Why Does Microtia Happen?
What is Microtia? Microtia is a congenital condition that impacts the development of the outer ear or ‘pinna’. This deformity can vary significantly in severity, from slight abnormalities to the complete absence of the ear, also known as anotia. The condition can occur in one or both ears, and it’s often accompanied by aural atresia, a malformation of the ear canal and inner ear structures. Microtia is observed in around 1 in 8,000-10,000 births globally and is more frequently found in males and in the right ear. Despite the prevalence of the condition, its exact causes are yet to be fully understood, but genetic and environmental factors are believed to play a crucial role. How Does Microtia Happen? One hypothesis about microtia’s etiology is that it’s a polygenic disorder, meaning it occurs due to the combined effects of multiple genes rather than a single mutation. Various studies have noted familial clustering, suggesting a potential genetic link. Moreover, certain genetic syndromes like Treacher Collins Syndrome and Goldenhar Syndrome have microtia as a component, strengthening the evidence of a genetic influence. However, genetics alone can’t explain all occurrences of microtia, so environmental factors during early pregnancy have been implicated as well. Specific exposures that have been linked to microtia include gestational diabetes, maternal alcohol consumption, use of Accutane (a medication for severe acne), and maternal smoking. Moreover, some studies have suggested that a lack of oxygen or blood supply to the developing ear could be another possible cause. Infections or illnesses during pregnancy, particularly during the first trimester when the ear is forming, may also increase the risk of microtia. Maternal illnesses such as rubella or influenza, or use of certain medications, have been associated with an increased risk, although more research is required to fully understand these relationships. Treatment of Microtia Moving on to the treatment of microtia, this primarily focuses on surgical reconstruction of the ear and the treatment of any accompanying hearing loss. The aim is to restore form and function, improving both aesthetics and hearing ability. There are different techniques for ear reconstruction, with rib cartilage grafts being a common choice. This approach uses the patient’s own rib cartilage to construct a new ear framework. The reconstructed ear is then positioned into a skin pocket in the correct anatomical position. This procedure is usually done when a child is between six and ten years old when the rib cartilage is sufficiently grown. An alternative to the rib cartilage graft is a Medpor ear reconstruction. This technique involves using a porous polyethylene framework instead of the patient’s cartilage. The advantage of this approach is that it can be done at a younger age and often requires fewer surgeries. In cases of severe microtia where the ear canal is also underdeveloped or missing (aural atresia), bone-anchored hearing aids (BAHAs) or cochlear implants might be considered to improve hearing. These devices work by sending sound vibrations directly to the inner ear through the bone, bypassing the outer and middle ear. In recent years, prosthetic ears have become another option. They’re created using 3D printing technology and are matched to the patient’s skin tone. These prosthetic ears can be attached with adhesive or anchored to the bone with titanium screws. Counseling and psychological support are also important components of treatment. As...
read moreDo ear molds hurt babies?
Do ear molds hurt babies? by: Nicholas Bastidas, MD One question i get asked is if ear molds are painful to the babies. Ear molds are designed to be worn comfortably and without any pain or discomfort to your baby. We currently use the ear well system which has a soft, compressible silicone shell that will cradle the ear. Your baby can sleep on their side or can feed lying on the molded ear without it causing any issues. The ear mold itself is attached to the skin by surgical tape and glue and so there are no needles involved or any penetration of the skin. The risks of ear moldings are very low and there is no significant risk of causing any serious injury. While the ear molds are on, your baby can hear totally normal because of the holes that are in the outer plate. In addition, even the inner conchal former piece (that I sometimes use) has holes within it to allow the passage of sound. Babies will sometimes cry when we put the molding on, which is mainly due to the us having to place them on their side and hold their head steady while we apply the ear mold. After the parents pick them up the crying almost immediately stops. In addition, we encourage parents to feed their babies at the same time we are applying the ear well device to make it an even more pleasant situation for the children. Rarely, in some babies who have severe eczema, ear molding may irritate the surrounding skin and precipitate an eczema reaction. In these situations, we may have you remove the ear molding device temporarily and apply a topical steroid cream. This will usually clear the skin condition up with 24-48hrs. Ear molding is really a low risk / high reward procedure for treating deformed infant ears. It is pain-free, requires absolutely no anesthesia and can be worn comfortably for the entire 4 week treatment period. Our experience of over 1200 ear molds allows to get the best results for your baby possible with the lowest risk of complications. Ear molding is a much better alternative to surgery down the road as better outcomes can be obtained by molding he natural cartilage and there is no downtime or recuperation...
