A microtia diagnosis brings a lot of questions, often all at once. We have gathered the ones parents ask us most, with clear answers from our reconstructive and hearing specialists. If you don’t see yours here, ask us directly.
Microtia is a condition present at birth in which the outer ear is small, not fully formed or missing. It usually affects one ear, though about one child in five has it on both sides. Most children with microtia also have a closed or narrow ear canal on the same side.
In most cases no cause is found, and nothing a parent did or didn’t do during pregnancy is known to cause it. Microtia happens early in development, often before a pregnancy is even confirmed. A small number of cases are linked to genetic syndromes or to certain medications, such as isotretinoin, taken during pregnancy.
Microtia is rare. In the United States it affects roughly 1 in 8,000 to 10,000 births. It is seen more often in boys and on the right side.
The chance is low. Most children with microtia have no family history of it, and siblings carry only a slightly higher risk than the general population. A genetics consultation can give your family a clearer picture.
Routine ultrasounds focus on major organs and growth, and the outer ear is small and hard to view clearly. Most parents learn about microtia at birth.
Usually microtia occurs on its own. In some children it appears with other facial differences, such as craniofacial (hemifacial) microsomia, Goldenhar syndrome or Treacher Collins syndrome, or with facial nerve weakness. We check for these at the first visit.
Microtia is graded from I to IV. Grade I is a smaller ear with its main shape present. Grade II has a partly formed upper ear. Grade III, the most common, is a small remnant with no ear canal. Grade IV, also called anotia, means no outer ear at all.
Yes. Most children with microtia on one side hear normally through their other ear. On the affected side, hearing is usually reduced because sound can’t pass through a closed canal. The inner ear typically works normally, which is why hearing can often be improved.
Aural atresia means the ear canal is closed or very narrow. The eardrum and middle ear bones may also be underdeveloped. It causes conductive hearing loss, meaning sound can’t travel through to the inner ear. Learn more about Aural Atresia.
It does. Children with one hearing ear can struggle to tell where sounds come from and to follow speech in noisy places such as classrooms. These challenges often become noticeable once a child starts school.
We usually recommend a temporal bone CT at around age 2½. By then the ear structures are large enough to assess, and waiting reduces radiation and sedation risks. Dr. Nazarian reviews the images himself to decide whether a new ear canal is likely to work.
Children with one hearing ear may not need one, but every child should have their hearing tested. Children with microtia on both sides need a hearing device early, usually a soft headband bone-conduction aid, to support speech and language.
Often, yes. If the CT shows suitable anatomy, Dr. Nazarian can create a new ear canal and eardrum. If not, an implanted bone-conduction device can send sound directly to the inner ear. Learn more about hearing considerations.
No. A reconstructed ear restores facial balance, makes glasses and masks easier to wear and can spare children unwanted attention at school. Combined with hearing treatment, it can also improve how a child hears and learns.
The main options are implant (porous polyethylene) ear reconstruction, rib cartilage reconstruction and a removable prosthetic ear. For hearing, options include ear canal reconstruction and bone-conduction hearing devices. Many children can have the ear and hearing treated together.
Implant reconstruction uses a custom framework covered with the child’s own tissue. It is usually done in one outpatient surgery from about age 3, with no chest surgery. Rib cartilage reconstruction uses cartilage from the chest, typically starts around age 8 to 10 and needs two or more surgeries and a hospital stay. See our comparison table for more detail.
Combined Atresia Microtia (CAM) surgery treats the ear canal, middle ear and outer ear in one operation. Dr. Nazarian builds the new canal and eardrum, and Dr. Reinisch reconstructs the outer ear around it. It means one anesthetic and earlier hearing improvement.
Implant reconstruction can usually be done from about age 3, by which time the ear has reached most of its adult size. Many families aim to finish before kindergarten. Hearing surgery depends on the CT findings.
Yes. There is no upper age limit for implant reconstruction or hearing surgery. Many teens and adults choose a single combined procedure.
Each ear is reconstructed in a separate surgery, usually a few months apart. Hearing is addressed early, because it matters most when both sides are affected.
In many cases, yes. We regularly see children after earlier rib cartilage or implant surgery. Send us photos and operative notes, and we will review the options with you.
Implant reconstruction takes about 4–5 hours, plus around an hour of preparation. CAM surgery takes longer because both surgeons operate in sequence.
Most children are comfortable within a day or two and need only simple pain relief. The surgery involves skin and soft tissue rather than bone or chest cartilage, which keeps discomfort low.
Most surgeries are done as same-day procedures at an accredited surgical center, with board-certified pediatric anesthesiologists. Children with complex medical needs may have surgery in a hospital. The location depends on your child’s health needs; our team will confirm before surgery.
Porous polyethylene is inert and is not rejected the way a transplanted organ can be. The most common issue is a small area of the framework becoming exposed if the covering tissue thins, which is usually repaired with a minor procedure.
An implant ear is firm and does not bend like a natural ear; a rib cartilage ear doesn’t either. Because the ear is near adult size by early school age, the framework is designed to look right as your child grows.
Incisions are placed in the scalp and are hidden by hair once healed. The skin graft is taken from a discreet area. There is no chest scar.
Most children go home the same day with a protective dressing. The first check is two to three days later. Over the next few weeks, stitches and the splint come off in stages, and parents learn how to clean and protect the ear.
Most children return to school within about a week, with their surgeon’s approval. Contact sports and rough play are usually avoided for four to six weeks.
After the dressings come off, your child wears a soft silicone mold over the ear at night for several months. It protects the new ear and helps it keep its shape and projection. We show you how to use and make it.
Families from within the U.S. can usually fly home a few days after surgery and return for a check around two weeks later. International families typically stay about 3–4 weeks.
Many plans cover microtia reconstruction and hearing surgery as medically necessary. Our team verifies your benefits and helps with pre-authorization.
Yes. Many families begin online. Send photos, hearing tests and any CT images ahead, and both surgeons will review them with you.
Bring photos of both ears, hearing test results, CT images (not just the report), notes from any previous surgery and your insurance details.
Dr. Reinisch and Dr. Nazarian hold Learn Microtia events in different cities, with private consultations for every family. See upcoming dates on our website and secure your spot!
