If you are considering ear reconstruction surgery for microtia, injury, or another deformity, it is important to weigh the different treatment options available and determine, with the help of the surgeon, which option is best for you and your situation. Choosing between a rib cartilage framework and a polyethylene framework (MEDPOR®) is an important decision. Dr. Charles Thorne will explain the advantages and disadvantages of each treatment during your appointment at his New York, NY, office and recommend a treatment plan based on a careful evaluation of your needs. In most cases, Dr. Thorne prefers to use the patient’s own tissue. However, there are some cases in which using the artificial material is the best choice.

Dr. Thorne can help patients weigh benefits of the two techniques to arrive at an informed decision.

Understanding Key Differences

The main differentiating factors between these two treatment options is the material used to fashion the framework and the need for scalp tissue. With rib cartilage ear reconstruction, Dr. Thorne uses the patient’s own cartilage tissue from the rib cage to sculpt a new ear framework. Because the framework is made from the patient’s own tissue, it can be covered with the skin in the area and does not require tissue from the scalp.

The MEDPOR technique uses high-density polyethylene to create the framework. Because the framework is a hard form of plastic, it must be covered with a thin layer of tissue from the scalp called a fascial flap and a skin graft on the surface of the fascia.

Age and Eligibility

Dr. Thorne can perform MEDPOR ear reconstruction on children as young as three years old but prefers to wait until age eight to 10. For the rib cartilage technique, there is no choice but to wait until age eight to 10 because the cartilage must be large enough to create the framework.

Number of Surgeries

A typical ear reconstruction with rib cartilage framework or polyethylene (MEDPOR) framework requires at least two surgical procedures separated by several months.

Dr. Thorne believes the best option is to use the patient’s natural tissue whenever possible. However, he recommends MEDPOR reconstruction if the patient’s rib cartilage has already been harvested in previous attempts at ear reconstruction.

Discomfort and Scars after Surgery

Rib cartilage reconstruction is associated with discomfort in the chest donor site for several days. The MEDPOR technique, on the other hand, does not involve as much pain. However, it does result in scarring on the scalp from the fascial flap and scars behind the other ear to obtain the skin graft. So, each technique carries its own disadvantages

Durability and Longevity

When it comes to ear reconstruction, the most durable and lasting results come from using natural, living tissue. Rib cartilage frameworks are more resistant to trauma, feel more lifelike, and can last a lifetime. The long-term lifespan of MEDPOR is unknown, as the product has only been used for ear reconstruction since 1991.

The Benefits of Using Living Tissue

While MEDPOR is a good solution for some patients, Dr. Thorne believes the best option is to use the patient’s own tissue whenever possible. MEDPOR is a foreign material. The hard plastic often feels unnatural or uncomfortable and will always carry the risk of exposure, infection, or in extreme cases, complete loss of the framework. Once the rib cartilage framework is in place, it heals like any natural tissue and can provide lasting results with a lower risk of complications. 

Find the Right Treatment for You

The best way to find out which type of ear construction is right for you is to schedule an appointment with Dr. Thorne. He can examine your or your child’s ear and determine which material is best suited to your unique needs. For more information about the differences between rib cartilage ear reconstruction and reconstruction with a plastic framework, contact the office online or call (212) 794-0044.

In cases where rib cartilage ear reconstruction is not a suitable option, MEDPOR® ear reconstruction can provide realistic results for children and adults diagnosed with microtia. At his Lenox Hill, Manhattan, practice, Dr. Charles Thorne can restore facial symmetry with a treatment plan tailored to the specific needs of you or your child. As editor-in-chief of the premier plastic surgery textbook Grabb and Smitth's Plastic Surgery, Dr. Thorne has extensive experience in reconstructing ears with MEDPOR.

Made of porous polyethylene, MEDPOR ears partially integrate with your natural tissue over time.

What Is MEDPOR® Ear Reconstruction?

Introduced by Dr. John Reinisch in 1991, the MEDPOR® technique (microporous high-density polyethylene implant) has been successfully performed over a quarter of a million times. Because the MEDPOR framework is porous, the surrounding tissues and blood vessels will partially grow into the framework so that it almost becomes a natural part of the body.

MEDPOR® ear reconstruction is suitable for patients of all ages, including patients as young as three years old.

During the procedure, Dr. Thorne will first construct a porous polyethylene framework made from biocompatible materials that matches the appearance and position of the other ear. Once this is complete, the patient is placed under general anesthesia and the newly fabricated ear stitched in placed. Tissue is harvested from under the patient’s scalp and carefully placed over the framework so that a skin graft can be placed on the outer surface.

Who Qualifies for MEDPOR?

MEDPOR ear reconstruction is suitable for patients of all ages, including children as young as three years old. While any person suffering from congenital microtiaor who has undergone trauma to their ear can potentially qualify for this type of reconstruction, it is especially suited to patients who are unsatisfied with the results of their original operation.

However, patients must have either an intact superficial temporal artery or a patent occipital artery to ensure proper blood flow for a successful recovery. Dr. Thorne can assess you or your child's situation during a consultation to determine if MEDPOR is appropriate.

Meeting with Dr. Thorne

During your initial consultation with Dr. Thorne, he will take the time to examine the impaired ear and review your medical and surgical history to make sure you are a good candidate. It is vital that you be upfront and honest about any prior operations or medical conditions during this meeting. When certain information is withheld, it can either delay the procedure or cause complications. Based off of his assessment, Dr. Thorne can create a treatment plan and carefully walk you through the treatment timeline, answering any questions you may have.