read moreHow to Correct Ear Shapes Without Surgery
Non-Surgical Ear Molding – The Safer Way to Correct Your Infant’s Ear Shape by Nicholas Bastidas, MD Like most new parents, you want the best for your child. That includes making sure their ears are shaped correctly! Many infants are born with ear deformities, which can be corrected through ear molding within the first three weeks of life. This process is non-invasive, painless, and covered by insurance. What is Infant Ear Molding? Several studies report an increased frequency of infant ear deformities. It consists mainly of prominent and curved ears with sticking edges, folded ears, floppy ears, and pointing ears. Deformities of the outer ear can lead to teasing and psychological impaction of child’s development, and it is, therefore, important to seek treatment as soon as possible. Studies have shown that the severity of ear deformities does not improve if they are not corrected after five to seven days after birth. There are several options for treating ear deformities; the best course of action will vary depending on the individual case. Infant Ear Deformations Ear deformities can range from minor imperfections within the external ear to severe sub-development. This defect can cause concern for newborn parents; if allowed to continue for longer, the child could become self-conscious and need surgical intervention which may be way harder to improve and require cartilage grafting. During pregnancy, many babies develop deformities that can affect their appearance and health. Fortunately, medical advances have made it possible to correct many of these problems with non-surgical methods. One such method is ear molding, which treats congenital ear deformations. Ear molding is a non-surgical technique that uses pressure to reshape the ear. It is often performed on newborns or young infants and is considered to be safe and effective. The procedure is relatively inexpensive and does not require any anesthesia or sedation. In most cases, only one ear needs to be treated. If your child has one of the congenital ear deformities, such as microtia or anotia, they may still be a candidate for ear molding. This relatively simple and low-risk procedure can help your child achieve a more normal appearance. The procedure is typically performed when the child is between two and six weeks old. Ear molding works by gradually reshaping the cartilage of the ear using soft, flexible splints. Over the course of several weeks, the splints gradually reshape the ear into a more normal shape. In some cases, ear molding may need to be combined with other procedures, such as bone conduction hearing devices, to achieve the best results. Prominent Ear (Protruding Ears) Prominent ears (commonly known as protruding ears) are a common ear deformity among infants. The condition is usually genetic, affecting both boys and girls equally. In most cases, the protrusion is mild, and it can be easily corrected with surgery. However, the condition is more severe in some cases, resulting in hearing loss or balance problems. Early intervention is important for preventing these complications. Folded Ear (Lop Ear) When an infant is born, the cartilage in their ears is soft and flexible. As a result, their earlobes may appear flattened or folded. This condition, known as folded ear (or lop ear), is quite common and usually resolves itself within the first few weeks of life. In some cases, however, the...
read moreIs Ear Molding Permanent?
