Classification and Diagnosis of External Ear Malformations

Compared with most mammals, we humans wait nine long months to see our newborns, making it quite the event when you finally hold your brand-new baby for the first time! Parents are both overjoyed and relieved to find that their infant has 10 little fingers and 10 tiny toes and is in excellent health. However, even the healthiest newborn may have something unusual in the shape of the baby’s ears. Since most parents aren’t sure what it is and, therefore, what to do about an ear abnormality, (called an “external ear deformity” by those in the medical profession), we’re sharing this blog post to help you.

Join us as we classify the types of ear deformities to help you to understand what they are and what can be done to remodel the ears into a normal appearance, which can be accomplished with EarWell quite easily and rapidly, assuming it is placed on the newborn as soon as possible—ideally within the first 3-4 weeks after birth.

The Definition of An External Ear Deformity
An external ear deformity is a birth defect whereby one or both ears are either misshapen, undeveloped or, in the case of anotia, completely missing. Anotia is often associated with hearing loss and/or facial abnormalities, but other external ear deformities, such as Stahl’s ear, prominent ear, concha ear, constricted ear and cryptonia, almost never have an associated hearing loss. 

Facts About Outer Ear Deformities

• An estimated 1 in 3800 infants will have an external ear abnormality.
• 70-90% of outer and middle ear malformations affect the right ear only, although bilateral inner ear abnormalities are not uncommon. 
• Ear deformities can be acquired (position in the womb) or hereditary (spontaneous mutations or family history). 
• Malformations can occur in the middle ear, inner ear, and outer ear (pinna and external auditory canal), and sometimes all at once. 
• The pinna (the visible portion of the outer ear that aids in gathering sound waves and guiding them into the ear canal) might have abnormalities related to its size, position, and inner configuration. It is composed of skin and cartilage and is essential to hearing.

Do Babies’ Ears Change as They Grow?

Yes, babies’ ears do change as they grow, but the changes are more about proportion and subtle development rather than dramatic transformation. At birth, a baby’s ears are already fully formed in terms of their basic structure—cartilage, conchal bowl, lobes, and all. Therefore, babies with external ear malformations will likely maintain those malformations as they age. Since the cartilage in a newborn’s ears is softer and more flexible at birth, applying EarWell device as soon as possible enhances the potential for a satisfactory outcome.  

The Most Common Types of Ear Deformities: Present at birth, caused by genetic factors or environmental influences during fetal development. Examples include:

• Microtia: Underdeveloped or missing ear.
• Anotia: Complete absence of the external ear.
• Stahl’s Ear (Spock Ear): Extra cartilage fold, giving the ear a pointed appearance.
• Lop Ear: The top of the ear folds down due to weak cartilage.
• Cryptotia: Part of the ear is hidden under the scalp.
• Cup Ear: The ear is small, cup-shaped, and protruding.
• Protruding Ear: The ear “sticks out” from the side of the head.

What Causes External Ear Deformities?

Although the precise origins of external ear deformities are not well known, here are several factors that have been identified:

1. Genetics
   1. Certain ear deformities are inherited; if one child or biological family member has an external ear deformity, another child may have a similar deformity.
   2. Microtia and Anotia have been associated with gene mutations.
   3. Children with genetic diseases like Treacher Collins syndrome, which is brought on by gene mutations, often have microtia or anotia.

2. Environmental factors
   1. Pregnancy-related illnesses, especially in the first trimester.
   2. Pregnancy-related maternal diabetes. 
   3. Maternal exposure to teratogens such mycophenolate mofetil1 and thalidomide. 
   4. Using Accutane, an isotretinoin, when pregnant.
   5. Pregnancy-related abnormal vitamin A levels.
   6. A maternal diet deficient in folic acid and carbs.
   7. Drug and alcohol exposure in mothers.

3. Vascular disruption
   1. According to some researchers, microtia1 may happen when there is a breakdown in the blood supply while the infant is in the womb. In essence, the ear doesn’t get enough blood supply to develop or to continue to develop.

4. Other elements
   1. Extreme age of mother or father.
   2. Multiple births.
   3. Exposure to high altitudes.
   4. Native American or Hispanic heritage.

How are Outer Ear Deformities Diagnosed?

Almost all external ear deformities are first noticed by an infant’s parents. Confirmation that an external ear deformity is present is made by the hospital nursery physician and/or staff, and the baby’s pediatrician. 

Two Treatment Options for External Ear Deformities

Not including microtia or anotia, there are two main treatment options for a newborn ear deformity: ear molding and surgery (called otoplasty).

Ear Molding with EarWell

In essence, EarWell for babies is a silicone-like “cover” that is very flexible and soft. EarWell is the most effective—and fastest—way to address external birth defects without surgery. Applying EarWell to the baby’s ears as soon as possible after delivery is the key to success. Why the rush? The delicate cartilage in your newborn’s ears allows for easy reshaping during the first three to four weeks of life as well as immediately after birth. Molding doesn’t work on older babies or kids because their ears have hardened by then. 

Therefore, if you give your baby this painless, non-surgical option, their ears will look normal sooner. The fact that an EarWell device only requires two or three office visits, doesn’t involve surgery, stitches, or anesthesia, and is likely undetectable to your baby is another advantage of applying EarWell as a baby ear corrector. Most external ear problems can be fixed with EarWell in as little as six weeks, demonstrating its extremely high success rate. EarWell is also covered by most health insurance policies, including Medicaid/Calcaid and military coverage.

Surgical Options for Children with an External Ear Deformity

If your child has passed the age during which an EarWell can be applied, the alternative is an otoplasty, which is a surgical procedure performed any time after the child’s ears are fully developed—usually around the age of 5 or 6 years, but even teens and adults have chosen an otoplasty to resolve concerns about their ears. 

The downsides of otoplasty are the challenges of any surgery: anesthesia, recovery, dressings, and discomfort, not to mention the fact that almost no health insurer will cover an otoplasty, as it is considered to be a “cosmetic” surgery by insurance companies. Additionally, your child will spend the first 5-6 years of his or her life exposed to the remarks of other children—maybe even family members—due to the appearance of their ears. 

Surgical Options for Children with Microtia or Anotia

EarWell is not an option for infants with Microtia or Anotia, as it works only when an intact ear is present. However, there have been great advances in surgical and even non-surgical solutions for children with anotia or microtia. Please see our blog about Microtia and Anotia on this website.

The Importance of Psychosocial Support for Children with External Ear Deformities 

All of us want to be accepted by others, including our children, who don’t want to be “different” from their peers. This is normal. Ears that are overly large, that stick out, that are pointed at the top and/or have other abnormalities compared to other children can make your little one a target for teasing, which can lead to social difficulties and a lack of self-esteem. 

Since EarWell has over a 95% success rate, takes very little time, won’t be noticed by your newborn, and is likely covered by your health insurance,

 it just makes sense to check it out.

Click here to find an EarWell physician provider near you.

If you have any difficulties locating an EarWell provider, contact us at Becon Medical by calling us at 866-431-0480 or sending us an email at info@EarWells.com. We look forward to helping you give your baby perfect ears!