Benefits and Drawbacks of the MEDPOR Technique

As with any procedure, there are both benefits and drawbacks to MEDPOR® ear reconstruction.

Benefits

The potential benefits of Medpor are: 

• Does not require harvesting rib cartilage
• Safe for patients as young as three years old
• Can be combined with ear canal reconstructions
• Does not require an overnight stay in the hospital
• Minimizes pain during recovery

As a result, it is often a reliable solution for many patients with microtia or ear trauma.

Drawbacks

However, patients should be aware that MEDPOR is not always an ideal option because it:

• Uses foreign material rather than your own tissue
• Does not always feel natural
• Has only been around for 26 years and the long-term results still unknown
• Does not withstand trauma as well as the patient’s own cartilage

Dr. Thorne is dedicated to ensuring the best results possible for you or your child and will explain the benefits and drawbacks in detail during your consultation. He almost always recommends reconstruction with the patient’s own cartilage because he thinks it is safer.

Learn if MEDPOR is Right for You

MEDPOR is one of many potential options for treating microtia or repairing a damaged ear. If you are interested in learning more about MEDPOR® ear reconstruction and how it can benefit you, contact our office online or give us a call at 212-794-0044.

Patients with microtiausually have aural atresia, which is the absence of the external auditory canal, eardrum, and connection to the middle ear. In addition, there are usually abnormalities of the middle ear structures. These patients have hearing problems that are different from the hearing loss that occurs as part of the aging process and traditional hearing aids will not help them. For microtia patients, whose hearing problem is related to the middle ear, the hearing can often be restored with a bone-anchored hearing aid (BAHA).

This device can either be worn on a headband in a newborn or very young child or attached to a titanium implant in the skull to bypass the middle and outer ear and directly stimulate the cochlea of the inner ear. In turn, the cochlea sends neural signals to the brain which translate into sound. As part of the comprehensive ear center at Lenox Hill Hospital in New York, NY, Dr. Charles Thorne can arrange for you to obtain a BAHA. Backed by over three decades of experience in microtia surgery and the treatment of ear deformities, Dr. Thorne is a trusted expert who is passionate about improving patients' quality of life.

BAHAs owe their effectiveness to a small titanium implant.

What is a Bone-Anchored Hearing Aid?

A BAHA consists of two or three parts depending on the type: a titanium implant, a sound processor, and possibly an abutment that connects the implant and the sound processor. In some patients, the sound processor is attached to the titanium implant with a magnet. During a short surgical procedure, a colleague of Dr. Thorne will place the implant into the bone behind the non-functioning ear.

The BAHA works by using the natural transmission pathways which are available through bone vibrations. The sound processor sends vibrations through the skull to the implant which, in turn, vibrates the surrounding bone. The bone then sends the vibrations to the inner ear where they are processed by the auditory nerve as sound waves.

Candidates for a BAHA

Ideal candidates for a bone-anchored hearing aid have issues which affect the middle ear or ear canal, such as patients with microtia. Since BAHAs bypass the middle ear, they can be especially helpful for patients who have:

• Malformations of the outer or middle ear: Deformations of the ear canal or middle ear, such as those present in microtia patients, can cause hearing loss. These issues are often present at birth. By delivering sound vibrations directly into the inner ear, BAHAs bypass the malformed areas and improve hearing. Patients with unilateral microtia will obtain the ability to localize sound to and discriminate sounds in noisy environments. Patients with bilateral aural atresiaare functionally deaf without a BAHA.
• Chronic ear infections: Placing a traditional hearing aid can often exacerbate infections by blocking the ear canal. In contrast, BAHAs allow for normal drainage and are less likely to cause infection.
• Single-sided deafness (SSD): Often, patients with single-sided deafness have normal hearing in one ear and total hearing loss in the other. A BAHA can restore complete hearing, allowing you to localize sounds more effectively and hear properly in noisy environments.

The Treatment Process

Implanting a BAHA is a simple procedure which takes about an hour to complete. Local anesthesia is often sufficient although some patients might also receive general anesthesia. Some skin follicles and fat behind the deaf ear will need to be removed before treatment. A skin graft may also be placed.

BAHAs can offer an effective hearing loss solution, even for patients who may be frustrated with past treatment experiences.

Once preparation is complete, a small hole is placed in the skull and the implant is inserted. If the magnetic type of BAHA is used, then only the implant is necessary before closing the scalp. If an abutment is used to attach the BAHA, a skin graft is then placed around the abutment.

In general, it takes about two months for the implant to fully heal, at which time the sound processor can be attached to the abutment. The advantage of the magnet is that there is no bald spot or visible abutment.

Learn More Today

BAHAs can offer an effective hearing loss solution, even for patients who may be frustrated with past treatment experiences. If you believe you or your child could benefit from this type of device, contact the office online or call (212) 794-0044 today.

What is Microtia?

The term microtia literally means “small ear” but in reality indicates a small, abnormally shaped or absent external ear. Microtia can occur on one side only (unilateral) or on both sides ("bilateral). The unilateral form is much more common, occurring in approximately 90% of patients. As will be discussed below, microtia is tremendously variable. Some patients have small, almost normal appearing ears while others have completely absent ears. Some patients have no evidence of an ear canal and some have a blind canal. While some patients appear to have a true ear canal, these canals are almost always blind and to not communicate with the middle ear (more on this below under Aural Atresia). Some patients have a hairline that is in normal position, leaving appropriate, hairless skin for the reconstructed ear. Other patients have a low hairline and additional maneuvers are required to avoid a reconstructed ear that is partially or completely covered with hair.

What is Aural Atresia?