Is Ear Molding Permanent? by Nicholas Bastidas, MD The short answer is YES. When started soon after your baby is born, ear molding can achieve permanent correction of your child’s ear deformity. Right after birth, your babies ear cartilage is very soft and therefore malleable. It is thought that the circulating estrogen from their mother allows the cartilage to remain pliable. The same forces can can deform their ear in utero, can also be manipulated to permanently correct the shape of the ear after birth. The most important factors I have found are: 1) Time of ear molding initiation Ear molding should ideally be started soon after 1 week of life and before 3 weeks of life. There is some auto-correction during the first week and so i often counsel to wait at least 5 days before beginning treatment. Prominent ear requires early intervention especially and longer treatment due to what i perceive as the inherent weakness and lack of rigidity of the cartilage. Cryptotia and Conchal crus deformities can sometimes be treated even several months later with success. Lop ear, lidding, constricted ear and cup ear should be treated within 1-3 weeks for the optimal effects. 2 ) Length of treatment For most ear deformities i suggest 4 weeks of treatment to be optimal and sufficient for permanent correction. Prominent ear needs at least 4-6 week of treatment given the high risk of relapse. Some conchal crus deformities can be treated in only 3 weeks. When babies present late (>3-4 weeks) to my clinic, i may due 5-8 weeks of treatment depending on the severity of the deformity. 3) Consistency of treatment Ear molding only works if the molds are maintained in place during the entire length of treatment. In our clinic we modify the molds and apply extra superficial tape to help ensure the ear molds do not shift during feeding or sleeping. If the molds are dislodged, we have our parents call and guide them through placing temporary fitting until the permanent ear mold can be replaced. To sum it all up – ear molding when done correctly and in the right setting is permanent and a better alternative to doing surgery in the future. We have performed over 1000 ear deformity corrections and our experience has helped us create the best strategic plan or your baby. Other then an occasional prominent ear relapse, we have not seen the need for any our ear molded infants to require any further correction in the future. If you have any questions – please contact us or an...
read moreWill Folded Ears Correct on their Own?
Will Folded Ears Correct on their Own? By Nicholas Bastidas, MD I often get asked from new moms and dads if folded or funny shaped ears will correct on their own. The answer of course depends on how long its been that way as well as if the ear is missing parts of the cartilage that will prevent it from correcting without help. The general rule of thumb is that deformed (not malformed) ears will correct within the first 5-7 days of life. In fact when my daughter was born she had elf looking ears and i was thinking i would have to mold her ears using an Earwell device. 2 days later the ears had fully self-corrected and i didn’t need to do anything. For this reason i always tell patients to wait at least 5 days before coming in for a consultation. After five to seven days of life however, if the ears have not improved on their own 85-90% will likely stay the same way for the rest of your child’s life. This creates a sweet spot for intervention which is 1-3 weeks and significant time limitation. I often see parents who present several months later and the treatment is not as efficacious. The old teaching was to just ignore misshapen ears, thinking that they will likely get better without intervention. Unfortunately, this is usually not the case and ears should be molded as close to 1 week after birth ideally if so desired. Some parents use hats and try to push the ears back to correct the deformity and we do not discourage that. The ear well device that we use has been designed to correct misshapen ears and offers vectors of molding that a simple hat or tape can not mimic. A good indicator to predict if ears will correct may be to see if there is a family history of folded or funny looking ears. A sibling or a parent perhaps. There seems to be some genetic link to the quality of the cartilage and the shape of the ears that newborn may possess. It is important to distinguish a deformation (misshapen ear due to force or compression in the womb) from a malformation (missing anatomic parts of the ear cartilage). Usually malformed ears are smaller (microtia) and may even be associated with ear tags (branchial remnants). A small ear canal may also be present in a malformed or microtia type ear. Ear molding will not fully correct a microtia problem and only ear reconstruction will serve that purpose. Please feel free to send us a picture if you are unsure or have any questions. To sum it all up, ears may correct on their own up 1 week after birth. If they haven’t please consider making an appointment soon after to do ear molding if you desire correction for your...
read moreWhat are the risks of ear molding?
