Hearing is a function of your inner and middle ear. The visible part of your ears, called the “external” ear (pinna, or auricle in medical terminology) helps collect sound waves, localize the source of sounds, filter specific frequencies, and funnel sound into your ear canal toward the middle ear. Also useful for supporting eyeglasses and suspending jewelry, auricles add aesthetic balance and symmetry to our face.
Completely formed at birth and reaching adult size by age 6, the external ear consists of a complex cartilage shape enveloped over its entire surface by smooth skin.
Formation of the ears is an elaborate biological process. Ear tissue derives from many sources that join together during development. Final size and shape of the ears on one or both sides may not be as desired.
Asymmetries between right and left sides are common. Ear projection from the scalp may be greater than expected. Rarely a problem in early childhood, appearance may be an issue at school age or even in adulthood. Long hair and head wear help conceal the ears. For definitive correction, ears may be reshaped by adding a fold in the upper scapha and intimating the ears toward the scalp. For older children and adults, the procedure, called OTOPLASTY, is successful, permanent, and may be accomplished in the office under local anesthesia.
Provided hearing is unaffected, our first question is: What result do you want? Most ask for ears repositioned closer to the scalp, right and left sides matching. Examination of the ears often shows a deep concha (conchal bowl) and/or an unfolded scapha. When both concha and scapha are affected, these areas should be adjusted for the most natural appearing ear. Dr. Laverson shallows the conchal bowl by reducing its depth and securing it with sutures closer to your scalp. The most delicate maneuver, however, is adding a “superior crus”, the scaphal fold that is often poorly formed in prominently protruding ears. Folding the cartilage permanently requires softening it along the planned fold and then precisely placing non-absorbing cartilage sutures and tightening them specifically for a gently curved contour. Under-tightening and over-tightening on both ears must be avoided, and under correction or over-correction are the most common reasons patients sometimes return for a minor secondary improvement in the result.
Scars from ear surgery are placed behind the ear so they are undetectable, and the upper ear is avoided so wearing glasses will not be affected. The reconstruction and ear architecture is delicate, and heals over weeks to months. Contact and collision sports should be avoided for 8 weeks or so, and compressive headgear and helmets are not advised until they can be worn comfortably. Dr. Laverson supplies specialized protective cups for young children to wear over the ears for two weeks, mainly to prevent unintended injury to the delicate reconstruction during sleep. For older children and adults, these are optional, but usually unnecessary.