What is Prominent Ear?
When the ears extend out of the head more vertically than they should and are especially visible when viewed from the front or from behind, it is called "protruding ear deformity". This condition, which is seen in approximately 5% of the population in different degrees and different types, can be observed in one or both ears and although it does not cause any health problems, it can cause significant aesthetic deformity and psychological distress.
Surgeries performed to correct prominent ear deformity, which requires surgery except the early neonatal period, are called "otoplasty".
What is the Normal Ear Structure?
The auricle, which grows rapidly from birth, reaches 70-90% of its adult size within the first year, and completes its development at approximately the age of 10. The auricle consists of the "auricular cartilage" with various folds on it and the skin covering this cartilage. There is no cartilage in the earlobe at the lower end of the ear; this part consists of skin and subcutaneous fatty tissue. The function of the auricle is to collect sound waves from the environment and direct them to the outer ear canal.
In adult sizes, the length of the normal auricle is 5.5-6.5 cm and the width is 3.5-4 cm. When viewed from the side, the upper end of the auricle is turned backwards at an angle of 15-30 degrees relative to the lower end, while when viewed from above, there is an angle of 20-25 degrees between the auricle and the skull bones. As a result of this angulation, a distance of 10-12 mm in the upper part of the ear, 16-18 mm in the middle part and 20-22 mm in the lower part of the ear is formed between the outer fold of the auricle, called the helix, and the area behind the ear, called the mastoid. These anatomical measurements provide guidance in performing the surgery in a way that provides a natural appearance, especially in patients with deformities in both ears.
What Causes the Protruding Ear Appearance?
There are two different problems that cause prominent ear deformity. These are the incomplete formation of the fold called "antihelix" in the auricle and the overdevelopment of the "conchal cartilage" that forms the cavum concha section in the inner part of the auricle. These two conditions, either alone or together, can cause the appearance of prominent ears.
In order to achieve successful results in prominent ear surgery, a detailed evaluation must be made before the surgery, the cause of the problem must be fully understood, and surgical procedures must be performed to correct all existing problems.
When is Prominent Ear Surgery Performed?
Although the development of the auricle is completed by the age of 10, it is largely completed by the age of 4-5.
There is no harm in performing prominent ear surgery at any time in life, but since this problem can cause psychological problems due to environmental factors, especially in school-age children, otoplasty surgeries are frequently performed on school-age children.
Is There a Non-Surgical Treatment Option for Protruding Ears?
The auricle can be shaped with bandages and or molds during the first six weeks of the neonatal period just after the birth. For this reason, taping is recommended when some other visual problems such as prominent ears or folding of the auricle are detected at birth. This method, which has a chance of success in the early period, has a very low chance of success after six weeks.
How is Prominent Ear Surgery Performed?
For unilateral or bilateral otoplasty surgeries, general anesthesia is always preferred in young children, and in older children and adults, the surgery can be performed using local anesthesia or sedative drugs (sedation).
There are many different techniques and approaches defined for otoplasty surgery. Some of these are applied by shaping the cartilages using stitches, some by weakening the cartilages to make them easier to shape, and some by partially removing the cartilages.
While it is more preferred to shape the auricle with stitches, especially at early ages when the cartilages are softer, other techniques may need to be used at older ages. In cases where the problem is caused by advanced development of conchal cartilage, some cartilage usually needs to be removed.
What is it like after Protruding Ear Surgery?
There are no serious pain complaints after the surgery, and simple painkillers are usually sufficient when necessary. At the end of the surgery, the bandage applied to the treated ears is changed several times as needed within the first week and then removed. If stitches that need to be removed during the surgery were used, they are removed at the first week check-up.
It is recommended that patients use a bandage or headband to keep the ears in the appropriate position while lying down for the first two weeks and then for the first month. Although postoperative tissue healing is usually completed in two months, the auricle must be protected from pulling trauma for six months, especially in surgeries in which the ear is shaped with stitches.
Are There Any Risks in Protruding Ear Surgery?
Otoplasty surgery is generally in the low-risk surgery group. The most common problems that can be seen in the short term after surgery are blood collection in the surgery area (hematoma formation) and infection. Both problems can be resolved with appropriate treatments without additional problems.
Problems that may be seen in the medium-long term are asymmetry in the ears or the appearance of prominent ears reoccurring over time. Repeat surgery is usually required to solve this relatively rare problem with detailed preoperative evaluation and appropriate surgical techniques.