The term aural atresia refers to the absence of the ear canal and ear drum. Patients who have microtia usually, but not always, have aural atresia. The reverse can also be true: some patients have aural atresia but a normal appearing external ear. The most common situation, however, is the patient with microtia AND aural atresia. Patients who have aural atresia do not have good hearing on that side but usually have completely normal hearing on the opposite side. Because of the normal hearing on the opposite side, these patients usually have no trouble hearing when someone speaks loudly to them in a quiet surrounding environment or in one-on-one conversations. Patients who hear on only one side, however, have difficulty localizing sounds and have difficulty distinguishing sounds in situations where there is background noise (play-ground, classrooms, parties etc).

It is important to note that patients who have atresia in both ears will be sufficiently hard of hearing to be totally dependent on a hearing aid in all situations (See below)

Patients who lack the ear canal are not just missing a “hole” in the skin; they also have no canal through in the skull. In other words, the outer ear is completely separated from the middle ear by bone. No wonder the sound can’t get through! These patients also have structural abnormalities of the middle ear itself with absence of the eardrum and incomplete formation of the tiny middle ear bones, which normally allow conduction of hearing through the middle ear. Microtia and aural atresia tend to occur together because the outer ear and the middle ear develop together in fetal life. The inner ear, on the other hand, develops with the brain, and is almost always normal in patients with microtia and aural atresia.

Diagram of Normal External Ear

Is Microtia an Isolated Condition?

In most patients microtia and aural atresia occur as isolated conditions. In approximately 10% patients, however, the ear deformity occurs in conjunction with other facial abnormalities. The most common condition in which microtia accompanies other anomalies is called "hemifacial microsomia". This condition has several other names which makes it difficult to research for patients and families. For example, hemifacial microsomia is also known as the "1st and 2nd branchial arch syndrome" and the "oto-mandibular syndrome" as well as by other names. This condition is also tremendously variable and involves underdevelopment, to some degree, of all the structures on one side of the face, including the ear, the jaw bones, the fullness of the cheek tissue, function of the facial nerve and the movement of the facial muscles. Like isolated microtia, hemifacial microsomia can also occur, in a minority of patients, on both sides of the face.

A patient with classic microtia and aural atresia (absent ear canal). An Earlobe is present but is in the wrong location.

Another syndrome where microtia may be present is Treacher Collins Syndrome. This condition is always bilateral and tends to be an inherited syndrome and involves underdevelopment of the lower eyelids, the cheekbones, and the lower jaw. Patients who have severe manifestations of the syndrome frequently have upper airway obstruction and require a tracheostomy and/or surgical elongation of the lower jaw at a very young age. Treacher Collins is inherited such that, statistically, half of the children born to a Treacher Collins patient will be affected to some degree. I say “statistical” because a Treacher Collins patient may have three unaffected children and another patient may have three affected children. “Statistically” means that on average, like flipping a coin, half the offspring will be affected.

Because of the association with these other conditions, patients with microtia may require access to other specialists and may require a genetics evaluation so that parents can be informed of any increase risk of these conditions in future children.

What Should We Do if We Have a Child With Microtia?

In most patients the only issue that requires attention early in childhood is an evaluation of the hearing. A hearing test (called an audiogram) will be recommended shortly after birth. There are two types of hearing tests, BAER testing (Brain Stem Auditory Evoked Response testing) and Behavioral Testing. BAER testing is performed before the child is old enough to cooperate with behavioral testing. BAER testing determines if the child has any hearing, but it does NOT indicate which side the child is hearing from. In other words, unilateral microtia patients will have normal or near normal BAER testing, indicating that hearing is present. Some parents think this means that the hearing is totally normal. This is not true. It simply means that hearing is present on at least one side.

Reliable behavioral testing is the hearing test of choice when the child is mature enough to cooperate. Behavioral testing can accurately evaluate the hearing in each ear and document that the microtic side has a conductive hearing loss and the other side has normal hearing.

As described above, patients who have involvement of one side of the face only (unilateral), almost always have normal hearing in the other ear and will consequently have adequate hearing function in some situations. Unilateral patients may do reasonably well without a hearing aid but can achieve binaural hearing (hearing on both sides), and may function better in the classroom and social situations, by wearing a headband with an attached bone conduction hearing aid known as a BAHA softband.

The 10% of patients in whom the condition affects both ears (bilateral aural atresia), however, are functionally deaf. It is essential that they receive bone conduction hearing aids as early in life as possible. Patients who are deaf and do not receive hearing aids will not have sufficient hearing to develop normal speech.

To reiterate, patients with a unilateral deformity usually have normal hearing in the opposite ear. They have functional hearing but will have difficulty localizing sounds and in discriminating sound in situations where there is background noise. These patients benefit from bone conduction hearing aids mentioned above. In a minority of patients the condition affects both ears and these patients will absolutely require a hearing aid in order to function in society and develop adequate speech.

What if Sufficient Hearing Does Not Exist?

The bone conduction hearing aids will be recommended within the first few months of life. Later in life it will be determined if the child is best served by a Bone Anchored Hearing Aid (BAHA) or by surgical reconstruction of the hearing. Surgical reconstruction is only possible in some patients and depends on how abnormal the middle ear anatomy is. The recommendation for a fixed BAHA or surgical reconstruction is not made for several years. The skull must be thick enough for the BAHA implant and, in the case of surgical reconstruction, the patient must have already had the outer ear reconstructed.

Treacher Collins patients usually have sufficient anatomic abnormalities of the middle ear that the hearing cannot be surgically reconstructed and these patients are usually dependent on a hearing aid for life.

