Microtia is a congenital malformation of the external ear with variable severity
Microtia affects 0.2–12 per 10 000 births, with severity ranging from a slightly smaller auricle to a complete absence (anotia). It is more common among males, is typically unilateral and right-sided, and has a higher prevalence among Hispanic, Asian, Andean, and Indigenous populations.1,2
Genetic and environmental factors contribute to microtia
Although the exact causes remain unknown, risk factors include maternal diabetes, low birth weight, and gestational exposure to teratogens and high altitude.1,2 Microtia can occur in isolation or as part of syndromes such as Treacher Collins or oculo-auriculo-vertebral spectrum. Patients with microtia are at high risk of renal anomalies and should be screened with renal ultrasonography at the time of microtia diagnosis.1,3
Microtia is frequently associated with conductive hearing loss
Around 75% of patients have incomplete ear canal development (aural atresia), resulting in conductive hearing loss.2 Newborns with microtia should receive a diagnostic hearing evaluation, as early intervention is crucial for speech and language development, especially in bilateral cases of microtia.4 Referral to an audiologist and otolaryngologist is advised.
Microtia may lead to psychosocial challenges
Parents may feel overwhelmed by the diagnosis, and children with microtia may experience self-esteem and social difficulties, particularly during the school-age period.5 Early counselling from primary care providers and connections to support groups can offer guidance on treatment options.
Management options include hearing rehabilitation and surgical reconstruction
Decisions about treatment require a multidisciplinary team of reconstructive surgeons, otolaryngologists, audiologists, speech–language pathologists, and primary care providers, as well as the child’s parents.4 Common reconstructive approaches include autologous costal cartilage grafts and alloplastic implants.2 Timing of surgery depends on the surgical technique, and planning should be guided by child-centred decision-making. 4 Surgery is elective, can be deferred until later in life, and non-surgical prosthetic ears are an alternative option.2
Footnotes
Competing interests: None declared.
This article has been peer reviewed.
References
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