What are the risks of ear molding? By Nicholas Bastidas, MD Ear molding is a powerful, non surgical way to correct the shape and position of a newborns ears and one of my personal favorite things to do in pediatric plastic surgery. One of the more common questions patients ask me is what are the risks or downsides associated with ear molding. Any procedure that is done has inherent risks and fortunately ear molding does not have many significant ones and nothing dangerous to your child. Risk #1: Risk of Undercorrection For ear molding to be most successful it should be started early (ideally less then 3 weeks). I usually give at least 1 week for ear deformities to correct on their own before intervening and i prefer to start as close to it as possible. Most ear deformities can be corrected within only 4 weeks of treatment. Usually I have patients come back in 2 weeks for me to reposition the Risk #2: Risk of Skin Irritation I find that spit up can cause a skin irritation when left uncleaned in the areas of the tape. We always send our families home with extra tape and instructions on how to replace the tape. We purposely use a hypoallergenic tape to reduce any potential allergy to the adhesive. Sometimes also we may notice that the pressure from the mold can cause an ulceration (blister). Removing the pressure and using a topical ointment will remedy this problem without any permanent problems. If your baby is more irritable then usual this may be due to skin irritation and we can assess this in the office. Skin irritation (inflammation) may resemble an infection but we can assure you that infection is incredibly rare and almost never seen in ear molding. Risk #3: Risk of Relapse Relapse or return to original deformity is a risk of ear molding. I decrease this risk by starting intervention ideally at less then 3 weeks of life. In addition, we secure the ear molding using extra tape and adhesive to keep the molds in place for the entire treatment plan. Some difficult deformities may require additional time and we may elect to continue molding another 1-2 weeks. One week after completing ear molding if you haven’t seen relapse then the ear will likely permanently maintain its new shape. Risk #4: Risk of an Ugly Haircut Unfortunately, there is a 100% risk of this happening as we need to shave about 1” around the ears to be treated. Fortunately, the hair will grow back within a couple months and you can tell your friends and family that your baby is starting a new hair trend ;). We have to shave this area of hair or else the molding will not stay stuck to the...
read moreIs Ear Molding Covered by Insurance?
Is Ear Molding covered by Insurance? By Nicholas Bastidas Many patients call our NYC and Long island offices asking if ear molding is covered by insurance? The answer is mostly yes and “it depends”. The majority of insurance carriers recognize ear deformities as congenital problems and therefore will likely cover the cost associated with the procedure. Most do not even require what’s known as pre-determination, which is approval prior to undergoing the procedure. Examples of insurances that cover ear molding are: Aetna, BCBS, Cigna, Fidelis, UHC, Healthfirst, Affinity, Magnacare, Northwell-direct and Oxford. What we find to be most important in obtaining coverage is having your baby placed on your insurance within the first 30 days of life. As long as your baby is on the plan by then your insurance will accept our submitted CPT codes. Usually this requires sending the birth certificate to the insurance company. You do not need to wait for the baby to be on the plan before beginning ear molding. Best results are obtained within the first 3 weeks of life and you should not delay the treatment. Some patients may be asked to sign a waiver, which basically dictates that if you don’t put the baby on the plan in 30 days, then you may be responsible for paying for the cost of ear molding. Also it is important that your doctor is IN-NETWORK with your insurance company. Many doctors who do ear molding are out-of-network but claim to “participate” or “will work” with your insurance. If the insurance company denies it you may be on the hook for thousands of dollars. In addition, if covered – you may be responsible for your out of network deductible which may end up costing you a small fortune. It’s always better to confirm with your doctor is they are in-network or par with your particular insurance plan. In some some cases I find that some insurance companies will want to see pictures prior to giving approval. For these insurance companies often we will arrange a telehealth visit and have you send photos so we can help expedite the approval process without delaying your child’s ear molding treatment. Once approved we can arrange to have you seen at either our Manhattan or Nassau county office where we can immediately place the ear molds, often the same day. Insurance also covers the followup visits which are usually 2 weeks from he day that we place the ear molds. If you have any questions please contact us or call to schedule an appointment...
read moreWhen does a Baby’s ear cartilage harden? Can we still do ear molding?