How Often Should Hearing and Language Be Monitored?

Regular monitoring of hearing and language is important and should be performed annually and after every ear infection. Since patients who have microtia/aural atresia on one side are completely dependent on the other ear for hearing, it is important to make sure that the hearing remains normal in that other ear. Middle ear infections (otitis media) can result in accumulation of fluid in the middle ear, which can significantly reduce hearing. You can imagine the situation where a patient with unilateral microtia/aural atresia on the right side, develops fluid accumulation in the left ear; that patient’s hearing would be significantly compromised. Middle ear fluid is easily treatable and therefore regular follow up by a pediatric otolaryngologist is essential before speech is affected.

Do Patients with Microtia/Aural Atresia Require Any Other Tests?

A high resolution CT scan will indicate if the middle ear structures can be surgically reconstructed. In other words, all patients with microtia are candidates for surgical reconstruction of the outer ear (auricle), but not all patients with aural atresia are candidates for reconstruction of the middle ear and ear canal – it depends on how abnormal or underdeveloped the middle ear structures are.

Is Middle Ear Surgery Recommended in the Unilateral Cases?

Patients with aural atresia on one side have functional hearing in some situations. These patients will experience difficulty localizing and discriminating sounds because they lack the stereo effect of having two ears. Unilateral patients should be evaluated by an experienced Otologist regarding the possibility of a BAHA or surgical reconstruction of a canal and the middle ear. Dr. Thorne works with Otologists in many cases. The surgical reconstruction of the hearing has improved dramatically over recent years and some families opt to have the middle ear reconstruction, when possible, on the affected side. This is an individual patient/family decision, which balances the benefit of having "stereo" hearing vs. having an additional procedure. In addition, the improvement in hearing that can be dramatic immediately post operatively, tends to deteriorate to some degree with time. The surgery to reconstruct the middle ear also adversely affects the aesthetics of the outer ear reconstruction to some degree.

At What Age Is the External Ear Reconstruction Initiated?

This is an important question, which has undergone evolution. Up until ten years ago, surgical reconstruction of the outer ear was recommended beginning at the age of approximately six years. At this age the patients were thought to have sufficient cartilage in the rib cage to allow reconstruction of the ear. As surgical techniques have improved, however, it is clear that a better quality, more detailed, ear reconstruction is possible when the surgery is delayed to after the age of 10 years. Parents all want the same thing: what is best for their child. When first hearing that reconstruction is not recommended for a few additional years, parents are inevitably disappointed. We have never seen, however, a child suffer psychological distress because of delaying the reconstruction. Remember, the child will have this ear for about 90 years, hopefully, and we want it to be as ideal as possible.

When Is Surgery Performed To Reconstruct the Ear Canal and Middle Ear?

If surgery is recommended for reconstruction of the middle ear, it only takes place after the outer ear has been reconstructed. It is important that the outer ear and middle ear reconstructions be coordinated. If the middle ear procedure is performed first, it may eliminate the chances for reconstruction of the outer ear.

How Many Stages Are Required To Reconstruct an Ear?

Ear reconstruction is generally accomplished in two stages, separated by approximately 6 months. Occasionally additional “touch up” procedures are performed in order to maximize the aesthetics of the final result.

What Other Support Is Available?

It is often difficult for parents to deal with their own responses to their child's condition as well as the responses of other people. It may be helpful to speak to other families who have children with similar conditions.

Protocol For Audiologic Testing:

1. Bilateral Aural Atresia:

• An audiogram is recommended within the first few days of life, ideally before the patient is discharged from the hospital after birth. The test is repeated until consistent, reliable results are obtained.
• Patients with bilateral aural atresia will require amplification (bone conduction hearing aids) within the first few months of life.
• The bone conduction hearing aid may be converted to the bone anchored hearing aid after the otolaryngologist and plastic surgeon have reviewed the entire treatment plan.
• Patients with bilateral atresia who are dependent on hearing aids may require speech therapy and therefore a referral to a speech therapist is appropriate as soon as the child begins speaking.

2. Unilateral Aural Atresia:

• An audiogram should be performed within the few months of life.
• The test is repeated at yearly intervals. In the event of an infection in the normal ear, more frequent audiograms will be recommended.
• Patients with unilateral microtia/aural atresia will function better with a bone conduction hearing aid.

SPECTRUM OF MICROTIA

Variability of microtia. The images below demonstrate the vast difference in the appearance of microtia. The reconstructive technique must be customized for each patient.

Large conchal microtia

Small conchal microtia

Lobular microtia

Lobular microtia

Lobular microtia with very small lobule

Anotia (complete absence of ear)

For most patients, recovery after rib cartilage ear reconstruction is relatively short. In general, patients are able to return to light activities after about three days. Dr. Charles Thorne routinely performs rib cartilage ear reconstruction for patients in the New York, NY, area. Two surgeries are typically required to achieve the final result for this type of surgery. Generally, Dr. Thorne recommends a six month healing period between the two procedures. Patients can return to normal activities about three weeks after the final surgery and contact sports six weeks after. Carefully following post-operative instructions can help ensure the best results for you or your child.

Knowing what to expect throughout the recovery process is an important aspect of your treatment.

The First Few Days after the Procedure

Most patients have pain in the chest donor site for several days. In addition, they may feel sleepy or groggy after their ear reconstruction surgery due to the anesthesia. Patients generally spend two nights in the hospital and are then discharged. We may attach drains and drainage tubes (like the ones used when you have blood drawn) to the site and leave them in place for a few days.

