Ear Surgery (Otoplasty)

By Dr Leow Aik Ming

Ear surgery or otoplasty is a surgical procedure to correct the deformities and defects of external ears resulting from congenital conditions or trauma. The purpose of this surgery is to create an external ear of natural proportions, contour, and appearance to the ears and face. Incisions for otoplasty are usually made behind the ears. Depending upon the deformities, the cartilaginous framework of the ear is reshaped, repositioned or reduced. Correction of even minor deformities can have profound bene?ts to appearance and self-esteem.

The surgical objectives of otoplasty are to reconstruct the ears so that they appear naturally contoured, proportionate, harmoniously set back and without any evidence of surgical correction. Therefore, when the corrected ears are viewed, they should appear normal, from the:

(i) Frontal view: When the ear is viewed from the front, the helical rim should be visible, but not set back so far (flattened) as if it is hidden behind the antihelical fold.

(ii) Rear view: When the ear is viewed from behind, the helical rim is straight and not bent or crooked. If the helical rim is straight and the setback is harmoniously achieved, the upper-, middle-, and lower-thirds of the ear will be proportionately setback in relation to each other.

(iii) Side view: The contours of the ear should be soft and natural, not sharp and artificial.

Indications of otoplasty

  • Overly large ears — a rare condition called macrotia
  • Protruding ears occurring on one or both sides in varying degrees — not associated with hearing loss
  • Adult dissatisfaction with previous ear surgery

Ideal candidates for otoplasty in children

  • Preschool age, preferably 5 years old or older
  • Able to communicate their feelings and do not object when surgery is discussed
  • Cooperative and follow instructions well
  • Healthy, without a life-threatening illness or untreated chronic ear infections

Ideal candidates for teen and adults

  • Individuals with a positive outlook and specific goals in mind
  • Healthy individuals without life-threatening illness or medical condition

Preoperative evaluation before otoplasty

Communication is vital in order to achieve the patient’s goals. During the initial consultation, patients will have the opportunity to discuss their goals and desirable results with the plastic surgeon. The plastic surgeon will work closely with the patients to reach an agreement about the expectations from the surgical procedures involved and their long term benefits.  Every patient is different, therefore a specific treatment regimen is planned to suit an individual’s need.

Postoperative expectations

Discomfort immediately following ear surgery is normal and can be controlled with pain medication. There may be an itchy feeling under bandages. Compression bandages or garment are usually applied for 5-7 days to the ears to prevent swelling and blood collection. It is essential that these bandages or garment remain intact and not to be removed, for any reason during recovery period. Failure to do so may result in loss of some of the correction and may require a secondary surgery. Stitches behind the ears are usually removed 7-10 days after the surgery. After the surgery, the ears will be permanently positioned closer to the head. The surgical scars are either hidden behind the ear or well hidden within the natural creases of the ear.

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