Ear Malformations

Minor problems during normal fetal development cause the ears to protrude unnaturally far from the head, or may result in constricted ear or “cup ear,” where the patient’s ears are abnormally small, or microtia where the majority of the external ear is missing. In all of these cases, ear surgery, or otoplasty, may be able to give the ear a more balanced and natural-looking appearance.

The ear is a very intricate organ, composed of cartilage, skin and fat folded into its characteristic complex pattern. Although every child is unique and every patient requires his own distinctive approach, congenital ear deformities tend to fall into two categories.

Prominent ears

Between the third and sixth months of fetal development, the cartilage forming the outer ears begins to undergo a series of folds which give the ear its characteristic appearance. In some cases, the process can be interrupted, and a missing fold causes the ears to protrude more than 2 centimeters from the side of the head.

Cosmetic otoplasty techniques can often decrease the prominent ear by recreating the missing cartilage folds, bringing the ear closer to the head and reducing the size of the earlobes in order to give the ear a more normal anatomical appearance. These procedures are generally carried out on children between the ages of five and seven when the ear is of nearly adult size and the cartilage is of adequate thickness to tolerate scoring or hold sutures. While it is optimal to perform the procedure as early as possible, to avoid many of the psychological and social difficulties that may occur, the procedure can actually be performed on patients of any age.

Constricted ears

Also known as a “cup ear” or “lop ear” deformity, this malformation occurs when the upper helical rim is folded over, wrinkled or tight. In the most severe cases, the ear may be rolled up almost into a tube and the front part tilted forward, requiring additional cartilage taken from elsewhere in the body to fully correct.


Microtia is a birth defect that happens when a baby’s external ear is underdeveloped. It can occur on one side or both sides. Microtia may occur with atresia, another ear-related birth defect in which a baby is born without an external ear canal. Depending on the severity of the defect and whether the outer ear is blocked, hearing loss may occur.

Reconstructive ear surgery can help with a child’s hearing loss and appearance. Magdelena Soldanska, M.D., one of our pediatric plastic surgeons, has received extra training in microtia surgery.

Frequently asked questions

Can otoplasty affect my child’s ability to hear?
Otoplasty addresses the ears but does not directly affect the internal structures that control hearing. It cannot improve hearing, but choosing a board-certified and experienced plastic surgeon will minimize complications and risks.

Can otoplasty fix ears that stick out too far?
Protruding or prominent ears are a common complaint for otoplasty patients. Children often complain of being teased and embarrassed by their protruding ears. Usually, this prominence is caused by the lack of a fold within the cartilage of the ear. During cosmetic otoplasty, we construct a fold in the cartilage to help the ears lie flat.

Can ear surgery correct the appearance of cauliflower ear or trauma?
Yes, we perform reconstructive ear surgery for children with congenital defects as well as conditions like cauliflower ear caused by trauma. Surgery may be postponed in cases of cauliflower ear if immediate attention is sought because this condition is the result of gradual fluid buildup within the ear from being struck repeatedly in the ear (common among boxers and wrestlers). However, if fluid collects, the internal fluid can harden and affect ear cartilage.

What is the biggest challenge you face during cosmetic or reconstructive surgery of the ears?
Unlike any other facial plastic surgery procedure, it’s difficult to see both ears simultaneously during surgery. This type of procedure requires an expert eye as well as extensive knowledge of the ear’s structure to ensure the results of ear surgery is symmetrical.

Related research publications

  • Cohen, S.R., Burstein, F.D.: “Protruding Ears.” In: Spitz, L., Coran, A.G. (ed.), Rob & Smiths’ Operative Surgery. Chapman & Hall Medical, London, 1995.
  • Burstein, F.D.: “Cartilage-Sparing Complete Otoplasty Technique: A Ten Year Experience with 100 Patients.” Journal of Craniofacial Surgery. 2003 Jul;14(4):521-5.

Visit PubMed for additional research publications by Dr. Burstein

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