Dr. Thorne recommends not placing any dressings or headbands on the newly constructed ear. Simply leave it open to the air and apply a small amount of Bacitracin ointment. You can shower normally after about a week, as long as Dr. Thorne believes the healing is progressing adequately.

Follow-Up Care

You will need to attend regular follow-up appointments with Dr. Thorne so he can monitor your progress and provide any additional care. Patients are usually seen about five days after surgery for drain removal and again about two weeks after the procedure for suture removal.

As a general rule, patients may shower after one week, participate in normal activities after three weeks and return to full contact sports about six weeks after surgery.

Recovery Following the Second Procedure

Most rib cartilage ear reconstruction patients require an additional procedure to elevate the ear and achieve a normal, balanced effect. During the second surgery, Dr. Thorne will use skin and cartilage grafts to lift the ear away from the head, so it properly matches the other ear.

Patients only require about another four to six weeks to heal from this procedure. Once the ear is fully reconstructed and the grafts heal, patients can resume all their normal activities, including sports, swimming, and physical education classes. Since rib cartilage ear reconstruction uses the patient’s own natural tissue, the healing process should be relatively comfortable and result in a lifelike, symmetrical appearance.

Contact Us to Learn More

Recovery after rib cartilage ear reconstruction requires careful supervision. With proper care and regular visits to Dr. Thorne, this procedure can transform an ear affected by microtia or another ear deformity and create a natural-looking, balanced result. To learn more about recovering from ear reconstruction, contact our office online or call (212) 794-0044 today.

Most patients with microtia also have aural atresia, which means absence of an ear canal. Patients who do not have an ear canal may be able restore their hearing with aural atresia repair or by use of a Bone Anchored Hearing Aid (BAHA). Dr. Charles Thorne in Lenox Hill, Manhattan, partners with a talented and trusted otologist for rebuilding the inner ear. A BAHAcan be worn immediately after birth. Aural atresia repair is best performed after the auricular reconstruction.

Understanding Aural Atresia Repair and BAHAs

Aural atresia repair involves restoring inner ear hearing loss through the surgical construction of an ear canal and an ear drum. A Bone Anchored Hearing Aid on the other hand consists of two types:

• Soft Band BAHA: During this procedure, a small processor is attached to a band worn around the head that receives and sends sounds to the middle ear bones, transmitting sound waves to the brain. This is traditionally chosen for infants with middle ear or conductive hearing loss.
• BAHA (Bone Anchored Hearing Aid): Rather than remaining on a band around the head, the processor is connected to a titanium post in the skull. Patients must be at least five years old and have adequate skull density to undergo this procedure. This type of aid provides the best possible replacement for the middle ear function.

To determine which option is most appropriate, Dr. Thorne will conduct a thorough assessment of you or your child's ears during a consultation.

This patient underwent both an aural atresia repair and a reconstruction of the external ear.

What are the Benefits?

Patients who undergo aural atresia repair or who wear a BAHA can enjoy restored hearing almost immediately. This is especially beneficial for young patients who have aural atresia on both sides and are functionally deaf without hearing aids or aural atresia repair. When this procedure is combined with rib cartilage ear reconstructive surgery, patients can have both their hearing and outer ear aesthetics restored, providing a better quality of life and improved self-confidence.

Who is a Candidate?

Unfortunately, aural atresia repair is not always a viable option. About 50 percent of patients with microtiaare candidates for aural atresia repair based on the extent of the deformity of the middle ear structures. Patients with Treacher Collins syndrome are almost never candidates for surgical repair of the aural atresia. Fortunately, almost all patients with microtia are candidates for the BAHAwhich actually provides superior hearing in the long term compared to aural atresia repair.

What to Expect During the Procedure

As one of the more challenging ear reconstruction surgeries available, aural atresia repair is always performed by an experienced otologist. A typical procedure usually includes providing the patient with a sterile, skin-lined external auditory canal in addition to improving hearing. Dr. Thorne works closely with a trusted and skilled otologist to make sure patients achieve optimal results.

Patients who undergo aural atresia repair can enjoy restored hearing almost immediately

If your child suffers from congenital aural atresia in addition to microtia, we encourage you to make an appointment with Dr. Thorne to determine if he or she is a candidate for aural atresia repair or a BAHA. The sooner treatment can be performed, the greater their chance of having hearing restored during crucial developmental stages.

Learn if Aural Atresia Repair is Right for You

Please contact our office today online or give us a call at 212-794-0044 to schedule your consultation with Dr. Thorne. He will perform a complete examination and outline the most suitable treatment options.

If you are dissatisfied with the results of a previous microtia surgery, Dr. Charles Thorne can perform microtia surgery revision at his practice in New York, NY. Microtia is a rare condition and there are only a small number of doctors who regularly perform ear reconstruction. For over 30 years, Dr. Thorne has dedicated his practice to performing ear reconstruction and otoplasty. Whether you had a rib cartilage ear reconstruction or MEDPOR® ear reconstruction, Dr. Thorne has the experience and training to revise your previous surgery and help you achieve the results you desire.

Revision surgery can help patients feel completely satisfied with their appearance.

Issues from Previous Surgeries

Surgical inexperience, along with unforeseen complications, can create unsatisfactory results for microtia repair patients. Revision surgery can address a range of concerns, such as:

• Disproportionate ears
• Flat ears which sit too close to the head
• Unsuccessful integration of tissue
• Unnatural appearance

In some cases, patients who undergo microtia treatment at a young age may outgrow their prosthetic or reconstructed ear. Others may experience side effects due to materials used in the reconstruction.

