Correction of prominent ears

This page explains about correction of prominent ears and what to expect when your child comes to Great Ormond Street Hospital (GOSH) to have this procedure.

Our ears naturally stand away from the side of the head but some people’s ears stick out more than others. Prominent ears (bat ears or jug ears) can run in families but are not linked with any medical conditions and have no effect on hearing ability. However, in childhood, they can cause unwanted attention, such as name calling and bullying.

A child’s ears are close to adult size by the age of six years, making any perceived abnormality more noticeable. The ears may look more prominent but are in fact perfectly normal size but with a larger bowl at the top or different folds. Prominent ears can be corrected in an operation called pinnaplasty.

What is a pinnaplasty operation?

This is the name given to the operation to correct prominent ears or other abnormalities of the external part of the ear (the pinna). An alternative name for the operation is otoplasty (oto = ear).

The operation involves shaping the skin and cartilage behind the ear so that it is pulled back to look less prominent. The operation usually lasts between one and two hours, although your child might be away from the ward a little longer than this, having and recovering from the anaesthetic.

Pinnaplasty is best carried out after a child is six years old. Children of this age usually have the operation under a general anaesthetic, but older children might prefer to have a local anaesthetic instead. The operation can be carried out on older children or even adults, but as we grow older the cartilage in our ears becomes stiffer.

Are there any alternatives?

There are some ear moulds available that shape the ear while the cartilage is soft enough to mould. Treatment with these moulds needs to start very soon after birth and they need to be worn all day everyday for several months. They may be useful for babies with mildly prominent ears but are less successful for very prominent ears. In many cases, an operation is the most reliable method of correcting prominent ears.

What happens before the operation?

Outpatient appointment and preoperative assessment clinic

At the outpatient appointment, the surgeon will explain about the operation in more detail, discuss any worries you may have and ask you to give permission for the operation by signing a consent form.

We will invite you to attend a preoperative assessment clinic before the operation. The aim of this clinic appointment is to prepare you and your child for the operation and give you an opportunity to ask questions and meet the team. We suggest making a note of the questions you want to ask before the appointment. This visit may include taking blood samples, photographs, swabs and meeting the surgical team.

Please bring in any prescription medicines he or she is currently taking and tell us if he or she has any allergies.

What does the operation involve?

First, the surgeon will make a small incision (cut) behind the ear and removes a thin sliver of skin. If the ear is missing some folds, he will form these using permanent stitches underneath the skin. Once the shape of the ear has been corrected, the wound is stitched closed.

An alternative method, which is rarely used at GOSH, is where the skin is pulled away from the ear and the cartilage is ‘cut’ allowing it to change shape, before the skin is put back and stitched closed.

Are there any risks or complications associated with the operation?

All surgery carries a risk of infection or bleeding. These are both minimised by the operating methods we use at GOSH. To further prevent infection, the surgeon will give your child a dose of antibiotics during the operation. There is usually no need for a course of antibiotics afterwards.

Your child’s ear might look swollen for a few weeks after the operation, which can make it difficult to tell if the operation has been a success. Within two months of the operation, all the swelling will have gone down so you will be able to see the final result better.

Very rarely, the ear starts to stick out again. If this happens, a second operation might be needed.

The scar behind the ear may take a while to settle down, but in time, it will hardly be visible. Some children develop lumpier scars than others, called keloid scars, which can be unsightly. If your child develops a keloid scar, its appearance can be improved with a minor operation in the future.

What happens after the operation?

When your child is under the general anaesthetic, a local anaesthetic injection is given to numb the back of the ear. This will last for a few hours after surgery reducing the pain.

Pain relief will be given towards the end of the operation but this will be topped up when your child returns to the ward. Once the operation has finished, a soft dressing will cover the ear to protect it while it heals.

Your child will come back to the ward to wake up fully from the anaesthetic. Correction of prominent ears is normally carried out as a day case procedure. Your child will be given regular pain relief on the ward and you should continue with over the counter pain medicines when you get home. Medicines such as paracetamol, given according to the instructions on the bottle, are usually enough to make your child’s ear comfortable.

When you get home

Your child will need to return to the dressing clinic to remove the head bandage and check the operation site.

The length of time that the dressing is needed varies from child to child, but is usually between a few days and a week. The skin under the bandage might feel hot, sweaty and itchy, particularly in hot weather, but please try to persuade your child not to scratch or rub as this could damage the ear and stop it healing well.

Keep the head bandage clean and dry. If the bandage falls off before the dressing clinic appointment, do not try to replace it.

The stitches used to close the skin are dissolvable so do not need to be removed. The stitches under the skin are permanent so are also not removed. For between six weeks and three months after the operation, your child should wear a soft headband at night to avoid damaging the ear while he or she is asleep. Make sure that the headband is not too tight and putting too much pressure on the ear.

Your child might find it difficult to find a comfortable sleeping position for the first few days, so might need some extra pillows to sleep in a more upright position.

Once the dressing has been removed, your child will be able to have a hair wash, but be careful when you are drying the hair, as the ear might be a bit sore if knocked. Use the cool setting of the hair dryer to dry the area around the ear rather than rubbing with a towel.

Your child should be able to return to school a few days after the dressing is removed. Your child should avoid swimming for four to six weeks and rough play or contact sports for three months.

Your child will have to come back to GOSH for an outpatient appointment in three months will be to check that the ear is healing well.

You should call the ward if:

  • your child is in a lot of pain and pain relief does not seem to help
  • your child has a temperature of 38°C or higher and pain relief does not bring it down
  • your child is not drinking any fluids
  • the operation site is red or inflamed, and feels hotter than the surrounding skin
  • there is any oozing or bleeding from the operation site
Compiled by: 
The Plastic Surgery department and Peter Pan Ward in collaboration with the Child and Family Information Group.
Last review date: 
February 2014
Ref: 
2013F0208

Disclaimer

Please note this is a generic GOSH information sheet. If you have specific questions about how this relates to your child, please ask your doctor. Please note this information may not necessarily reflect treatment at other hospitals.