Written by: Nicholas Bastidas, MD Ear Cartilage in the Newborn All newborns have soft, pliable cartilage that is present in their ears and noses. Over the course of 3-8 weeks the cartilage gradually hardens taking on the shape the shape at that moment in time. It is thought that circulating maternal estrogen is reponsible for making baby’s cartilage stay soft and as the estrogen dissipates from the newborns system the baby’s cartilage will harden. We have learned from cleft surgery that noses can be molded into a more anatomic shape if intervention is started early. For this reason surgeons can apply a nasal molding appliance to push the cartilage into a better position prior to doing the cleft lip and nasal reconstruction. Similarly, we have learned that ear cartilage can also be molded prior to the baby’s cartilage hardening. Most surgeons agree that early ear molding offers the best chance of success. Many believe 3 weeks is the optimal time to begin ear molding before the ear cartilage hardens. Other factors such as prematurity and breast feeding may also come into play by helping the cartilage maintain its pliability. Late Ear Molding After molding over a thousand ears i have learned that each situation is different and success can still be had in late presenting patients for ear molding (greater then 3 weeks old). We have published a study looking at older children who were treated with ear molding and have still had success in molding these babies. The journal article can be located here: https://pubmed.ncbi.nlm.nih.gov/36102908/ Success seems to be related to prolonged treatment 6-8 weeks) and maintaining the ear molding (ear well) device in place for the entire time. Certain ear deformities such as cryptotia. conceal crus and lop ear can easily still be molded in older children. In contrast, prominent ear we find to be the most difficulty to correct (even in young childen) and perhaps 2 weeks old is an optimal time to intervene. During your presentation for ear molding, we will examine your babies ears to determine the consistency of the cartilage and apply the appropriate mold for correction. Sometimes, babies are encouraged to wear hats to protect the ear molds from inadvertent removal. We also reinforce the molds with tape to decrease the risk of them falling off from spit-up and sweat. To summarize, ear molding can be performed even after the 3 week old mark, but early presentation is always preferred to allow significant time for Dr. Bastidas to intervene prior to your baby’s cartilage setting in its final form and position. We offer ear molding at both our New York and Long Island locations and are in-network with most major insurers. Please contact us if you would like to learn more information....
read moreThe Evolution of Microtia Surgery and Introduction of the Real Ear Reconstruction Technique
The Evolution of Microtia Surgery and Introduction of the Real Ear Reconstruction Technique What is Microtia? Microtia is the second most common deformity of the face. In plain language, microtia simply means “small ear”. While all children technically have small ears, those with microtia have ears that are disproportionally small for their heads or, in severe cases, are completely missing. Microtia varies widely in severity, to categorize each case a 4-point grading system is used where a higher grade indicates a more severe case, and a lower grade indicates a less severe case. Grade 1: Patients with grade 1 microtia usually have a small ear with most of the typical anatomy present. The ear may not appear abnormal when seen in isolation, but the size deficit is obvious when compared to the patient’s unaffected ear. These patients or their parents sometimes choose to opt out of treatment since the deformity may not be too concerning, although reconstructive options may be available. Grade 2: Patients with grade 2 microtia begin to have more obvious anatomical deficits. The fine details of the ear will not be clearly distinguishable, and the ear may have a squished or constricted appearance. Patients with grade 2 microtia are therefore often seen by reconstructive specialists early in life and can benefit greatly from ear reconstruction. Grade 3: Patients with grade 3 microtia have pretty much none of the typical anatomical features of an ear and may have what is often described as a peanut shaped lump of skin with some cartilage where an ear would typically be found. Parents of patients with grade 3 microtia are almost always interested in learning about reconstructive options. Grade 4: Finally, patients with grade 4 microtia have no ear at all, this is also referred to as anotia. These patients will often have no sign of an ear and sometime have a hairline that covers the skin where an ear would typically be positioned. Again, these patients are prime candidate for ear reconstruction since the missing ear is obvious. Patients with grade 3 and grade 4 microtia have the most severe cases and therefore very often choose to undergo complete ear reconstruction. Evaluation by an ear reconstruction specialist is required to determine what treatment options are available to each individual patient. What Treatment Options Exist? Three major treatment options have been used to correct microtia in the past. The goal of all three options is the same, to create a functional and aesthetically appealing external ear. For patients with type 3 or type 4 microtia, an entirely new ear must be created, this is often referred to as complete ear reconstruction. In contrast, patients with type 2 microtia might undergo reconstruction of only specific anatomical features rather than the whole external ear. As far as complete ear reconstruction goes, the three major treatment options are as follows: Prosthetic Ear: Prosthetic ears typically require the least extensive surgery. This option is less so reconstruction and more of a cover up. A small titanium anchor is surgically implanted onto the side of the head which holds the prosthetic in place. Well-made prosthetic ears can be extraordinarily lifelike and sit on the side of the head disguising the fact that an ear is missing. While this option can...
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