Planning Revisional Surgery

If you are dissatisfied with the results of a previous procedure, the first step is to schedule a consultation with Dr. Thorne.

Dr. Thorne can choose between several forms of reconstruction to improve the results of a previous microtia surgery. 

During the appointment, you can explain your concerns in detail and discuss your medical and surgical history. Then, he will perform a full evaluation of the treatment site and assess your facial symmetry, hairline, and the anatomy of your other ear. Based on the information he gathers, Dr. Thorne can design a treatment plan suited to your unique needs.

Immediate and Long-Term Treatment Options

Dr. Thorne offers several forms of ear reconstruction which can help improve the results of a previous microtia repair surgery. The best option will depend on what type of surgery you had in the past and the types of results you are hoping to achieve.

Rib Cartilage Frameworks

Issues resulting from rib cartilage ear reconstruction may be aesthetic or functional, or a combination of the two. If the appearance of your reconstructed ear bothers you, Dr. Thorne can replace the framework by using tissue from the other side of your rib cage. However, if your body is rejecting the harvested tissue, you may experience better results with a MEDPOR ear reconstruction. For some patients, the biocompatible material offers a safe alternative to cartilage.

MEDPOR Ear Reconstruction

Dr. Thorne can replace unsatisfactory MEDPOR frameworks with rib cartilage or a new polyethylene framework. MEDPOR ear reconstructions are prone to exposure of the polyethylene framework which requires a procedure to ensure that the entire framework is covered with healthy tissue.  However, Dr. Thorne can precisely plan and perform your procedure to ensure natural-looking results.

Silicone Prosthetic Ears

In some cases, scar tissue from previous reconstructions can interfere with revision surgery. Dr. Thorne can use a silicone prosthetic to immediately restore the appearance of your ear without surgery. Prosthetics can be attached to the skin with adhesive or titanium posts which are embedded in the bone for added stability. Typically, prosthetics are only recommended as a temporary solution or for older patients who do not have an active lifestyle.

Restore Your Confidence

For some patients, ear reconstruction for microtia is a long and difficult process. Dr. Thorne recognizes that reaching the end of this process and seeing unsatisfactory results can be incredibly frustrating. Learn more about the benefits of revision surgery for microtia repair by contacting his office online or calling (212) 794-0044 today.

Individuals born with an ear deformity frequently undergo a physical and emotional transformation with rib cartilage ear reconstruction in New York City. Dr. Charles Thorne is on the leading edge of surgical ear reconstruction in the world and has decades of experience helping patients who were born with microtia, hemifacial microsomia, and other conditions. After a personal consultation, Dr. Thorne will provide you with an outline of the surgical timeline, as well as what to expect before, during, and after the procedure.

Dr. Thorne will assess your facial symmetry, hairline, and the anatomy of your other ear to most successfully plan your treatment.

Before and after right ear reconstruction using rib cartilage grafts, The position, angle, size and details of the ear are normal.

The Initial Consultation

During your initial appointment, which usually takes about 30 minutes, Dr. Thorne will ask about your medical and surgical history. It is important to be transparent about your medical history, as prior operations can impact this procedure. He will assess your facial symmetry, hairline, and the anatomy of your other ear to most successfully plan your treatment. In most cases, rib cartilage ear reconstruction involves two surgeries, and should not be considered until the child has enough rib cartilage to construct an adult ear. Childrenare usually ready for this surgery once they reach the age of ten years.

Understanding the Procedure

Dr. Thorne will make an incision in the patient’s chest to gain access to the ribcage. He will carefully and precisely remove a certain amount of rib cartilage which will serve as the framework for the new ear. Once enough cartilage has been harvested from the ribs, Dr. Thorne will close the incision site, and begin to create the new ear. Once he has completed the framework of the ear, he will carefully place it under a strategically formed pocket of skin on the side of the head.

During the next operation, Dr. Thorne will elevate the ear, wedge a piece of cartilage behind it, and place a skin graft to recreate the depth behind the ear.

Secondary Reconstruction

The patient underwent microtia repair in childhood but was not satisfied (Left). Dr. Thorne performed redo reconstruction (Right).

Risks and Benefits of Surgery

Perhaps the key benefit of rib cartilage ear reconstruction is the final, natural-looking results that most patients experience, and the fact that the patient’s own tissue will heal normally if ever injured. There are, however, certain risks that should be considered when pursuing this surgical procedure:

• Removing rib cartilage is uncomfortable for a few days
• Removing the cartilage in very thin patients can result in an indentation in the chest contour
• There is a permanent scar on the chest

The advantages of the new ear consisting of the patient’s own tissues, rather than a foreign body that is more prone to exposure and infection, far outweigh the disadvantages listed above.

Begin Your Treatment Plan

Dr. Charles Thorne wants to help you achieve a more natural-looking facial appearance. Contactour practice today to learn more about rib cartilage ear reconstruction, or to schedule an initial consultation.

For patients who do not qualify for reconstructive ear surgeries such as rib cartilage ear reconstruction or MEDPOR® ear reconstruction, we can fashion customized silicone prosthetic ears to restore facial symmetry. While these prosthetics cannot improve hearing, they do offer realistic, aesthetically pleasing results for adults or adolescents.

Dr. Charles Thorne is Chairman of the Department of Plastic Surgery at Lenox Hill Hospital and the editor-in-chief of Grabb and Smith’s Plastic Surgery, the premier textbook in plastic surgery, and has designed prosthetics for many patients at his Lenox Hill, Manhattan, practice. You can view previous patient’s results in our gallery.

What Are Silicone Prosthetic Ears?

