Disease Description (Causes and Symptoms)
- Definition: A condition in which the auricle (antihelix) is flattened and spread out (e.g., an underdeveloped antihelical fold or insufficient auricular folds), or in which the angle between the auricle and the skull is large, causing the ear to protrude from the head (synonyms: donkey ear, Mickey Mouse ear, bat ear).
- Causes and pathophysiology: Mainly associated with congenital abnormalities of cartilage shape (underdevelopment of the antihelix or conchal hypertrophy). There may be a genetic predisposition, and it may occur on both sides or on one side. Because neonatal cartilage is soft and malleable, early conservative correction is possible. It does not affect hearing.
- Main symptoms: Visible protrusion (a cosmetic issue), and psychological/social stress (teasing and withdrawal). Changes in hearing are generally absent.
- Diagnostic criteria (clinical): A clinical criterion is used in which prominent ears are considered when the edge of the auricle is approximately 2.5 cm or more from the head, or when the angle between the auricle and the head is approximately 40 degrees or more.
Treatment Methods
- Non-surgical treatment
- Newborns (from a few days to within a few weeks after birth): The shape can be corrected while the cartilage is malleable using ear-molding splints or tape fixation. Early treatment is most effective.
- Surgical treatment (plastic-surgical correction, otoplasty)
- Suture technique: A method of creating the antihelical fold with sutures without excising cartilage (e.g., the Mustardé technique). It has few complications and is widely used.
- Conchal excision or posterior incision technique (conchal setback): A method of partially removing excessive conchal cartilage or pulling the concha backward and fixing it (Furnas-type).
- Cartilage scoring/excision: A method of reducing the angle by incising the cartilage or shaping and fixing it after incision (e.g., the Stenström or Chongchet technique).
- In many cases, the above techniques are used in combination.
- Anesthesia: Children generally receive general anesthesia; adults may receive local anesthesia plus sedation or general anesthesia.
- Postoperative care / lifestyle management
- Maintain a compression bandage and careful dressing of the surgical site (for several days to weeks). Avoid activities that press on the ears (sleeping position, helmets, glasses, etc.).
- Monitor for signs of pain and infection, and take prescribed antibiotics and analgesics.
- Recovery period: Daily activities are possible within several days, but complete recovery and a stable appearance take several weeks to several months.
- Precautions and risk of complications
- Bleeding/hematoma, infection, suture irritation, overcorrection (the ear being attached too closely) or undercorrection (recurrence), scarring, keloids, and skin necrosis (rarely) may occur. Recurrence is possible because of the elasticity of the cartilage.
- Achieving complete symmetry between both ears may be difficult.
- Prognosis: The surgery is generally safe and has a high satisfaction rate, but some cases may require revision correction (reoperation).
Checklist Before an Outpatient Visit (Including Sample Questions)
Items/information to prepare
- List of medications currently being taken (including anticoagulants, aspirin, and vitamin E) and supplements
- History of previous surgery and anesthesia, and history related to bleeding (such as bleeding disorders)
- Allergies (medications, latex, etc.)
- Record of symptoms and changes (when the protrusion first became noticeable, and whether it is bilateral or unilateral)
- For children, notes on psychosocial effects such as peer relationships and problems at school (including whether bullying is occurring)
- Front and side photographs of the ears (helpful for discussing the treatment plan)
- Previous related test results and medical records (if available) Sample questions (to check for yourself during the outpatient visit)
- Whether any medications have been taken within the past 6 months and whether there were any unusual reactions
- Whether anyone in the family has similar symptoms
Examples of General Questions to Ask the Doctor
- What are the advantages and disadvantages of this treatment (or surgery), and what side effects are expected?
- What is the recommended age for surgery, and what anesthesia options are available?
- How long is the recovery period, and how much time is expected before returning to daily activities?
- What is the recurrence rate (or likelihood of needing reoperation)?
Examples of Condition-Specific Questions
- This is a newborn—can correction with molding (tape/splint) still be performed? Until when should it be attempted to be effective?
- In my case (or my child’s case), is the suture technique alone sufficient, or is cartilage excision/conchal setback necessary?