Microtia is a congenital difference in which the ear does not develop fully. Reconstruction builds a new ear, usually with cartilage from the child's own ribs.
There is something worth separating from the first consultation, because families usually arrive with the two things mixed together: the shape of the ear and hearing are different problems, with different specialists and different timetables. Ear reconstruction resolves the shape; hearing depends on the middle and inner ear and is assessed by ENT, who decide whether hearing surgery, a bone-anchored hearing aid or neither is appropriate. In most cases of one-sided microtia the other ear is normal and language develops without difficulty.
The reconstruction is done in stages and with the child's own rib cartilage, which is carved into the shape of an ear and placed under the skin. That is why the timing is set not by the family's anxiety but by the size of the cartilage available: before eight to ten years of age there is not enough rib to build an adult-sized ear. It is a long and difficult wait, especially when the child starts school, and what happens during those years is part of the conversation too.
It usually helps when there is
- An ear absent or incompletely developed from birth.
- Sufficient age and chest development: generally eight to ten years.
- The child wanting the reconstruction, not only the family.
- Loss of part of the ear through trauma or a burn.
- A hearing assessment already carried out by ENT.
Worth discussing first if
- Young age: there is not yet enough rib cartilage.
- Previous hearing surgery that has left scars in the area.
- A child who does not want surgery: their view carries weight and is respected.
- Expecting the reconstruction to improve hearing.
- Associated differences that take priority.
None of these rules the procedure out on its own; all of them change the conversation.
What it is reconstructed with
Each option has different advantages and not all are indicated at the same age.
The child's own rib cartilage
The reference technique. It is carved from the child's own cartilage, grows with them and lasts a lifetime. It requires two or more stages.
Synthetic implant
It allows surgery earlier and in fewer stages, avoiding chest surgery. In exchange it carries a higher risk of exposure and of infection in the long term.
External prosthesis
A prosthetic ear fixed to implants. It is a reasonable alternative when reconstruction is not possible or the patient does not want surgery.
The order with hearing is not reversed
When hearing surgery is also planned, the ear reconstruction goes first. The reason is practical: ear surgery leaves scars in the skin of the area, and that skin is exactly what is needed intact to cover the carved cartilage. Reversing the order compromises the result of the reconstruction irreversibly.
The timing is determined by the chest, not by age on the calendar. Enough rib cartilage is needed to carve an adult-sized ear, and that usually happens between eight and ten years of age. Operating earlier means building a small ear that will then not grow at the same rate as the other one.
And there is a consideration that weighs more here than usual: the child's own view. They are the one who will go through several operations and who will live with the result, and at that age they can take part in the decision. When the wish belongs only to the parents, it is better to wait.
What the process is like
Two or more operations separated by several months.
Assessment
The ear, the skin available and the chest development are studied, and the hearing side is coordinated with ENT, which follows its own timetable.
First stage
Cartilage is taken from the ribs, the structure of the ear is carved and placed under the skin of the area. It is the main operation.
Second stage
Four to six months later: the ear is lifted away from the skull to give it projection and the back is covered with a skin graft.
Refinements
Smaller stages to adjust the lobe, the tragus or the contour, as needed. They are not always necessary.
What to expect
What bothers most is not the ear but the chest the cartilage came from.
-
Days 1 to 7
A short hospital stay. The main pain is in the chest on breathing and coughing, not in the ear. Protective dressing and a drain.
-
Weeks 2 to 4
The chest discomfort settles. The ear is protected when sleeping and at school. No contact sports.
-
Months 1 to 4
The ear takes shape as the swelling goes down. Maturation is awaited before the second stage.
-
Months 6 to 18
After the second stage, the ear reaches its final projection. The scars mature and lighten.
Risks, and what is not promised
From the ear: loss of the skin covering the cartilage, with exposure of the framework — the most serious complication — infection, haematoma, partial reabsorption of the cartilage, loss of projection over time and an irregular contour. With synthetic implants, the risk of exposure and long-term infection is higher.
From the chest: pain during the first weeks, a permanent scar, deformity of the rib contour where the cartilage was taken and, infrequently, a pneumothorax during surgery.
An ear identical to the other side is not promised: what is built is a natural-looking, recognisable and well-proportioned ear, with differences of detail visible close up. And hearing is not promised: the reconstruction resolves the shape, not the ear itself. These risks are reduced by the right surgical timing, intact skin and careful technique. They are not eliminated. The ones that apply to your child's case are set down in writing in the informed consent.
The information on this page is for guidance and does not replace an in-person medical consultation. Medical practice is an obligation of means, not of result.
The questions families ask most
Ear reconstruction resolves the shape, not the hearing: they are two different problems with different specialists.
Hearing is assessed by ENT, who decide whether hearing surgery, a bone-anchored hearing aid or neither is appropriate. In one-sided microtia the other ear is usually normal and language develops well.
Because the ear is built with cartilage from the child's own ribs, and before that age there is not enough cartilage to carve an adult-sized ear.
Operating earlier means making a small ear that will then not grow at the same rate as the other. The wait is difficult and we go through it with you.
The ear. Hearing surgery leaves scars in the skin of the area, and that skin is exactly what is needed intact to cover the cartilage.
Reversing the order compromises the result of the reconstruction irreversibly, so it is coordinated with ENT from the start.
The chest, not the ear. The area the cartilage was taken from is sore on breathing, coughing and laughing during the first weeks, and it surprises almost every family.
It is managed with painkillers and settles gradually. It also leaves a permanent scar on the chest.
Question not answered here? There are more answers in the frequently asked questions.