Silicone ears are prosthetics used to create symmetry with your healthy ear. An experienced anaplastologist can create the prosthetic from a mold of your ear so that they match in shape, size, and color.

When selecting your silicone prosthetic ear, there are two types to choose from. The first type attaches to the skin temporarily with a safe and biocompatible adhesive. The second type is known as an osseointegrated prosthesis and attaches to the head using titanium implant posts that are inserted into the bone around the ear. Although both types are removable, the osseointegrated prosthetic ear provides more durability and security.

Prosthetic silicone ears are usually recommended to ​patients​ ​who​ ​are​ ​unable to qualify for​ ​reconstructive​ ​surgeries

Regardless of which kind you opt for, you should remove your prosthetic ear nightly before sleeping or before any athletic activities. With attentive care, a prosthetic can last one to three years.

Who is a Good Candidate?

Prosthetic silicone ears are usually recommended to patients who are unable to qualify for reconstructive surgeries or to older patients whose health could be at risk with cosmetic ear surgery. Because the attachments are temporary, prosthetics are not ideal for children, as they could fall off during play. The ideal candidates are elderly patients or patients whose ears are so scarred from trauma or previous attempts at ear reconstruction that no further reconstruction is possible.

Risks and Benefits of Silicone Prosthetic Ears

Since silicone prosthetic ears do not require surgery, they are often a beneficial option for patients who are looking for immediate results or who do not qualify for reconstructive surgery due to health reasons.

However, patients should be aware that silicone prosthetic ears are fashioned from realistic looking materials, rather than using your own tissue. As a result, the outcome is not as lifelike as that of MEDPOR® or rib cartilage ear reconstruction. It can also be difficult to conceal the area where the ear and head meet and may leave some patients dissatisfied or frustrated with the appearance of their ear. While initial treatment is faster and more affordable than surgical procedures, the silicone prosthetic must be replaced periodically and costs can begin to add up. Both the pros and cons of this option should be considered carefully when deciding on treatment.

Meet with Dr. Thorne Today

If you or your teenage child suffer from microtia and have been unable to qualify for traditional ear reconstructive procedures, you may find success with a customized silicone prosthetic ear. To schedule a consultation with Dr. Thorne and discuss your options, please contact our office today online or give us a call at 212-794-0044.

Ear deformities, also known as ear malformations or ear anomalies, include a wide range of birth defects that ultimately cause ears to be misshapen, deformed, or absent at birth. Dr. Charles Thorne has over 25 years of experience in the treatment of ear deformities, and can reconstruct a new ear for patients at his New York City practice. Dr. Thorne has provided considerable success for patients with microtia, Stahl’s ear, hemifacial microsomia, cryptotia, question mark ears, prominent ears, and macrotia, as well as post-traumatic deformities and several other conditions.

Dr. Thorne creating an ear framework from the patient’s rib cartilage for reconstruction of microtia.

Common Ear Deformities

Microtia can affect one or both ears, and is categorized into four different types, grades one through four.

Microtia: A congenital birth defect, microtia causes one or both ears to be malformed or completely absent. These defects can, and usually do, cause impaired hearing as well as self-consciousness associated with the appearance. Microtia most commonly appears in boys and is more common on the right side but can occur in either sex and on either side. As mentioned in the section on “Microtia” above, there is tremendous variation in the appearance of microtia. There are a number of classifications used to describe the severity of microtia but, from a practical point of view, the ear either looks acceptable to the patient or it doesn’t and if it doesn’t, then Dr. Thorne can help by reconstructing the auricle.

Hemifacial Microsomia: This condition is characterized by underdevelopment of the tissues on one, or rarely both, sides of the face. The ear, jaw bones, soft tissue and nerves can be affected. In some patients the asymmetry is barely noticeable and in others it is severe. The cause of hemifacial mircosomia is unknown. The sequence of treatment is based on the severity of the asymmetry. Dr. Thorne examines the patient with his team of physicians and specialists and, in consultation with the patient and family, the treatment plan is developed.

Stahl’s Ear: This condition involves the development of an extra ridge of cartilage, and can produce a pointed or "Dr. Spock" appearance of the ear. Correction can be performed at any age after 4 years.

Treatment for Ear Deformities

During your consultation, Dr. Thorne will determine which course of reconstruction is best for you or your child. Possible treatments may include:

Rib Cartilage Ear Reconstruction: Since the normal ear consists of skin overlying a flexible cartilage framework, it makes sense to use cartilage when reconstructing an ear. As shown in the image above, cartilage from the rib cage is spliced together to create a realistic framework. The framework is constructed do that it is the same size as the existing ear on the other side and is placed in a skin pocket, taking care that the position and angle are correct.

Medpor Framework and Prosthetic Ear Reconstruction: One of the alternatives to using the patient’s own cartilage is to use an artificial framework composed of polyethylene, known as Medpor. The procedure has the advantage of avoiding the scar and possible indentation on the chest, but the material is a hard, plastic substance and is not flexible. In addition, if the framework is exposed due to trauma from sports or other activities, it may not heal the way an ear made from the patient’s own tissues would heal. In general, Dr. Thorne believes that if a surgeon can carve a realistic framework from the patient’s cartilage, then that is a better option than using a foreign material.

Prosthetic Ear Reconstruction: Prosthetic reconstruction involves creation of an entirely artificial ear as one might see in a wax museum. The artificial ear is attached to the side of the head with glue or with titanium implants much like those used to attach dentures. Prosthetic ears can be made very realistic but most patients, particularly young ones, will not wear them. Prostheses are a daily reminder that something is wrong rather than a solution that allows the patient to move on. Prosthetic reconstruction can be very helpful for older patients who have lost an ear or part of an ear from skin cancer and would like a prosthesis for social events. The other disadvantage of prosthetic ears is that they have to be replaced every few years for the life of the patient.

