilateral microtia where there is almost complete deafness, I think there are substantially different priorities and surgical decisions. For example, since the way you learn to speak is to hear, kids with bilateral microtia who I knew got a surgically implanted BAHA when they were young so that their speech developed normally.
Although they didn't show it to me at the time (and I'm grateful that they did not), I now know that my parents worried about my microtia: how it would affect my speech and learning and whether I would be teased and make friends.
I moved cities and schools several times when I was young. Therefore, I had to meet and make new friends repeatedly. I think that, socially, the surgeries (especially the microtia repair) helped me to adjust to new environments better and make friends more quickly because I was not self conscious about my little ear.
Also, when I moved at the age of seven, the school that I attended required very short (military-style) hair cuts, so of course, my ear was exposed. Although it doesn't look exactly like my other ear, it is not the first thing you notice about me. It allows me to get to know people a little bit before the inevitable question comes up:
What's up with your ear?
My microtia repair was performed by Dr. Sheryl Lewin, an extraordinarily talented, smart and warm reconstructive surgeon who has a background in architecture as well as medicine. Dr. Lewin uses the Medpor technique. She is passionate about helping kids, and it shows.
