When you make an appointment with our microtia team and the diagnosis is established, Lurie Children’s microtia providers will counsel patients and their families about the medical and possible surgical care involved.
After your child is examined and the care plan is determined, our multidisciplinary team will follow your child throughout their development from the start of their treatment into the teenage years. The team visit approach streamlines the evaluation and treatment process, quickly connecting you with the best specialists to manage your child’s condition. Each treatment plan is customized for the child as we consider the medical and developmental needs of the child, as well as the needs of the family.
What is Treatment Like?
There are several treatment options for microtia: reconstruction of the ear, a prosthetic ear or medical monitoring without surgical treatment. Lurie Children’s Microtia and Aural Atresia Program staff counsel parents on all of the options during the initial clinic visit.
One way it is treated it to perform ear reconstructions using cartilage, which is sculpted into a new ear and placed under the skin on the microtia side. The cartilage is from the child’s own ribs. This method is preferred rather than using synthetic implants (which is another option) because the cartilage is part of the child’s own body, and after surgery and the ear heals, there are no restrictions on activity. Reconstruction with rib cartilage has been a proven technique for 60 years. Most children do not undergo surgery to treat microtia until the ear has stopped growing, usually around 10 years of age. Age 10 is best time to do cartilage surgery because enough amount rib cartilage is available to make a full ear shape framework, and rib cartilage does not become rigid until age 15. Even after 15 years of age, rib cartilage surgery is still possible for some patients.
At Lurie Children’s, a two-stage surgery method is used. The first stage to create the ear shape and the second stage is for ear elevation. If there is redundant skin left over after stage two surgery, the abundant skin can be trimmed surgically. Our preferred method is to use your child’s own rib cartilage for the ear framework because of its proven sustainability, synthetic framework (known as MEDPORE) is an option if a family does not wish to use rib cartilage for the ear framework, or wishes to have the ear shaped earlier than age 10. The timing of this surgery is a little bit earlier -- around 6-9 years of age -- when fascia (connective tissue around an organ) is thinner to cover the framework. This method is one-stage surgery that spares rib cartilage harvest. However, this method needs more skin harvest and may leave more skin scars.
Click here for more details about the surgical options for ear reconstruction.
Aural Atresia and Hearing Loss Management
Children with unilateral or bilateral aural atresia and/or microtia will obtain an audiological evaluation to diagnose the degree and type of hearing loss. The type of audiological evaluation will vary depending on the age of the child. Information obtained on the audiological evaluation will be used to determine candidacy for a bone conduction hearing device(s). Bone conduction hearing devices pick up sound and convert it into vibration. The vibration of sound is transferred to the cochlea.
Infants and young children with aural atresia and an associated conductive hearing loss are typically fitted with non-surgical transcutaneous bone conduction hearing device(s). These devices are worn on a softband, headband, or coupled to a medical grade adhesive.
Older children may explore surgical candidacy for bone conduction hearing devices. Lurie Children’s was one of the first centers in the U.S. to implant the Baha® Attract system. This is a passive transcutaneous system that uses a sound processor coupled to a magnetic baseplate. The device converts sound into vibrations that are transferred through an external magnet. The magnet is attracted to a surgically implanted magnet and titanium implant. The implant transfers sound through vibrations from the skull to the inner ear and cochlea.
Other surgical options include active transcutaneous systems. Active transcutaneous systems use a sound processor connected to surgically implanted magnet and transducer. Sound vibrations are sent directly to the implant which transfers the sound to the inner ear and cochlea. Lurie Children’s is currently implanting the Cochlear Osia® and MEDEL BONEBRIDGE® systems.
These surgically implanted devices are safe and implanted with one surgery. Activation of the device will be completed by your audiologist approximately one month after surgery. Bone conduction hearing devices are expected to improve a child’s ability to hear and develop spoken language, while also improving understanding in difficult listening situations such as a classroom or noisy environment.