Schedule Your Consultation

Dr. Thorne understands the impact that ear deformities can have on a patient and a family. It is his mission to provide state-of-the-art surgical care for patients with ear malformations and he has been doing so for three decades.

Dr. Thorne also stays at the cutting edge of technology research and would be happy to present to you the current state of science and the future possibilities of bioprinting an ear framework from the patient’s own ear cartilage. This process is not available now but may be in the future.

Contact our office to schedule your personal consultation.

Dr. Thorne has experience with all types of ear reconstruction. A summary of the alternatives and their relative advantages and disadvantages will be presented below as well as Dr. Thorne’s recommendations for what age to perform each procedures.

The alternatives for ear reconstructionfor microtia fall into three categories:

• A plastic artificial ear (prosthesis), like what you might see in a wax museum. (Completely artificial)
• An artificial framework covered with the patient’s normal tissue (Partially artificial, partially natural)
• A framework made from the patient’s own cartilage covered by the patient’s normal tissue. (Completely natural and the technique that Dr. Thorne prefers in most cases)

Treatment

Tracings are made of the normal ear and used to determine the size and shape of the cartilage pieces to harvest from the patient's chest.

Individual pieces of cartilage are sutured together to create the framework.

Undersurface of framework. Additional pieces have been added to stabilize and project the tragus as well as to augment the posterior wall of the concha.

Prosthesis

A prosthesis is a plastic ear that is worn on the surface of the skin. It can look quite life-like from a distance. The disadvantage is that it has to be held in place. Glue adhesives are time consuming, messy and are not practical for sports and activities where sweating occurs. From a practical point of view, children refuse to wear them and tend to leave them in the drawer or lose them on the school bus. In addition, prostheses have to be taken off every night and put on every morning and are a daily reminder to the patient that he/she is deficient in some fashion. In our practice, prostheses are almost always reserved for elderly patients who lose an ear, or part of an ear, from trauma or cancer. They can occasionally be used in children as a salvage procedure when all other techniques have failed.

Artificial frameworks covered with the patient’s normal tissue

This type of ear reconstruction has a long history. The first artificial frameworks were made of silicone rubber. The most recent artificial framework is made of porous polyethylene, called Medpor. This hard plastic material is pre-made by the manufacturer. It can be modified slightly by the surgeon for an individual case and is covered with a combination of the normal skin on the side of the head, a layer of tissue from the scalp called the temporoparietal fascia, and a skin graft. The advantage is that it can be performed by surgeons unfamiliar with carving cartilage. The disadvantage is that the material is very hard and some patients complain of discomfort when they lie on it and if injured, is more prone to serious complications than the patient’s own cartilage. Proponents say that it avoids a chest incision, which is true, but the incisions that are used in the scalp and behind the other ear can be more disfiguring than a chest incision. I tend to reserve it for cases where patients specifically request it or where cartilage has already been removed from the chest and there are limited alternatives.

Rib cartilage frameworks

As mentioned in other parts of this site, my preference is to use a framework from the patient’s own rib cartilage covered with the patient’s own skin. The advantages are that the color and texture are preferable to Medpor techniques, the reconstruction is less likely to have a framework exposure or infection over the life of the patient and it is the most lifelike. The disadvantages are that in a very thing patient dent may be visible in the chest where the cartilage was removed and this technique requires the most experience and skill of all the techniques mentioned above. My rationale is this: If the surgeon can carve a framework out of cartilage that is of similar shape to a normal ear, wouldn’t you rather have native cartilage in your child’s head for decades than a hard plastic material?

Timing

This is an important question, which has undergone evolution. Up until about a decade ago, surgical reconstruction of the outer ear was recommended beginning at the age of approximately six years. As surgical techniques have improved, however, it has become clear that a better quality, more detailed, ear reconstruction is possible when the surgery is delayed to after the age of 8-10 years. When first told that the reconstruction is not recommended for a few additional years, some parents are disappointed. We have never seen, however, a child suffer psychological distress because of delaying the reconstruction. Remember, the child will have this ear for about 90 years, hopefully, and we want it to be as ideal as possible.

Stages

Dr. Thorne’s technique requires two stages separated by approximately 6 months. The framework is placed at the first stage. After this stage the ear will be visible and complete but it will be stuck down to the head. Six months later the reconstructed ear is elevated so that it projects off the head and the sulcus behind the ear is created with a skin graft. This two stage approach doesn’t mean that an additional touch up procedure is never performed. Occasionally there are scars or irregularities that can be improved with a third procedure some years later.

The ears develop during the first 4 weeks of fetal gestation.  If that process does not occur completely, then various forms of underdeveloped ears may be present at birth. One of these conditions is called anotia and reconstructive ear surgery (the most major form of otoplasty) can help.

What is Anotia?

Anotia is the most extreme form of microtia. Microtialiterally means “little ear” and can be just that - a little ear - or it can refer to almost complete absence of the ear with the presence of only a nubbin of tissue where the ear would normally be. Anotia refers to the complete absence of any ear remnant at all. Microtia is quite common but anotia is extremely rare; there is almost always some evidence of an ear. These conditions most commonly affect one ear (90% of the time) and much less commonly affect both ears (10% of the time). When the outer, visible portion of the ear is underdeveloped, the ear canal and eardrum are usually absent and the middle ear is also usually underdeveloped, resulting in hearing loss on that side.