Prominent ears in children: at what age, and why

A prominent ear is not an illness and it does not affect hearing. What it very often does produce is sustained teasing at school, and that is why most consultations are parents with school-age children.

It is one of the few cosmetic operations whose main benefit is measured in how the child relates to others, not in how they look.

The age: from five or six

The ear reaches almost its adult size by five or six years old. That is the age from which it can be operated on without compromising growth: you are correcting a structure that is not going to change size.

Operating earlier makes no sense. Operating much later poses no technical problem either — in adults the procedure is the same, with slightly stiffer cartilage requiring an extra manoeuvre — but it leaves the child to go through the years when teasing weighs most.

In practice the usual moment is before starting primary school, or in a long holiday if the problem has already appeared.

Who decides

This is the part worth thinking about slowly. Two very different consultations arrive with the same request:

• The child it bothers. They cover their ears in photographs, ask to wear their hair long, report being called names. Here surgery solves something of theirs.
• The child it does not bother and it is the parents who see it. Here it is better to wait.

From six or seven a child can understand what is going to be done and say whether they want it. Asking them, in a separate conversation and without pressure, is part of the consultation.

A prominent ear that does not bother the person who has it does not need an operation.

What the surgery is like

The ear is repositioned and the missing fold is rebuilt, working on the cartilage from behind. The scar sits behind the ear, in the groove, and stays hidden. It takes one to two hours. In children it is done under general anaesthesia; in adults, local with sedation. It is a day case.

The recovery, and the instruction everyone abandons

• Days 1 and 2. A dressing covering the ears, moderate discomfort controlled with painkillers and a feeling of pressure. Sleeping on your back.
• Days 3 to 7. The dressing is replaced by an elastic band. Children usually go back to school around day five to seven, without sport.
• Weeks 2 to 6. Elastic band at night only.
• Months 3 to 6. The final shape settles and the scar behind finishes fading. Contact sports from about six weeks to two months.

That night band in weeks 2 to 6 is the instruction most often abandoned and the one that prevents most recurrences. It is exactly when you fold the ear without realising, in your sleep. It is hard to keep up because the child already seems fine; that is precisely when it is doing its work.

What is not promised

Perfect symmetry is not promised: the two ears were never identical and will not be afterwards, and the differences of detail are visible close up. Nor an ear flat against the head, because that looks artificial: the aim is a natural position, not the minimum possible.

And partial recurrence is possible, with the cartilage recovering some of its position over the months. It is reduced by good technique and the night band. It is not eliminated.