Microtia literally means 'small ear'. It's a condition which affects the outer ear (that's the bit you can see) and the ability to hear.
Patients may have one or both ears affected. Microtia affects about one in 7,000 people in the UK.
What causes microtia and who can get it?
Microtia is a congenital condition. That means it is something which you are born with – you cannot catch it from someone else. Scientists don't know exactly what causes it.
It affects about one in 7,000 people born in the UK. For some reason microtia affects more boys than girls, and the right ear more often than the left. Asian babies are more likely to get microtia than anyone else. The reasons for this are being investigated.
What are the signs and symptoms of microtia?
This condition is easy to spot as soon as a baby is born because one or both of their ears is smaller than normal. If just one is affected it is called unilateral microtia. If both ears are small it is called bilateral. Around one in ten cases are bilateral.
There are four different grades of microtia:
- The ear is slightly smaller than normal and the ear canal (the hole in the middle of the ear) is small but you can see it.
- The ear is partially or half formed and the ear canal is closed.
- There is no external ear, you can just see a small 'peanut' of tissue and the ear canal is closed.
- The ear is totally missing (also called 'anotia').
The most common is the third type.
There is usually some hearing loss in the ear which is affected. This is because sound waves can't go down the ear canal, through the middle ear, into the inner ear and on to the brain as normal.
The inner ear is usually OK so there are ways to improve hearing. If you have microtia in just one ear then the hearing in other ear is usually totally normal.
How is microtia normally diagnosed and treated?
Doctors usually spot microtia when a baby is born. There are then quite a few treatment options, depending on the kind of microtia you have and your age.
First of all the patient has hearing tests
. They will also have a CT scan
if the ear canal is closed. This is to see what is happening in the middle and inner ear.
There are then two types of treatment – one to make the ear look 'normal', and another to improve hearing with a hearing aid.
Some people decide to have a cosmetic procedure to rebuild a new ear. Others choose to leave their ear as it is. If you opt for a new ear there are several ways to do it:
- Prosthesis (fake ear) – This is a custom made ear which fixes to the side of your head with magnets or small clips. They can look very realistic but need to be looked after carefully. You can usually have this done at six to nine years old.
- Rib cartilage graft reconstruction – A skilled surgeon takes a piece of cartilage from your ribs and carves it to match your other ear. It is then placed under a pocket of skin. This involves two operations and is not usually started until around ten years old.
- No reconstruction – You don't have to have ear reconstruction. It is only done after detailed discussions about the options, and if the patient is happy to proceed.
If the microtia only affects one ear then doctors usually do not try and improve the hearing on that side. This is because you can live and develop perfectly well with limited hearing on just one side.
But doctors can attach small hearing aids onto the bone of your skull which transmit sound to the inner ear. This improves hearing. Younger children will usually wear this kind of 'bone conductor' hearing aid on a headband for a while before it is attached to the skull. This is most common in cases of bilateral microtia.
When to ask for medical help
You will be able to talk to your doctor about your treatment as you grow up. Some cosmetic options cannot be done until your other ear is adult sized, which is usually around 10 years old.
Other options, such as attaching a fake ear, make it difficult to do a bone graft later on. You will need to speak to your medical team about which option is best for you.
What's going to help?
The main problems people with microtia experience are feeling self-conscious about their small ear and having hearing problems.
Some people grow their hair long to cover up the smaller ear. But others don't mind people seeing and are happy to tell people about the condition. It is a good idea to know a bit about microtia so you can answer people's questions – and tell people the truth about it if they are making life difficult for you.
If you have limited hearing on one side it is best to ask people to speak on your good side, or to position yourself so your good ear catches the conversation.
It's especially important to be able to hear in the classroom. Sit near the front and keep the teacher on your good side. Ask for some quite study time if the noise in the classroom makes it harder for you to hear the lessons.
People with microtia have the same opportunities as anyone else. Treatment can make your smaller ear, or ears, look like 'normal' ears and hearing aids can help with any hearing problems. The condition shouldn't stop you doing anything you want to do with your life.